Difficult Ventilation in ARDS Patients

Size: px
Start display at page:

Download "Difficult Ventilation in ARDS Patients"

Transcription

1 Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author by the author

2 ERS International Congress 2016 London, UK Monday, September 5, 07:00 08:15 Difficult Ventilation in ARDS Patients CC3 Problematic application of mechanical ventilation MJ Schultz for the PROVE Network (

3 Disclosures I have no real or perceived conflicts of interest that relate to this presentation MJ Schultz for the PROVE Network (

4 Aims of the Presentation understand the diagnosis of ARDS understand the concepts of VILI understand lung protective ventilation understand rescue ventilation strategies MJ Schultz for the PROVE Network (

5 60 year old male, 2 days of sore throat, coughing and productive sputum admission through ER: respiratory insufficient

6 Blood gas analysis: PaO 2 6 kpa, PaCO 2 2 kpa, ph 7.2 CXR: massive bilateral infiltrates

7 sputum: Gram+ cocci PCR: H1N1 +

8 diagnosis? next steps?

9 Agenda ventilation induced lung injury ARDS tidal volume and pressure reduction rescue therapies MJ Schultz for the PROVE Network (

10 [ADJUSTED FROM] Serpa Neto A. Swiss Medical Weekly 2015; 45:w14211

11 Barotrauma

12 Volutrauma Webb & Tierney. Am. Rev. Respir. Dis. 1974;110:556

13 Atelectotrauma

14 Slutsky A. NEJM 2013; 369:2126 Biotrauma

15 Agenda ventilation induced lung injury ARDS tidal volume and pressure reduction rescue therapies MJ Schultz for the PROVE Network (

16 Who is Afraid of Red, Yellow and Blue? Barnet Newman, 1966, Museum for Contemporary Art, Amsterdam, the Netherlands

17 LungSafe Practice of Ventilation in ICUs Worldwide international observational study 2,396 patients with mild, moderate or severe ARDS Bellani G. JAMA 2016; 315:788 V T (ml/kg PBW) V T (ml/kg PBW) assist assisted RR (/minute) total set PEEP (cm H 2 O) Mild (N = 722) Moderate (N = 1110) Severe (N = 564) 7.8 ± ± ± ± ± ± 6 17 ± ± ± ± 6 18 ± ± ± ± ± 14 7 [5 10] 8 [5 10] 10 [8 12] FiO 2 (%) 40 [40 50] 60 [50 70] 100 [80 100]

18 Was ARDS Correctly Recognized and Identified in LUNGSAFE? prevalence of 23% clinical recognition of ARDS ranged from 51% (mild) to 79% (severe) Bellani G. JAMA 2016; 315:

19 PRoVENT Practice of Ventilation in ICUs Worldwide international observational study 1,022 patients, 937 without ARDS Serpa Neto A. The PRoVENT study [SUBMITTED]

20 119 centers 1,022 patients PRoVENT Practice of Ventilation in ICUs Worldwide 85 patients with ARDS (8,3%) Serpa Neto A. The PRoVENT study [SUBMITTED] 30%

21 The Berlin Definition Timing Chest Imagine a Acute Respiratory Distress Syndrome Within 1 week of a known clinical insult or new/worsening respiratory symptoms Bilateral opacities not fully explained by effusions, lobar/lung collapse, or nodules Origin of Edema Respiratory failure not fully explained by cardiac failure or fluid overload; Need objective assessment (e.g., echocardiography) to exclude hydrostatic edema if no risk factor present Mild Moderate Severe Oxygenation b with with with 200<PaO 2 /FiO 2 < <PaO 2 /FiO 2 <200 PaO 2 /FiO2<100 PEEP 5 cmh 2 O c,d PEEP 5 cmh 2 O PEEP 5 cmh 2 O a chest X-ray or CT Scan b if altitude higher than 1000m correction factor should be made as follows: PaO 2 /FiO 2 x (barometric pressure/760) c or CPAP d this may be delivered non-invasively in the mild ARDS group, e.g., CPAP Ferguson N. ICM 2012; 38:1573

22 4,188 Patients with ARDS from 4 Multicenter Clinical Data Sets ARDS Definition Task Force. JAMA 2013; 307:2526 AUROC of 0.58 [ ]

23 AECC and Berlin are Neither Sensitive nor Specific 356 patients had criteria for ARDS at time of death Berlin sensitivity and specificity 63 and 89% Thille A. AJRCCM 2013; 187:761 Proportion of Patients No Lesion Other Diagnostic Pneumonia DAD Mild (N = 49) No Lesion Other Diagnostic Pneumonia DAD Moderate (N = 141) No Lesion Other Diagnostic Pneumonia DAD Severe (N = 166)

24 AECC and Berlin are Neither Sensitive nor Specific 356 patients had criteria for ARDS at time of death DAD more frequently found after 72 hours Thille A. AJRCCM 2013; 187:761 Proportion of Patients with DAD < 72 hours > 72 hours P = 0.38 Mild (N = 49) P < 0.01 Moderate (N = 141) P < 0.01 Severe (N = 166)

25 No Independently Association between Severity (Berlin) and Mortality 6 month French study 278/3,504 ARDS Cox proportional hazard regression analysis Hernu R. ICM 2013; 39:2161

26 Early Response to Conventional Care, Including PEEP, Predicts Outcome retrospective analysis of a RCT (PGE 1 ) 74 patients with ARDS receiving placebo Bone R. CHEST 1989; 96:849

27 Mortality in P/F groups at 0 and 24 Hours after Diagnosis prospective study in 586 patients in 38 ICUs age, opportunistic pneumonia, MOD, P/F at 24 hours Artigas A. ICM 1998; 24:1018

28 Clinical Classification after 24 Hours Improves Prognostication Villars J. CCM 2015; 43:346

29 Clinical Classification after 24 Hours Improves Prognostication Bos L. ICM 2015; 41:2004

30 P/F under Standardized Ventilator Settings Improves Prognostication Villars J. BMJ Open 2015; 5:e006812

31 Conclusion (I) ARDS is a challenging diagnosis AECC and Berlin definitions are not helpful consider the effect of standard therapy and re look after 24 hours MJ Schultz for the PROVE Network (

32 Agenda ventilation induced lung injury ARDS tidal volume and pressure reduction rescue therapies MJ Schultz for the PROVE Network (

33 What is the origin of the tidal volume size discussion?

34 High tidal volumes were advised to be used during intraoperative ventilation to recruit those lung parts that collapse at end of expiration, as such preventing the need for higher levels of FiO 2 and PEEP Bendixen H. NEJM 1963; 269: 991

35 Use of Lower Tidal Volumes Benefits Patients with ARDS RCT, Brazil 53 ARDS patients 6 ml/kg plus PEEP > LIP vs. conservative settings Amato M. NEJM 1998; 338;347

36 Use of Lower Tidal Volumes Benefits Patients with ARDS RCT, USA, 821 ARDS patients 6 vs. 12 ml/kg stopped early ARDS Network. NEJM 2000; 342:1301

37 LungSafe Practice of Ventilation in ICUs Worldwide international observational study 2,396 patients with mild, moderate or severe ARDS Bellani G. JAMA 2016; 315:788 V T (ml/kg PBW) V T (ml/kg PBW) assist assisted RR (/minute) total set PEEP (cm H 2 O) Mild (N = 722) Moderate (N = 1110) Severe (N = 564) 7.8 ± ± ± ± ± ± 6 17 ± ± ± ± 6 18 ± ± ± ± ± 14 7 [5 10] 8 [5 10] 10 [8 12] FiO 2 (%) 40 [40 50] 60 [50 70] 100 [80 100]

38 Use of Lower Tidal Volumes Benefits Patients without ARDS 2,184 ICU patients without ARDS from 7 studies outcome: duration of ventilation Serpa Neto A. ICM 2014; 40:950 [METANALYSIS]

39 Use of Lower Tidal Volumes Benefits Patients without ARDS 2,184 ICU patients without ARDS from 7 studies outcome: hospital stay and ARDS development Serpa Neto A. CCM 2015; 43:4155 [METANALYSIS]

40 PRoVENT Practice of Ventilation in ICUs Worldwide international observational study 1,022 patients, 937 without ARDS Serpa Neto A. The PRoVENT study [SUBMITTED]

41 4 New Trials of Low Tidal Volume Ventilation in Patients without ARDS PReVENT, Netherlands EPALI, Spain ISIC IMIC, SE Asia a new ARDS Network trial (PETHAL) MJ Schultz for the PROVE Network (

42 What is the origin of the PEEP level discussion?

43 Preclinical studies and clinical investigations showed that a strategy using high levels of PEEP improved lung aeration, and usually also oxygenation

44 Use of Higher PEEP Benefits Patient with Moderate or Severe ARDS 2,299 ICU patients with ARDS from 3 investigations outcome: death Briel M. JAMA 2010; 303:865 [METANALYSIS]

45 Trade off Between Alveolar Recruitment and Overdistension Bellardine Black CL et al. Crit Care Med 2007, 35:870-8 Black C. CCM 2007; 35:870

46 High PEEP Prevents Alveolar Collapse but Increases Hyperinflation 48 healthy rats intratracheal challenge with E. coli LPS 1 hour of ventilation after 24 hours Samary C. Anesthesiology 2015; 123:423

47 LungSafe Practice of Ventilation in ICUs Worldwide international observational study 2,396 patients with mild, moderate or severe ARDS Bellani G. JAMA 2016; 315:788 V T (ml/kg PBW) V T (ml/kg PBW) assist assisted RR (/minute) total set PEEP (cm H 2 O) Mild (N = 722) Moderate (N = 1110) Severe (N = 564) 7.8 ± ± ± ± ± ± 6 17 ± ± ± ± 6 18 ± ± ± ± ± 14 7 [5 10] 8 [5 10] 10 [8 12] FiO 2 (%) 40 [40 50] 60 [50 70] 100 [80 100]

48 Use of Higher PEEP Does not Benefit Patient without ARDS metaanalysis of 21 RCTs in patients without ARDS primary outcome death Serpa Neto A. in preparation

49 Agenda ventilation induced lung injury ARDS tidal volume and pressure reduction 2.0 rescue therapies MJ Schultz for the PROVE Network (

50 Energy transfer?

51 Lungs Conserve Energy during each Respiratory Cycle ( Lung Hysteresis ) 10 13% of energy is transferred energy transfer is proportional to (ΔP) 2 x Crs [COURTISY FROM] Serpa Neto A

52 High PEEP Prevents Alveolar Collapse but Increases Hyperinflation* 48 healthy rats, intratracheal challenge with E. coli LPS 1 hour of ventilation after 24 hours Samary C. Anesthesiology 2015; 123:423

53 Low PEEP and low ΔP Prevents Pulmonary Inflammation* 48 healthy rats, intratracheal challenge with E. coli LPS 1 hour of ventilation after 24 hours Samary C. Anesthesiology 2015; 123:423

54 Independent Association between Driving Pressure and Mortality Brazilian RCT in 53 ARDS patients 6 ml/kg plus PEEP > LIP plus Pdelta < 20 cm H 2 O) vs. conservative settings Amato M. NEJM 1998; 338;347

55 Factors with an Independent Association with Mortality observational study, Argentina 235 ARDS patients P/F, SOFA, ph, BE and Pdelta Estensorro E. Crit Care Med 2002; 30:2450

56 Driving Pressure and Survival in Patients with ARDS 3,562 patients from 9 investigations driving P as independent variable, mediation analysis Amato M. NEJM 2015; 372:747 [METANALYSIS]

57 Driving Pressure and Survival in Patients with ARDS 3,562 patients from 9 investigations driving P as independent variable, mediation analysis Amato M. NEJM 2015; 372:747 [METANALYSIS]

58 Decrease in ΔP after ECMO Start is Associated with a Better Outcome 545 patients from 12 investigations, 1,653 ECMO days median settings in the first 3 days of ECMO A Serpa Neto for the PROVE Network (

59 ΔP and FiO 2 are Associated with Death in ECMO Patients OR [95% CI], p HR [95% CI], p Age, years 1.04 [ ], [ ], BMI, kg/m [ ], [ ], Interval MV ECMO, hours 1.00 [ ], [ ], Ventilator parameters 1 ΔP, cm H 2 O Laboratory Parameters Lactate A Serpa Neto for the PROVE Network ( [ ], [ ], < [ ], [ ], Multivariate logistic regression and Cox proportional hazard model BMI: body mass index; OR: odds ratio; HR: hazard ratio; CI: confidence interval; FiO 2 : inspired fraction of oxygen 1, median value of the first three days after ECMO

60 LungSafe Practice of Ventilation in ICUs Worldwide* international observational study 2,396 patients with mild, moderate or severe ARDS Bellani G. JAMA 2016; 315:788

61 Intraoperative Driving Pressure and PPC in Surgery Patients 2,171 patients from 15 RCTs driving P as independent variable, mediation analysis Serpa Neto A. Lancet Respir Med 2016; 4:272 [METANALYSIS]

62 Ventilation During General Anesthesia for Surgery Ventilation in Intensive Care Unit patients with Uninjured Lungs Ventilation in Intensive Care Unit patients with (ARDS) mild ARDS moderate and severe ARDS Protective ventilation includes: Protective ventilation includes: Protective ventilation includes: Protective ventilation includes: Tidal volume size < 8 ml/kg predicted body weight evidence comes from 3 RCTs and 1 metaanalysis Tidal volume size 6 ml/kg predicted body weight evidence comes from 1 RCT, 1 metaanalysis and 2 IPD meta analyses Tidal volume size 6 8 ml/kg predicted body weight evidence comes from 2 RCTs and 1 metaanalysis Tidal volume size 6 8 ml/kg predicted body weight evidence comes from 2 RCTs and 1 metaanalysis Level of PEEP 2 cm H 2 O evidence comes from 1 RCT and 1 IPD metaanalysis Level of PEEP?? Convincing RCT evidence is lacking Level of PEEP 5 10 cm H 2 O evidence comes from 1 IPD metaanalysis of 3 RCTs Level of PEEP 10 cm H 2 O evidence comes from 1 IPD metaanalysis of 3 RCTs Low driving pressure suggestion comes from several studies and 1 IPD metaanalysis of 15 RCTs Driving pressure?? studies are lacking Low driving pressure suggestion comes from several observational studies and 1 IPD metaanalysis of 9 studies Low driving pressure suggestion comes from several observational studies and 1 IPD metaanalysis of 9 studies

63 Conclusion (II) the goal is prevention of additional lung injury through low tidal volumes, the lowest possible level of PEEP, and the lowest driving pressure (energy) MJ Schultz for the PROVE Network (

64 Agenda ventilation induced lung injury ARDS tidal volume and pressure reduction 2.0 rescue therapies MJ Schultz for the PROVE Network (

65 How are lungs recruited?

66 Ways to Recruit sustained inflation PEEP, I:E, recruitment maneuvers proning (assisted ventilation) MJ Schultz for the PROVE Network (

67 Sustained Inflation maybe adjust (i.e., raise) PEEP careful in hemodynamic instable patients MJ Schultz for the PROVE Network (

68 PEEP, I:E in steps of 5 cm H 2 O, up to 15 cm H 2 O inverse ratio ventilation careful in hemodynamic instable patients beware of over distension MJ Schultz for the PROVE Network (

69 Recruitment Through PEEP

70 PEEP, I:E in steps of 5 cm H 2 O, up to 15 cm H 2 O inverse ratio ventilation careful in hemodynamic instable patients beware of over distension MJ Schultz for the PROVE Network (

71 Three Recruitment Maneuver Sustained Inflation Techniques Incremental PEEP Pressure Control Ventilation Lim S. CCM 2004; 32:2378

72 Why Prone? decreased V/Q mismatch? or recruitment and decrease in driving pressure MJ Sch ultz for the PROVE Network (

73 How Prone (May) Work(s) Supine Prone less mismatch less compression by the heart Spronk P. NJCC 2005; 9;77

74 How Prone (May) Work(s) Supine Prone change in position of the trachea recruitment of depending lung tissue Spronk P. NJCC 2005; 9;77

75 Prone Ventilation Improves Outcome of Patients with Severe ARDS 10 RCTs, 1,867 patients PaO 2 /FiO 2 < 100 mmhg vs. PaO 2 /FiO mmhg Sud S. ICM 2010; 36:585

76 Prone Ventilation Improves Outcome of Patients with Severe ARDS RCT 466 patients with severe ARDS 28 day mortality Guerin C. NEJM 2013; 368:2159

77 Prone Ventilation Improves Outcome of Patients with Severe ARDS Beitler J. ICM 2014; 40:332

78 Conclusion (III) several ways to recruit the lungs simple to complex short to long interventions MJ Schultz for the PROVE Network (

Phenotyping of ARDS and non ARDS Patients

Phenotyping of ARDS and non ARDS Patients Critical Care Canada Forum 2018 Sheraton Toronto, Toronto, Canada November 8, 2018; 11:05h 11:25h Phenotyping of and non Patients Berlin & Kigali, RALE score, Reclassification, Driving Pressure and Mechanical

More information

Protective ventilation for ALL patients

Protective ventilation for ALL patients Protective ventilation for ALL patients PAOLO PELOSI, MD, FERS Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital IRCCS for Oncology, University of Genoa,

More information

Landmark articles on ventilation

Landmark articles on ventilation Landmark articles on ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity ARDS AECC DEFINITION-1994 ALI Acute onset Bilateral chest infiltrates PCWP

More information

Sub-category: Intensive Care for Respiratory Distress

Sub-category: Intensive Care for Respiratory Distress Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Acute Respiratory Distress

More information

How ARDS should be treated in 2017

How ARDS should be treated in 2017 How ARDS should be treated in 2017 2017, Ostrava Luciano Gattinoni, MD, FRCP Georg-August-Universität Göttingen Germany ARDS 1. Keep the patient alive respiration circulation 2. Cure the disease leading

More information

Application of Lung Protective Ventilation MUST Begin Immediately After Intubation

Application of Lung Protective Ventilation MUST Begin Immediately After Intubation Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose

More information

The new ARDS definitions: what does it mean?

The new ARDS definitions: what does it mean? The new ARDS definitions: what does it mean? Richard Beale 7 th September 2012 METHODS ESICM convened an international panel of experts, with representation of ATS and SCCM The objectives were to update

More information

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3

More information

Ventilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc

Ventilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone

More information

ACUTE RESPIRATORY DISTRESS SYNDROME

ACUTE RESPIRATORY DISTRESS SYNDROME ACUTE RESPIRATORY DISTRESS SYNDROME Angel Coz MD, FCCP, DCE Assistant Professor of Medicine UCSF Fresno November 4, 2017 No disclosures OBJECTIVES Identify current trends and risk factors of ARDS Describe

More information

ARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up?

ARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up? ARDS: The Evidence Todd M Bull MD Professor of Medicine Division of Pulmonary Sciences and Critical Care Division of Cardiology Director Pulmonary Vascular Disease Center Director Center for Lungs and

More information

Acute Lung Injury/ARDS. Disclosures. Overview. Acute Respiratory Failure 5/30/2014. Research funding: NIH, UCSF CTSI, Glaxo Smith Kline

Acute Lung Injury/ARDS. Disclosures. Overview. Acute Respiratory Failure 5/30/2014. Research funding: NIH, UCSF CTSI, Glaxo Smith Kline Disclosures Acute Respiratory Failure Carolyn S. Calfee, MD MAS UCSF Critical Care Medicine and Trauma CME May 30, 2014 Research funding: NIH, UCSF CTSI, Glaxo Smith Kline Medical advisory boards: Cerus

More information

ARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc

ARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc ARDS Assisted ventilation and prone position ICU Fellowship Training Radboudumc Fig. 1 Physiological mechanisms controlling respiratory drive and clinical consequences of inappropriate respiratory drive

More information

Ventilator ECMO Interactions

Ventilator ECMO Interactions Ventilator ECMO Interactions Lorenzo Del Sorbo, MD CCCF Toronto, October 2 nd 2017 Disclosure Relevant relationships with commercial entities: none Potential for conflicts within this presentation: none

More information

Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye

Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: conclusion Give low-dose steroids if indicated for another problem

More information

Breathing life into new therapies: Updates on treatment for severe respiratory failure. Whitney Gannon, MSN ACNP-BC

Breathing life into new therapies: Updates on treatment for severe respiratory failure. Whitney Gannon, MSN ACNP-BC Breathing life into new therapies: Updates on treatment for severe respiratory failure Whitney Gannon, MSN ACNP-BC Overview Definition of ARDS Clinical signs and symptoms Causes Pathophysiology Management

More information

Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016

Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:

More information

Oxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators

Oxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators Oxygenation Failure Increase FiO2 Titrate end-expiratory pressure Adjust duty cycle to increase MAP Patient Positioning Inhaled Vasodilators Extracorporeal Circulation ARDS Radiology Increasing Intensity

More information

Biomarkers for ARDS not so simple. John Laffey. Critical Illness and Injury Research Centre St Michael s Hospital, University of Toronto, CANADA

Biomarkers for ARDS not so simple. John Laffey. Critical Illness and Injury Research Centre St Michael s Hospital, University of Toronto, CANADA Biomarkers for ARDS not so simple John Laffey Critical Illness and Injury Research Centre St Michael s Hospital, University of Toronto, CANADA Berlin ARDS definition - 2012 Mild Moderate Severe Acute Onset

More information

Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación. Hospital Clinico Universitario Valencia (Spain)

Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación. Hospital Clinico Universitario Valencia (Spain) Analyzing Lung protective ventilation F Javier Belda MD, PhD Sº de Anestesiología y Reanimación Hospital Clinico Universitario Valencia (Spain) ALI/ARDS Report of the American-European consensus conference

More information

Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG-SAFE)

Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG-SAFE) Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG-SAFE) John Laffey, Giacomo Bellani, Tai Pham, Eddy Fan, Antonio Pesenti on behalf of the LUNG SAFE Investigators

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

Best of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine

Best of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without

More information

Respiratory insufficiency in bariatric patients

Respiratory insufficiency in bariatric patients Respiratory insufficiency in bariatric patients Special considerations or just more of the same? Weaning and rehabilation conference 6th November 2015 Definition of obesity Underweight BMI< 18 Normal weight

More information

11 th Annual Congress Turkish Thoracic Society. Mechanical Ventilation in Acute Hypoxemic Respiratory Failure

11 th Annual Congress Turkish Thoracic Society. Mechanical Ventilation in Acute Hypoxemic Respiratory Failure 11 th Annual Congress Turkish Thoracic Society Mechanical Ventilation in Acute Hypoxemic Respiratory Failure Lluis Blanch MD PhD Senior Critical Care Center Scientific Director Corporació Parc Taulí Universitat

More information

ARDS and Lung Protection

ARDS and Lung Protection ARDS and Lung Protection Kristina Sullivan, MD Associate Professor University of California, San Francisco Department of Anesthesia and Perioperative Care Division of Critical Care Medicine Overview Low

More information

ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013

ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013 ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013 Pauline K. Park MD, FACS, FCCM University of Michigan School of Medicine Ann Arbor, MI OVERVIEW New Berlin definition of ARDS

More information

ARDS & TBI - Trading Off Ventilation Targets

ARDS & TBI - Trading Off Ventilation Targets ARDS & TBI - Trading Off Ventilation Targets Salvatore M. Maggiore, MD, PhD Rome, Italy smmaggiore@rm.unicatt.it Conflict of interest Principal Investigator: RINO trial o Nasal high-flow vs Venturi mask

More information

Steroids for ARDS. Clinical Problem. Management

Steroids for ARDS. Clinical Problem. Management Steroids for ARDS James Beck Clinical Problem A 60 year old lady re-presented to ICU with respiratory failure. She had previously been admitted for fluid management and electrolyte correction having presented

More information

Prone Position in ARDS

Prone Position in ARDS Prone Position in ARDS Rich Kallet MS RRT FAARC, FCCM Respiratory Care Services San Francisco General Hospital University of California, San Francisco, Case Study A 39 yo F admitted to SFGH TICU s/p hanging,

More information

THE ACUTE RESPIRATORY DISTRESS SYNDROME. Daniel Brockman, DO

THE ACUTE RESPIRATORY DISTRESS SYNDROME. Daniel Brockman, DO THE ACUTE RESPIRATORY DISTRESS SYNDROME Daniel Brockman, DO Objectives Describe the history and evolution of the diagnosis of ARDS Review the diagnostic criteria for ARDS Discuss the primary interventions

More information

9/5/2018. Conflicts of Interests. Pediatric Acute Respiratory Distress Syndrome. Objectives ARDS ARDS. Definitions. None

9/5/2018. Conflicts of Interests. Pediatric Acute Respiratory Distress Syndrome. Objectives ARDS ARDS. Definitions. None Pediatric Acute Respiratory Distress Syndrome Conflicts of Interests Diane C Lipscomb, MD Director Inpatient Pediatric Medical Director Mercy Springfield Associate Clerkship Clinical Director University

More information

The Berlin Definition: Does it fix anything?

The Berlin Definition: Does it fix anything? The Berlin Definition: Does it fix anything? Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre

More information

Pro: Early use of VV ECMO for ARDS

Pro: Early use of VV ECMO for ARDS Pro: Early use of VV ECMO for ARDS Kyle J. Rehder, MD, FCCP Associate Professor Division of Pediatric Critical Care Medicine Department of Pediatrics Duke Children s Hospital The ventilator is slowly killing

More information

Management of Severe ARDS: Current Canadian Practice

Management of Severe ARDS: Current Canadian Practice Management of Severe ARDS: Current Canadian Practice Erick Duan MD FRCPC Clinical Scholar, Department of Medicine, Division of Critical Care, McMaster University Intensivist, St. Joseph's Healthcare Hamilton

More information

ARDS and treatment strategies

ARDS and treatment strategies ARDS and treatment strategies Geoff Bellingan Medical Director University College Hospital ARDS: Definitions History of predisposing condition Refractory hypoxaemia of acute onset PaO 2 /FiO 2 ratio:

More information

Prone Position in ARDS

Prone Position in ARDS Prone Position in ARDS Rich Kallet MS RRT FAARC, FCCM Respiratory Care Services Department of Anesthesia & Perioperative Care University of California, San Francisco, San Francisco General Hospital Case

More information

Does proning patients with refractory hypoxaemia improve mortality?

Does proning patients with refractory hypoxaemia improve mortality? Does proning patients with refractory hypoxaemia improve mortality? Clinical problem and domain I selected this case because although this was the second patient we had proned in our unit within a week,

More information

Management of refractory ARDS. Saurabh maji

Management of refractory ARDS. Saurabh maji Management of refractory ARDS Saurabh maji Refractory hypoxemia as PaO2/FIO2 is less than 100 mm Hg, inability to keep plateau pressure below 30 cm H2O despite a VT of 4 ml/kg development of barotrauma

More information

Biomedical engineer s guide to the clinical aspects of intensive care mechanical ventilation

Biomedical engineer s guide to the clinical aspects of intensive care mechanical ventilation https://doi.org/10.1186/s12938-018-0599-9 BioMedical Engineering OnLine REVIEW Open Access Biomedical engineer s guide to the clinical aspects of intensive care mechanical ventilation Vincent J. Major

More information

ARDS: MANAGEMENT UPDATE

ARDS: MANAGEMENT UPDATE ARDS: MANAGEMENT UPDATE Tanıl Kendirli, Assoc. Prof. Ankara University School of Medicine, Pediatric Critical Care Medicine The AECC Definition Timing Acute onset, within 48-72 hours Oxygenation ALI PaO2/FiO2

More information

Acute Respiratory Distress Syndrome (ARDS) An Update

Acute Respiratory Distress Syndrome (ARDS) An Update Acute Respiratory Distress Syndrome (ARDS) An Update Prof. A.S.M. Areef Ahsan FCPS(Medicine) MD(Critical Care Medicine) MD ( Chest) Head, Dept. of Critical Care Medicine BIRDEM General Hospital INTRODUCTION

More information

Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen

Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen Year in Review 2013 Intensive Care Training Program Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation Enteral feeding Fluid

More information

Effect of peak inspiratory pressure on the development. of postoperative pulmonary complications.

Effect of peak inspiratory pressure on the development. of postoperative pulmonary complications. Effect of peak inspiratory pressure on the development of postoperative pulmonary complications in mechanically ventilated adult surgical patients: a systematic review protocol Chelsa Wamsley Donald Missel

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE

More information

PAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre

PAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis

More information

Lung Recruitment Strategies in Anesthesia

Lung Recruitment Strategies in Anesthesia Lung Recruitment Strategies in Anesthesia Intraoperative ventilatory management to prevent Post-operative Pulmonary Complications Kook-Hyun Lee, MD, PhD Department of Anesthesiology Seoul National University

More information

What is Acute Respiratory Distress Syndrome? Acute Respiratory Distress Syndrome (ARDS)

What is Acute Respiratory Distress Syndrome? Acute Respiratory Distress Syndrome (ARDS) Acute Respiratory Distress Syndrome (ARDS) Sonal Pannu, MD Clinical Assistant Professor Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and Sleep Medicine The Ohio State University

More information

Acute Respiratory Distress Syndrome (ARDS) What is Acute Respiratory Distress Syndrome?

Acute Respiratory Distress Syndrome (ARDS) What is Acute Respiratory Distress Syndrome? Acute Respiratory Distress Syndrome (ARDS) Sonal Pannu, MD Clinical Assistant Professor Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and Sleep Medicine The Ohio State University

More information

CSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018

CSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no

More information

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity

NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998

More information

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with

More information

ARDS Survival: Building A Roadmap to Achieve Successful Short and Long Term Outcomes

ARDS Survival: Building A Roadmap to Achieve Successful Short and Long Term Outcomes ARDS Survival: Building A Roadmap to Achieve Successful Short and Long Term Outcomes Kathleen Vollman MSN, RN, CCNS, FCCM, FAAN Clinical Nurse Specialist/Educator/Consultant LLC Director/Ambassador WFCCN

More information

«Best» PEEP? Physiologic? Therapeutic? Optimal? Super? Preferred? Minimal? Right? Protective? Prophylactic?

«Best» PEEP? Physiologic? Therapeutic? Optimal? Super? Preferred? Minimal? Right? Protective? Prophylactic? 1936-2005 «Best» PEEP? Physiologic? Therapeutic? Optimal? Super? Preferred? Minimal? Right? Protective? Prophylactic? 1990-2000 Post cardiac arrest First day of mechanical ventilation 1990-1991 No patient

More information

ECMO: a breakthrough in care for respiratory failure. PD Dr. Thomas Müller Regensburg no conflict of interest

ECMO: a breakthrough in care for respiratory failure. PD Dr. Thomas Müller Regensburg no conflict of interest ECMO: a breakthrough in care for respiratory failure? PD Dr. Thomas Müller Regensburg no conflict of interest 1 Overview Mortality of severe ARDS Indication for ECMO PaO 2 /FiO 2 Efficiency of ECMO: gas

More information

NIV in hypoxemic patients

NIV in hypoxemic patients NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet

More information

ICU management and referral guidelines for severe hypoxic respiratory failure

ICU management and referral guidelines for severe hypoxic respiratory failure Aim: ICU management and referral guidelines for severe hypoxic respiratory failure 1) To provide a concise management plan Non ventilatory Ventilatory 2) Timeline for referring patient with refractory

More information

DAILY SCREENING FORM

DAILY SCREENING FORM DAILY SCREENING FORM Patient s initials: Date of admission: Time of admission: Gender: M F Year of Birth: Type of admission: Medical/Surgical/Postoperative (elective) Days Date Mechanical ventilation Lung

More information

Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill

Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures

More information

ARDS Management Protocol

ARDS Management Protocol ARDS Management Protocol February 2018 ARDS Criteria Onset Within 1 week of a known clinical insult or new or worsening respiratory symptoms Bilateral opacities not fully explained by effusions, lobar/lung

More information

Year in Review: Critical Care Medicine

Year in Review: Critical Care Medicine Year in Review: Critical Care Medicine No disclosures Eric J. Seeley, M.D. Assistant Professor of Medicine Division of Pulmonary and Critical Care Medicine Why I Selected These Studies High quality studies

More information

Is ARDS Important to Recognize?

Is ARDS Important to Recognize? Is ARDS Important to Recognize? Lorraine B. Ware MD Vanderbilt University Financial Disclosures: research funding from Boehringer Ingelheim, Global Blood Therapeutics Why diagnose ARDS? -initiate specific

More information

Author: Thomas Sisson, MD, 2009

Author: Thomas Sisson, MD, 2009 Author: Thomas Sisson, MD, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/

More information

Noninvasive respiratory support:why is it working?

Noninvasive respiratory support:why is it working? Noninvasive respiratory support:why is it working? Paolo Pelosi Department of Surgical Sciences and Integrated Diagnostics (DISC) IRCCS San Martino IST University of Genoa, Genoa, Italy ppelosi@hotmail.com

More information

Update in Critical Care Medicine

Update in Critical Care Medicine Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update

More information

ECMO and refractory Hypoxemia

ECMO and refractory Hypoxemia ECMO and refractory Hypoxemia Dr. Vinay Dhingra MD FRCPC Clinical Associate Professor of Medicine Clinical Lead Critical Care BCPSQC Medical Director Quality VGH Disclosures ARDS Lancet 1967; 2:319-323

More information

Ventilation in Paediatric ARDS: extrapolate from adult studies?

Ventilation in Paediatric ARDS: extrapolate from adult studies? Ventilation in Paediatric ARDS: extrapolate from adult studies? ASMIC 2014 Dr Adrian Plunkett Consultant Paediatric Intensivist Birmingham Children s Hospital, UK Aims of the presentation Ventilation

More information

Agenda. Mechanical Ventilation in Morbidly Obese Patients. Paolo Pelosi. ESPCOP, Ostend, Belgium Saturday, November 14, 2009.

Agenda. Mechanical Ventilation in Morbidly Obese Patients. Paolo Pelosi. ESPCOP, Ostend, Belgium Saturday, November 14, 2009. Mechanical Ventilation in Morbidly Obese Patients t Paolo Pelosi Department of Ambient, Health and Safety University of Insubria - Varese, ITALY ppelosi@hotmail.com ESPCOP, Ostend, Belgium Saturday, November

More information

Part 2 of park s Ventilator and ARDS slides for syllabus

Part 2 of park s Ventilator and ARDS slides for syllabus Part 2 of park s Ventilator and ARDS slides for syllabus Early Neuromuscular Blockade Question 4 The early use of cis-atracurium in severe ARDS is: A. Contraindicated in patients with diabetes B. Associated

More information

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality

More information

A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics

A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics A Bundle for Treatment after Cardiac Arrest: Protective Ventilation, Temperature Control and Stable Hemodynamics PAOLO PELOSI, MD, FERS Department of Surgical Sciences and Integrated Diagnostics (DISC)

More information

Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation response to PEEP: a systematic review and meta-analysis

Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation response to PEEP: a systematic review and meta-analysis Guo et al. BMC Anesthesiology (2018) 18:172 https://doi.org/10.1186/s12871-018-0631-4 RESEARCH ARTICLE Open Access Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation

More information

7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability

7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Identify the 5 criteria for the diagnosis of ARDS. Discuss the common etiologies

More information

Lung-protective ventilation in intensive care unit and operation room Serpa Neto, A.

Lung-protective ventilation in intensive care unit and operation room Serpa Neto, A. UvA-DARE (Digital Academic Repository) Lung-protective ventilation in intensive care unit and operation room Serpa Neto, A. Link to publication Citation for published version (APA): Serpa Neto, A. (2017).

More information

Prone ventilation revisited in H1N1 patients

Prone ventilation revisited in H1N1 patients International Journal of Advanced Multidisciplinary Research ISSN: 2393-8870 www.ijarm.com DOI: 10.22192/ijamr Volume 5, Issue 10-2018 Case Report DOI: http://dx.doi.org/10.22192/ijamr.2018.05.10.005 Prone

More information

PEEP nuove indicazioni, stesse problematiche

PEEP nuove indicazioni, stesse problematiche PEEP nuove indicazioni, stesse problematiche Franco Valenza Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Ossigenazione Clearance CO 2 Kats,

More information

What s New About Proning?

What s New About Proning? 1 What s New About Proning? J. Brady Scott, MSc, RRT-ACCS, AE-C, FAARC Director of Clinical Education and Assistant Professor Department of Cardiopulmonary Sciences Division of Respiratory Care Rush University

More information

Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal

Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre

More information

ARDS A Brief Overview. Lucas Pitts, M.D. Assistant Professor of Medicine Pulmonary and Critical Care Medicine University of Kansas School of Medicine

ARDS A Brief Overview. Lucas Pitts, M.D. Assistant Professor of Medicine Pulmonary and Critical Care Medicine University of Kansas School of Medicine ARDS A Brief Overview Lucas Pitts, M.D. Assistant Professor of Medicine Pulmonary and Critical Care Medicine University of Kansas School of Medicine Outline Definition of ARDS Epidemiology of ARDS Pathophysiology

More information

Weaning and extubation in PICU An evidence-based approach

Weaning and extubation in PICU An evidence-based approach Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.

More information

5/11/2018. Refining your Therapist Driven Protocols & Clinical Guidelines of Care. Objectives

5/11/2018. Refining your Therapist Driven Protocols & Clinical Guidelines of Care. Objectives Refining your Therapist Driven Protocols & Clinical Guidelines of Care Tom Malinowski, MSc, RRT, FAARC Director, Pulmonary Diagnostics, Respiratory Therapy Services University of Virginia Health System

More information

Noninvasive Ventilation: Non-COPD Applications

Noninvasive Ventilation: Non-COPD Applications Noninvasive Ventilation: Non-COPD Applications NONINVASIVE MECHANICAL VENTILATION Why Noninvasive Ventilation? Avoids upper A respiratory airway trauma system lacerations, protective hemorrhage strategy

More information

Seminar. Current Concepts

Seminar. Current Concepts Seminar Current Concepts In ARDS What I think is possible to cover in 40 minutes- Definition Management Ventilatory strategies Conventional LPV Rescue therapy Non Ventilatory strategies Definition and

More information

1/26/16. Prone Position How does asynchrony impact LPV and how should it be managed? Is there a role for NIV and HFNC in ARDS?

1/26/16. Prone Position How does asynchrony impact LPV and how should it be managed? Is there a role for NIV and HFNC in ARDS? What is ARDS?: how our understanding changed over time What are the risk factors and major etiologies? How does MV exacerbate or attenuate lung injury? Ventilator managment of ARDS Rich Kallet MS RRT FAARC

More information

ACUTE RESPIRATORY DISTRESS SYNDROME CHALLENGES FOR TRANSLATIONAL RESEARCH AND OPPORTUNITIES FOR PRECISION MEDICINE

ACUTE RESPIRATORY DISTRESS SYNDROME CHALLENGES FOR TRANSLATIONAL RESEARCH AND OPPORTUNITIES FOR PRECISION MEDICINE ACUTE RESPIRATORY DISTRESS SYNDROME CHALLENGES FOR TRANSLATIONAL RESEARCH AND OPPORTUNITIES FOR PRECISION MEDICINE Acute respiratory distress syndrome: challenges for translational research and opportunities

More information

Acute Respiratory Failure. Respiratory Failure. Respiratory Failure. Acute Respiratory Failure. Ventilatory Failure. Type 1 Respiratory Failure

Acute Respiratory Failure. Respiratory Failure. Respiratory Failure. Acute Respiratory Failure. Ventilatory Failure. Type 1 Respiratory Failure Acute Respiratory Failure Physiologic Classification Acute Respiratory Failure Type 1 Hypoxemic Type 2 Ventilatory Type 3 Post-op Type 4 Shock Mechanism Shunt Va Atelectasis Cardiac Output Phil Factor,

More information

Tracking lung recruitment and regional tidal volume at the bedside. Antonio Pesenti

Tracking lung recruitment and regional tidal volume at the bedside. Antonio Pesenti Tracking lung recruitment and regional tidal volume at the bedside Antonio Pesenti Conflicts of Interest Maquet: Received research support and consultation fees Drager: Received research support and consultation

More information

15 Years Of Clinical Trials In ARDS: What Progress Have We Made?

15 Years Of Clinical Trials In ARDS: What Progress Have We Made? 15 Years Of Clinical Trials In ARDS: What Progress Have We Made? Niall D. Ferguson, MD, FRCPC, MSc Head of Critical Care Medicine University Health Network & Mount Sinai Hospital Senior Scientist, Toronto

More information

OLB (Open Lung Biopsy) in ARDS

OLB (Open Lung Biopsy) in ARDS OLB (Open Lung Biopsy) in ARDS Claude GUERIN MD PhD Réanimation Médicale Hôpital de la Croix-Rousse Université de Lyon Lyon, France CCF Toronto October 28 th 2012 CCF 2012 1 Disclosure No conflict of interest

More information

The Art and Science of Weaning from Mechanical Ventilation

The Art and Science of Weaning from Mechanical Ventilation The Art and Science of Weaning from Mechanical Ventilation Shekhar T. Venkataraman M.D. Professor Departments of Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Some definitions

More information

Dr. AM MAALIM KPA 2018

Dr. AM MAALIM KPA 2018 Dr. AM MAALIM KPA 2018 Journey Towards Lung protection Goals of lung protection Strategies Summary Conclusion Before 1960: Oxygen; impact assessed clinically. The 1960s:President JFK, Ventilators mortality;

More information

Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS Zee and Gommers Critical Care (2019) 23:73 https://doi.org/10.1186/s13054-019-2365-1 REVIEW Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS Philip van der

More information

Fluid responsiveness and extravascular lung water

Fluid responsiveness and extravascular lung water Fluid responsiveness and extravascular lung water Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Conflicts of interest Member of the Medical Advisory Board of Maquet/Pulsion

More information

Inhaled nitric oxide: clinical evidence for use in adults

Inhaled nitric oxide: clinical evidence for use in adults Inhaled nitric oxide: clinical evidence for use in adults Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 31 October 2014 Conflict of interest Ikaria provided

More information

Should the ART trial change our practice?

Should the ART trial change our practice? Editorial Should the ART trial change our practice? Jesús Villar 1,2,3, Fernando Suárez-Sipmann 1,4,5, Robert M. Kacmarek 6,7 1 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid,

More information

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures The GOLD Study Goal of Open Lung Ventilation in Donors Michael A. Matthay M.D. and Lorraine B. Ware, MD Disclosures Research grants from the NHLBI, FDA & Industry - R37 HL51856 - R01 HL126176 - HL 110969

More information

FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME

FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME FAILURE OF NONINVASIVE VENTILATION FOR DE NOVO ACUTE HYPOXEMIC RESPIRATORY FAILURE: ROLE OF TIDAL VOLUME Guillaume CARTEAUX, Teresa MILLÁN-GUILARTE, Nicolas DE PROST, Keyvan RAZAZI, Shariq ABID, Arnaud

More information

APRV Ventilation Mode

APRV Ventilation Mode APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher

More information

Patient-Ventilator Synchrony and Impact on Outcome

Patient-Ventilator Synchrony and Impact on Outcome Variables Controlled during Mechanical Ventilation Patient-Ventilator Synchrony and Impact on Outcome 9-30-17 Cox Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

More information