Acute lung injury (ALI) and Acute respiratory distress syndrome ...

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• 21 yo female WKU student • Previously healthy • Admitted with Gullian-Barre • Day 5 aspiration-induced ARDS • Ventilation – Tidal volume 10 ml/kg –FiO 2 0.8 – PEEP 15 – PIP 70 cm H 2 0 – Adjustments made to normalize blood gases
• Day 23 bilateral tension pneumothoraces – Multiple (4+3) chest tubes – Large bilateral (R>L) cystic areas – Pneumomediastinum – Interstitial emphysema
Page 1: Acute lung injury (ALI) and Acute r
Page 5 and 6: Acute lung injury (ALI) Acute respi
Page 7 and 8: Mortality rate of ALI/ARDS 100 80 M
Page 9 and 10: Causes of death Multiple organ fail
Page 11 and 12: ALI is heterogeneous Near normal Ma
Page 13 and 14: ARDSnet Mass General Washington San
Page 15 and 16: Airway pressures Airway Pressure Pe
Page 17 and 18: Ventilation can cause systemic infl
Page 19 and 20: Tidal volume in practice 50 40 Perc
Page 21 and 22: normal Hypothesis: In patients with
Page 23 and 24: Macro-barotrauma is not the mechani
Page 25 and 26: PaO 2 / FiO 2 180 160 * * P/F 140 1
Page 27 and 28: Median organ failure free days CNS
Page 29 and 30: Tidal volume as a risk factor for A
Page 31 and 32: Hypothesis: In patients with ALI ve
Page 33 and 34: Barotrauma 20 15 Low PEEP High PEEP
Page 35 and 36: Physiology of higher / lower PEEP P
Page 37 and 38: Median organ failure free days Rena
Page 39 and 40: Summary • Lower tidal volumes red
Page 41 and 42: Ketoconazole for Early Treatment of
Page 43 and 44: RCT of Steroids for persistent ARDS
Page 45 and 46: • Randomized, blinded controlled
Page 47 and 48: Summary • With the exception of h
Page 49 and 50: Is a PA catheter harmful or helpful
Page 51 and 52: Effectiveness of PAC in the initial
Page 53 and 54:
FACTT: Factorial trial design C A T
Page 55 and 56:
FACTT: Treatment principles • If
Page 57 and 58:
Conservative fluid strategy Furosem
Page 59 and 60:
FACTT: outcome variables Primary Mo
Page 61 and 62:
N Engl J Med 2006; 354: 2213
Page 63 and 64:
Baseline demographics Characteristi
Page 65 and 66:
Timing of protocol initiation Time
Page 67 and 68:
Catheter use and complications Comp
Page 69 and 70:
Positive blood cultures 20 15 p=0.4
Page 71 and 72:
Proportion of assessments in shock
Page 73 and 74:
11.0 Hemoglobin (gm/dL) 10.5 10.0 9
Page 75 and 76:
Organ failure free days to day 28 R
Page 77 and 78:
SICU mortality and PAC use 40 1 Per
Page 79 and 80:
Frequency of diuretic and fluid bol
Page 81 and 82:
8000 Net fluid balance ml of fluid
Page 83 and 84:
Cumulative fluid balance at day 7:
Page 85 and 86:
PAOP separation 17 16 PAC Liberal P
Page 87 and 88:
Tidal volume (mL/kg PBW) 8.00 7.00
Page 89 and 90:
Respiratory rate PaCO2 30 48 46 28
Page 91 and 92:
ICU free days to day 28 Conservativ
Page 93 and 94:
Dialysis to Day 60 Renal support Co
Page 95 and 96:
Frequency of metabolic abnormalitie
Page 97 and 98:
Conclusions • Use a normal tidal
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