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

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Trials of lower tidal ventilation Mortality (%) Pressure Traditional “Protective” Limits Stewart 1 (n = 120) 47 50 PIP=50 Brochard 2 (n = 116) 38 47 PIP=60 Brower 3 (n = 52) 46 50 Pplat 45-55 Amato 4 (n = 53) 71 38 1. NEJM 338:355-361, 1998 2. AJRCCM 158: 1831, 1998 3. CCM 27:1492, 1999 4. NEJM 339: 347, 1998
normal Hypothesis: In patients with <strong>ALI</strong>, ventilation with smaller tidal volumes (6 mL/kg) will result in better clinical outcomes than traditional tidal volumes (12 mL/kg) ventilation. ARDS Network N Engl J Med 2000; 342:1301
Page 1 and 2: Acute lung injury (ALI) and Acute r
Page 3 and 4: • Day 23 bilateral tension pneumo
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: Tidal volume in practice 50 40 Perc
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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