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

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Baseline severity of illness Characteristic APACHE III Shock (%) Pre-study fluid intake (L/24 h) PAC CVC p value 95+1 94+1 0.55 37 32 0.06 4.9+0.2 4.9+0.2 0.99 Tidal volume (ml/kg PBW) PEEP (cm H 2 O) PaO 2 /FIO 2 Plateau pressure (cm H 2 0) 7.4+0.1 7.4+0.1 0.88 9.3+0.2 9.7+0.2 0.09 159+3 151+3 0.10 26.2+0.4 26.2+0.4 0.93 N Engl J Med 2006; 354: 2213
Timing of protocol initiation Time to first protocol instruction (hours) ICU admission <strong>ALI</strong> qualification R<strong>and</strong>omization PAC CVC p value 44.4+2 40.8+3 0.23 25.2+0.7 23.0+0.6 0.02 3.5+0.1 2.2+0.1
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Acute lung injury (ALI) and Acute r
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• Day 23 bilateral tension pneumo
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Acute lung injury (ALI) Acute respi
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Mortality rate of ALI/ARDS 100 80 M
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Causes of death Multiple organ fail
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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: Baseline demographics Characteristi
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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Acute lung injury (ALI) and Acute respiratory distress syndrome ...

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