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

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Summary • Using the data from a PAC compared to that from a CVC in an explicit protocol: – Did not alter survival. – Did not improve organ function. – Did not change outcomes for patients entering in shock compared to those without shock. • PAC use resulted in more non-fatal complications, mostly arrhythmias. N Engl J Med 2006; 354: 2213
SICU mortality <strong>and</strong> PAC use 40 1 Percent PAC use 35 30 25 20 15 10 5 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 PAC Use O/E mortality 0 0 '98 '99 '00 '01 '02 '03 '04 '05 '06 Brunswold M Crit Care Med 2007;34:A55
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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
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ARDSnet Mass General Washington San
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Airway pressures Airway Pressure Pe
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Ventilation can cause systemic infl
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Tidal volume in practice 50 40 Perc
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normal Hypothesis: In patients with
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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: Organ failure free days to day 28 R
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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