021003 - RM Solutions

More documents

Recommendations

Info

6/21/2012Optimizing ventilation & OxygenationHIgherAmplitudeLower CO2Higher Frequency Higher CO2Higher mPAW betteroxygenationIS THERE CLINICAL DATA TO SUPPORT THE USE OFHFOV IN ADULTS?• 6 observational studies, all with severe ARDS (P/F ratios
6/21/2012Table 2—Patient Outcomes Using HFOV*OutcomesValuesDuration of HFOV, d 5.1 6.3Pneumothorax during HFOV 34 (21.8)Reason for withdrawal of HFOVSuccessfully weaned 76 (48.7)Withdrawal of life support/death 38 (24.4)Technical problem 5 (3.2)Oxygenation difficulty 12 (7.7)Ventilation difficulty 23 (14.7)Hemodynamic instability 8 (5.1)Other therapiesINO 68 (43.6)Steroids 58 (37.2)Prone positioning 10 (6.4)HFJV 5 (3.2)ECMO 2 (1.2)Outcome at 30 dDied 95 (61.7)AliveNo ventilatory support 28 (18.2)Ventilated 31 (20.1)• 156 patients• HFOV was used as rescue therapy for ARDS• APACHE II 24, OI 31, mortality 61.7%• Predictors of poor outcome on multivariable analysis:• older age, higher APACHE II score, lower pH• greater number of CV days prior to HFOV• OI at 24 hours*Values given as means SD or No. (%). HFJV high-frequencyjet ventilation; ECMO extracorporeal membrane oxygenation.Mehta.Chest 2004;126:518–27eart rate (top, A), andver the duration of thering CV immediatelyequent measurementse 0 represents valuesn. Values are given ast to each data pointvalues for trends inlic BP, p 0.03; heart0.004.number of CV days prior to starting HFOV therapy(p 0.0115); and baseline pH (p 0.0083). Stepwiselogistic regression identified OI as the mostsignificant posttreatment predictor of mortality andOI at 24 h as the most significant time point(p 0.0066). The relationship between predictedmortality and OI at 24 h, controlling for baselineconditions, is shown in Figure 4.We identified an OI of 15 at 24 h or animprovement of at least 30% in the OI at 24 h asthe best dichotomous criteria for survival (sensitivity,0.63; specificity, 0.67; p 0.007).• 8 RCTs, 419 patientsBMJ 2010;340:c2327ter the initiation ofand nonsurvivors.and nonsurvivorshown). Pao 2 /Fio 2ower in survivorsely). Fio 2 could beHFOV therapy inired lower Fio 20.0001). Thereen the two groups.Discussion• HFOV v/s CMV as initial ventilation strategyThe purpose of the current study was to summarizethe experience with HFOV therapy in threeToronto medical/surgical ICUs. We observed the• following. Median First, PaO2/FiO2 HFOV isratio used 112 as rescue therapy inadults with ARDS due to a wide variety of etiologies,when patients are already requiring high Fio 2 and/orhigh airway pressures. Second, the use of HFOV isassociated with improvements in ventilation andoxygenation, the latter permitting significant reductionsin delivered Fio 2 . Third, 26% of patients hadHFOV therapy discontinued due to difficulties with11
Page 1 and 2: 6/21/2012HIGH FREQUENCYOSCILLATORY
Page 3 and 4: 6/21/2012Unique that Inspiration &E
Page 5 and 6: 6/21/2012Muellenbach et al. BMC Ane
Page 7 and 8: 6/21/2012PROOF?Compared to Conventi
Page 9: 6/21/2012mPAWOPTIMIZING OXYGENATION
Page 13 and 14: 6/21/2012SO WHAT’S THE BOTTOM LIN
Page 15 and 16: 6/21/2012CLINICAL APPLICATION OF HF

021003 - RM Solutions

Create successful ePaper yourself

Delete template?

Save as template?