bibliography of selected studies by the ARDS Network Kenneth Nugent MD

This pivotal study reported the outcome in 861 patients in a randomized controlled trial which compared a low tidal volume strategy (6ml/kg IBW) with a plateau pressure < 30 cm H2O against a conventional tidal volume strategy (12ml/kg IBW) with a plateau pressure <50 cm H2O. The absolute mortality difference was 8.8% (NNT= 11). This now represents the standard of care in ARDS.

 

  • Brower RG, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2001; 351: 327–36.
    This study randomized 549 patients with acute lung injury into either a high PEEP (13 cm H2O) or a low PEEP (8 cm H2O) protocol. All patients were ventilated with a low tidal volume (6 ml/Kg IBW)) and a controlled plateau pressure (<30 cm H2O) strategy. There was no difference in mortality.
     

  • Brower RG, et al. Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med. 2004 Mar;32(3):907.
    72 patients with acute lung injury underwent either active recruitment maneuvers (CPAP 35–40 cmH2O for 30 seconds) or sham recruitment maneuvers. The mean increase in SpO2 was 1.7 % at 10 minutes post maneuver. This increase did not persist, and there were no long term benefits. This maneuver did not cause barotrauma.
     

  • Hager DN, et al. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 2005; 172: 1241–5.
    This analysis suggests that there is no “safe” upper limit of plateau pressure. However, reducing the tidal volume when the plateau pressure is already low may not be warranted as hypercapnea has physiological consequences.
     

  • Eisner MD, et al. Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome. Am J Respir Crit Care Med 2001; 165: 978–82.
    This study retrospectively examined the risk factors for early barotrauma in 718 ARDS/ALI patients. The cumulative incidence of barotrauma was 13 % during the first four days of ventilation. Higher concurrent PEEP was associated with an increased risk of barotrauma with a relative hazard of 1.67 per 5 cm H2O increase in PEEP.
     

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    Jan 28, 2017 | Posted by in CARDIOLOGY | Comments Off on bibliography of selected studies by the ARDS Network Kenneth Nugent MD

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