Critical care medicine
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Critical care medicine · Jan 2016
Randomized Controlled TrialVolume Delivered During Recruitment Maneuver Predicts Lung Stress in Acute Respiratory Distress Syndrome.
Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver (V(RM)) is inversely associated with lung stress and mortality in acute respiratory distress syndrome. ⋯ Low V(RM) independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome.
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Critical care medicine · Jan 2016
Randomized Controlled Trial Multicenter StudyOpen Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial.
The open lung approach is a mechanical ventilation strategy involving lung recruitment and a decremental positive end-expiratory pressure trial. We compared the Acute Respiratory Distress Syndrome network protocol using low levels of positive end-expiratory pressure with open lung approach resulting in moderate to high levels of positive end-expiratory pressure for the management of established moderate/severe acute respiratory distress syndrome. ⋯ In patients with established acute respiratory distress syndrome, open lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma. This pilot study supports the need for a large, multicenter trial using recruitment maneuvers and a decremental positive end-expiratory pressure trial in persistent acute respiratory distress syndrome.