Arthur S Slutsky : ac. Abstract The acute respiratory distress syndrome ARDS is an inflammatory disease of the lungs characterized clinically by bilateral pulmonary infiltrates, decreased pulmonary compliance and hypoxemia. Although supportive care for ARDS seems to have improved over the past few decades, few studies have shown that any treatment can decrease mortality for this deadly syndrome. The implications of this study with respect to clinical practice, further ARDS studies and clinical research in the critical care setting are discussed. Keywords: acute lung injury, artificial respiration, barotrauma, biotrauma, iatrogenic, respiratory failure Introduction ARDS is an inflammatory disease of the lungs characterized clinically by bilateral pulmonary infiltrates, decreased pulmonary compliance and hypoxemia [ 1 , 2 ]. Despite intense research for decades, the mortality rate in patients with ARDS remains very high, although there is some evidence that these rates might be decreasing [ 3 ].
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Print 1. Low tidal volume ventilation also led to an increase in ventilator-free days and a decrease in the number of days with systemic organ failure. There was no change in the incidence of barotrauma between the two groups. Patients assigned to lower tidal volume ventilator settings initially required a higher PEEP to maintain arterial oxygenation and were more likely to develop respiratory acidosis, although the difference disappeared by day 7. However, studies in animals showed that higher tidal volumes were associated with increased lung inflammation and injury.
There was no difference in barotrauma between the two groups. Of note, patients in the lower tidal volume group required higher PEEP and had a slight, but significant, respiratory acidosis, both of which resolved after 7 days. Patients with chronic lung disease, high pulmonary capillary wedge pressure or evidence of left atrial hypertension, less than 6 months of estimated survival, and other medical problems that would cause poor respiration or oxygenation, were excluded.
Patients were followed up weekly for a total of days. The primary endpoint was in-hospital mortality, with significant reduction from All rights reserved. No works may be reproduced without written consent from 2minutemedicine. Disclaimer: We present factual information directly from peer reviewed medical journals.
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The ARMA trial: Lower tidal volume ventilation in ALI/ARDS [Classics Series]
The ARDS Network was established as a contract program in and renewed in following two national competitions. The goal of the Network was to efficiently test promising agents, devices, or management strategies to improve the care of patients with ARDS. During its 20 years of service, 5, patients were enrolled in 10 randomized controlled trials and one observational study In some of the most highly cited articles in critical care, network investigators reported improved survival with lung protective ventilation and shortened duration of mechanical ventilation with conservative fluid management. Additional trials informed best practices by suggesting no role for routine use of corticosteroids, beta agonists, pulmonary artery catheterization, or early full calorie enteral nutrition. The ARDS Network also developed new outcome measures ventilator free days and promoted innovative and efficient techniques factorial designs and coenrollment to speed the discovery of new treatment approaches for patients with ARDS. Finally, through the foresight of many investigators within the Network, additional resources were obtained for the collection and analysis of biospecimens and to perform numerous ancillary studies, efforts that have advanced our understanding of the pathogenesis and natural history of ARDS. On June 30th, , the Network contract came to a close.
Mechanical ventilation: lessons from the ARDSNet trial
ARDS Network (NHLBI) Studies – Successes and Challenges in ARDS Clinical Research