Effectiveness of inspiratory pressure-limited approach to mechanical ventilation in septic patients.
ABSTRACT Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see if a protective strategy based approach with a plateau pressure < 30 cm H2O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign (SSC) international database.A retrospective analysis of an international multicentric database of 15,022 septic patients from the 165 ICUs was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3 vs. 33.0%; p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of a inspiratory plateau pressures maintained < 30 cm H2O was associated with lower mortality by chi-square test (46.4 vs. 55.1%; p<0.001) and by Kaplan-Meier and log-rank test (p<0.001). In the multivariable random-effects Cox regression, plateau pressure < 30 cm H2O was significantly associated with lower mortality (HR=0.84, 95% CI: 0.72-0.99, p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented.
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ABSTRACT: Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Recently, the new definition of ARDS has been published, and this definition suggested severity-oriented respiratory treatment by introducing three levels of severity according to PaO2/FiO2 and positive end-expiratory pressure. Lung-protective ventilation is still the key of better outcome in ARDS. Through randomized trials, short-term use of neuromuscular blockade at initial stage of mechanical ventilation, prone ventilation in severe ARDS, and extracorporeal membrane oxygenation in ARDS with influenza pneumonia showed beneficial efficacy. However, ARDS mortality still remains high. Therefore, early recognition of ARDS modified risk factors and the avoidance of aggravating factors during the patient's hospital stay can help decrease its development. In addition, efficient antifibrotic strategies in late-stage ARDS should be developed to improve the outcome.Journal of intensive care. 01/2014; 2(1):2.
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ABSTRACT: Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.Annals of intensive care. 04/2013; 3(1):11.