Sun28November0333PM 37

Are the following true or false when ventilating a patient with acute/adult respiratory distress syndrome (ARDS) on the intensive care unit?

True / False

The tidal volume should be set to 12 mls/kg ideal body weight Correct

The plateau pressure should be kept below 30 cmH2O Correct

High Frequency Oscillation Ventilation (HFOV) has been shown to significantly improve outcomes Correct

In isolated ARDS, a raised PaCO2 can be tolerated Correct

A liberal fluid resuscitation strategy has been shown to improve outcomes in ARDS Correct

Explanation

The ARDSnet trial of 1999 has changed practice dramatically in intensive care medicine. A tidal volume of 6-8 ml/kg has been shown to significantly reduce morbidity and mortality, along with a plateau pressure of less than 30 cmH2O. The follow up fluids and catheters trial showed that a restrictive fluid strategy improved outcomes.

The consequence of reducing minute ventilation is that PaCO2 may rise. This is a lower priority than normal, as aggressive ventilation to lower PaCO2 may further damage the lungs and worsen systemic complications.

The OSCAR and OSCILLATE trials both showed an increase in in-hospital mortality when HFOV was compared with conventional lung protective ventilation.

Reference:

Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795-805.

The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-8.

The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564-75.

Young D, Lamb SE, Shah S, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806-13.

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