Thu7October1249PM 10

A patient is ventilated on the intensive care unit with ARDS secondary to septic shock.

Which of the following is true with regard to their management?

True / False

Peak airway pressures must be kept below 30 cmH2O Incorrect answer selected

A pulmonary artery (PA) catheter should be inserted to allow careful titration of fluid therapy Correct

The tidal volume should be set to 6 ml/kg predicted body weight Correct

The patient should be maintained at a 30-45° head-up position Correct

Positive end expiratory pressure (PEEP) should be used to minimise atelectotrauma Correct

Explanation

The ARDSnet series of papers have revolutionised the management of ARDS.

Small tidal volumes (6 ml/kg predicted body weight) are associated with better outcomes than large ones.

PEEP aids recruitment and minimises atelectotrauma (but needs to be set appropriately).

A plateau (rather than peak) pressure of less than 30 cmH2O should be sought. Plateau airway pressures are more reflective of alveolar peak pressures, and these should be measured using an inspiratory hold.

A conservative, rather than liberal fluid strategy should be used if tissue perfusion allows, and there is no benefit (and possible harm) from the routine use of PA catheters.

Head up positioning has been shown to reduce the risk of ventilator-associated pneumonia (VAP).

Reference:

Surviving Sepsis Campaign. Recommendations: Other Supportive Therapy of Severe Sepsis.

Answer Statistics

Not enough data to display the statistics

Average score: 81.30%

Times answered: 323