Author: Bein, Thomas; Grasso, Salvatore; Moerer, Onnen; Quintel, Michael; Guerin, Claude; Deja, Maria; Brondani, Anita; Mehta, Sangeeta
Title: The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia Document date: 2016_4_4
ID: krpg9u1u_51
Snippet: Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment are mandatory [90] ; however, a "simple" definition of life-threating hypoxemia has not been identified. Specific ventilator settings comprising limitation of tidal volume, adequate high PEEP, a recruitment maneuver (open lung approach) in special situations, I:E ratio = 1:1 with a "balanced" respiratory rate as well as prone position (early and prol.....
Document: Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment are mandatory [90] ; however, a "simple" definition of life-threating hypoxemia has not been identified. Specific ventilator settings comprising limitation of tidal volume, adequate high PEEP, a recruitment maneuver (open lung approach) in special situations, I:E ratio = 1:1 with a "balanced" respiratory rate as well as prone position (early and prolonged) are recommended in a specific "timetable" (Fig. 1) . Additionally, neuromuscular blockade (within 48 h after onset of ARDS) and an adequate sedation strategy are important supportive therapies (Fig. 2) of bacterial, atypical, viral, and fungal specimen (BC, BAL) and of infection sources by CT scan, followed by broad-spectrum anti-infectives. Various techniques of extracorporeal lung support are discussed in recent years as rescue measures in severe hypoxemic ARDS, but these specific measures are not in the scope of this article, and they are described extensively elsewhere. Actual mortality rates in ARDS patients are presented in Table 4 . A large recent database of 2377 ARDS patients from 50 countries [91] indicates a different mortality in terms of the grade of the severity with the highest mortality rate of 46.1 % for those patients with severe ARDS.
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