Guidelines On The Management Of Acute Respiratory Distress-Books Pdf

GUIDELINES ON THE MANAGEMENT OF ACUTE RESPIRATORY DISTRESS
24 Sep 2020 | 5 views | 0 downloads | 54 Pages | 1.19 MB

Share Pdf : Guidelines On The Management Of Acute Respiratory Distress

Download and Preview : Guidelines On The Management Of Acute Respiratory Distress

Report CopyRight/DMCA Form For : Guidelines On The Management Of Acute Respiratory Distress



Transcription

Executive Summary 3, List of Contributors 4, List of Abbreviations 5. Introduction 7, Technical Summary 9, Corticosteroids 11. Extra Corporeal Membrane Oxygenation 14, Extra Corporeal Carbon Dioxide Removal 16. Fluid Management 19, High Frequency Oscillatory Ventilation 22. Inhaled Vasodilators 25, Mechanical Ventilation at Lower Tidal Volume 27.
Neuromuscular Blocking Agents 31, Positive End Expiratory Pressure 34. Prone Positioning 37, Conclusion 41, Management of ARDS in Practice 44. References 47, EXECUTIVE SUMMARY, The FICM ICS Guideline Development Group have used GRADE methodology to make the following. recommendations for the management of adult patients with acute respiratory distress syndrome ARDS. The British Thoracic Society supports the recommendations in this guideline. Where mechanical ventilation is required the use of low tidal volumes 6 m l k g ideal body weight and. airway pressures plateau pressure 30 cmH2O was recommended For patients with moderate severe ARDS. PF ratio 20kPa prone positioning was recommended for at least 12 hours per day. By contrast high frequency oscillation is not recommended and it is suggested that inhaled nitric oxide is not. used The use of a conservative fluid management strategy was suggested for all patients whereas mechanical. ventilation with high positive end expiratory pressure PEEP and the use of the neuro muscular blocking agent. cisatracurium for 48 hours was suggested for ARDS patients with PF ratios less than or equal to 27 and 20 kPa. respectively, Extra corporeal membrane oxygenation ECMO was suggested as an adjunct to protective mechanical. ventilation for patients with very severe ARDS In the absence of adequate evidence research. recommendations were made for the use of corticosteroids and extra corporeal carbon dioxide removal. LIST OF CONTRIBUTORS, Guideline Development Group, Professor Mark Griffiths Barts Health NHS Trust.
Dr Nicholas Barrett Guy s and St Thomas NHS Foundation Trust. Professor Bronagh Blackwood Queen s University Belfast. Dr Andrew Boyle Queen s University Belfast, Dr Bronwen Connolly Guy s and St Thomas NHS Foundation Trust. Professor Paul Dark The University of Manchester, Dr Simon Finney Barts Health NHS Trust. Professor Danny McAuley Queen s University Belfast. Professor Gavin Perkins University of Warwick, Dr Aemun Salam Barts Health NHS Trust. Dr Jonathan Silversides Queen s University Belfast. Dr Nicholas Tarmey Queen Alexandra Hospital Portsmouth. Dr Matt Wise University Hospital Wales Cardiff, Dr Simon Baudouin The Newcastle upon Tyne Hospitals NHS Foundation Trust. Guideline Development Group Co Chairs, Professor Mark Griffiths.
Dr Simon Baudouin, Guideline Development Group Patient Representatives. Ms Julie Cahill, Mr Gordon Sturmey, Library Liaison Manager. Ms Clare Crowley King s College London, External Consultants. Professor Ognjen Gajic Mayo Clinic Rochester, Professor B Taylor Thompson Massachusetts General Hospital Harvard Medical School. Associate Professor Eddy Fan Toronto General Hospital. Guideline Development Group Co ordinator, Mrs Dawn Tillbrook Evans FICM Co ordinator.
LIST OF ABBREVIATIONS, AECC American European Consensus Conference. AKI Acute Kidney Injury, ARDS Acute Respiratory Distress Syndrome. BMI Body mass index, CESAR Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult. respiratory failure, CI Confident interval, cmH2O Centimetres of water. EALI Early acute lung injury, ECCOR Extra corporeal carbon dioxide removal.
ECMO Extra corporeal membrane oxygenation, ELSO Extra corporeal Life Support Organization. ESICM European Society of Intensive Care Medicine, EVLW extravascular lung water. FICM Faculty of Intensive Care Medicine, FiO2 Fraction of inspired oxygen. g dl Grams per decilitre, GDG Guideline Development Group. HFOV High Frequency Oscillation, HV HTV Higher Tidal Volume.
I2 Meta analysis heterogeneity, IBW Ideal body weight. ICS Intensive Care Society, ICU Intensive Care Unit. iNO Inhaled nitric oxide, iVasoD Inhaled Vasodilator. kPa Kilopascal, LIPS Lung injury prediction score, LIS Lung injury score. LV LTV Lower Tidal Volume, MA Meta analysis, ml kg Millilitres per kilogram.
mmHg Millimetres of mercury, NICE The National Institute for Clinical Excellence. NMBA Neuromuscular Blocking Agents, p f PaO2 FiO2 ratio. PaO2 Partial pressure of oxygen in arterial blood, PCWP Pulmonary capillary wedge pressure. PEEP Positive end expiratory pressure, PETAL National Institutes of Health s Prevention and Early Treatment of Acute Lung Injury Network. PICO Population Intervention Comparison Outcome, RCT Randomised clinical trials.
RR Relative risk, RR Respiratory rate in Table 2 The Lung Injury Prediction Score only. RRT Renal Replacement Therapy, SpO2 Oxygen saturation by pulse oximetry. SR Systematic review, VALI Ventilator associated lung injury. Vt Tidal Volume, vvECMO Veno venous extra corporeal membrane oxygenation. INTRODUCTION, The purpose of this guideline is to provide an evidence based framework for the management of adult patients.
with acute respiratory distress syndrome ARDS that will inform both key decisions in the care of individual. patients and broader policy Our recommendations are neither dictates nor standards of care We cannot take. into account all of the features of individual patients and complex local factors all we can do is to synthesise. relevant evidence and to put it into the context of current critical care medicine Similarly our. recommendations are not comprehensive these guidelines have relevance to a fraction of the total number. of decisions that are required of carers for these complex patients Indeed the current state of the art for the. management of ARDS has been recently reviewed1 4 and comparable guidelines have been produced by. national and international stakeholders5 6, The topics considered were chosen by the Guideline Development Group GDG in the light of results from a. survey carried out for the Intensive Care Society ICS including 556 responses from 3 200 members Popular. topics were excluded by the GDG if it was felt that there was a dearth of evidence e g appropriate. investigations and the role of specialist centres when the evidence was not specific to ARDS weaning from. mechanical ventilation nutrition and the timing of tracheostomy and if there was over lap with existing. guidelines post ICU care and rehabilitation, Definitions. ARDS was first reported in a case series from Denver in 19677 The American European Consensus Conference. AECC 1994 defined ARDS as an acute inflammatory syndrome manifesting as diffuse pulmonary oedema and. respiratory failure that cannot be explained by but may co exist with left sided heart failure8 In 2012 the. AECC definition was re evaluated and minor alterations were proposed by the European Society of Intensive. Care Medicine ESICM ARDS Definition Task Force Table 1 This iteration recognised 3 grades of severity. depending on the degree of hypoxaemia and stipulated the application of at least 5 cmH2O of positive end. expiratory pressure PEEP or continuous positive airway pressure CPAP This so called Berlin definition was. validated using retrospective cohorts and captures patients with a mortality of 24 in patients with mild ARDS. rising to 48 in the group of patients with the most severe respiratory failure9. A four point lung injury scoring system Murray Score or LIS is the most widely used means of quantifying. ARDS severity It is based on the level of PEEP the ratio of the partial pressure of arterial oxygen PaO2 to the. fraction of inspired oxygen FiO2 the dynamic lung compliance and the degree of radiographic infiltration 7. Although the LIS has been widely used in clinical studies and a score of 3 0 is commonly used as a qualifying. threshold for support with extra corporeal membrane oxygenation ECMO it cannot predict outcome during. the first 24 to 72 hours of ARDS8 When the scoring system is used 4 to 7 days after the onset of the syndrome. scores of 2 5 or higher predicted a complicated course requiring prolonged mechanical ventilation9. As a syndrome rather than a disease there is no laboratory imaging or other gold standard diagnostic. investigation for ARDS Therefore like acute kidney injury ARDS is caused by a huge range of conditions and. as a consequence patients with ARDS are heterogeneous The outcome of these patients is determined by the. underlying causes of ARDS patient specific factors such as co morbidities clinical management and the. severity of illness, Epidemiology and Outcomes, Using the AECC definition several population based studies of ARDS showed a fairly consistent picture of the. age mortality and severity of illness however there was almost a fourfold difference in incidence probably. contributed to by differences in study design and ICU utilisation10 In the United States there are estimated to. be 190 000 cases and 74 000 deaths annually from ARDS11 Whereas in a third world setting from 1046. patients admitted to a Rwandan referral hospital over 6 weeks 4 median age 37 years met modified ARDS. criteria Only 30 9 of patients with ARDS were admitted to an ICU and hospital mortality was 50 0 This. study used the Kigali modification of the Berlin definition without a requirement for PEEP hypoxia threshold. of SpO2 FiO2 less than or equal to 315 and bilateral opacities on lung ultrasound or chest radiograph 12. The recently published LUNG SAFE trial was designed to study prospectively the performance of the Berlin. definition and to reflect modern management of ARDS To those ends the investigators recorded admissions. over 4 weeks to 459 ICU in 50 countries over 5 continents including 29 144 patients In total 3022 10 4. cases fulfilled ARDS criteria including almost a quarter of those supported with invasive mechanical. ventilation13 Despite this relatively high prevalence and the study s focus on ARDS the syndrome was. recognised in only half of the mild ARDS group Furthermore in a study that reported on 815 patients with at. least one risk factor for ARDS who were admitted to one of 3 Spanish hospitals over 4 months 15 out of 53. patients 28 were not admitted to an ICU suggesting that LUNG SAFE may have underestimated both ARDS. incidence and over looked diagnoses 14, Survivors commonly suffer from muscle weakness and neuropsychiatric problems such that fewer than 50. have returned to work 12 months after leaving intensive care15 However it is unusual for ARDS survivors to. be significantly limited by chronic respiratory failure Therefore ARDS is important both clinically and. financially because it is a not uncommon contributor to the deaths of critically ill patients of all ages and. because survivors carry on suffering from the sequelae of critical illness long after they leave hospital 16. Pathophysiology, The pathophysiology of ARDS results from acute inflammation affecting the lung s gas exchange surface the.
alveolar capillary membrane1 Firstly there follows an increase in the permeability of the membrane. associated with the recruitment of neutrophils and other mediators of acute inflammation into the airspace. manifesting as high permeability pulmonary oedema The resulting acute inflammatory exudate inactivates. surfactant leading to collapse and consolidation of distal airspaces with progressive loss of the lung s gas. exchange surface area This would be compensated for by hypoxic pulmonary vasoconstriction if the. inflammatory process did not also effectively paralyse the lung s means of controlling vascular tone thereby. allowing deoxygenated blood to cross unventilated lung units on its way to the left heart The combination of. these two processes causes profound hypoxaemia and eventually type 2 respiratory failure as hyperventilation. fails to keep pace with carbon dioxide production, Any diagnostic strategy for ARDS is sufficiently dependent on local factors such as the prevalent causes of. infectious pneumonia and access to imaging modalities that a single protocol cannot be recommended An. exemplar from a tertiary referral centre used to dealing with complex and very severe cases is included Figure. A p43 44 There are two main broad categories of condition that resemble ARDS but have a distinct. pathophysiology Firstly cardiovascular conditions of rapid onset including left heart failure right to left. vascular shunts usually with some lung pathology and major pulmonary embolism Secondly lung conditions. which develop more slowly than ARDS for example interstitial lung diseases especially acute interstitial. pneumonia broncho alveolar cell carcinoma lymphangitis and the pulmonary vasculitides. TECHNICAL SUMMARY, The guidelines for the management of adult patients with ARDS were created by a multi disciplinary writing. group constituted by the Joint Standards Committee of the Faculty of Intensive Care Medicine FICM and the. Intensive Care Society ICS All group members including lay members are co authors of the guideline The. group first met in 2013 and completed the guidelines in 2018 The guidelines have undergone both. independent external peer review and also input from stakeholder organisations. The process for guideline creation adhered to that of the National Institute for Health and Care Excellence. NICE In brief the writing group first performed a scoping exercise on the topic having decided that the focus. MANAGEMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME Version 1 July 2018 2 ONTENTS Executive Summary 3 List of Contributors 4 List of Abbreviations 5 Introduction 7 Technical Summary 9 Corticosteroids 11 Extra Corporeal Membrane Oxygenation 14 Extra Corporeal Carbon Dioxide Removal 16 Fluid Management 19 High Frequency Oscillatory Ventilation 22 Inhaled Vasodilators 25 Mechanical

Related Books

A study on synthesis and biological evaluation of curcumin

A study on synthesis and biological evaluation of curcumin

A study on synthesis and biological evaluation of curcumin pyrazole derivatives for anticancer and antioxidant properties 1Sharada Angatahally Chandrashekariah 2Honnalagere Ramesh Puneeth 1Associate Professor of Biochemistry 2Student Department of Biochemistry Yuvaraja s College University of Mysore Mysuru Karnataka India 570005 ABSTRACT A series of curcumin pyrazole derivatives 2a

Manual de Instalaci n Usuario y Control remoto Carrier

Manual de Instalaci n Usuario y Control remoto Carrier

Manual de Instalaci n Usuario y Control remoto Muchas gracias por comprar nuestros equipos de aire acondicionado Antes de utilizar su equipo de aire acondicionado por favor leer detenidamente el presente manual y conservarlo para futuras consultas Acondicionador de aire de habitaci n Tipo Split de pared Manual v lido para los modelos Conjuntos splits 53CMC09015F 53HMC09015F 53CMC12015F

Portable Air Conditioner OWNER S MANUAL Honeywell

Portable Air Conditioner OWNER S MANUAL Honeywell

instruction manual for future reference This manual is designed to provide important information needed to setup operate maintain and troubleshoot your portable air conditioner Failure to follow these instructions may void the warranty

SLIM CASSETTE TYPE AIR CONDITIONER OWNER S MANUAL

SLIM CASSETTE TYPE AIR CONDITIONER OWNER S MANUAL

SLIM CASSETTE TYPE AIR CONDITIONER OWNER S MANUAL Indoor Unit Outdoor Unit Power Supply 42TSV052P1 42TSV067P1 42TSV080P1 42TSV110P1 38TSV052P1 38TSV067P1 38TSV080P1 38TSV110P1 220 240V 50Hz 42TSV130P1 38TSV130P1 220 240V 50Hz 220 240V 50Hz 220 240V 50Hz 220 240V 50Hz Thank you very much for purchasing our air conditioner Before using your air conditioner please read this manual

OWNER S MANUAL ENGLISH Carrier

OWNER S MANUAL ENGLISH Carrier

OWNER S MANUAL AIR CONDITIONER SPLIT TYPE For general public use Indoor unit 42TVU010 012 018 703 Outdoor unit 38TVU010 012 018 703 1110650168 ENGLISH DANGER Do not install repair open or remove the cover It may expose you to dangerous voltages Ask the dealership or the specialist to do this Turning off the power supply will not prevent potential electric shock

Transport Air Conditioning GMCMI

Transport Air Conditioning GMCMI

This manual provides identification of service replacement parts for the Carrier Transport Air Conditioning Air V air conditioning units listed in the following Model Chart To find replacement parts determine major group in which replacement parts are located Upper Unit or Ceiling Unit and turn to the appropriate page for the illustrated breakdown of the replacement parts Carrier s Air

Exam IFM Study Manual

Exam IFM Study Manual

Exam IFM Study Manual 1st Edition Fifth Printing Abraham Weishaus Ph D F S A C F A M A A A NO RETURN IF OPENED Customizable versatile online exam question bank Thousands of questions Access your exclusive StudyPlus bonus content GOAL Flashcards Formula sheet Key Code Inside This manual includes GOAL TO OUR READERS Please check A S M s web site at www studymanuals

Data Structures and Algorithms Amazon S3

Data Structures and Algorithms Amazon S3

Contents 1 Abstract Data Types 1 1 1 Review on C Programming 1 1 2 Basic Concepts 3

DATA AND GAME EVELOPERS Lagout

DATA AND GAME EVELOPERS Lagout

Data Structures and algorithms for Game Developers ISBN 1 58450 495 1 ISBN 13 978 1 58450 495 5 All brand names and product names mentioned in this book are trademarks or service marks of their respective companies Any omission or misuse of any kind of service marks or trademarks should not be regarded as intent to infringe on the property of others The publisher recognizes and respects

Pre Public Examination GCSE Mathematics Edexcel style

Pre Public Examination GCSE Mathematics Edexcel style

PiXL Club It may not be copied sold nor transferred to a third party or used by the school after It may not be copied sold nor transferred to a third party or used by the school after membership ceases

Algorithms and Data Structures in C

Algorithms and Data Structures in C

Algorithms and Data Structures in C Complexity analysis Answers the question How does the time needed for an algorithm STL Standard Template Library Most notable example of generic programming Widely used in practice Theory Stepanov Musser Implementation Stepanov Lee Standard Template Library Proposed to the ANSI ISO C Standards Committee in 1994 After small revisio