Both the ARDSnet protocol and the open lung approach require low tidal volumes and plateau pressures.
#Ardsnet tidal volume chart trial
Briefly, this was a randomized controlled trial in which patients were ventilated with a ARDSnet protocol, which uses low tidal volumes, relatively high respiratory rates, with oxygenation managed according to PEEP and FIO2 relationships as defined in a table, or with an open lung approach strategy, which uses a technique to recruit collapsed lung areas and then uses the lowest PEEP level that prevents recollapse of recruited lung units, being the best PEEP level determined by a decremental PEEP trial involving a series of pressure measurements taken after the recruitment maneuver. The institutional review committee approved the study that included the follow-up, and informed consent was obtained from each patient or legal representative. Patients were enrolled in this study in conjunction with a clinical trial in mechanical ventilation, the “ARDSnet Protocol versus Open Lung Approach in ARDS” trial (NCT 00431158).
We conducted a prospective longitudinal cohort study of 22 survivors of moderate/severe ARDS, recruited from six different ICUs located in Hospital das Clínicas, São Paulo, Brazil, from November 2008 to January 2012. Supporting this analysis, we also assessed the acute production of N-terminal-peptide type III procollagen (NT-PCP-III), from enrollment till weaning, as well as other long-term outcomes such as quantitative computed tomography (which enabled us to estimate excess tissue reorganization), 6-min walk test (6MWT) and quality of life (QoL). We decided to explore the relationship between ventilator settings and long-term outcomes for the entire cohort. As protective mechanical ventilation is an important intervention to reduce mortality of ARDS, probably by decreasing lung inflammation, we hypothesized that the parameters used during the ventilation strategy could be related to long-term lung fibrosis, impairing the lung function among ARDS survivors.ĭuring a recent ARDS trial comparing two strategies of protective mechanical ventilation, we collected lung function data for survivors, during the first 6 months after ARDS onset. The risk factors for a reduced long-term lung function in ARDS patients are unknown. Among ARDS survivors, abnormal findings in chest tomography correlate with restrictive lung changes and poorer health-related quality of life (HRQoL), suggesting that pulmonary dysfunction could be associated with limited activity in these patients. Ībout 25% of ARDS survivors present some reduction in the forced vital capacity (FVC) and in diffusion capacity 6 months after discharge. Up to 5 years after discharge from the intensive care unit (ICU), ARDS survivors still present persistent disabilities, including muscle weakness, altered lung function (e.g., decreased lung volumes, or decreased lung diffusion capacity) and an impaired mental health and cognition. ConclusionĮven in patients ventilated with protective tidal volume, higher driving pressure is associated with worse long-term pulmonary function and structure.Īcute respiratory distress syndrome (ARDS) is a rapidly progressive illness associated with high mortality and morbidity. Driving pressure was also related to general health domain of SF-36 at 6 months. There was a significant correlation between driving pressure and lung densities and nonaerated/poorly aerated lung volume after 6 months. At 6 months driving pressure was associated with lower FVC independently on tidal volume, plateau pressure and baseline static respiratory compliance after adjustments ( r 2 = 0.51, p = 0.02). At 1 and 6 months forced vital capacity (FVC) was negatively correlated to driving pressure ( p < 0.01). In extubation day an association between driving pressure and NT-PCP-III was observed. Thirty-three patients were enrolled, and 21 patients survived after 6 months. A health-related quality of life survey after 6 months was also performed.
Whole-lung computed tomography analysis and pulmonary function test were performed at 1 and 6 months of follow-up.
#Ardsnet tidal volume chart serial
We obtained serial measurements of plasma NT-PCP-III levels. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. Acute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy.
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