ARDS: Standard of Care

Life-threatening hypoxemia defined as:

  1. ABG PO2 <60mm Hg
  2. SPO2 <88%
  3. PF ratio <100

“Simple” and global parameters (PaO2, SaO2, SvO2, lactate) are imprecise surrogates for hypoxia in ARDS patients. However an individualized, organ-specific approach for monitoring of hypoxemia is currently not available. Therefore a target for conservative arterial oxygenation is recommended (PaO2 =  65–75  mmHg, SaO2 = 90–95 %), which should be bundled in a general “organ failure prevention” strategy.

Standard of Care inclues:

  1. Mechanical ventilator settings
    1. limited TV (6ml/Kg BW)
    2. high PEEP (>12 cmH20)
    3. recruit maneuvers
    4. balanced respiratory rate (20-30/min)
  2. prone positioning
    1. early (</=48h after onset)
    2. prolonged (repetition of 16-hour sessions)
  3. advanced infection management / control
    1. early diagnosis (blood culture, BAL) and infection source (CT scan)
    2. administration of broad spectrum anti-inefctives
  4. neuromuscular blockage (cisatracurium <=48h after onset) and adequate sedation (score-guided)
  5. negative fluid balance

ARDS Network Protocol (Marino, 2014)

Reference

Bein, Thomas et al. “The Standard Of Care Of Patients With ARDS: Ventilatory Settings And Rescue Therapies For Refractory Hypoxemia”. Intensive Care Med 42.5 (2016): 699-711. Web. 14 May 2016.

Advertisements

Tagged: , , , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: