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2016 | OriginalPaper | Buchkapitel

10. Acute Respiratory Distress Syndrome (ARDS)

verfasst von : Univ.-Prof. Dr. med. C. Putensen

Erschienen in: Sepsis und MODS

Verlag: Springer Berlin Heidelberg

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Zusammenfassung

Die Berliner Definition des ARDS differenziert anhand des Schweregrades der Hypoxämie zwischen mildem (p_aO₂/F_iO₂ <300), moderatem (<200) und schwerem (<100) ARDS. Die Beatmung kann eine beatmungsassoziierte Lungenschädigung verursachen. Die lungenprotektive Beatmung mit niedrigem V_T (6 ml/kg standardisiert KG) ist daher heute Standard. Die Einstellung des PEEP-Wertes soll einen Kollaps der Lunge vermeiden; höhere PEEP-Werte werden bei Sepspispatienten mit moderatem bis schwerem ARDS und bei refraktärer Hypoxämie empfohlen. Die Bauchlage ist vorteilhaft und soll bei ausreichender Erfahrung des Zentrums angewendet werden. Der Vorteil des Rekrutierungsmanövers ist nicht belegt. Die Hochfrequenzoszillation zeigt keinen Effekt auf die Letalität bei höherem Risiko für Barotrauma und Hypotension. ARDS-Patienten sollten schnell von der Beatmung entwöhnt werden. Ein Entwöhnungsprotokoll in Kombination mit einem Sedierungsprotokoll reduziert die Langzeitletalität und ist daher Standard.

Agarwal R, Srinivas R, Nath A, Jindal SK (2008) Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis. Chest 133 (6): 1463–1473CrossRefPubMed

Amato MB, Barbas CS, Meddeiros DM, Magaldi RB, Schettino GP, Lorenzi-Fiho G, Kairalla RA, Deheinzellin D, Munzo C, Oliveira R, Talagalo TY, Carvalho CR (1998) Effect of protective-ventilation strategy on mortality in the adult respiratory distress syndrome. New Engl J Med 338: 347–354CrossRefPubMed

ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307 (23): 2526–2533 [Definition des ARDS unter Berücksichtigung der Pathophysiologie und Epidemiologie. Muss als Standartwerk gelten.] ←

Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2 (7511): 319–323CrossRefPubMed

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818–824

Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P (2011) Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ 342: c7237PubMedCentralCrossRefPubMed

Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150 (4): 896–903CrossRefPubMed

Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondejar E, Clementi E, Mancebo J, Factor P, Matamis D, Ranieri M, Blanch L, Rodi G, Mentec H, Dreyfuss D, Ferrer M, Brun-Buisson C, Tobin M, Lemaire F (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trial Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158 (6): 1831–1838CrossRefPubMed

Brower RG, Shanholtz CB, Fessler HE, Shade DM, White P Jr, Wiener CM, Teeter JG, Dodd-o JM, Almog Y, Piantadosi S (1999) Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 27 (8): 1492–1498CrossRefPubMed

Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson B T (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351 (4): 327–336CrossRefPubMed

Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L (2008) Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 178 (4): 346–355 [Darstellung der Mechanismen der beatmungsassoziierten Lungenschädigung.] ← CrossRefPubMed

Combes A, Bacchetta M, Brodie D, Muller T, Pellegrino V (2012) Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care 18 (1): 99–104CrossRefPubMed

Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto MG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160(5 Pt 1): 1585–1591CrossRefPubMed

Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettila V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M (2009) Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1) Acute Respiratory Distress Syndrome. JAMA 302 (17): 1888–1895CrossRefPubMed

Dellinger RPI, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup Sepsis Campaign; Surviving Sepsis Campaign (2013) International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39: 165–228CrossRefPubMed

Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, Carlin B, Lowson S, Granton J (2002) High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 166 (6): 801–808CrossRefPubMed

Domenighetti G, Gayer R, Gentilini R (2002) Noninvasive pressure support ventilation in non-COPD patients with acute cardiogenic pulmonary edema and severe community-acquired pneumonia: acute effects and outcome. Intensive Care Med 28 (9): 1226–1232CrossRefPubMed

Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335 (25): 1864–1869 [Dieses RCT zeigt die Vorteile eines Weaning-Protokolls in Bezug auf den Weaning-Erfolg.] ← CrossRefPubMed

Esteban A, Frutos F, Tobin MJ, Alia I, Solsona JF, Valverdu I, Fernandez R, de la Cal MA, Benito S, Tomas R (1995) A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 332 (6): 345–350CrossRefPubMed

Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO (2013) High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013;368: 795–805 [Dieses RCT zeigt eine erhöhte Letalität bei HFO im Vergleich zur konventionellen Beatmung.] ←

Freebairn RC, Derrick J, Gomersall CD et al. (1997) Oxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock. Crit Care Med 25: 72–77CrossRefPubMed

Gattinoni L, Caironi P (2008) Refining ventilatory treatment for acute lung injury and acute respiratory distress syndrome. JAMA 299 (6): 691–693CrossRefPubMed

Gattinoni L, Presenti A, Torresin A, Baglioni S, Rivolta M, Rossi F, Scarani F, Marcolin R, Cappelletti G (1986) Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imaging 1 (3): 25–30CrossRefPubMed

Gattinoni L, Pesenti A, Baglioni S, Vitale G, Rivolta M, Pelosi P (1988) Inflammatory pulmonary edema and positive end-expiratory pressure: correlations between imaging and physiologic studies. J Thorac Imaging 3 (3): 59–64CrossRefPubMed

Gattinoni L, D'Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269 (16): 2122–2127 [Diese Untersuchung erklärt die regionalen Effekte der Anwendung von PEEP.] ← CrossRefPubMed

Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151 (6): 1807–1814CrossRefPubMed

Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di GP, Fumagalli R, Pelosi P, Brazzi L, Latini R (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345 (8): 568–573CrossRefPubMed

Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354 (17): 1775–1786CrossRefPubMed

Gattinoni L, Carlesso E, Taccone P, Polli F, Guerin C, Mancebo J (2010) Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol 76 (6): 448–454PubMed

Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371 (9607): 126–134 [Dieses RCT zeigt die Vorteile eines kombinierten Sedierungs- und Weaning-Protokolls auf die Langzeitletalität.] ← CrossRefPubMed

Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M (2004) Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 292 (19): 2379–2387CrossRefPubMed

Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368: 2159–2168 [Dieses RCT zeigt eine Reduktion der Letalität bei Anwendung der Bauchlage bei Patienten mit schwerem ARDS.] ←

Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B (1994) Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 80 (4): 751–760CrossRefPubMed

Hodgson C, Keating JL, Holland AE, Davies AR, Smirneos L, Bradley SJ, Tuxen D (2009) Recruitment manoeuvres for adults with acute lung injury receiving mechanical ventilation. Cochrane Database Syst Rev (2): CD006667

Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D (1997) A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25 (4): 567–574CrossRefPubMed

Lim CM, Kim EK, Lee JS, Shim TS, Lee SD, Koh Y, Kim WS, Kim DS, Kim WD (2001) Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med 27 (3): 477–485CrossRefPubMed

Mancebo J, Fernandez R, Blanch L, Rialp G, Gordo F, Ferrer M, Rodriguez F, Garro P, Ricart P, Vallverdu I, Gich I, Castano J, Saura P, Dominguez G, Bonet A, Albert RK (2006) A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med 173 (11): 1233–1239CrossRefPubMed

Marini JJ, Gattinoni L (2004) Ventilatory management of acute respiratory distress syndrome: a consensus of two. Crit Care Med 32 (1): 250–255CrossRefPubMed

McAuley DF1, Laffey JG, O'Kane CM, Perkins GD, Mullan B, Trinder TJ, Johnston P, Hopkins PA, Johnston AJ, McDowell C, McNally C; HARP-2 Investigators; Irish Critical Care Trials Group (2014)) Simvastatin in the acute respiratory distress syndrome. N Engl J Med 371: 1695–1703CrossRef

Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28 (5): 596–608PubMed

Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299 (6): 637–645CrossRefPubMed

Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, Tolley EA (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 280 (2): 159–165CrossRefPubMed

Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umberger R (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131 (4): 954–963CrossRefPubMed

Mentzelopoulos SD, Malachias S, Kokkoris S, Roussos C, Zakynthinos SG (2010) Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure. Intensive Care Med 36 (5): 810–816CrossRefPubMed

Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299 (6): 646–655CrossRefPubMed

Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 273 (4): 306–309CrossRefPubMed

National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, Truwit JD, Bernard GR, Steingrub J, Matthay MA, Liu KD, Albertson TE, Brower RG, Shanholtz C, Rock P, Douglas IS, deBoisblanc BP, Hough CL, Hite RD, Thompson BT (2014) Rosuvastatin for sepsis-associated acute respiratory distress syndrome. N Engl J Med 370: 2191–2200CrossRef

Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363 (12): 1107–1116CrossRefPubMed

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374 (9698): 1351–1363 [Diese Untersuchung zeigt die Vorteile der ECMO als Rescue-Therapie.] ← CrossRefPubMed

Pelosi P, Cadringher P, Bottino N, Panigada M, Carrieri F, Riva E, Lissoni A, Gattinoni L (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159 (3): 872–880CrossRefPubMed

Pelosi P, Gattinoni L (2001) Acute respiratory distress syndrome of pulmonary and extra-pulmonary origin: fancy or reality? Intensive Care Med 27 (3): 457–460 [Diese Untersuchung erklärt die atemmechanischen Unterschiede von pulmonalem und extrapulmonalem ARDS.] ← CrossRefPubMed

Pelosi P, Tubiolo D, Mascheroni D, Vicardi P, Crotti S, Valenza F, Gattinoni L (1998) Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 157 (2): 387–393CrossRefPubMed

Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159(4 Pt 1): 1241–1248CrossRefPubMed

Putensen C, Zech S, Wrigge H, Zinserling J, Stüber F, Von Spiegel T, Mutz N (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164 (1): 43–49CrossRefPubMed

Putensen C, Theuerkauf N, Zinserling J, Wrigge H, Pelosi P (2009) Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med 151 (8): 566–576CrossRefPubMed

Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ (1998) A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group. Am J Respir Crit Care Med 158(5 Pt 1): 1644–1655CrossRefPubMed

Roupie E, Dambrosio M, Servillo G, Mentec H, Beydon L, Brun-Buisson C, Lemaire F, Brochard L (1995) Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med 152 (1): 121–128CrossRefPubMed

Schönhofer B, Kuhlen R, Neumann P, Westhoff M, Berndt C, Sitter H (2008) Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz. S3 Leitlinie herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin. Pneumologie 62 (8): 449–479CrossRefPubMed

Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, Mazer CD, McLean RF, Rogovein TS, Schouten BD, Todd TR, Slutsky AS (1998) Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med 338 (6): 355–361CrossRefPubMed

Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R, Pesenti A, Guerin C, Mancebo J, Curley MA, Fernandez R, Chan MC, Beuret P, Voggenreiter G, Sud M, Tognoni G, Gattinoni L (2010a) Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med 36 (4): 585–599CrossRefPubMed

Sud S, Sud M, Friedrich JO, Meade MO, Ferguson ND, Wunsch H, Adhikari NK (2010b) High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis. BMJ 340: c2327CrossRefPubMed

Sud S, Sud M, Friedrich JO, Wunsch H, Meade MO, Ferguson ND, Adhikari NK (2013) High-frequency ventilation versus conventional ventilation for treatment of acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2: CD004085PubMed

Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, Caspani L, Raimondi F, Bordone G, Iapichino G, Mancebo J, Guerin C, Ayzac L, Blanch L, Fumagalli R, Tognoni G, Gattinoni L (2009) Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA 302 (18): 1977–1984CrossRefPubMed

Tang BM, Craig JC, Eslick GD, Seppelt I, McLean AS (2009) Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 37 (5): 1594–1603CrossRefPubMed

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. [see comments]. N Engl J Med 342 (18): 1301–1308 [Dieses RCT zeigt die Vorteile der lungenprotektiven Beatmung mit niedrigem V _T (6 ml/kg standardisiertes KG).] ← CrossRef

Thille AW, Richard JC, Maggiore SM, Ranieri VM, Brochard L (2007) Alveolar recruitment in pulmonary and extrapulmonary acute respiratory distress syndrome: comparison using pressure-volume curve or static compliance. Anesthesiology 106 (2): 212–217CrossRefPubMed

Villar J, Kacmarek RM, Perez-Mendez L, Aguirre-Jaime A (2006) A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 34 (5): 1311–1318CrossRefPubMed

Wrigge H, Zinserling J, Neumann P, Muders T, Magnusson A, Putensen C, Hedenstierna G (2005) Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleic-acid-induced lung injury: a randomized controlled computed tomography trial. Crit Care 9 (6): R780–R789PubMedCentralCrossRefPubMed

Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH (2013) High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med 368: 806–813 [Dieses RCT zeigt eine Reduktion der Letalität bei Anwendung der Bauchlage bei Patienten mit schwerem ARDS.] ←

Titel: Acute Respiratory Distress Syndrome (ARDS)
verfasst von: Univ.-Prof. Dr. med. C. Putensen
Verlag: Springer Berlin Heidelberg
Buch: Sepsis und MODS
Print ISBN: 978-3-662-45147-2

Electronic ISBN: 978-3-662-45148-9

Copyright-Jahr: 2016
DOI: https://doi.org/10.1007/978-3-662-45148-9_10

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10. Acute Respiratory Distress Syndrome (ARDS)

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Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

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S3-Leitlinie zu Pankreaskrebs aktualisiert

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