nach oben

Erschienen in:

01.06.2004 | Original

Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial

verfasst von: Niall D. Ferguson, Robert M. Kacmarek, Jean-Daniel Chiche, Jeffrey M. Singh, David C. Hallett, Sangeeta Mehta, Thomas E. Stewart

Erschienen in: Intensive Care Medicine | Ausgabe 6/2004

Einloggen, um Zugang zu erhalten

Abstract

Objectives

The American–European consensus conference (AECC) definition for acute respiratory distress syndrome (ARDS) requires a PaO₂/F_IO₂≤200 mmHg, regardless of ventilator settings. We report the results of using standardized ventilator settings to screen and enroll ARDS patients in a clinical trial of high-frequency oscillatory ventilation (HFOV), including the impact on study enrollment, and potential effects on study outcome.

Design

Prospective cohort study.

Setting

Intensive care units in two teaching hospitals.

Participants

A consecutive sample of 41 patients with early ARDS by AECC criteria (baseline PaO₂/F_IO₂≤200) who met all other inclusion/exclusion criteria for the HFOV trial.

Interventions

Patients were placed on standardized ventilator settings (tidal volume 7–8 ml/kg, PEEP 10 cmH₂O, F_IO₂ 1.0), and the PaO₂/F_IO₂ was reassessed after 30 min.

Results

Seventeen patients (41.5%) had PaO₂/F_IO₂ ratios that remained ≤200 mmHg [Persistent ARDS; PaO₂/F_IO₂=94±36 (mean±SD)] and went on to inclusion in the HFOV study; however, in 24 patients (58.5%) the PaO₂/F_IO₂ was >200 mmHg [Transient ARDS; PaO₂/F_IO₂=310±74] and these patients were ineligible for the HFOV study. The ICU mortality was significantly greater (52.9 vs 12.5%; p=0.01) in the Persistent ARDS patients.

Conclusions

The use of these standardized ventilatory significantly impacted the PaO₂/F_IO₂ ratio and therefore the ARDS prevalence and trial enrollment. These results have effects on the evaluation of the current ARDS literature and conduct of clinical trials in ARDS and hence consideration should be given to the use of standardized ventilatory settings in future ARDS trials.

Nur mit Berechtigung zugänglich

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

Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349PubMed

Douglas ME, Downs JB, Dannemiller FJ, Hodges MR, Munson ES (1976) Changes in pulmonary venous admixture with varying inspired oxygen. Anesth Analg 55:688–693PubMed

Suter PM, Fairley HB, Schlobohm RM (1975) Shunt, lung volume and perfusion during short periods of ventilation with oxygen. Anesthesiology 43:617–627PubMed

Shapiro BA, Crane RD, Harrison RA, Steiner MC (1980) Changes in intrapulmonary shunting with administration of 100 percent oxygen. Chest 77:138–141PubMed

McAslan TC, Matiasko-Chiu J, Turney SZ, Cowley RA (1973) Influence of inhalation of 100% oxygen on intrapulmonary shunt in severely traumatized patients. J Trauma 13:811–821PubMed

Markello R, Winter P, Olszowka A (1972) Assessment of ventilation–perfusion inequalities by arterial-venous nitrogen difference in intensive care patients. Anesthesiology 37:4–15PubMed

Santos C, Ferrer M, Roca J, Torres A, Hernandez C, Rodriguez-Roisin R (2000) Pulmonary gas exchange response to oxygen breathing in acute lung injury. Am J Resp Crit Care Med 161:26–31PubMed

Zapol WM, Snider MT, Hill D, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Peirce EC, Thomas AN, Proctor HJ, Drinker PA, Pratt PC, Bagniewski A, Miller RG (1979) Extracorporeal membrane oxygenation in severe respiratory failure: a randomized prospective study. J Am Med Assoc 242:2193–2196CrossRef

10.

Ferguson ND, Kacmarek RM, Mehta S, Granton JT, Chiche JD, Lapinsky SE, Hallett D, Slutsky AS, Stewart TE (2001) Treatment with high-frequency oscillatory ventilation and an open-lung strategy: the TOOLS trial pilot study. Am J Respir Crit Care Med 163:A686

11.

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. N Engl J Med 342:1301–1308PubMed

12.

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 338:355–361PubMed

13.

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 Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158:1831–1838PubMed

14.

Brower RG, Shanholtz CB, Fessler HE, Shade DM, White PJ, Wiener CM, Teeter JG, Dodd, 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 27:1492–1498PubMed

15.

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMed

16.

Gowda MS, Klocke RA (1997) Variability of indices of hypoxemia in adult respiratory distress syndrome. Crit Care Med 25:41–45PubMed

17.

Villar J, Perez-Mendez L, Kacmarek RM (1999) Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med 25:930–935PubMed

18.

Squara P, Dhainaut JF, Artigas A, Carlet J (1998) Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS Study. Intensive Care Med 24:1018–1028CrossRefPubMed

19.

Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F (1998) Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 158:1076–1081

20.

Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA (1995) Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med 152:1818–1824PubMed

21.

Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, Bonde J (1999) Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med 159:1849–1861PubMed

22.

Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation. A 28-day international study. J Am Med Assoc 287:345–355CrossRef

Titel: Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial
verfasst von: Niall D. Ferguson
Robert M. Kacmarek
Jean-Daniel Chiche
Jeffrey M. Singh
David C. Hallett
Sangeeta Mehta
Thomas E. Stewart
Publikationsdatum: 01.06.2004
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 6/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2163-2

Neu im Fachgebiet AINS

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial

Abstract

Objectives

Design

Setting

Participants

Interventions

Results

Conclusions

Neu im Fachgebiet AINS

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Update AINS

Springer Medizin

Abstract

Objectives

Design

Setting

Participants

Interventions

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2004

What does chest physiotherapy do to sick infants and children?

Cyclic changes in arterial pressure during mechanical ventilation

Intensive care physicians’ attitudes concerning distribution of intensive care resources

Sufentanil in the ICU setting

High infection rates in patients with severe acute necrotizing pancreatitis

A new concept for DRG-based reimbursement of services in German intensive care units: results of a pilot study

Neu im Fachgebiet AINS

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Update AINS