ICU SAQs · Respiratory / ventilation
Adjuncts for refractory hypoxaemia in severe ARDS
A CICM SAQ on refractory-hypoxaemia adjuncts — proning (PROSEVA, first-line, mortality), iNO (transient oxygenation), recruitment (gentle, ART harm), NMBA (ACURASYS vs ROSE), ECMO (EOLIA rescue).
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CICMFFICMEDIC
Prompt
A patient with severe ARDS remains hypoxaemic despite optimised lung-protective ventilation. Outline the adjuncts available and the evidence for each.
Question
A patient with severe ARDS remains hypoxaemic despite optimised lung-protective ventilation. Outline the adjuncts available and the evidence for each.
[7]References7ShowHide
- [1]Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 2013.PMID 23688302
- [2]Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. New England Journal of Medicine, 2010.PMID 20843245
- [3]Moss M, Huang DT, Brower RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. New England Journal of Medicine, 2019.PMID 31112383
- [4]Combes A, Hajage D, Capellier G, et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2018.PMID 29791822
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [6]Cavalcanti AB, Suzumura ÉA, Laranjeira LN, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial JAMA, 2017.PMID 28973363
- [7]Combes A, Peek GJ, Hajage D, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis Intensive Care Med, 2020.PMID 33021684