Quote from Dodongo
My MICU uses rotaprone beds pretty frequently with ARDS patients. Our intensivists do not use ECMO and I think the literature at this point favors proning. Good article.
I think the absence of a "standard practice guideline" is what's creating this variation in how centers use different modalities. The strength of evidence relies on the amount of randomized trials and as of now, the consensus is low lung volume ventilation is protective in ARDS and all centers agree on that. ECMO had a randomized trial in CESAR and now PROSEVA is defying previously held thought about proning. I think a combination of lung protective ventilatory strategies in combination with proning may gain favor like you said.
The diagnostic criteria for ARDS have also been defied with experts now saying that presence of a high PAWP or L atrial HTN shouldn't be an exclusionary criteria. Patients with heart failure can still have ARDS. That criteria is now modified to say that the "respiratory failure that exist in ARDS must not be fully explained by cardiac failure or fluid overload based on available clinical data".
Last edit by juan de la cruz on Jun 13