ARDS: Should we be prone to prone? - page 2
by juan de la cruz 6,051 Views | 15 Comments Guide
The buzz in critical care circles these days is the recent publication of the results of the PROSEVA Study Group in the New England Journal of Medicine. This European study begs to answer the question long-debated by critical... Read More
- 4Jun 13, '13 by juan de la cruz GuideQuote from DodongoI 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.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.
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, '13
- 2Jun 19, '13 by Esme12 Senior ModeratorQuote from juan de la cruzAh....the Bennett MA1NRSKarenRN, I did catch the tail end of the Bird Ventilator...I remember being amazed at its little size yet annoyed at the loud piston-like hissing sound it made with each breath, lol. Pretty soon they were left in the corner unused and collecting dust. The vents that took over were bulky and had bellows! another lol moment.