Page 627 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

446 PART 4: Pulmonary Disorders

Outcome A, B, D No differences No differences No differences A, C No differences in mortality; unpublished A No differences in mortality No difference in mortality. B. High PEEP reduced organ failure

Allowed but not recommended

Control
Clinical Trials Evaluating the Effects of Different Lung-Protective Strategies Using Conventional Mechanical Ventilation on Outcome in Acute Respiratory Distress Syndrome
Recruitment None None None None None None None None

Intervention Yes None None None None Yes None Yes Allowed but not recommended

Not reported P-Flex 10.8 ± 2.7 (day 2) 8.4 ± 3.8 (day 3) 8.6 ± 4.2 (day 3) Same as ARDSNet trial PEEP > 5 cm H 2 O Same as ARDSNet trial Values between 5 and

Control 8 (day 3) 9 cm H 2 O

PEEP, cm H 2 O

Intervention Not reported P-Flex 10.6 ± 3.2 (day 2) 8.7 ± 3.6 (day 3) 8 (day 3) 9.2 ± 3.6 (day 3) Goal of 2-6 cm H 2 O > controls PEEP 2 cm H 2 O above LIP High PEEP/Fi O 2 combination table with Pplat < 40 cm H 2 O Plateau pressure between 28 and 30 cm H 2 O

Not reported Goal >12 10.3 ± 1.7 (day 1) 10.8 ± 1.0 (day 3) 10.2 ± 0.1 (day 5) 11.8 ± 0.8 (day 3) 6.1 ± 1.1 (day 3) 10.0 ± 1 (day 3) 6.7 ± 1.5 (day 3) 6.2 ± 0.6 (day 3)

Tidal Volumes, mL/kg Control A = Reduction in mortality compared to conventional group. B = Improvement in physiological parameters (oxygenation and compliance). C = Reduction in inflammatory mediators. D = Reduction in barotrauma.

Intervention Not reported Goal <6 7.1 ± 1.3 (day 1) 7.2 ± 0.8 (day 3) 7.3 ± 0.1 (day 5) 6.2 ± 0.8 (day 3) 5.8 ± 1 (day 3) 7.1 ± 0.9 (day 3) 6.9 ± 1.5 (day 3) 6.2 ± 0.5 (day 3)

Intervention Used Low stretch, lung open; using P-V curve a Low stretch Low stretch Low stretch Low stretch Low stretch, lung open Low stretch, open lung using P-V curve Low stretch, lung open; present PEEP levels depending on Fi O 2 Low stretch, open lung a PEEP was adjusted in the intervention arm to 2 to 4 cm H 2 O greater than the lower inflection point (P-Flex).

ALVEOLI (n = 550) stopped Villar (n = 103) stopped early PEEP, positive end-expiratory pressure; FiO 2 , fraction of inspired oxygen.
TABLE 51-3 Amato (n = 53) 101 Brochard (n = 116) 113 Stewart (n = 120) 115 Brower (n = 52) 114 ARDS Network (n = 861) 2 for efficacy 102 LOVS trial (n = 983) 16 EXPRESS trial (n = 768) 17

Study early 119

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