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Acute Respiratory Distress Syndrome
Initial assessment and management• Diagnose and treat underlying cause of ARDS• Measure patient height and calculate predicted body weight• Start oxygen therapy and ventilatory support according to disease severity
Controlled mechanical ventilation• Target tidal volume 6 ml/kg predicted body weight and Pplat ≤ 30 cm H2O• Consider higher PEEP in moderate and severe ARDS• Keep PaO2 55-80 mm Hg or SpO2 88%-95% and pH ≥ 7.25
Mild ARDSPaO2/FIO2 >200 ≤300 with PEEP or CPAP ≥ 5 cm H2O
Moderate ARDSPaO2/FIO2 >100≤200 with PEEP or CPAP ≥ 5 cm H2O
Severe ARDSPaO2/FIO2 ≤ 100 mm Hgwith PEEP ≥ 5 cm H2O
A Treatment GuideA sample treatment algorithm for adults with ARDS typically begins with optimization of lung protective ventilation, and progresses to more invasive interventions based on the condition of the patient. Treatment plans must be individualized to the cause and available interventions at the treating facility.
Is patient receiving non-invasive ventilation?
Is patient clinically stable, PaO2/FIO2>>200 mm Hg, and toleratingnon-invasive ventilation?
Consider continuingnon-invasive ventilation?
Consider current strategy and deescalate interventions when possible a�er patient improves
If patient deteriorates, reassess strategy
Yes
Yes
Is PaO2/FIO2 ≤ 150 mm Hg?
Is Pao2/FIO2 ≤ 80 mm Hg?
No
No
• Start deep sedation and prone positioning• Consider neuromuscular blocking agent and lung recruitment maneuver
Consider alternative therapies on a case-by-case basis (eg. VV ECMO, HFOV)
No
No
Yes
Yes
Patient meets Berlin definition of ARDS• Acute onset• Respiratory failure not primarily due to hydrostatic edema• Bilateral opacities on chest radiograph
JAMA. 2018;319(7):698-710. doi:10.1001/jama.2017.21907
Recognizing Pulmonary Edema is Critical1
In cases of severe ARDS associated with shock, advanced monitoring should be considered early to assist in defining a individualized therapeutic approach.
Central venous catheter
Positive response to initial therapy
Clinical assessment
Acute circulatory failure
Lactate
Associated severe ARDS?
No
Continue with same hemodynamic monitoring until shock resolution
Transpulmonary thermodilution systems
OR
Pulmonary artery catheter(especially in case of RV dysfunction)
Yes
Echocardiography Arterial catheter
Insufficient response to initial therapy
Thermodilution provides keys to identifying extravascular lung water and pulmonary vascular permeability. In clinical studies it was demonstrated that chest x-ray evaluation for pulmonary edema is very inaccurate when comparing it to the direct quantification by transpulmonary thermodilution.
Examples of chest x-rays that do not reflect the level of pulmonary edema
ELWI = 21 ml/kgSevere pulmonary edema
ELWI = 14 ml/kgModerate pulmonary edema
ELWI = 8 ml/kgNo pulmonary edema
This information is intended for an international audience outside the US and does not replace any individual therapeutic decision of the treating physician . Indications, contraindications, warnings and instructions for use are listed in the separate Instructions for Use . Products may be pending regulatory approvals to be marketed in your country . * , Getinge, and Maquet are trademarks or registered trademarks of Getinge AB, its subsidiaries or affiliates in the United States or other countries. Maquet is registered with the U.S. Patent and Trademark Office . Copyright 2018 Maquet Critical Care AB . All rights reserved . 09/18 . MPI4541EN_R00 . MX-7372 Rev01
Getinge . Lindholmspiren 7A, 417 56 Gothenburg, Sweden
1 Teboul, JL., Saugel, B., Cecconi, M. et al. Intensive Care Med (2016) 42: 1350. h�ps://doi.org/10.1007/s00134-016-4375-7
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