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Syndrome de Détresse
Respiratoire AiguWare & Matthay, 2000
Rubenfeld et al, 2005 Ware & Matthay, 2000
Ware & Matthay, 2000 Ware & Matthay, 2000
2
Ware & Matthay, 2000 Ware & Matthay, 2000
Gattinoni et al, 2001
Dreyfuss et al, 1985
3
Dreyfuss et al, 1988 Dreyfuss et al, 1985
Dreyfuss et al, 1988 Roupie et al, 1995
ARDSnetARDSnet
ARDSnetARDSnet
NIH NHLBI ARDS Clinical Trials NetworkNIH NHLBI ARDS Clinical Trials Network
ARDSnetARDSnet
NIH NHLBI ARDS NetworkNIH NHLBI ARDS Network
Prospective, Randomized, Multi-Center Trial of 12 ml/kg Vs 6 ml/kg Tidal Volume Positive Pressure Ventilation for Treatment of Acute Lung Injury and Acute Respiratory Distress
Syndrome
“Respiratory Management in ALI/ARDS”
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ARDSnetARDSnet
Plateau PressurePlateau Pressure
20
25
30
35
40
45
0 1 2 3 4Study Day
cm w
ater
6 ml/kg12 ml/kg
** * *
ARDSnetARDSnet
Mortality Prior to Hospital DischargeMortality Prior to Hospital Discharge
0
10
20
30
40
50
Mortality (Percent)
6 ml/kg 12 ml/kg
P=0.0054
ARDSnetARDSnet
Median # VentilatorMedian # Ventilator--Free DaysFree Days
0
2
4
6
8
10
12
14
6 ml/kg 12 ml/kg
ARDSnetARDSnet
Median Organ Failure Free DaysMedian Organ Failure Free Days
0 7 14 21 28
Renal
Coagulation
Cardiovascular
Hepatic
CNS
Pulmonary
Days
*
*
*
*
= 6 ml/kg= 12 ml/kg
ARDSnetARDSnet
Plasma ILPlasma IL--66
0
500
1000
1500
2000
2500
3000
3500
Plasma IL-6
(pg/ml)
P=0.001
0
500
1000
1500
2000
2500
3000
35006 ml/kg 12 ml/kg
0 3Day
0 3Day ARDSnetARDSnet
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Tremblay et al, 1997 Murphy et al, 2000
Murphy et al, 2000 Murphy et al, 2000
Gattinoni et al, 2001
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Pelosi et al, 2001
Pelosi et al, 2001 Ware & Matthay, 2000
Derdak et al, 2000 Ware & Matthay, 2000
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Luhr et al, 1999 Luhr et al, 1999
Luhr et al, 1999 Vincent et al, 2002
Angus et al, 2001 Angus et al, 2001
8
Angus et al, 2001 Angus et al, 2001
Tobin, 2001
Et quoi maintenant?
• Comment déterminer un VT et PEEP idéal? Courbes P-V automatisées?
• Quelle(s) technique(s) de recruitement doit-on utiliser?
• Ventilation haute fréquence/oscillation?• Quel est l’impact de la toxicité à l ’oxygène
dans l ’ARDS?
