Academic Half Day 7/21/2022: Acute Hypoxemic Respiratory Failure and ARDS References

Ventilatory Dyssynchrony

Patient-ventilator Interactions: Implications or Clinical Management – AJRCCM 2013

• Evergreen review of trigger, flow, and cycle dyssynchronies including recognition and management

Alveolar Gas Equation

Teaching an intuitive derivation of the clinical alveolar equations: mass balance as a fundamental physiological principle – Adv Physiol Educ 2020

• In-depth derivation of alveolar gas equation for those interested in a deep dive

Bias in Pulse Oximetry

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study – BMJ 2022

• Recently published large retrospective study that found occult hypoxemia (SaO2 <88% with SpO2 ≥92%) more common in Black vs White patient

Non-invasive Ventilation in the ICU

Philips Respironics V60 User Manual 

• Critically important to know how to use the devices available to you
• Page 4-7 reviews trigger, target, and cycle for the different modes available on the V60

ATS/ERS Guidelines on use of NIV for Acute Respiratory Failure – ERJ 2017

• Consensus guidelines on use of NIV in respiratory failure. A nice summary of the literature on the use of NIV in the pre-intubation and post-extubation setting

Liberation from Mechanical Ventilation in Critically Ill Adults: An Official ATS/ACCP Clinical Practice Guideline – AJRCCM 2017

• Summary of 3 important guidelines from the ATS/ACCP on evidence-based liberation from mechanical ventilation in critically ill adults. References to the parent documents are provided in this summary

Journal Club: PROSEVA

Prone positioning in severe acute respiratory distress syndrome – NEJM, 2013

• Landmark RCT which found prone positioning for 16 hrs/day associated with a significant mortality benefit for patients with severe ARDS

Prone position-induced improvement in gas exchange does not predict improved survival in the acute respiratory distress syndrome – AJRCCM 2014

• Retrospective analysis of PROSEVA data which found that did not find an association between the improvement in gas exchange and survival – suggesting perhaps that proning mechanism of benefit is largely through limiting VILI

Evidence-based ARDS Care

An OfficialAmerican Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome – AJRCCM 2017

• Evidence-based multi-society guidelines on mechanical ventilation in ARDS. Only LTVV + Pplt < 30 cmH20 and prone positioning for > 12hrs/day in severe ARDS receive strong recommendations FOR

Formal guidelines: management of acute respiratory distress syndrome – Annals Intensive Care 2019

• More recent guidelines from Société de Réanimation de Langue Française. Their approach: