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Literature Summary

Major Literature

  1. The Acute Respiratory Distress Syndrome Network. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med 2000; 342:1301-1308
    • In a randomized controlled trial of 861 patients with ARDS, mechanical ventilation with a tidal volume of 6 ml/kg and plateau pressure ≤ 30 cmH20, in comparison with tidal volume of 12 ml/kg and plateau pressure ≤ 50cm H20, was associated with a 9% absolute mortality decrease (31% vs 40%, P=0.007; NNT=11) and a 2 day increase in ventilator-free days (12±11 vs. 10±11; P=0.007).
  2. Guérin. Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA). New Engl J Med 2013; 368:2159-2168
    • In a multicentre, randomised control trial, comparing prolonged periods of prone position ventilation with ongoing supine position ventilation, in 466 patients with moderate-to-severe ARDS, prone positioning was associated with reduced 28 day mortality (16% versus 32.8%, hazard ratio 0.39, 95% CI 0.25 to 0.63, P<0.001), reduced 90 day mortality (23.6% versus 41%, HR 0.44, 95% CI 0.29 to 0.67, P<0.001), and less cardiac arrests (31 patients versus 16 patients, P=0.02), with no difference in other complications.
  3. Determann. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14(1):R1
    • Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production, as measured in plasma. Our data suggest that mechanical ventilation with conventional tidal volumes contributes to the development of lung injury in patients without ALI at the onset of mechanical ventilation.
  4. Papazian. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010;363:1107-1116
    • In a multicentre, double-blind, randomized controlled trial comparing 48 hours of cisatracurium besylate with placebo in 340 patients with early severe ARDS, neuromuscular blockade was associated with a trend for reduced crude 90-day mortality {31.6% (95% CI 25.2 – 38.8) vs 40.7% (95% CI 33.5 – 48.4)} (P=0.08). After adjustment for baseline PaO2:FiO2, plateau pressure and Simplified Acute Physiology II scores, neuromuscular blockade reduced the adjusted hazard ratio for death at 90 days (HR 0.68, 95% CI 0.48 to 0.98; P=0.04). There was no difference in the rate of ICU-acquired paresis.
  5. The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome. N Engl J Med 2004;351:327-36.
    • In patients with acute lung injury and ARDS who receive mechanical ventilation with a tidal-volume goal of 6 ml per kilogram of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm of water, clinical outcomes are similar whether lower or higher PEEP levels (mean of 8 vs 13 cmH2O) are used.
  6. Ferguson. High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome (OSCILLATE). New Engl J Med 2013;epublished January 22rd
    • In adults with moderate-to-severe ARDS, early application of HFOV, as compared with a ventilation strategy of low tidal volume and high positive end-expiratory pressure, does not reduce, and may increase, in-hospital mortality.
  7. Young. High-Frequency Oscillation for Acute Respiratory Distress Syndrome (OSCAR). New Engl J Med 2013;epublished January 22nd
    • The use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS.
  8. The ARDS Definition Task Force. Acute Respiratory Distress Syndrome. The Berlin Definition. JAMA 2012;
    •  3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg)
  9. Mikkelsen. The ARDS Cognitive Outcomes Study (ACOS): Long-Term Neuropsychological Function in Acute Lung Injury Survivors. Am J Respir Crit Care Med 2012; 
    • Long-term neuropsychological impairment is common in survivors of ALI. Hypoxemia is a risk factor for long-term neuropsychological impairment.
  10. Khemani et al. Pediatric Acute Lung InjuryConsensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015 Jun;16
    • Proposes using OI to define pediatric ARDS: 4-<8= mild, 8-<16= moderate, >16 = severe