Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndromes

Recruitment Maneuvers and PEEP Titration

“…Moreover, there is evidence supporting the use of a V T of 6 mL/kg predicted body weight in all mechanically ventilated patients and suggesting that large V T might contribute to the development of ARDS. 9 The use of conventional ventilation in patients with ARDS has been reviewed elsewhere. [10][11][12] Although volume and pressure limitation has become well accepted as a lung-protective strategy, the roles of recruitment maneuvers and lower versus higher PEEP are more controversial.…”

The Epidemiology of Acute Respiratory Distress Syndrome in Patients Presenting to the Emergency Department With Severe Sepsis

“…Our study, therefore, validates the fact that the vast majority of patients admitted with severe sepsis will not develop ARDS. Because in-hospital death was four-fold higher in patients who developed ARDS, these findings also emphasize the need to identify those at greatest risk of ARDS development and to elucidate strategies to prevent ARDS beyond preventive ventilatory approaches (34)(35). Although death occurred relatively early in the hospitalization, culminating in multi-system organ failure complicated by refractory shock, further investigation is required to determine if care delivery in the ED or initial hospital course could be optimized to improve outcomes.…”

“…We categorized serum lactate levels as low (<2 mmol/L), intermediate (2-3.9 mmol/ L) and high (≥ 4 mmol/L) (25,(34)(35).…”

Manejo del potencial donante cadáver

“…Desgraciadamente, esta ventilación puede aumentar la respuesta inflamatoria y aumentar el daño pulmonar y sistémico 2,48 . Más aún, pocas guías se refieren a la necesidad de corregir este Vt al peso ideal, lo cual pone en mayor riesgo de daño a mujeres y obesos 49 .…”

“…Más aún, pocas guías se refieren a la necesidad de corregir este Vt al peso ideal, lo cual pone en mayor riesgo de daño a mujeres y obesos 49 . Cada vez hay más evidencia que la ventilación con alto volumen corriente también puede producir daño en pacientes con pulmones sanos 48,51 . En un estudio prospectivo observacional en 86 pacientes con trauma cerebral grave, Mascia et al, mostraron que 22% de ellos desarrolló SDRA durante las primeras 72 h de ventilación, siendo el uso de un Vt elevado (> 11 ml/kg IBW) un predictor independiente para el desarrollo de esta complicación 50 .…”