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

Neto, Ary Serpa; Cardoso, Sérgio Oliveira; Manetta, José Antônio; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Pasqualucci, M de Oliveira Prado; Damasceno, Maria Cecília Toledo; Schultz, Marcus J.

doi:10.1001/jama.2012.13730

Cited by 716 publications

(297 citation statements)

References 47 publications

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“…Observational studies suggest reductions in the development of ARDS with LPV use in patients at risk for ARDS but who had not yet developed the syndrome [101]. Two meta-analyses suggest that use of LPV in patients without ARDS reduces the duration of mechanical ventilation, the risk of pulmonary infection and the duration of hospitalization [102,103]. Given the frequency of respiratory failure in sepsis, with consequent high risk for developing ARDS and its attendant complications of prolonged mechanical ventilation and mortality, optimizing the approach to mechanical ventilation could save thousands of lives and reduce healthcare costs through reductions in mechanical ventilation and ICU stay.…”

Section: What Is the Role Of Lung Protective Ventilation In Septic Pamentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: What Is the Role Of Lung Protective Ventilation In Septic Pamentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…Therefore, suitable treatment strategies are necessary using protective mechanical ventilation that shows a significant reduction in morbidity and mortality of affected patients [2,3]. Beside this effort, a detailed understanding of the mechanical transactions in alveolar lung tissue is still lacking.…”

Section: Introductionmentioning

confidence: 99%

Optical Coherence Tomography (OCT) for Time-Resolved Imaging of Alveolar Dynamics in Mechanically Ventilated Rats

2017

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Though artificial ventilation is an essential life-saving treatment, the mechanical behavior of lung tissue at the alveolar level is still unknown. Therefore, we need to understand the tissue response during artificial ventilation at this microscale in order to develop new and more protective ventilation methods. Optical coherence tomography (OCT) combined with intravital microscopy (IVM) is a promising tool for visualizing lung tissue dynamics with a high spatial and temporal resolution in uninterruptedly ventilated rats. We present a measurement setup using a custom-made animal ventilator and a gating technique for data acquisition of time-resolved sequences.

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“…1 However, mechanical ventilation under these circumstances is a two-edged sword: it is life-saving and injurious at the same time. To date, it is well known that ventilator-induced lung injury (VILI) has a negative impact on patient outcome [2][3][4][5]6 • , 7 •• ].…”

Section: Introductionmentioning

confidence: 99%

“…Increasing evidence suggests that mechanical ventilation induces VILI even in patients with healthy lungs, such as during general anesthesia [5,6 • , 7 •• ]. The origin of VILI resides in the high stress that mechanical breaths induce within collapsed lung zones and the high strain on normally ventilated areas which receive excessive ventilation [5,8].…”

Section: Introductionmentioning

confidence: 99%

“…This new knowledge calls for the intra-operative use of protective ventilatory strategies based on low tidal volume ventilation and limited airway pressures [5,6 • , 7 •• ]. However, the main shortcoming of such protective concepts is that the root cause of lung injury-mechanical ventilation of a partially collapsed lung-although attenuated is not totally abolished.…”

Section: Introductionmentioning

confidence: 99%

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Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

Tusman

Böhm

Suárez-Sipmann

2014

Curr Anesthesiol Rep

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Especially during thoracic surgery, anesthesiologists have to cope with both the drastic alteration of normal pulmonary physiology and the mechanical stress on the lung tissue induced by ventilation. These problems result from the total collapse of the lung being operated on and the partial collapse of the ventilated other lung. In addition, technical factors inherent to thoracic surgery and the patient's condition potentiate such adverse effects. Traditional ventilatory settings described for thoracic surgery have not led to a decrease in the incidence of hypoxemia or perioperative atelectasis. However, lung recruitment maneuvers and ventilatory strategies are aimed at resolving lung collapse in mechanically ventilated patients, improving lung function, and decreasing the rate of post-operative pulmonary complications directly related to lung collapse. This article summarizes recent evidence for the role that lung recruitment maneuvers play during one-lung ventilation anesthesia.

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

Cited by 716 publications

References 47 publications

Surviving sepsis campaign: research priorities for sepsis and septic shock

Surviving sepsis campaign: research priorities for sepsis and septic shock

Optical Coherence Tomography (OCT) for Time-Resolved Imaging of Alveolar Dynamics in Mechanically Ventilated Rats

Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

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