Effect of Protective Strategy on Outcome in Patients with Acute Respiratory Distress Syndrome (ARDS).
10.4097/kjae.2005.48.2.153
- Author:
Myung Sin SEO
1
;
Pyung Bok LEE
;
Young Joo LEE
Author Information
1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Korea.
- Publication Type:Original Article
- Keywords:
acute respiratory distress syndrome;
protective ventilatory strategy
- MeSH:
Acute Lung Injury;
Adolescent;
Barotrauma;
Blood Gas Analysis;
Catheters;
Diagnosis;
Dialysis;
Hemodynamics;
Humans;
Hypercapnia;
Incidence;
Mortality;
Positive-Pressure Respiration;
Pulmonary Artery;
Pulmonary Wedge Pressure;
Renal Insufficiency;
Respiration, Artificial;
Respiratory Distress Syndrome, Adult*;
Respiratory Rate;
Tidal Volume;
Ventilation
- From:Korean Journal of Anesthesiology
2005;48(2):153-158
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: A strategy of mechanical ventilation that limits tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome. We attempted to evaluate the effects of protective-ventilatory strategy on the outcome of the acute respiratory distress syndrome. METHODS: The study was performed on 31 patients over 16 years old who were under the mechanical ventilation with the diagnosis of acute lung injury (ALI)/ARDS in the Surgical ICU. Pulmonary artery catheter was inserted after start of ventilation. A tidal volume (VT) of 10 to 12 ml per kg and positive end expiratory pressure (PEEP) 10 cmH2O or less was used in conventional group (n = 15), and VT of 6 to 8 ml/kg and PEEP 15 cmH2O or less was used in protective group (n = 16). Arterial blood gas analysis, hemodynamic parameters and metabolic parameters were recorded 1, 3, 5 and 7 day interval. RESULTS: 1) VT, PEEP and respiratory rate showed statistical differences between groups (10.5 +/- 1.2 vs. 6.7 +/- 0.8 ml/kg, 7.7 +/- 3.3 vs. 13.3 +/- 3.1 cmH2O, 15.0 +/- 3.7 vs. 20.3 +/- 4.1 rate/min), but minute volume didn't showed significant difference in between groups. 2) Mortality was 46% in the conventional group and 25% in protective group (P < 0.001). 3) Significant difference was identified in PaO2/FiO2 (176.9 +/- 81.7 vs. 274.7 +/- 83.5), wedge pressure (11.1 +/- 3.7 vs. 16.2 +/- 3.9 mmHg) and mean pulmonary artery pressure (23.0 +/- 4.5 vs. 30.2 +/- 6.5 mmHg) during study periods. 4) The incidence of barotrauma and dialysis for renal failure were similar in the both groups. CONCLUSIONS: Protective ventilatory strategy with low VT and high PEEP shows low mortality in ALI/ARDS patients, it is recommended method for the ALI/ARDS patients.
