Treatment of the Acute Respiratory Distress Syndrome

Pulmonary Disease Board Review Manual Statement of Editorial Purpose The Hospital Physician Pulmonary Disease Board Review Manual is a peer-reviewed s...
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Pulmonary Disease Board Review Manual Statement of Editorial Purpose The Hospital Physician Pulmonary Disease Board Review Manual is a peer-reviewed study guide for fellows and practicing physicians preparing for board examinations in pulmonary disease. Each manual reviews a topic essential to current practice in the subspecialty of pulmonary disease.

Treatment of the Acute Respiratory Distress Syndrome Contributor: Joseph E. Levitt, MD, MS

Assistant Professor, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA

PUBLISHING STAFF PRESIDENT, Group PUBLISHER

Bruce M. White

Senior EDITOR

Robert Litchkofski executive vice president

Barbara T. White

executive director of operations

Jean M. Gaul

Table of Contents Definitions and Improved Recognition. . . . . . . . 1 Lung Protective Ventilation . . . . . . . . . . . . . . . . . 3 Alternative Modes of Mechanical Ventilation. . . . 5 Pharmacologic Therapies . . . . . . . . . . . . . . . . . . 9

NOTE FROM THE PUBLISHER: This publication has been developed without involvement of or review by the AmerĀ­ ican Board of Internal Medicine.

Supportive Care of Mechanically Ventilated Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Improved Prevention of Acute Lung Injury. . . . 13 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Board Review Questions. . . . . . . . . . . . . . . . . . . 18 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Hospital Physician Board Review Manual

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Pulmonary Disease Board Review Manual

Treatment of the Acute Respiratory Distress Syndrome Joseph E. Levitt, MD, MS

DEFINITIONS AND IMPROVED RECOGNITION A critical first step in improving outcomes of the acute respiratory distress syndrome (ARDS) is improving recognition of standardized criteria. In 1994, the American-European Consensus Conference (AECC) established specific clinical criteria for ARDS and acute lung injury (ALI).1 The AECC criteria defined ALI and ARDS as acute respiratory failure with bilateral pulmonary infiltrates on chest radiograph; a Pao2/Fio2 ratio 30) Hypoalbuminemia Chemotherapy Fio2 >35% (>4 L/min) Tachypnea (RR >30 bpm) SpO2

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