09-06-18 Latest and Greatest in ARDS Treatment
Drs. Yau, Tenure and Kiamanesh
6:00 PM @ Curry Club, 10 Woods Corner Rd, Setauket- East Setauket
• Guérin C et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-6 [PubMed]
• Combes A et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome . N Engl J Med. 2018 May 24;378(21):1965-1975 [PubMed]
...Dr Tenure gave a concise review of the Combes et al article. This was a randomized trial that compared ARDS patients given ECMO with those given standard mechanical ventilation and ECMO for rescue. Continuous ECMO did not lower the 60 day mortality significantly. Pulmonologist Dr. Paul Richman noted that that physicians who are very pro ECMO thought that the study was stopped too early. Extending the study timeframe and recruitment of more patients, might have revealed a significant benefit to ECMO.
Dr. Yau gave an excellent review on the Guérin C et al. article. This prospective, multicenter, randomized controlled trial of 466 patients in France and Spain, explored whether prone positions improved survival among patients who received mechanical ventilation with PEEP (5 cm H2O) and in who the partial pressure arterial oxygen to fraction of inspired oxygen was less than 150 mmHg. The researchers found that early prone position sessions decreased both 28 day and 90 day mortality. Dr Paul Richman noted that, although rotoprone beds can be ordered if needed, it is not necessary to use them. The same results can be obtained by manual turn/flip of the patient ( similar to what we do in the OR for prone cases.) It was also noted that the low body habitus of Europeans makes for easier access to the abdomen. All that might be necessary is placement of a blanket under the shoulders and hips. This option is less useful in the US patient population where the BMI is much higher overall.
Drs. Lee, Mouch, Makaryus
6:00 PM @ HSC Galleria
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