Académique Documents
Professionnel Documents
Culture Documents
OBJECTIVES
To review
Epidemiology
1972
Epidemiology
Author
Incidence
Mortality
rate
Fowler
1983
88
5.2
65
Webster
1988
139
4.5
38
Evans
1988
62
25
60
Thomsen
1995
110/ 89
8.8/ 4.8
Lewandowski
1995
17
58.8
Review of Pathogenesis:
Acute Phase
Radiologic Correlation:
Acute Phase
Diffuse bilateral
alveolar opacities
consistent with
pulmonary edema
Histologic Correlation:
Acute Phase
Pathogenesis:
Fibrosing Alveolitis
Radiographic Correlation
Pathogenesis: Resolution
MODIFIED DELPHI
METHODOLOGY
Grading of Evidence
I. Large, randomized trials with clear-cut results; low
risk of false-positive (alpha) error or false-negative
(beta) error
II. Small, randomized trials with uncertain results;
moderate-to-high risk of false-positive (alpha) and/or
false-negative (beta) error
III. Nonrandomized, contemporaneous controls
IV. Nonrandomized, historical controls and expert
opinion
V. Case series, uncontrolled studies, and expert opinion
Acute Respiratory Distress Syndrome
MODIFIED DELPHI
METHODOLOGY
Grading of Recommendations
A. Supported by at least two level I
investigations
B. Supported by one level I investigation
C. Supported by level II investigations only
D. Supported by at least one level III
investigation
E. Supported by level IV or V evidence
Acute Respiratory Distress Syndrome
placement of an ET tube or
institution of mechanical ventilation
improve outcome in respiratory failure
secondary to sepsis?
placement of an ET tube
/mechanical ventilation improve
outcome in respiratory failure
secondary to sepsis?
ET tube No, Grade E
MV - Yes, Grade E
TV
Plateau
Pressure
Rate
IE
1:1 to 1:3
Oxygenation
goal
FiO2/ PEEP
combinations
TV
Plateau
Pressure
Rate
IE
1:1 to 1:3
Oxygenation
goal
FiO2/ PEEP
combinations
No
Should
Prone positioning
Uniform pleural pressures
Allowed dorsal regions to open up and participate in gas
exchange