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ARTICLE |

Innovative Life Support in the Acute Respiratory Distress Syndrome FREE

Thomas L. Petty, MD
[+] Author Affiliations

Reprint requests to the Center for Health Sciences Education, HealthOne, 1719 E 19th Ave, Denver, CO 80218 (Dr Petty).


JAMA. 1996;275(5):404-405. doi:10.1001/jama.1996.03530290074042
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An expanding number of techniques that can provide adequate oxygenation and carbon dioxide elimination in acute respiratory distress syndrome (ARDS) are available for the critical care expert. These include mechanical ventilation with positive end-expiratory pressure (PEEP)1 and newer modifications of the ventilator's pressure waveforms.2 In addition, extracorporeal life support (ECLS) using a membrane oxygenator can nearly match the success rate achieved by mechanical ventilation using inverse ratio mechanical ventilation and PEEP in ARDS. These observations were obtained in a randomized controlled clinical trial3; the survival rate was 35% to 40% in ARDS patients who, by previous entry criteria, had only a 10% salvage rate.4

See also p 383.

A new innovation in supportive care, partial liquid ventilation using a perfluorocarbon (PFC) instilled directly into the trachea until airways and alveolar units were partially "flooded," appears to be another alternative that can be applied if any one

REFERENCES

Petty TL, Ashbaugh DG.  The adult respiratory distress syndrome: clinical features and factors influencing prognosis and principles of management. Chest . 1971;;60:233-239.
Petty TL.  Does modern mechanical ventilation represent progress? Contemp Intern Med . 1992;;4:37-48.
Morris AH, Wallace CJ, Menlowe RL, er al.  Randomized clinical trial of pressurecontrolled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med . 1994;;149:295-305.
Zapol WM, Snider MT, Hill JD, et al.  Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA . 1979;;242:2193-2196.
Hirschl RB, Pranikoff T, Wise C, et al.  Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA . 1996;; 275:383-389.
Milberg JA, Davis DR, Steinberg KR, Hudson LD.  Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA . 1995;;273:306-309.
Weg JG, Balk RA, Tharatt S, et al.  Safety and potential efficacy of an aerosolized surfactant in human sepsis-induced adult respiratory distress syndrome. JAMA . 1994;;272:1433-1438.
Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM.  Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med . 1993;;328:399-405.
Fierobe L, Brunet F, Dhaihut JF, et al.  Effect of inhaled nitric oxide on right ventricular function in adult respiratory distress syndrome. Am J Respir Crit Care Med . 1995;;151:1414-1419.
Bernard GR, Artigas A, Brigham KL, et al.  The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med . 1994;;149:818-824.

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Petty TL, Ashbaugh DG.  The adult respiratory distress syndrome: clinical features and factors influencing prognosis and principles of management. Chest . 1971;;60:233-239.
Petty TL.  Does modern mechanical ventilation represent progress? Contemp Intern Med . 1992;;4:37-48.
Morris AH, Wallace CJ, Menlowe RL, er al.  Randomized clinical trial of pressurecontrolled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med . 1994;;149:295-305.
Zapol WM, Snider MT, Hill JD, et al.  Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA . 1979;;242:2193-2196.
Hirschl RB, Pranikoff T, Wise C, et al.  Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA . 1996;; 275:383-389.
Milberg JA, Davis DR, Steinberg KR, Hudson LD.  Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA . 1995;;273:306-309.
Weg JG, Balk RA, Tharatt S, et al.  Safety and potential efficacy of an aerosolized surfactant in human sepsis-induced adult respiratory distress syndrome. JAMA . 1994;;272:1433-1438.
Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM.  Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med . 1993;;328:399-405.
Fierobe L, Brunet F, Dhaihut JF, et al.  Effect of inhaled nitric oxide on right ventricular function in adult respiratory distress syndrome. Am J Respir Crit Care Med . 1995;;151:1414-1419.
Bernard GR, Artigas A, Brigham KL, et al.  The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med . 1994;;149:818-824.
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