PMID: 9556124Apr 29, 1998Paper

An approach to the treatment of severe adult respiratory failure

Journal of Critical Care
P B RichR H Bartlett

Abstract

The purpose of this article is to evaluate outcome in adult patients with severe respiratory failure managed with an approach using (1) limitation of end inspiratory pressure, (2) inverse ratio ventilation, (3) titration of PEEP by SvO2, (4) intermittent prone positioning, (5) limitation of FiO2, (6) diuresis, (7) transfusion, and (8) extracorporeal life support (ECLS) if patients failed to respond. This study was designed as a retrospective review in the intensive care unit of a tertiary referral hospital. One-hundred forty-one consecutive patients with hypoxic (n = 135) or hypercarbic (n = 6) respiratory failure referred for consideration of ECLS between 1990 and 1996. Overall, initial PaO2/FiO2 (P/F) ratio was 75+/-5 (median = 66). Lung recovery occurred in 67% of patients and 62% survived. Forty-one patients improved without ECLS (83% survived); 100 did not and were supported with ECLS (54% survived). Survival was greater in patients cannulated within 12 hours of arrival (59%) compared with those cannulated after 12 hours (40%, P < .05). Multiple logistic regression identified age, duration of mechanical ventilation before transfer, four or more dysfunctional organs, and the requirement for ECLS as independent predictors of...Continue Reading

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Citations

Aug 19, 2006·Critical Care Medicine·Mark R Hemmila, Lena M Napolitano
Sep 24, 2004·Annals of Surgery·Mark R HemmilaRobert H Bartlett
Feb 25, 2014·Journal of the American College of Surgeons·Robert H Bartlett
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Aug 27, 2019·Critical Care Nursing Quarterly·Mouhib NaddourTariq Cheema

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