• Pulmonary infections associated with pigeons/birds:
  
  1. Cryptococcus
  2. Chlamydia psittaci (psittacosis)
  
  

  Posted 06/08/16 05:41:55 PM by Anna Krigel

• ARDS diagnostic criteria (Berlin definition):
  
  1. Acute (respiratory symptoms began within 1 week or have worsened within 1 week)
  2. Bilateral opacities
  3. Respiratory failure not exclusively explained by heart failure
  4. Severe impairment of oxygenation as measured by PaO2/FiO2 ratio
              - Mild ARDS = PaO2/FiO2 >200 but less than or equal to 300, on PEEP of 5 or more
              - Moderate ARDS = PaO2/FiO2 >100 but less than or equal to 200, on PEEP of 5 or more
              - Severe ARDS = PaO2/FiO2 less than or equal to 100, on PEEP of 5 or more
  
  

  Posted 06/08/16 07:05:49 PM by Anna Krigel

• Lessons from the ARMA trial
  
  - low tidal volume ventilation (6cc/kg predicted body weight vs 12cc/kg predicted body weight) had lower mortality rate (31% vs 40%) and more ventilator free days (12 vs 10 days)
  - can go as low as 4cc/kg predicted body weight, though any lower likely leads to ventilation of dead space
  - allowed for permissive hypercapnea and plateau pressure less than or equal to 30, though average plateau pressure was mid 20s, suggesting lower Ppl is better
  
  

  Posted 06/08/16 07:23:15 PM by Anna Krigel

• Management of moderate to severe ARDS
  
  1. Paralysis  (ACURASYS) - used cisatracurium continuous drip, did not use train of 4 to assess for paralysis, showed improved mortality in patients with moderate to severe ARDS
  2. Proning (PROSEVA) - proning patients with severe ARDS (PaO2/FiO2 <100) for at least 16 hours had an ICU mortality benefit
  3. ECMO (CESAR) - trial of referral to ECMO center rather than of ECMO intervention itself; many patients in control group did not get low tidal volume ventilation; found increased survival in patients referred to ECMO center 
  
  

  Posted 06/08/16 07:25:38 PM by Anna Krigel

• For further reading...

  Berlin definition
  ARMA
  ACURASYS
  PROSEVA
  CESAR
  
  

  Posted 06/09/16 06:13:13 PM by Anna Krigel

Created by Christopher Kelly

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