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Acute_Lung_Injury_ARDS_-_FINAL2

Acute_Lung_Injury_ARDS_-_FINAL2 - Acute Lung Injury and...

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Acute Lung Injury and ARDS Acute Lung Injury and ARDS Pierre Moine, MD, PhD Pierre Moine, MD, PhD Associate Professor of Anesthesiology Department of Anesthesiology Edward Abraham, MD Edward Abraham, MD Roger Sherman Mitchell Professor of Pulmonary and Critical Care Medicine Vice Chair, Department of Medicine Head, Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Health Sciences Center
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Definitions Definitions The 1994 North American-European Consensus Conference (NAECC) criteria: Onset - Acute and persistent Radiographic criteria - Bilateral pulmonary infiltrates consistent with the presence of edema Oxygenation criteria - Impaired oxygenation regardless of the PEEP concentration, with a Pao 2 /Fio 2 ratio 300 torr (40 kPa) for ALI and 200 torr (27 kPa) for ARDS Exclusion criteria - Clinical evidence of left atrial hypertension or a pulmonary-artery catheter occlusion pressure of 18 mm Hg . Bernard GR et al., Am J Respir Crit Care Med 1994
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The 1994 NAECC Definition Limitations The 1994 NAECC Definition Limitations Atabai K and Matthay MA, Thorax 2000 Abraham E et al., Crit Care Med 2000 Descriptive definition - Permits inclusion of a multiplicity of clinical entities ranging from autoimmune disorders to direct and indirect pulmonary injury Does not address the cause of lung injury Does not provide guidelines on how to define acute The radiological criteria are not sufficiently specific Does not account for the level of PEEP used, which affects the Pao 2 /Fio 2 ratio Does not specify the presence of nonpulmonary organ system dysfunction at the time of diagnosis Does not include the different specific mechanistic pathways involved in producing lung injury
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The 1998 NAECC Updated The 1998 NAECC Updated Recommendations Recommendations Artigas A et al., Am J Respir Crit Care Med 1998 1. The collection of epidemiologic data should be based on the 1994 NAECC definitions. 2. The severity of ALI/ARDS should be assessed by the Lung Injury Score (LIS) or by the APACHE III or SAPS II scoring systems. 3. The factors that affect prognosis should be taken into account. The most important of these are incorporated into the GOCA stratification system. 4. It will be also useful to record: Information relating to etiology (at a minimum, direct or indirect cause) Mortality, including cause of death, and whether death was associated with withdrawal of care Presence of failure of other organs and other time-dependent covariates Follow-up information, including recovery of lung function and quality of life
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Stratification System of Acute Lung Injury Stratification System of Acute Lung Injury GOCA GOCA Letter Meaning Meaning Scale Scale Definition G Gas exchange Gas exchange (to be combined with the numeric descriptor) 0 1 2 3 A B C D Pao 2 /Fio 2 301 Pao 2 /Fio 2 200 -300 Pao 2 /Fio 2 101 – 200 Pao 2 /Fio 2 100 Spontaneous breathing, no PEEP Assisted breathing, PEEP 0-5 cmH 2 O Assisted breathing, PEEP 6-10 cmH 2 O Assisted breathing, PEEP 10 cmH 2 O O Organ failure A B C D Lung only Lung + 1 organ
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