10. Clinical relevant information from key papers over the last decade: optimizing care in ALI/ARDS Solid proof – restrictive use of sedation – restrictive use of fluids – restrictive use of SG-catheters – use of lower tidal volumes No proof (yet?) – use of high PEEP – use of corticosteroids Speculative – anticoagulant strategies
32. Solid proof –restrictive use of sedation “ daily interruption”shortens duration of MV, also in patients with ALI/ARDS” Kress JP N EnglJ Med.2000; 342:1471
60. 37 years old ,75 kg , had been suffered of car accident , intubated and ventilated , Gcs=7 3days later you have been called for consultation Ventilator setting
90. • FiO 2 = 1.0 (initially) • Long expiratory time (I:E ratio >1:2) • Low tidal volume 5–7 ml/kg • Low ventilator rate (8–10 breaths/min) • Set inspiratory pressure 30–35 cm H2O on pressure control ventilation or limit peak inspiratory pressure to <40 cm H2O • Minimal PEEP <5 cm H2O