Syndrome de Détresse Respiratoire Aigu - Département d ... · Syndrome de Détresse Respiratoire...
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14-11-22 1 Syndrome de Détresse Respiratoire Aigu Pierre Aslanian, MD FRCPC Intensiviste, Hôpital Saint-Luc du CHUM Ware & Matthay, 2000 JAMA 2012 Ware & Matthay, 2000 Arroliga et al, 2002 Luhr et al, 1999
Transcript of Syndrome de Détresse Respiratoire Aigu - Département d ... · Syndrome de Détresse Respiratoire...
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Syndrome de Détresse Respiratoire Aigu
Pierre Aslanian, MD FRCPC Intensiviste, Hôpital Saint-Luc du CHUM
Ware & Matthay, 2000
JAMA 2012 Ware & Matthay, 2000
Arroliga et al, 2002 Luhr et al, 1999
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Luhr et al, 1999 Luhr et al, 1999
Vincent et al, 2002 Rubenfeld et al, 2005
Rubenfeld et al, 2005 Ware & Matthay, 2000
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Ware & Matthay, 2000 Ware & Matthay, 2000
Ware & Matthay, 2000 Tobin, 2001
Gattinoni et al, 2001
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Dreyfuss et al, 1985
Dreyfuss et al, 1985 Dreyfuss et al, 1985
Dreyfuss et al, 1985 Dreyfuss et al, 1988
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Roupie et al,1995 ARDSnet
ARDSnet
NIH NHLBI ARDS Clinical Trials Network
ARDSnet
NIH NHLBI ARDS Network
Prospective, Randomized, Multi-Center Trial of 12 ml/kg Vs 6 ml/kg Tidal Volume Positive
Pressure Ventilation for Treatment of Acute Lung Injury and Acute Respiratory Distress
Syndrome
“Respiratory Management in ALI/ARDS”
ARDSnet
Baseline Non-pulmonary Organ Failures
System 6 ml/kg 12 ml/kg p (Percent)
Cardiovascular 66 69 0.515 CNS 55 54 0.809 Coagulation 62 59 0.477 Hepatic 28 23 0.099 Renal 21 25 0.198
ARDSnet
Plateau Pressure
20
25
30
35
40
45
0 1 2 3 4Study Day
cm w
ater
6 ml/kg12 ml/kg
* * * *
ARDSnet
Mortality Prior to Hospital Discharge
0
10
20
30
40
50
Mortality (Percent)
6 ml/kg 12 ml/kg
P=0.0054
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ARDSnet
28 Day Survival
0
0.2
0.4
0.6
0.8
1
0 7 14 21 28Days after study entry
Proportion Surviving
12 ml/kg
6 ml/kg
ARDSnet
Median # Ventilator-Free Days
0
2
4
6
8
10
12
14
6 ml/kg 12 ml/kg
ARDSnet
Median Organ Failure Free Days
0 7 14 21 28
Renal
Coagulation
Cardiovascular
Hepatic
CNS
Pulmonary
Days
*
*
*
*
= 6 ml/kg = 12 ml/kg
ARDSnet
Plasma IL-6
0
500
1000
1500
2000
2500
3000
3500
Plasma IL-6
(pg/ml)
P=0.001
0
500
1000
1500
2000
2500
3000
35006 ml/kg 12 ml/kg
0 3 Day
0 3 Day
Tremblay et al, 1997 Murphy et al, 2000
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Murphy et al, 2000 Murphy et al, 2000
Ware & Matthay, 2000
Ware & Matthay, 2000
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Gattinoni et al, 2001
Pelosi et al, 2001
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Pelosi et al, 2001
Slutsky et al, 2006
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Derdak et al, 2000
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Angus et al, 2001
Angus et al, 2001 Angus et al, 2001
Angus et al, 2001
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