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Minerva Anestesiologica 2014 September;80(9):1046-57


lingua: Inglese

Friday night ventilation: a safety starting tool kit for mechanically ventilated patients

Gattinoni L. 1, 2, Carlesso E. 2, Brazzi L. 3, 4, Cressoni M. 2, Rosseau S. 5, Kluge S. 6, Kalenka A. 7, Bachmann M. 8, Toepfer L. 9, Wrigge H. 10, Redaelli F. 11, Vetter C. 12, Wysocki M. 13

1 Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italia; 2 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italia; 3 Dipartimento di Scienze Chirurgiche, Microchirurgiche e Mediche, Università degli Studi di Sassari, Sassari, Italia; 4 Unità Operativa di Anestesia e Rianimazione, AOU Sassari, Sassari, Italia; 5 Medizinische Klinik m.S. Infektiologie und Pneumologie, Charité-Universitätsmedizin Berlin, Berlin, Germany; 6 Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 7 Anästhesie und Intensivmedizin, Kreiskrankenhaus Bergstraße gemeinnützige, Heppenheim, Germany; 8 Sektion Pneumologische Intensiv- und Beatmungsmedizin, Asklepios Klinik Harburg, Hamburg, Germany; 9 Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany; 10 Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Germany; 11 GE Healthcare, Buc, France; 12 GE Healthcare, Germany; 13 GE Healthcare, Buc, France and Research Center, CHU Sainte-Justine Hospital, Montreal, QC, Canada


We wish to report here a practical approach to an acute respiratory distress syndrome (ARDS) patient as devised by a group of intensivists with different expertise. The referral scenario is an intensive care unit of a Community Hospital with limited technology, where a young doctor, alone, must deal with this complicate syndrome during the night. The knowledge of pulse oximetry at room air and at 100% oxygen allows to estimate the PaO2 and the cause of hypoxemia, shunt vs. VA/Q maldistribution. The ARDS severity (mild [200 < PaO2/FiO2≤300], moderate [100 < PaO2/FiO2≤200] and severe [PaO2/FiO2≤100]) must be immediately assessed. Noninvasive ventilation should be attempted in mild ARDS only. Possible errors due to inappropriate premature intubation are preferable to a delayed intubation. In moderate and severe ARDS tracheal intubation associated with heavy sedation/muscle relaxation allows to fully characterize the patient. A tidal volume of 6 mL/kg predicted body weight is recommended, either in pressure or volume control ventilation. Tailoring tidal volume on residual functional capacity, however, is preferable. Plateau pressure greater than 30 cmH2O is acceptable only if chest wall compliance is decreased. In this case maximal attention must be devoted to the hemodynamics. PEEP from 5 to 10, from 10 to 15 and greater than 15 cmH2O should be set in mild, moderate and severe ARDS, respectively. Prone position should be applied in severe ARDS, if experience is available. In case of unchanged conditions or increased ARDS severity a referral center should be contacted.

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