Personalized mechanical ventilation in acute respiratory distress syndrome

Paolo Pelosi, Lorenzo Ball, Carmen S V Barbas, Rinaldo Bellomo, Karen E A Burns, Sharon Einav, Luciano Gattinoni, John G Laffey, John J Marini, Sheila N Myatra, Marcus J Schultz, Jean Louis Teboul, Patricia R M Rocco, Paolo Pelosi, Lorenzo Ball, Carmen S V Barbas, Rinaldo Bellomo, Karen E A Burns, Sharon Einav, Luciano Gattinoni, John G Laffey, John J Marini, Sheila N Myatra, Marcus J Schultz, Jean Louis Teboul, Patricia R M Rocco

Abstract

A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (VT) is a standard of care, further individualization of VT may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust VT and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda.

Keywords: Biomarkers; Chest computed tomography scan; Driving pressure; Phenotype; Tidal volume; Transpulmonary pressure.

Conflict of interest statement

JL discloses consultancy fees for Baxter and GlaxoSmithKline. JLT is member of the medical advisory board of Getinge. KB holds a Physician Services Incorporated Mid-Career Award. MJS has received speaker-fees from Hamilton Medical. JL has received consultancy fees from Baxter and Glaxosmithkline. All other authors declare no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Summary of recommendations. VT: tidal volume; ΔP: driving pressure; PEEP: positive end-expiratory pressure; EELV: end-expiratory lung volume; IC: inspiratory capacity; AI: artificial intelligence; PPLAT: plateau pressure; VILI: ventilator-induced lung injury

References

    1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet Lond Engl. 1967;2:319–323. doi: 10.1016/S0140-6736(67)90168-7.
    1. Thille AW, Peñuelas O, Lorente JA, Fernández-Segoviano P, Rodriguez J-M, Aramburu J-A, et al. Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: a retrospective analysis of clinical autopsies. Crit Care Lond Engl. 2017;21:254. doi: 10.1186/s13054-017-1852-5.
    1. Goligher EC, Costa ELV, Yarnell CJ, Brochard LJ, Stewart TE, Tomlinson G, et al. Effect of lowering Vt on mortality in acute respiratory distress syndrome varies with respiratory system elastance. Am J Respir Crit Care Med. 2021;203:1378–1385. doi: 10.1164/rccm.202009-3536OC.
    1. Bos LDJ, Artigas A, Constantin J-M, Hagens LA, Heijnen N, Laffey JG, et al. Precision medicine in acute respiratory distress syndrome: workshop report and recommendations for future research. Eur Respir Rev Off J Eur Respir Soc. 2021;30:200317. doi: 10.1183/16000617.0317-2020.
    1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800. doi: 10.1001/jama.2016.0291.
    1. Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017;390:415–423. doi: 10.1016/S0140-6736(16)31592-6.
    1. Brochard L, Hedenstierna G. Ten physiologic advances that improved treatment for ARDS. Intensive Care Med. 2016;42:814–816. doi: 10.1007/s00134-016-4320-9.
    1. Battaglini D, Sottano M, Ball L, Robba C, Rocco PRM, Pelosi P. Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome. J Intensive Med. 2021.
    1. Silva PL, Gama de Abreu M. Regional distribution of transpulmonary pressure. Ann Transl Med. 2018;6:385–385. doi: 10.21037/atm.2018.10.03.
    1. Putensen C, Theuerkauf N, Zinserling J, Wrigge H, Pelosi P. Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med. 2009;151:566–576. doi: 10.7326/0003-4819-151-8-200910200-00011.
    1. Hubmayr RD. Point: is low tidal volume mechanical ventilation preferred for all patients on ventilation? Yes Chest. 2011;140:9–11. doi: 10.1378/chest.11-0825.
    1. Mattingley JS, Holets SR, Oeckler RA, Stroetz RW, Buck CF, Hubmayr RD. Sizing the lung of mechanically ventilated patients. Crit Care Lond Engl. 2011;15:R60. doi: 10.1186/cc10034.
    1. Botta M, Wenstedt EFE, Tsonas AM, Buiteman-Kruizinga LA, van Meenen DMP, Korsten HHM, et al. Effectiveness, safety and efficacy of INTELLiVENT–adaptive support ventilation, a closed–loop ventilation mode for use in ICU patients—a systematic review. Expert Rev Respir Med. 2021;2021(17476348):1933450.
    1. Mamandipoor B, Frutos-Vivar F, Peñuelas O, Rezar R, Raymondos K, Muriel A, et al. Machine learning predicts mortality based on analysis of ventilation parameters of critically ill patients: multi-centre validation. BMC Med Inform Decis Mak. 2021;21:152. doi: 10.1186/s12911-021-01506-w.
    1. Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–755. doi: 10.1056/NEJMsa1410639.
    1. Barbas CSV, Palazzo RF. Should we titrate mechanical ventilation based on driving pressure?—yes. Ann Transl Med. 2018;6:393. doi: 10.21037/atm.2018.06.26.
    1. Chen L, Jonkman A, Pereira SM, Lu C, Brochard L. Driving pressure monitoring during acute respiratory failure in 2020. Curr Opin Crit Care. 2021;27:303–310. doi: 10.1097/MCC.0000000000000827.
    1. Sakr Y, François B, Solé-Violan J, Kotfis K, Jaschinski U, Estella A, et al. Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts. Crit Care Lond Engl. 2021;25:87. doi: 10.1186/s13054-020-03455-8.
    1. Villar J, Martín-Rodríguez C, Domínguez-Berrot AM, Fernández L, Ferrando C, Soler JA, et al. A Quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung-protective ventilation. Crit Care Med. 2017;45:843–850. doi: 10.1097/CCM.0000000000002330.
    1. Costa ELV, Slutsky A, Brochard LJ, Brower R, Serpa-Neto A, Cavalcanti AB, et al. Ventilatory variables and mechanical power in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2021 doi: 10.1164/rccm.202009-3467OC.
    1. Yoshida T, Brochard L. Esophageal pressure monitoring: why, when and how? Curr Opin Crit Care. 2018;24:216–222. doi: 10.1097/MCC.0000000000000494.
    1. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189:520–531. doi: 10.1164/rccm.201312-2193CI.
    1. Pelosi P, Goldner M, McKibben A, Adams A, Eccher G, Caironi P, et al. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med. 2001;164:122–130. doi: 10.1164/ajrccm.164.1.2007010.
    1. Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L. Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:8–13. doi: 10.1164/ajrccm.149.1.8111603.
    1. Yoshida T, Amato MBP, Grieco DL, Chen L, Lima CAS, Roldan R, et al. Esophageal manometry and regional transpulmonary pressure in lung injury. Am J Respir Crit Care Med. 2018;197:1018–1026. doi: 10.1164/rccm.201709-1806OC.
    1. Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346–355. doi: 10.1164/rccm.200710-1589OC.
    1. Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9:52. doi: 10.1186/s13613-019-0522-y.
    1. Tilmont A, Coiffard B, Yoshida T, Daviet F, Baumstarck K, Brioude G, et al. Oesophageal pressure as a surrogate of pleural pressure in mechanically ventilated patients. ERJ Open Res. 2021;7:00646-2020. doi: 10.1183/23120541.00646-2020.
    1. Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med. 2016;42:1360–1373. doi: 10.1007/s00134-016-4400-x.
    1. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253–1263. doi: 10.1164/rccm.201703-0548ST.
    1. Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359:2095–2104. doi: 10.1056/NEJMoa0708638.
    1. Beitler JR, Sarge T, Banner-Goodspeed VM, Gong MN, Cook D, Novack V, et al. Effect of titrating positive end-expiratory pressure (PEEP) With an esophageal pressure-guided strategy vs an empirical high PEEP-Fio2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2019;321:846–857. doi: 10.1001/jama.2019.0555.
    1. Marini JJ, Rocco PRM, Gattinoni L. Static and dynamic contributors to ventilator-induced lung injury in clinical practice. Pressure, energy, and power. Am J Respir Crit Care Med. 2020;201:767–774. doi: 10.1164/rccm.201908-1545CI.
    1. Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42:1567–1575. doi: 10.1007/s00134-016-4505-2.
    1. Becher T, van der Staay M, Schädler D, Frerichs I, Weiler N. Calculation of mechanical power for pressure-controlled ventilation. Intensive Care Med. 2019;45:1321–1323. doi: 10.1007/s00134-019-05636-8.
    1. Giosa L, Busana M, Pasticci I, Bonifazi M, Macrì MM, Romitti F, et al. Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. Intensive Care Med Exp. 2019;7:61. doi: 10.1186/s40635-019-0276-8.
    1. Silva PL, Ball L, Rocco PRM, Pelosi P. Power to mechanical power to minimize ventilator-induced lung injury? Intensive Care Med Exp. 2019;7:38. doi: 10.1186/s40635-019-0243-4.
    1. Huhle R, Serpa Neto A, Schultz MJ, Gama de Abreu M. Is mechanical power the final word on ventilator-induced lung injury?—no. Ann Transl Med. 2018;6:394–394. doi: 10.21037/atm.2018.09.65.
    1. Vasques F, Duscio E, Pasticci I, Romitti F, Vassalli F, Quintel M, et al. Is the mechanical power the final word on ventilator-induced lung injury?—we are not sure. Ann Transl Med. 2018;6:395. doi: 10.21037/atm.2018.08.17.
    1. Marini JJ, Gattinoni L, Rocco PR. Estimating the damaging power of high-stress ventilation. Respir Care. 2020;65:1046–1052. doi: 10.4187/respcare.07860.
    1. Rocco PRM, Silva PL, Samary CS, Hayat Syed MK, Marini JJ. Elastic power but not driving power is the key promoter of ventilator-induced lung injury in experimental acute respiratory distress syndrome. Crit Care Lond Engl. 2020;24:284. doi: 10.1186/s13054-020-03011-4.
    1. Marini JJ, Rocco PRM. Which component of mechanical power is most important in causing VILI? Crit Care Lond Engl. 2020;24:39. doi: 10.1186/s13054-020-2747-4.
    1. Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The, “baby lung” became an adult. Intensive Care Med. 2016;42:663–673. doi: 10.1007/s00134-015-4200-8.
    1. Caironi P, Carlesso E, Cressoni M, Chiumello D, Moerer O, Chiurazzi C, et al. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study. Crit Care Med. 2015;43:781–790. doi: 10.1097/CCM.0000000000000770.
    1. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017;318:1335–45.
    1. Hodgson CL, Cooper DJ, Arabi Y, King V, Bersten A, Bihari S, et al. Maximal recruitment open lung ventilation in acute respiratory distress syndrome (PHARLAP): a phase II, multicenter, randomized, controlled trial. Am J Respir Crit Care Med. 2019;200:1363–1372. doi: 10.1164/rccm.201901-0109OC.
    1. Ball L, Serpa Neto A, Trifiletti V, Mandelli M, Firpo I, Robba C, et al. Effects of higher PEEP and recruitment manoeuvres on mortality in patients with ARDS: a systematic review, meta-analysis, meta-regression and trial sequential analysis of randomized controlled trials. Intensive Care Med Exp. 2020;8:39. doi: 10.1186/s40635-020-00322-2.
    1. Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I, et al. Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome. A clinical trial. Am J Respir Crit Care Med. 2020;201:178–187. doi: 10.1164/rccm.201902-0334OC.
    1. Pelosi P, Rocco PRM, Gama de Abreu M. Close down the lungs and keep them resting to minimize ventilator-induced lung injury. Crit Care Lond Engl. 2018;22:72. doi: 10.1186/s13054-018-1991-3.
    1. Danek SJ, Lynch JP, Weg JG, Dantzker DR. The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am Rev Respir Dis. 1980;122:387–395.
    1. Krachman SL, Lodato RF, Morice R, Gutierrez G, Dantzker DR. Effects of dobutamine on oxygen transport and consumption in the adult respiratory distress syndrome. Intensive Care Med. 1994;20:130–137. doi: 10.1007/BF01707668.
    1. Steltzer H, Hiesmayr M, Mayer N, Krafft P, Hammerle AF. The relationship between oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value? A meta-analysis. Anaesthesia. 1994;49:229–236. doi: 10.1111/j.1365-2044.1994.tb03429.x.
    1. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med. 1994;330:1717–1722. doi: 10.1056/NEJM199406163302404.
    1. Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 collaborative group. N Engl J Med. 1995;333:1025–1032. doi: 10.1056/NEJM199510193331601.
    1. Teboul J-L, Saugel B, Cecconi M, De Backer D, Hofer CK, Monnet X, et al. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016;42:1350–1359. doi: 10.1007/s00134-016-4375-7.
    1. Vieillard-Baron A, Matthay M, Teboul JL, Bein T, Schultz M, Magder S, et al. Experts’ opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation. Intensive Care Med. 2016;42:739–749. doi: 10.1007/s00134-016-4326-3.
    1. Morales-Quinteros L, Schultz MJ, Bringué J, Calfee CS, Camprubí M, Cremer OL, et al. Estimated dead space fraction and the ventilatory ratio are associated with mortality in early ARDS. Ann Intensive Care. 2019;9:128. doi: 10.1186/s13613-019-0601-0.
    1. Fengmei G, Jin C, Songqiao L, Congshan Y, Yi Y. Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS. Respir Care. 2012;57:1578–1585. doi: 10.4187/respcare.01497.
    1. Bonifazi M, Romitti F, Busana M, Palumbo MM, Steinberg I, Gattarello S, et al. End-tidal to arterial PCO2 ratio: a bedside meter of the overall gas exchanger performance. Intensive Care Med Exp. 2021;9:21. doi: 10.1186/s40635-021-00377-9.
    1. Ferluga M, Lucangelo U, Blanch L. Dead space in acute respiratory distress syndrome. Ann Transl Med. 2018;6:388. doi: 10.21037/atm.2018.09.46.
    1. Pesenti A, Musch G, Lichtenstein D, Mojoli F, Amato MBP, Cinnella G, et al. Imaging in acute respiratory distress syndrome. Intensive Care Med. 2016;42:686–698. doi: 10.1007/s00134-016-4328-1.
    1. Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ. Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult respiratory distress syndrome. Intensive Care Med. 2000;26:1215–1227. doi: 10.1007/s001340051340.
    1. Constantin J-M, Grasso S, Chanques G, Aufort S, Futier E, Sebbane M, et al. Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome. Crit Care Med. 2010;38:1108–1117. doi: 10.1097/CCM.0b013e3181d451ec.
    1. Mrozek S, Jabaudon M, Jaber S, Paugam-Burtz C, Lefrant J-Y, Rouby J-J, et al. Elevated plasma levels of sRAGE are associated with nonfocal CT-based lung imaging in patients with ARDS: a prospective multicenter study. Chest. 2016;150:998–1007. doi: 10.1016/j.chest.2016.03.016.
    1. Constantin J-M, Jabaudon M, Lefrant J-Y, Jaber S, Quenot J-P, Langeron O, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7:870–880. doi: 10.1016/S2213-2600(19)30138-9.
    1. Ball L, Robba C, Herrmann J, Gerard SE, Xin Y, Mandelli M, et al. Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study. Crit Care. 2021;25:214. doi: 10.1186/s13054-021-03610-9.
    1. Temsah M-H, Al-Sohime F, Alhaboob A, Al-Eyadhy A, Aljamaan F, Hasan G, et al. Adverse events experienced with intrahospital transfer of critically ill patients: a national survey. Medicine. 2021;100:e25810. doi: 10.1097/MD.0000000000025810.
    1. Chiumello D, Mongodi S, Algieri I, Vergani GL, Orlando A, Via G, et al. Assessment of lung aeration and recruitment by CT scan and ultrasound in acute respiratory distress syndrome patients. Crit Care Med. 2018;46:1761–1768. doi: 10.1097/CCM.0000000000003340.
    1. Costamagna A, Pivetta E, Goffi A, Steinberg I, Arina P, Mazzeo AT, et al. Clinical performance of lung ultrasound in predicting ARDS morphology. Ann Intensive Care. 2021;11:51. doi: 10.1186/s13613-021-00837-1.
    1. Xirouchaki N, Kondili E, Prinianakis G, Malliotakis P, Georgopoulos D. Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med. 2014;40:57–65. doi: 10.1007/s00134-013-3133-3.
    1. Smit MR, Pisani L, de Bock EJE, van der Heijden F, Paulus F, Beenen LFM, et al. Ultrasound versus computed tomography assessment of focal lung aeration in invasively ventilated ICU patients. Ultrasound Med Biol. 2021 doi: 10.1016/j.ultrasmedbio.2021.05.019.
    1. Scaramuzzo G, Spinelli E, Spadaro S, Santini A, Tortolani D, Dalla Corte F, et al. Gravitational distribution of regional opening and closing pressures, hysteresis and atelectrauma in ARDS evaluated by electrical impedance tomography. Crit Care Lond Engl. 2020;24:622. doi: 10.1186/s13054-020-03335-1.
    1. Scaramuzzo G, Spadaro S, Dalla Corte F, Waldmann AD, Böhm SH, Ragazzi R, et al. Personalized positive end-expiratory pressure in acute respiratory distress syndrome: comparison between optimal distribution of regional ventilation and positive transpulmonary pressure. Crit Care Med. 2020;48:1148–1156. doi: 10.1097/CCM.0000000000004439.
    1. Borges JB, Suarez-Sipmann F, Bohm SH, Tusman G, Melo A, Maripuu E, et al. Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse. J Appl Physiol. 2012;112:225–236. doi: 10.1152/japplphysiol.01090.2010.
    1. Hentze B, Muders T, Luepschen H, Maripuu E, Hedenstierna G, Putensen C, et al. Regional lung ventilation and perfusion by electrical impedance tomography compared to single-photon emission computed tomography. Physiol Meas. 2018;39:065004. doi: 10.1088/1361-6579/aac7ae.
    1. Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA, et al. Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med. 2014;2:611–620. doi: 10.1016/S2213-2600(14)70097-9.
    1. Famous KR, Delucchi K, Ware LB, Kangelaris KN, Liu KD, Thompson BT, et al. Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med. 2017;195:331–338. doi: 10.1164/rccm.201603-0645OC.
    1. Sinha P, Delucchi KL, Thompson BT, McAuley DF, Matthay MA, Calfee CS, et al. Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study. Intensive Care Med. 2018;44:1859–1869. doi: 10.1007/s00134-018-5378-3.
    1. Delucchi K, Famous KR, Ware LB, Parsons PE, Thompson BT, Calfee CS, et al. Stability of ARDS subphenotypes over time in two randomised controlled trials. Thorax. 2018;73:439–445. doi: 10.1136/thoraxjnl-2017-211090.
    1. Calfee CS, Delucchi KL, Sinha P, Matthay MA, Hackett J, Shankar-Hari M, et al. Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. Lancet Respir Med. 2018;6:691–698. doi: 10.1016/S2213-2600(18)30177-2.
    1. Bos LD, Schouten LR, van Vught LA, Wiewel MA, Ong DSY, Cremer O, et al. Identification and validation of distinct biological phenotypes in patients with acute respiratory distress syndrome by cluster analysis. Thorax. 2017;72:876–883. doi: 10.1136/thoraxjnl-2016-209719.
    1. Hagens LA, Verschueren ARM, Lammers A, Heijnen NFL, Smit MR, Nijsen TME, et al. Development and validation of a point-of-care breath test for octane detection. Analyst. 2021 doi: 10.1039/D1AN00378J.
    1. Du M, Garcia JGN, Christie JD, Xin J, Cai G, Meyer NJ, et al. Integrative omics provide biological and clinical insights into acute respiratory distress syndrome. Intensive Care Med. 2021;47:761–771. doi: 10.1007/s00134-021-06410-5.
    1. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.
    1. Ranieri VM, Thompson BT, Barie PS, Dhainaut J-F, Douglas IS, Finfer S, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366:2055–2064. doi: 10.1056/NEJMoa1202290.
    1. Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367:124–134. doi: 10.1056/NEJMoa1204242.
    1. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–1502. doi: 10.1056/NEJMoa1102077.
    1. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384:2283–2294. doi: 10.1056/NEJMoa2100591.
    1. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–517. doi: 10.1056/NEJMoa1102662.
    1. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368:1489–1497. doi: 10.1056/NEJMoa1212722.
    1. Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364:2483–2495. doi: 10.1056/NEJMoa1101549.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever