Episode 3: Refractory ARDS

What stops do you make along the garden path of hypoxic respiratory failure?

Resources

References

An ARDS review: Fan E, Brodie D, Slutsky A. Acute Respiratory Distress: Syndrome Advances in Diagnosis and Treatment. JAMA. 2018;319(7):698-710

Lung protective ventilation (The original ARDSnet ARMA trial): Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308.

Steroids for ARDS (SCCM/ESICM guidelines): Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Prone positioning (PROSEVA trial): Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndromeN Engl J Med. 2013;368(23):2159–2168.

Driving pressure: Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndromeN Engl J Med. 2015;372(8):747–755.

… and a driving pressure meta-analysis: Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, et al. Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Crit Care Med. 2018;46(2):300–306.

APRV: Zhou Y, Jin X, Lv Y, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndromeIntensive Care Med. 2017;43(11):1648–1659.

Recruitment maneuvers (ART trial): Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, 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(14):1335–1345.

Paralysis (PETAL trial): National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Moss M, Huang DT, et al. Early Neuromuscular Blockade in the Acute Respiratory Distress SyndromeN Engl J Med. 2019;380(21):1997–2008.

ECMO (EOLIA trial): Combes A, Hajage D, Capellier G, et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress SyndromeN Engl J Med. 2018;378(21):1965–1975.

Episode 2: Takotsubo (Stress) Cardiomyopathy

A tricky case of refractory heart failure.

Case files

Image credit: B Boling, personal files
Image credit: B Boling, personal files

Resources

References

Champion S, Belcour D, Vandroux D, et al. Stress (Tako-tsubo) cardiomyopathy in critically-ill patients. Eur Heart J. 2015;4(2):189-96.

Chockalingam A. Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms. Indian Heart J. 2018;70(1):177-84.

Dawson D. Acute stress-induced (takotsubo) cardiomyopathy. Heart. 2018;104:96-102.

Ghadri JR, Cammann VL, Jurisic S, Seifert B, Napp LC, Diekmann J, et al. A novel score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail. 2017;19:1036-42.

Muratsu A, Muroya T, Kuwagat Y. Takotsubo cardiomyopathy in the intensive care unit. Acute Med Surg. 2019;6(2):152-7.

Nunez-Gil IJ, Almendro-Delia M, Andres M, et al. Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis. Euro Heart J. 2016;5(4):308-16

Episode 1: Necrotizing Soft Tissue Infection

A troubling case of a painful finger.

Resources

References

Links