An Early PEEP/FiO2 Trial Identifies Different Degrees of Lung Injury in Patients with Acute Respiratory Distress Syndrome

• DOI: 10.1164/rccm.200610-1534oc
• Publication Date: 2007-06-22T01:47:29Z
• Authors: Jesús Villar; Lina Pérez-Méndez; José López; Javier Belda; Jesús Blanco; Iñaki Saralegui; Fernando Suárez-S...; Julia López; Santiago Lubillo; Robert M. Kacmarek
• Keywords: Positive End-Expiratory Pressure

Current American-European Consensus Conference definitions for acute lung injury (ALI) and respiratory distress syndrome (ARDS) are inadequate inclusion into clinical trials due to the lack of standardization measuring oxygenation defect.We questioned whether an early assessment on specific ventilator settings would identify patients with established ARDS (persisting over 24 h).At time meeting criteria (Day 0) hours later 1), arterial blood gases were obtained standard settings, Vt 7 ml/kg predicted body weight plus following positive end-expiratory pressure (PEEP) Fi(O(2)) in sequence: (1) PEEP >or= 5 cm H(2)O 0.5, (2) 1.0, (3) 10 Fi(O(2))>or=0.5, (4) 1.0.One hundred seventy (Pa(O(2))/Fi(O(2)) 128 +/- 33 mm Hg) enrolled. Overall hospital mortality was 34.1%. The that best identified differences intensive care unit (ICU) 0.5 at Day 1 (P = 0.0001). Only 99 (58.2%) continued meet (Pa(O(2))/Fi(O(2)), 155.8 29.8 Hg; ICU mortality, 45.5%), whereas 55 reclassified as having ALI 246.5 25.6 20%) 16 failure 370 54 6.3%) 0.0001) these settings.Patients current may have highly variable levels outcomes. A systematic method assessing severity is required enrollment randomized controlled trials. Clinical trial registered www.clinicaltrials.gov (NCT 00435110).