Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency.
Identifieur interne : 000082 ( Main/Exploration ); précédent : 000081; suivant : 000083Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency.
Auteurs : Falk Fichtner ; Onnen Moerer ; Sven Laudi ; Steffen Weber-Carstens ; Monika Nothacker ; Udo KaisersSource :
- Deutsches Arzteblatt international [ 1866-0452 ] ; 2018.
Descripteurs français
- KwdFr :
- Allemagne (épidémiologie), Consommation d'oxygène (MeSH), Décubitus ventral (physiologie), Essais contrôlés randomisés comme sujet (MeSH), Humains (MeSH), Insuffisance respiratoire (diagnostic), Insuffisance respiratoire (physiopathologie), Insuffisance respiratoire (sang), Lever précoce (normes), Maladie aigüe (MeSH), Méta-analyse comme sujet (MeSH), Oxygénation extracorporelle sur oxygénateur à membrane (instrumentation), Sevrage de la ventilation mécanique (méthodes), Sevrage de la ventilation mécanique (normes), Syndrome de détresse respiratoire de l'adulte (diagnostic), Syndrome de détresse respiratoire de l'adulte (mortalité), Syndrome de détresse respiratoire de l'adulte (thérapie), Syndrome de détresse respiratoire de l'adulte (épidémiologie), Unités de soins intensifs (statistiques et données numériques), Ventilation artificielle (effets indésirables), Ventilation à pression positive (instrumentation), Volume courant (MeSH), Échanges gazeux pulmonaires (physiologie).
- MESH :
- diagnostic : Insuffisance respiratoire, Syndrome de détresse respiratoire de l'adulte.
- effets indésirables : Ventilation artificielle.
- mortalité : Syndrome de détresse respiratoire de l'adulte.
- méthodes : Sevrage de la ventilation mécanique.
- normes : Lever précoce, Sevrage de la ventilation mécanique.
- physiologie : Décubitus ventral, Échanges gazeux pulmonaires.
- physiopathologie : Insuffisance respiratoire.
- sang : Insuffisance respiratoire, Oxygénation extracorporelle sur oxygénateur à membrane, Ventilation à pression positive.
- statistiques et données numériques : Unités de soins intensifs.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- épidémiologie : Allemagne, Syndrome de détresse respiratoire de l'adulte.
- Consommation d'oxygène, Essais contrôlés randomisés comme sujet, Humains, Maladie aigüe, Méta-analyse comme sujet, Volume courant.
- Wicri :
- geographic : Allemagne.
English descriptors
- KwdEn :
- Acute Disease (MeSH), Early Ambulation (standards), Extracorporeal Membrane Oxygenation (instrumentation), Germany (epidemiology), Humans (MeSH), Intensive Care Units (statistics & numerical data), Meta-Analysis as Topic (MeSH), Oxygen Consumption (MeSH), Positive-Pressure Respiration (instrumentation), Prone Position (physiology), Pulmonary Gas Exchange (physiology), Randomized Controlled Trials as Topic (MeSH), Respiration, Artificial (adverse effects), Respiratory Distress Syndrome, Adult (diagnosis), Respiratory Distress Syndrome, Adult (epidemiology), Respiratory Distress Syndrome, Adult (mortality), Respiratory Distress Syndrome, Adult (therapy), Respiratory Insufficiency (blood), Respiratory Insufficiency (diagnosis), Respiratory Insufficiency (physiopathology), Tidal Volume (MeSH), Ventilator Weaning (methods), Ventilator Weaning (standards).
- MESH :
- geographic , epidemiology : Germany.
- adverse effects : Respiration, Artificial.
- blood : Respiratory Insufficiency.
- diagnosis : Respiratory Distress Syndrome, Adult, Respiratory Insufficiency.
- epidemiology : Respiratory Distress Syndrome, Adult.
- instrumentation : Extracorporeal Membrane Oxygenation, Positive-Pressure Respiration.
- methods : Ventilator Weaning.
- mortality : Respiratory Distress Syndrome, Adult.
- physiology : Prone Position, Pulmonary Gas Exchange.
- physiopathology : Respiratory Insufficiency.
- standards : Early Ambulation, Ventilator Weaning.
- statistics & numerical data : Intensive Care Units.
- therapy : Respiratory Distress Syndrome, Adult.
- Acute Disease, Humans, Meta-Analysis as Topic, Oxygen Consumption, Randomized Controlled Trials as Topic, Tidal Volume.
Abstract
BACKGROUND
Mechanical ventilation is life-saving for patients with acute respiratory insufficiency. In a German prevalence study, 13.6% of patients in intensive care units received mechanical ventilation for more than 12 hours; 20% of these patients received mechanical ventilation as treatment for acute respiratory distress syndrome (ARDS). The new S3 guideline is the first to contain recommendations for the entire process of treatment in these groups of patients (indications, ventilation modes/parameters, ac- companying measures, treatments for refractory impairment of gas exchange, weaning, and follow-up care).
METHODS
This guideline was developed according to the GRADE methods. Pertinent publications were identified by a systematic search of the literature, the quality of the evidence was evaluated, a risk/benefit assessment was conducted, and recommendations were issued by interdisciplinary consensus.
RESULTS
Mechanical ventilation is recommended as primary treatment for patients with severe ARDS. In other patient groups, non-in- vasive ventilation can lower mortality. If mechanical ventilation is needed, ventilation modes allowing spontaneous breathing seem beneficial (quality of evidence [QoE]: very low). Protective ventilation (high positive end-expiratory pressure, low tidal volume, limited peak pressure) improve the survival of ARDS patients (QoE: high). If a severe impairment of gas exchange is present, prone posi- tioning lessens mortality (QoE: high). Veno-venous extracorporeal membrane oxygenation (vvECMO) has not unequivocally been shown to improve survival. Early mobilization and weaning protocols can shorten the duration of ventilation (QoE: moderate).
CONCLUSION
Recommendations for patients undergoing mechanical ventilation include lung-protective ventilation, early sponta- neous breathing and mobilization, weaning protocols, and, for those with severe impairment of gas exchange, prone positioning. It is further recommended that patients with ARDS and refractory impairment of gas exchange should be transferred to an ARDS/ECMO center, where extracorporeal methods should be applied only after application of all other therapeutic options.
DOI: 10.3238/arztebl.2018.0840
PubMed: 30722839
PubMed Central: PMC6375070
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Consumption</term><term>Randomized Controlled Trials as Topic</term><term>Tidal Volume</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Consommation d'oxygène</term><term>Essais contrôlés randomisés comme sujet</term><term>Humains</term><term>Maladie aigüe</term><term>Méta-analyse comme sujet</term><term>Volume courant</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Allemagne</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Mechanical ventilation is life-saving for patients with acute respiratory insufficiency. In a German prevalence study, 13.6% of patients in intensive care units received mechanical ventilation for more than 12 hours; 20% of these patients received mechanical ventilation as treatment for acute respiratory distress syndrome (ARDS). The new S3 guideline is the first to contain recommendations for the entire process of treatment in these groups of patients (indications, ventilation modes/parameters, ac- companying measures, treatments for refractory impairment of gas exchange, weaning, and follow-up care).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This guideline was developed according to the GRADE methods. Pertinent publications were identified by a systematic search of the literature, the quality of the evidence was evaluated, a risk/benefit assessment was conducted, and recommendations were issued by interdisciplinary consensus.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Mechanical ventilation is recommended as primary treatment for patients with severe ARDS. In other patient groups, non-in- vasive ventilation can lower mortality. If mechanical ventilation is needed, ventilation modes allowing spontaneous breathing seem beneficial (quality of evidence [QoE]: very low). Protective ventilation (high positive end-expiratory pressure, low tidal volume, limited peak pressure) improve the survival of ARDS patients (QoE: high). If a severe impairment of gas exchange is present, prone posi- tioning lessens mortality (QoE: high). Veno-venous extracorporeal membrane oxygenation (vvECMO) has not unequivocally been shown to improve survival. Early mobilization and weaning protocols can shorten the duration of ventilation (QoE: moderate).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Recommendations for patients undergoing mechanical ventilation include lung-protective ventilation, early sponta- neous breathing and mobilization, weaning protocols, and, for those with severe impairment of gas exchange, prone positioning. It is further recommended that patients with ARDS and refractory impairment of gas exchange should be transferred to an ARDS/ECMO center, where extracorporeal methods should be applied only after application of all other therapeutic options.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30722839</PMID><DateCompleted><Year>2019</Year><Month>08</Month><Day>14</Day></DateCompleted><DateRevised><Year>2020</Year><Month>02</Month><Day>25</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1866-0452</ISSN><JournalIssue CitedMedium="Internet"><Volume>115</Volume><Issue>50</Issue><PubDate><Year>2018</Year><Month>12</Month><Day>14</Day></PubDate></JournalIssue><Title>Deutsches Arzteblatt international</Title></Journal><ArticleTitle>Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency.</ArticleTitle><Pagination><MedlinePgn>840-847</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3238/arztebl.2018.0840</ELocationID><ELocationID EIdType="pii" ValidYN="Y">arztebl.2018.0840</ELocationID><Abstract><AbstractText Label="BACKGROUND">Mechanical ventilation is life-saving for patients with acute respiratory insufficiency. In a German prevalence study, 13.6% of patients in intensive care units received mechanical ventilation for more than 12 hours; 20% of these patients received mechanical ventilation as treatment for acute respiratory distress syndrome (ARDS). The new S3 guideline is the first to contain recommendations for the entire process of treatment in these groups of patients (indications, ventilation modes/parameters, ac- companying measures, treatments for refractory impairment of gas exchange, weaning, and follow-up care).</AbstractText><AbstractText Label="METHODS">This guideline was developed according to the GRADE methods. Pertinent publications were identified by a systematic search of the literature, the quality of the evidence was evaluated, a risk/benefit assessment was conducted, and recommendations were issued by interdisciplinary consensus.</AbstractText><AbstractText Label="RESULTS">Mechanical ventilation is recommended as primary treatment for patients with severe ARDS. In other patient groups, non-in- vasive ventilation can lower mortality. If mechanical ventilation is needed, ventilation modes allowing spontaneous breathing seem beneficial (quality of evidence [QoE]: very low). Protective ventilation (high positive end-expiratory pressure, low tidal volume, limited peak pressure) improve the survival of ARDS patients (QoE: high). If a severe impairment of gas exchange is present, prone posi- tioning lessens mortality (QoE: high). Veno-venous extracorporeal membrane oxygenation (vvECMO) has not unequivocally been shown to improve survival. Early mobilization and weaning protocols can shorten the duration of ventilation (QoE: moderate).</AbstractText><AbstractText Label="CONCLUSION">Recommendations for patients undergoing mechanical ventilation include lung-protective ventilation, early sponta- neous breathing and mobilization, weaning protocols, and, for those with severe impairment of gas exchange, prone positioning. It is further recommended that patients with ARDS and refractory impairment of gas exchange should be transferred to an ARDS/ECMO center, where extracorporeal methods should be applied only after application of all other therapeutic options.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fichtner</LastName><ForeName>Falk</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Moerer</LastName><ForeName>Onnen</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Center for Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Laudi</LastName><ForeName>Sven</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Weber-Carstens</LastName><ForeName>Steffen</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Operative Intensive Care Medicin, Charité–Universitätsklinikum Berlin</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nothacker</LastName><ForeName>Monika</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>AWMF-Institute for Medical Knowledge Management (AWMF-IMWi), AWMF office Berlin</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kaisers</LastName><ForeName>Udo</ForeName><Initials>U</Initials><AffiliationInfo><Affiliation>Board of directors, Ulm University Hospital</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>Investigators and the Guideline Group on Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D017065">Practice Guideline</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Dtsch Arztebl Int</MedlineTA><NlmUniqueID>101475967</NlmUniqueID><ISSNLinking>1866-0452</ISSNLinking></MedlineJournalInfo><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Dtsch Arztebl Int. 2019 Apr 19;116(16):286</RefSource><PMID Version="1">31159916</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000208" MajorTopicYN="N">Acute Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004434" MajorTopicYN="N">Early Ambulation</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015199" MajorTopicYN="N">Extracorporeal Membrane Oxygenation</DescriptorName><QualifierName UI="Q000295" MajorTopicYN="Y">instrumentation</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005858" MajorTopicYN="N" Type="Geographic">Germany</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015201" MajorTopicYN="N">Meta-Analysis as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010101" MajorTopicYN="N">Oxygen Consumption</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="N">Positive-Pressure Respiration</DescriptorName><QualifierName UI="Q000295" 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