| Title |
The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
|
|---|---|
| Published in |
Intensive Care Medicine, April 2016
|
| DOI | 10.1007/s00134-016-4325-4 |
| Pubmed ID | |
| Authors |
Thomas Bein, Salvatore Grasso, Onnen Moerer, Michael Quintel, Claude Guerin, Maria Deja, Anita Brondani, Sangeeta Mehta |
| Abstract |
Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO2/FIO2 < 100. For mechanical ventilation specific settings are recommended: limitation of tidal volume (6 ml/kg predicted body weight), adequate high PEEP (>12 cmH2O), a recruitment manoeuvre in special situations, and a 'balanced' respiratory rate (20-30/min). Individual bedside methods to guide PEEP/recruitment (e.g., transpulmonary pressure) are not (yet) available. Prone positioning [early (≤ 48 hrs after onset of severe ARDS) and prolonged (repetition of 16-hr-sessions)] improves survival. An advanced infection management/control includes early diagnosis of bacterial, atypical, viral and fungal specimen (blood culture, bronchoalveolar lavage), and of infection sources by CT scan, followed by administration of broad-spectrum anti-infectives. Neuromuscular blockage (Cisatracurium ≤ 48 hrs after onset of ARDS), as well as an adequate sedation strategy (score guided) is an important supportive therapy. A negative fluid balance is associated with improved lung function and the use of hemofiltration might be indicated for specific indications. A specific standard of care is required for the management of severe ARDS with refractory hypoxemia. |
X Demographics
The data shown below were collected from the profiles of 17 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 2 | 12% |
| Australia | 2 | 12% |
| United Kingdom | 2 | 12% |
| Nicaragua | 1 | 6% |
| Colombia | 1 | 6% |
| India | 1 | 6% |
| Switzerland | 1 | 6% |
| France | 1 | 6% |
| Mexico | 1 | 6% |
| Other | 1 | 6% |
| Unknown | 4 | 24% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 10 | 59% |
| Practitioners (doctors, other healthcare professionals) | 4 | 24% |
| Scientists | 3 | 18% |
Mendeley readers
The data shown below were compiled from readership statistics for 567 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 3 | <1% |
| Italy | 3 | <1% |
| Germany | 1 | <1% |
| Netherlands | 1 | <1% |
| Portugal | 1 | <1% |
| Sweden | 1 | <1% |
| South Africa | 1 | <1% |
| France | 1 | <1% |
| New Zealand | 1 | <1% |
| Other | 3 | <1% |
| Unknown | 551 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 88 | 16% |
| Researcher | 85 | 15% |
| Student > Postgraduate | 74 | 13% |
| Student > Master | 57 | 10% |
| Student > Ph. D. Student | 42 | 7% |
| Other | 130 | 23% |
| Unknown | 91 | 16% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 369 | 65% |
| Nursing and Health Professions | 34 | 6% |
| Biochemistry, Genetics and Molecular Biology | 14 | 2% |
| Agricultural and Biological Sciences | 10 | 2% |
| Engineering | 10 | 2% |
| Other | 28 | 5% |
| Unknown | 102 | 18% |
Attention Score in Context
This research output has an Altmetric Attention Score of 27. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 June 2021.
All research outputs
#1,417,323
of 25,257,066 outputs
Outputs from Intensive Care Medicine
#1,252
of 5,384 outputs
Outputs of similar age
#23,651
of 307,076 outputs
Outputs of similar age from Intensive Care Medicine
#12
of 111 outputs
Altmetric has tracked 25,257,066 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,384 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 29.7. This one has done well, scoring higher than 76% of its peers.
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We're also able to compare this research output to 111 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 90% of its contemporaries.