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ARDS: challenges in patient care and frontiers in research

Lieuwe D. Bos, Ignacio Martin-Loeches, Marcus J. Schultz
European Respiratory Review 2018 27: 170107; DOI: 10.1183/16000617.0107-2017
Lieuwe D. Bos
1Dept of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands
2Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
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  • For correspondence: l.d.bos@amc.uva.nl
Ignacio Martin-Loeches
3Dept of Intensive Care, St James's Hospital, Dublin, Ireland
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Marcus J. Schultz
1Dept of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands
4Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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    FIGURE 1

    Differential response to treatment between two phenotypes of acute respiratory distress syndrome. a) High and low positive end-expiratory pressure (PEEP); b) conservative and liberal fluid management.

Tables

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  • TABLE 1

    Ventilatory and pharmacological management of acute respiratory distress syndrome (ARDS) per responsive phenotype

    InterventionSuggested/recommendedResponsive phenotype
    NIVRecommendedEarly phase of respiratory failure, with rapid response after start of NIV
    TracheotomySuggestedProlonged mechanical ventilation
    Low tidal volumesRecommendedAll patients with ARDS
    Plateau pressure <30 cmH2ORecommendedAll patients with ARDS
    Driving pressure <15 cmH2OSuggestedAll patients with ARDS
    High PEEP strategyRecommendedPaO2/FIO2 <200
    Prone positionRecommendedPaO2/FIO2 <150
    Neuromuscular blocking agentsRecommendedPaO2/FIO2 <150 and first 48 h of ARDS
    Extracorporeal membrane oxygenationSuggestedPatients requiring rescue therapy
    GlucocorticosteroidsSuggestedNo responsive phenotype identified

    NIV: noninvasive ventilation; PEEP: positive end-expiratory pressure; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.

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      L.D. Bos ERR-0107-2017_Bos

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    ARDS: challenges in patient care and frontiers in research
    Lieuwe D. Bos, Ignacio Martin-Loeches, Marcus J. Schultz
    European Respiratory Review Mar 2018, 27 (147) 170107; DOI: 10.1183/16000617.0107-2017

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    ARDS: challenges in patient care and frontiers in research
    Lieuwe D. Bos, Ignacio Martin-Loeches, Marcus J. Schultz
    European Respiratory Review Mar 2018, 27 (147) 170107; DOI: 10.1183/16000617.0107-2017
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    • Article
      • Abstract
      • Abstract
      • Introduction
      • Ventilatory support
      • Pharmacological interventions
      • Challenges in research in patients with ARDS
      • Conclusions
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      • References
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    • Acute lung injury and critical care
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    Highlights in Acute Respiratory Failure

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