FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2002108377> ?p ?o ?g. }

• W2002108377 endingPage "883" @default.
• W2002108377 startingPage "883" @default.
• W2002108377 abstract "ACUTE LUNG INJURY (ALI) IS A COMMON, LETHAL, AND complex syndrome. Estimates of attributable mortality from ALI or its more severe form, acute respiratory distress syndrome (ARDS), in the United States place it above asthma and human immunodeficiency virus infection as a cause of death. The current mortality of 35% associated with ALI is roughly 3-fold higher than that associated with ST-segment elevation myocardial infarction. Most of the salient features of ARDS, including the therapeutic use of positive end-expiratory pressure (PEEP), were described by Ashbaugh et al in their classic description of the syndrome: “ventilation without positive end-expiratory pressure resulted in immediate hypoxaemia. . . . Collapsed alveoli require greater pressures for reopening, thus explaining the notable loss of compliance. Positive end-expiratory pressure would theoretically prevent complete collapse and improve oxygenation by maintaining alveolar ventilation.” Ashbaugh et al thought that mechanical ventilation merely prevented hypoxemic death, thereby providing clinicians with time to treat the underlying cause of ARDS. However, recent research has focused on the degree to which mechanical ventilation is injurious, depending on how it is applied, by causing inflammation and multiple organ failure. There is little disagreement about the principles of mechanical ventilation in patients with ALI: a PEEP sufficient to recruit collapsed lung areas should be used while delivering small tidal volumes to protect the uninjured lung from overdistention. These basic concepts do not provide any of the details required to manage the care of patients at the bedside. Although the use of PEEP is a simple physiological intervention, it has potentially deleterious effects on right and left ventricular function, pulmonary vascular resistance, and thoracic compliance, leading to unpredictable effects on gas exchange and hemodynamics in individual patients. Airway pressures necessary to recruit collapsed lung areas can improve oxygenation but also can overdistend normal areas of pulmonary parenchyma, worsen inflammation, and reduce cardiac output. Therefore, identifying the optimal PEEP to use in ALI has been the focus of a substantial amount of clinical investigation. Many strategies exist: clinicians can increase PEEP to achieve the maximal improvement in oxygenation, sacrificing overdistention of normal alveoli; balance oxygenation benefits against cardiac output or blood pressure; use pressure-volume curves or dynamic stress indices to identify a trade-off point of lung recruitment; or use sophisticated imaging techniques to assess how much lung has been opened. However, in clinical practice, patients with ALI do not appear to benefit from any of these strategies. Large cohorts of patients receiving mechanical ventilation show that patients with ALI, ARDS, acute respiratory failure that is neither ALI nor ARDS, and patients with chronic obstructive pulmonary disease all receive, on average, about 8 cm H2O of PEEP. Current practice may reflect the lack of evidence demonstrating a patient-centered outcome benefit of any specific approach to titrating PEEP. Four recent clinical trials address the question of “How much PEEP in acute lung injury?”: ALVEOLI, LOVS, EXPRESS, and EPVENT. All of these investigations were designed to measure the benefits of a protocolized higher PEEP strategy in a broad range of patients with ALI receiving tidal volumes thought to be protective. The protocols tested were related only in that they delivered approximately 14.5 to 18 cm H2O of PEEP on day 1 to patients in the intervention groups. The usual set of explanations were invoked to interpret the results of high-quality, wellconceived, but statistically negative trials; ie, the wrong patients were enrolled; too few patients were enrolled because of overly optimistic projections of the effect of PEEP on mortality; and unlucky randomization led to sicker patients in the intervention groups and to investigators not using the right approach to setting PEEP. In this issue of JAMA, a meta-analysis of individualpatient data by Briel and colleagues addresses 3 of these 4 important limitations. Using primary data from the actual trials, the authors demonstrated that, after adjusting for individual patient covariates, higher PEEP was associated with" @default.
• W2002108377 created "2016-06-24" @default.
• W2002108377 creator A5000256626 @default.
• W2002108377 date "2010-03-03" @default.
• W2002108377 modified "2023-09-25" @default.
• W2002108377 title "How Much PEEP in Acute Lung Injury" @default.
• W2002108377 cites W1903005360 @default.
• W2002108377 cites W1974404062 @default.
• W2002108377 cites W2015076149 @default.
• W2002108377 cites W2029284686 @default.
• W2002108377 cites W2037459166 @default.
• W2002108377 cites W2067879188 @default.
• W2002108377 cites W2068854215 @default.
• W2002108377 cites W2083931054 @default.
• W2002108377 cites W2093852073 @default.
• W2002108377 cites W2109704422 @default.
• W2002108377 cites W2113410829 @default.
• W2002108377 cites W2116685432 @default.
• W2002108377 cites W2120076396 @default.
• W2002108377 cites W2149590783 @default.
• W2002108377 cites W2154581887 @default.
• W2002108377 cites W2333411966 @default.
• W2002108377 doi "https://doi.org/10.1001/jama.2010.226" @default.
• W2002108377 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/20197538" @default.
• W2002108377 hasPublicationYear "2010" @default.
• W2002108377 type Work @default.
• W2002108377 sameAs 2002108377 @default.
• W2002108377 citedByCount "17" @default.
• W2002108377 countsByYear W20021083772012 @default.
• W2002108377 countsByYear W20021083772013 @default.
• W2002108377 countsByYear W20021083772014 @default.
• W2002108377 countsByYear W20021083772015 @default.
• W2002108377 countsByYear W20021083772019 @default.
• W2002108377 countsByYear W20021083772020 @default.
• W2002108377 crossrefType "journal-article" @default.
• W2002108377 hasAuthorship W2002108377A5000256626 @default.
• W2002108377 hasConcept C126322002 @default.
• W2002108377 hasConcept C177713679 @default.
• W2002108377 hasConcept C2777714996 @default.
• W2002108377 hasConcept C71924100 @default.
• W2002108377 hasConceptScore W2002108377C126322002 @default.
• W2002108377 hasConceptScore W2002108377C177713679 @default.
• W2002108377 hasConceptScore W2002108377C2777714996 @default.
• W2002108377 hasConceptScore W2002108377C71924100 @default.
• W2002108377 hasIssue "9" @default.
• W2002108377 hasLocation W20021083771 @default.
• W2002108377 hasLocation W20021083772 @default.
• W2002108377 hasOpenAccess W2002108377 @default.
• W2002108377 hasPrimaryLocation W20021083771 @default.
• W2002108377 hasRelatedWork W1965567535 @default.
• W2002108377 hasRelatedWork W2007746127 @default.
• W2002108377 hasRelatedWork W2043417603 @default.
• W2002108377 hasRelatedWork W2420746378 @default.
• W2002108377 hasRelatedWork W2780028606 @default.
• W2002108377 hasRelatedWork W2807974132 @default.
• W2002108377 hasRelatedWork W3005652238 @default.
• W2002108377 hasRelatedWork W4229689163 @default.
• W2002108377 hasRelatedWork W4240407444 @default.
• W2002108377 hasRelatedWork W4252371801 @default.
• W2002108377 hasVolume "303" @default.
• W2002108377 isParatext "false" @default.
• W2002108377 isRetracted "false" @default.
• W2002108377 magId "2002108377" @default.
• W2002108377 workType "article" @default.