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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 69 No. 3, 2015.

Review article

ACUTE RESPIRATORY DISTRESS SYNDROME AND OTHER RESPIRATORY DISORDERS IN SEPSIS

MATEA BOGDANOVIĆ DVORŠČAK ; Merkur University Hospital, Department of Anesthesia and Intensive Care, Zagreb, Croatia
TAMARA LUPIS ; Merkur University Hospital, Department of Anesthesia and Intensive Care, Zagreb, Croatia
MIRTA ADANIĆ ; Merkur University Hospital, Department of Anesthesia and Intensive Care, Zagreb, Croatia
JADRANKA PAVIČIĆ ŠARIĆ ; Merkur University Hospital, Department of Anesthesia and Intensive Care, Zagreb, Croatia

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Abstract

Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic infl ammatory response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause of ARDS. Sepsis-related ARDS patients have signifi cantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS. Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation rate slower. Clinical outcomes in patients with sepsis-related ARDS are also worse, associated with signifi cantly higher 28-day and 60-day mortality rates (31.1% vs. 16.3% and 38.2% vs. 22.6%, respectively). It is extremely important to optimally adjust ventilator setting to current condition of lungs, while providing all other therapeutic measures in the treatment of sepsis, severe sepsis and septic shock. The pool of data on treatment possibilities for patients with ARDS grows every year, with specifi cally designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice? This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when systematically and consistently applied.

Keywords

sepsis; ARDS (acute respiratory distress syndrome); protective ventilation; PEEP (positive end-expiratory pressure)

Hrčak ID:

151876

URI

https://hrcak.srce.hr/151876

Publication date:

27.1.2016.

Article data in other languages: croatian

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