There probably isn't much to say about ARDS that hasn't been said in some form within the past couple years. We've debated continually about the optimal approach to this syndrome, in the absence of much solid evidence (the only large, multi-center RCT which has been replicated in ARDS was ACURASYS – and it failed to yield reproducible results!).
This intellectual debate is being played out on the stage of a global pandemic that is increasingly causing major resource shortages. ECMO – the traditional standby for refractory ARDS – is increasingly a scarce resource. This may force the utilization of other modalities and techniques to manage refractory patients.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
Latest posts by Josh Farkas (see all)
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Hi Josh, you suggest we should stop proning if “after proning the PaO2/FiO2 ratio fails to improve”, which is something I’ve seen in practice a lot. My understanding however was that in the PROSEVA trial the same mortality benefit was seen in both the ‘responders’ & ‘non-responders’, suggesting that any survival benefit may be conferred from a reduction in VILI in the prone position, rather than improved gas exchange/PF ratio. https://www.atsjournals.org/doi/10.1164/rccm.201311-2056LE Stopping proning if there is a decrease in PF ratio as per the PROSEVA protocol thus seems appropriate, but don’t you think that stopping in those who simply ‘fail… Read more »
Morning Dr. Farkus,
When faced with a patient who has ongoing dyssynchrony with the patient attempting to take larger volumes than 6- 8 ml/kg IBW, do you feel it would be more acceptable to 1) Utilize PCV with a relatively low PIP (usually 5-10 cmH2O) even if the patient is now taking Tv larger than 8 ml/kg IBW but they are comfortable on the vent or 2) Increasing sedation and possible paralysis in order to ensure low Tv are being delivered? Or is there a another option you would utilize?
very cool and very extensive review of ARDS josh.. thank you
tom fiero, merced
Josh do you thinks there is still a place for vit C at the dosage of CITRIS trial or more? Since it seems that there is not harm from the administration vit C at such high dosages (oxalate nephropahty seems very unlikely) do you think it make sense to use it until it will be definetely clear if it works or not?
Hi Josh, thanks for this outline. Just started my ICU rotation, and your article on this topic was rather helpful!
hi josh thanks for the nice information
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