A NEW CONCEPT FOR A UNIFORM TREATMENT AND THERAPEUTIC SCORING OF RESPIRATOR SETTINGS IN SEVERE ARDS

  • 1 January 1983
    • journal article
    • research article
    • Vol. 32  (12) , 576-581
Abstract
To achieve a uniform, easily taught teach respiratory management in severe adult respiratory distress syndrome (ARDS), a combined treatment, called step-by-step scheme, was formulated. It was aimed towards a regulation of the arterial O2 tension at levels between 90 and 130 mm Hg. This was achieved by combination of PEEP [positive end-expiratory pressure] and IRV [inspiratory reserve volume] to minimize the inspiratory O2 fraction [FiO2]. Nine patients underwent this schedule. Benzer''s AaDO2 [alveolar arterial O2 diffusion] quotient as an estimation of lung function and PIF (PEEP .times. I:E .times. FiO2) as a quantifying parameter for the strength of the respirator were calculated. AaDO2 quotient showed no statistically significant differences but PIF suggested a clearly marked day of maximum respiratory support during the clinical course. A variable defined by therapeutic procedures may also be an estimation of a certain degree of sickness as a pure diagnostic parameter. In plotting AaDO2 quotient vs. PIF, characteristically formed loops result. These loops give some evidence about the interactions between improving or worsening ARDS and properly adjusted therapeutic efforts by means of a respirator. The diagram may be also helpful in deciding conventional respirator settings or weaning procedures and show points where new techniques (like high frequency ventilation, extracorporeal devices or arteriovenous hemofiltration) might be considered.