Spontaneous effort causes occult Pendelluft during mechanical ventilation

In the injured lung, local negative pleural pressure generated by diaphragmatic contraction is not uniformly transmitted, but is concentrated in dependent lung. This causes Pendelluft (using EIT), with shift of air from non-dependent to dependent lung regions. Thus, during lung-protective ventilation with strictly limited tidal volume, the presence of strong inspiratory effort can result in a hidden, local over-stretch of the dependent lung

An official American Thoracic Society/European Society of intensive care medicine/society of critical care medicine clinical practice guideline : mechanical ventilation in adult patients with acute respiratory distress syndrome

Background: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). Methods: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates). For patients with severe ARDS, the recommendation is strong for prone positioning for more than 12 h/d (moderate confidence in effect estimates). For patients with moderate or severe ARDS, the recommendation is strong against routine use of high-frequency oscillatory ventilation (high confidence in effect estimates) and conditional for higher positive end-expiratory pressure (moderate confidence in effect estimates) and recruitment maneuvers (low confidence in effect estimates). Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation in patients with severe ARDS. Conclusions: The panel formulated and provided the rationale for recommendations on selected ventilatory interventions for adult patients with ARDS. Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline

Mechanical ventilation in adults with acute respiratory distress syndrome: An official clinical guideline of American Thoracic Society/European Society of Intensive Care medicine/Society of Critical care medicine

The aim of this guideline is to provide clinical recommendation on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). Methods. This guideline is based on systematic review and metaanalysis of available literature on the use of mechanical ventilation in adult patients with ARDS. Results. All patients with ARDS should be mechanically ventilated with the use of lower tidal volumes (4\u20138 ml/kg predicted bodyweight) and lower inspiratory pressures (plateau pressure, 30 cm H2O). In severe ARDS, the prone positioning for more than 12 h/d is strongly recommended. In patients with moderate to severe ARDS, routine use of high-frequency oscillatory ventilation is not recommended; conditional recommendation has been developed for the use of higher positive end-expiratory pressure and recruitment maneuvers. Cu?? \u2013 ently, there is not enough evidence for the use of extracorporeal membrane oxygenation in patients with severe ARDS. Conclusions. Practical recommendations on selected methods to co?? \u2013 ect ventilation disturbances in adult patients with ARDS have been developed. Clinicians involved in the management of patients with ARDS should use personalized approach to the treatment of these patients. Key words: acute respiratory distress syndrome, adults, mechanical ventilation, guideline, end-expiratory pressure, tidal volume, inspiratory pressure, extracorporeal membrane oxygenation. \ua9 2018 National Research University Higher School of Economics. All rights reserved

Lieutenant William Douglas Bell

Lieutenant William Douglas Bell, 4th Machine Gun Coy., Canadian Machine Gun Corps, 24 years old, Class of 1915, Remembered at Vimy Memorial. Son of James Anthony Bell and Katerine Bell, of 81 Elm St., St. Thomas, Ontario. Admitted as a law student in 1910 at age 18. Enlisted 2nd overseas contingent, 4 November 1914. Lieutenant 4th Canadian Machine Gun Corps. Killed in action 15 September 1916. Never called to the bar.https://digitalcommons.osgoode.yorku.ca/remembrance_day/1010/thumbnail.jp