Noncardiogenic pulmonary edema.
How to confirm “Noncardiogenic”?
Gold standard would be RHC,
but typically defined clinically
Severity ratings (for prognostication, do not influence tx)
- <300 mild
- 100-200 moderate
- <100 severe
PEEP >= 5.
Acute: onset w/in 1wk of insult
Two major branches:
Pulmonary vs extrapulmonary.
Extrapulmonary: anything inflammatory (pancreatitis, sepsis)
Low-tidal volume ventilation: 6mL/kg of ideal body weight
Finer points from this article:
- 6 vs 12
- plateau pressure targets differed
- allowances for adjusting tidal volume based on ventilation needs
- used pressure control, which has led to wider use of this mode
Conservative fluid mgmt
- no mortality difference
- improvements in ventilator-days and ICU days
- CVP endpoint less than 4, almost never reached == never cease to diurese
- large reported mortality benefit
- results called into question
- no mortality benefit
- still will paralyse patients, but not early as part of routine practice
- done just prior to COVID-19
- long enrollment period, very strict enrollment criteria
- possible improvement in ventilator-days and mortality
- trial ended early for futility, but KM curves did diverge