Outcome of Acute Respiratory Distress Syndrome Patients Mechanically Ventilated with Low Flow Rate,Decelerating Pattern and Positive End Expiratory Pressure

Negm, Mustafa Samy; Morsy, Amany Fawzy; Ahmed, Adel Salah

doi:10.21608/zumj.2019.15514.1384

Outcome of Acute Respiratory Distress Syndrome Patients Mechanically Ventilated with Low Flow Rate,Decelerating Pattern and Positive End Expiratory Pressure

Document Type : Original Article

Authors

¹ resident at chest department,faculty of medicine,zagazig university ,zagazig,Egypt

² chest department,faculty of medicine,zagazig university ,zagazig,Egypt

³ chest department,faculty of medicine ,zagazig university,zagazig,Egypt

10.21608/zumj.2019.15514.1384

Abstract

Acute Respiratory Distress Syndrome(ARDS) was recognized as the most severe form of acute lung injury, a form of diffuse alveolar injury. The current ARDS protocol does not specify any particular ventilator mode.We aimed to assess the outcome of ARDS patients in relation to low tidal volume,low inspiratory flow rate with decelerating pattern and average Positive End Expiraory Pressure(PEEP) .
Patients and Methods: Twenty four newly admitted patients with ARDS were studied. Data parameters at onset of diagnosis were measured, upon them ARDS protocol of mechanical ventilation has been conducted.They were admitted in the period of November 2017 to December 2018 at Respiratory and General Intensive Care Units of Zagazig University Hospitals.Low tidal volume with permissive hypercapnea, of 8 mL/kg of predicted body weight was applied then justified by 7 ml/kg then 6ml/kg to achieve best oxygenation.Plateau pressures not exceeding 30 cm H2O was maintained.Recruitment maneuvers with PEEP of 5cm H2O with titration by 2cm H2O aiming to achieve best PEEP which reach O2 saturation≤90% without cardiac output deterioration.Lowest flow rate with decelerating pattern was applied to increase inspiratory time with subsequent improvement oxygenation. Serial recording of ventilator and ABGs parameters at 1,4,8th day of mechanical ventilation.
Results:In spite of using ARDS network ventilatory protocol ,the mortality is still high (58.3%) .Trauma was the most frequent risk factor in 60% of survived patients followed by pneumonia in 20% of survived patients ,aspiration in 10% and drug overdose in10%of survived patients.Trauma was the most frequent risk factor in 28.56%

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