ABSTRACT
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.
Subject(s)
Humans , Adult , Respiration, Artificial , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn , Respiratory Distress Syndrome, Newborn/therapy , Extracorporeal Membrane Oxygenation , Positive-Pressure Respiration , Prone Position , Chest Wall OscillationABSTRACT
OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy wasdeveloped at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroupsand among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.(AU)
Subject(s)
Humans , Shock, Septic/drug therapy , Sepsis/drug therapy , Patient Care Planning , Respiration, Artificial , Vasoconstrictor Agents/therapeutic use , Calcitonin/therapeutic use , Nutrition Assessment , Chronic Disease/drug therapy , Renal Replacement Therapy , Fluid Therapy/methods , Anti-Bacterial Agents/administration & dosageABSTRACT
The relationship among stress, age, and social support was explored in 30 women scheduled for a breast biopsy. Stress was determined using the State Trait Anxiety Inventory. Social support strength and network size were measured using the Norbeck Social Support Questionnaire in this correlational study. Findings demonstrated that women do experience stress before their biopsies. Stress was also found to have a negative correlation with social support strength. Moreover, although statistically insignificant, these women tended to have increased stress with aging until age 40, then stress decreased with increasing age. Additional research should replicate the natural age division of < or = 40 years and > 40 years in a larger sample of women. Advanced practitioners are ideally suited to affect patient outcomes by providing social support. This social support could consist of facilitated support groups or access to the information needed by women during this stressful diagnostic experience.
