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VI CURSO NACIONAL DE VM 27 de março de 2014 Carmen Silvia Valente Barbas

Posição prona e ECMO na SDRA. VI CURSO NACIONAL DE VM 27 de março de 2014 Carmen Silvia Valente Barbas Professora Livre Docente da Disciplina de Pneumologia da FMUSP Médica Intensivista e Pneumologista do Hospital Albert Einstein. ACUTE RESPIRATORY DISTRESS SYNDROME.

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VI CURSO NACIONAL DE VM 27 de março de 2014 Carmen Silvia Valente Barbas

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  1. Posição prona e ECMO na SDRA VI CURSO NACIONAL DE VM 27 de março de 2014 Carmen Silvia Valente Barbas Professora Livre Docente da Disciplina de Pneumologia da FMUSP Médica Intensivista e Pneumologista do Hospital Albert Einstein

  2. ACUTE RESPIRATORY DISTRESS SYNDROME • Lessthan 1 week • bilateral infiltrate • Notexplainedby CHF or • hypervolemia • Presenceofriskfactor • PaO2/FIO2 <300- mild • PaO2/FIO2 <200-moderate • PaO2/FIO2<100- severe JAMA 2012; 307(23): 2526-2533

  3. The New EnglandJournalof Medicine Vol.345, n 8, August 23, 2001 ________________________________________________ EFFECT OF PRONE POSITIONING ON THE SURVIVAL OF PATIENTS WITH ACUTE RESPIRATORY FAILURE Luciano Gattinoni,MD; Gianni Tognoni,MD...............................Roberto Latini ,MD for theProne-SupineStudyGroup Italian + SwitzerlandMulticenterRandomizedTrial 152 patientssupine 152 patientsprone Meanincreaseof PaO2 to FIO2 44.6±68.2 63±66.8 p=0.02 10 Daysmortality 25 % 21.1% ICU dischargeMortality 50.7% 48% 6 monthsmortality 62.5% 58.6% Pos Hoc analysis 10 daymortality -PaO2/FIO2<88 47.2% 23.1% p<0.05

  4. ALVEOLAR RECRUITMENT AND PRONE POSITION G R A V I T Y - PULMONARY HYPERTENSION AND OR RIGHT VENTRICULAR DYSFUNCTION SEVERE ARDS OR DIFFICULT TO RECRUIT ARDS

  5. FEATURE ARTICLES Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome Gattinoni L,Vagginelli F; Carlesso E; Taccone P; Conte V; Chiumello D; Valenza F; Caironi P; Pesenti ACrit Care Med - 01-DEC-2003; 31(12): 2727-33

  6. CESAR TRIAL : EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES SURVIVAL IN PATIENTS WITH SEVERE RESPIRATORY FAILURE. Peek GJ et al Lancet , 2009. Glenfield (Leicester-Julho 2001-Agosto 2006) • Insuficiencia respiratória grave , mas potencialmente reversivel • Escore de Murray 3 ou maior • pH < 7,2 Exclusões : altas pressões em vias aéreas ou FIO2 > 80% mais de 7 dias e ou contraindicações para tratamento

  7. CESAR TRIAL : EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES SURVIVAL IN PATIENTS WITH SEVERE RESPIRATORY FAILURE. Peek GJ et al Lancet , 2009. 180 pacientes 90 ECMO 90 CMV sobrevida em 6 meses 57/90 (63%) versus 41/90 (47%) – RR= 0.69(0.05-0.97-p=0.03) • Sobrevivente extra para cada 6 pacientes tratados • ECMO aumenta a sobrevida após 6 meses e é custo efetiva comparada com CMV

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