Treatment of Acute Respiratory Distress Syndrome (ARDS) requires correcting the underlying cause as quickly as possible while supporting the lungs with mechanical ventilation in a way that minimizes injury. In this interview with Dr. Patricia Kritek, we go beyond the sound bites about low tidal-volume ventilation, the importance of PEEP, neuromuscular blockade and prone positioning to highlight the key clinical trials and discuss in detail how these therapies may work.
00:00 introduction 02:27 history and overview of ARDS 04:47 diagnosis 10:22 ARMA trial, low tidal volume ventilation, and ventilator associated lung injury 19:16 PEEP and recruiting lung 28:59: optimizing PEEP and assessing pleural pressure 37:30: additional therapies 40:52: neuromuscular blockade 46:07: prone positioning 51:52: rescue therapies 55:02: summary and concluding remarks 57:07: credits
This podcast is the first in a new series, Curbside Consults, which complements the foundational information in Rotation Prep by taking a deep dive into key topics with expert clinicians and educators. As we explore the details of pathophysiology and critique the evidence behind clinical practice, these conversations are intended to give you better understanding of the topic and greater confidence when treating your patients.
Dr. Kritek is a Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Washington, Seattle. She regularly attends in the medical intensive care unit at UW Medical Center, where she teaches and advises medical students, residents, and fellows. Her education work focuses on how best to provide feedback and guidance to medical trainees. Dr. Kritek has been writing for NEJM Journal Watch General Medicine since 2011.
Mike Mi is a 2017-2018 NEJM Editorial Fellow and a hospitalist at Beth Israel Deaconess Medical Center. He graduated from Harvard Medical School and completed his internal medicine training at BIDMC.