Thread by @MJGriksaitis

Opening talk @WFPICCS is ‘protective lung ventilation’ by Robinder Khemani

Much data is from the adult ARDSNet work demonstrating 6ml/kg is optimal data for adults

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However - limited #PedsICU data for #pARDS and some data suggests higher tidal volumes in children may have better survival.

But this is not an RCT data...and some data shows higher driving pressure is associated with increased mortality...

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Should we be using transpulmonary pressure as a measurement rather than driving pressures in #pARDS?

In our unit we don’t measure transpulmonary pressures... but might be worth thinking about

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What about PEEP?

This matters in ARDS: some phenotypes are PEEP responders & some are not

If you cannot recruitwith #PEEP then you maybe doing harm by keeping it high (from lung damage or haemodynamic compromise)

Personal suggestion: use #POCUS to help recruitment assessment

The conclusions on #PEEP in #pARDS are shown below:

Need to personalise PEEP - and again, lung aeration scores on #POCUS is potentially one means of doing this

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Patients can also worsen or induce their own lung injury... (relevant to those on non-invasive ventilation particularly)

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Use of high flow nasal cannulae in #ARDS:
- seems to reduce need for intubation
- improves survival

Perhaps this can be explained by washing out dead space and protecting lungs?

Or is this a self selected group....?

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Robinder Khemani concludes his talk on #pARDS

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