SFGH 4.25 pearls: ARDS and Procalcitonin

  • In the Lancet article attached, procalcitonin was shown to result in earlier discontinuation and decreased mortality for critically ill patients with presumed bacterial infection (note that viral infections actually lower the procalcitonin value)
  • As demonstrated in the attached article from the NEJM, there is data suggesting a mortality benefit of high-flow oxygen over other non-invasive ventilation modalities for hypoxemic respiratory failure
    • There was also no significant difference in intubation in the high-flow group vs the other NIV group
  • ARDS criteria reminder (note that these currently only include mechanically ventilated patients)
    • Respiratory symptoms that began within one week of a clinical insult (or worsening over a week)
    • Bilateral opacities on CXR or CT not explained by effusions, lobar collapse or pulmonary nodules
    • Respiratory failure is not explained by cardiac failure or volume overload
    • PaO2/FiO2 of >200mmHg with vent settings that include a PEEP of ≥5cmH2o
  • Most common precipitants of ARDS are sepsis, pneumonia, and aspiration, though there are many other known causes, such as severe trauma and burns.




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