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Respiratory Distress Treatment Studies Conflict
Date:2/12/2008

res for the 983 people treated for ARDS in the Canadian study was 40.4 percent for those getting conventional treatment, and 36.4 percent for receiving higher PEEP based on individual characteristics.

"While neither study changed overall mortality much, both made moves in the right direction," Angus said. "There was a trend toward lower mortality in both studies [with higher PEEP]. In both studies, there was clearly improved oxygenation. And both reduced the need to use rescue therapies, last-ditch attempts to use experimental, sometimes crazy, things to keep patients alive."

Another expert was more cautious.

"I don't think the results of the Canadian study would be enough to change practice in a systematic way," said Dr. Leonard C. Hudson, head of the division of pulmonary and critical medicine at the University of Washington.

But the Canadian researchers begged to differ.

Their results do offer support for a change to higher PEEP levels, said Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Toronto and a member of the Canadian research team.

"It is not clear that higher PEEP is better, in terms of a lower mortality rate, but it is very likely that higher PEEP is at least as good," Guyatt said. "There is an established way of treatment using lower PEEP. We now have shown that using higher PEEP is at least as good, and perhaps better. Clinicians who prefer using a higher PEEP can now feel comfortable in doing so."

ARDS develops in people who suffer major injuries or who are critically ill with diseases such as pneumonia or bacterial infections. Fluid builds up in the lungs until breathing becomes more and more difficult. In treatment, air is forced into the lungs. A marked feature of the two studies was a continuation of the trend to change the pattern of forced breathing, with the number of breaths per minute doubled, and the tidal volume, the amount of air forced into th
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