{
    "abstract": "Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described.\nTo describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS, including refractory hypoxemia.\nThis was a prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring an Fi\nWe enrolled 664 patients: 222 (33%) with moderate and 442 (67%) with severe ARDS. On Study Day 1, mean Vt was 7.5 (SD\u2009=\u20092.1) ml/kg predicted body weight (n\u2009=\u2009625); 80% (n\u2009=\u2009501) received Vt greater than 6 ml/kg. Mean positive end-expiratory pressure (PEEP) was 10.5 (3.7) cm H\nPatients with moderate-to-severe ARDS receive treatment adjuncts frequently, especially with refractory hypoxemia. Paradoxically, therapies with less evidence supporting their use (e.g., pulmonary vasodilators) were over-used, whereas those with more evidence (e.g., prone positioning, neuromuscular blockade) were under-used. Patients received higher Vts and lower PEEP than would be suggested by the evidence.",
    "authors": [
        {
            "affiliation": "1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.\n2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n3 St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.",
            "firstname": "Erick H",
            "initials": "EH",
            "lastname": "Duan"
        },
        {
            "affiliation": "4 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.\n5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "Neill K J",
            "initials": "NKJ",
            "lastname": "Adhikari"
        },
        {
            "affiliation": "2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n6 Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Universit\u00e9 de Sherbrooke, Sherbrooke, Quebec, Canada.\n7 Department of Anesthesia, Universit\u00e9 de Sherbrooke, Sherbrooke, Quebec, Canada.",
            "firstname": "Frederick",
            "initials": "F",
            "lastname": "D'Aragon"
        },
        {
            "affiliation": "1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.\n2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n3 St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.",
            "firstname": "Deborah J",
            "initials": "DJ",
            "lastname": "Cook"
        },
        {
            "affiliation": "5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.\n8 Sinai Health Center, Toronto, Ontario, Canada.",
            "firstname": "Sangeeta",
            "initials": "S",
            "lastname": "Mehta"
        },
        {
            "affiliation": "1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.\n2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n3 St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.",
            "firstname": "Waleed",
            "initials": "W",
            "lastname": "Alhazzani"
        },
        {
            "affiliation": "5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.\n9 Division of Respirology, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.",
            "firstname": "Ewan",
            "initials": "E",
            "lastname": "Goligher"
        },
        {
            "affiliation": "10 Department of Critical Care, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, Montreal, Quebec, Canada.",
            "firstname": "Emmanuel",
            "initials": "E",
            "lastname": "Charbonney"
        },
        {
            "affiliation": "11 King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.",
            "firstname": "Yaseen M",
            "initials": "YM",
            "lastname": "Arabi"
        },
        {
            "affiliation": "1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.\n12 Juravinski Hospital, Hamilton, Ontario, Canada.",
            "firstname": "Tim",
            "initials": "T",
            "lastname": "Karachi"
        },
        {
            "affiliation": "13 Centre de Recherche du Centre Hospitalier Universitaire de Qu\u00e9bec, Universit\u00e9 Laval, Quebec, Quebec, Canada.\n14 Department of Anesthesiology and Critical Care Medicine, Division of Critical Care, Universit\u00e9 Laval, Quebec, Quebec, Canada.",
            "firstname": "Alexis F",
            "initials": "AF",
            "lastname": "Turgeon"
        },
        {
            "affiliation": "2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n15 Hamilton General Hospital, Hamilton, Ontario, Canada.",
            "firstname": "Lori",
            "initials": "L",
            "lastname": "Hand"
        },
        {
            "affiliation": "2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.",
            "firstname": "Qi",
            "initials": "Q",
            "lastname": "Zhou"
        },
        {
            "affiliation": "2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.",
            "firstname": "Peggy",
            "initials": "P",
            "lastname": "Austin"
        },
        {
            "affiliation": "5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.\n16 Critical Care and Medicine Departments, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.",
            "firstname": "Jan",
            "initials": "J",
            "lastname": "Friedrich"
        },
        {
            "affiliation": "6 Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Universit\u00e9 de Sherbrooke, Sherbrooke, Quebec, Canada.\n7 Department of Anesthesia, Universit\u00e9 de Sherbrooke, Sherbrooke, Quebec, Canada.",
            "firstname": "Francois",
            "initials": "F",
            "lastname": "Lamontagne"
        },
        {
            "affiliation": "14 Department of Anesthesiology and Critical Care Medicine, Division of Critical Care, Universit\u00e9 Laval, Quebec, Quebec, Canada.",
            "firstname": "Fran\u00e7ois",
            "initials": "F",
            "lastname": "Lauzier"
        },
        {
            "affiliation": "17 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.",
            "firstname": "Rakesh",
            "initials": "R",
            "lastname": "Patel"
        },
        {
            "affiliation": "18 Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada.",
            "firstname": "John",
            "initials": "J",
            "lastname": "Muscedere"
        },
        {
            "affiliation": "19 Departments of Critical Care Medicine and Anesthesiology, Dalhousie University, Halifax, Nova Scotia, Canada.",
            "firstname": "Richard",
            "initials": "R",
            "lastname": "Hall"
        },
        {
            "affiliation": "20 Division of Critical Care, Department of Medicine and Centre de Recherche, Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Quebec, Canada.",
            "firstname": "Pierre",
            "initials": "P",
            "lastname": "Aslanian"
        },
        {
            "affiliation": "3 St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.\n21 Departments of Anesthesia, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.",
            "firstname": "Thomas",
            "initials": "T",
            "lastname": "Piraino"
        },
        {
            "affiliation": "22 Departments of Medicine and Critical Care, Centre de recherche H\u00f4pital de Sacr\u00e9-C\u0153ur de Montr\u00e9al, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada.",
            "firstname": "Martin",
            "initials": "M",
            "lastname": "Albert"
        },
        {
            "affiliation": "23 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.",
            "firstname": "Sean M",
            "initials": "SM",
            "lastname": "Bagshaw"
        },
        {
            "affiliation": "23 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.",
            "firstname": "Mike",
            "initials": "M",
            "lastname": "Jacka"
        },
        {
            "affiliation": "24 Island Health Authority, Victoria, British Columbia, Canada.",
            "firstname": "Gordon",
            "initials": "G",
            "lastname": "Wood"
        },
        {
            "affiliation": "25 Critical Care Medicine, Vancouver General Hospital University of British Columbia, Vancouver, British Columbia, Canada; and.",
            "firstname": "William",
            "initials": "W",
            "lastname": "Henderson"
        },
        {
            "affiliation": "26 Center for Heart Lung Innovation, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.",
            "firstname": "Delbert",
            "initials": "D",
            "lastname": "Dorscheid"
        },
        {
            "affiliation": "5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.\n9 Division of Respirology, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.",
            "firstname": "Niall D",
            "initials": "ND",
            "lastname": "Ferguson"
        },
        {
            "affiliation": "1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.\n2 Department of Health Research Methods, Evidence and Impact. McMaster University, Hamilton, Ontario, Canada.\n15 Hamilton General Hospital, Hamilton, Ontario, Canada.",
            "firstname": "Maureen O",
            "initials": "MO",
            "lastname": "Meade"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1513/AnnalsATS.201612-1042OC",
    "journal": "Annals of the American Thoracic Society",
    "keywords": [
        "acute respiratory distress syndrome",
        "lung protective ventilation",
        "neuromuscular blocking agents",
        "prone positioning",
        "refractory hypoxemia"
    ],
    "methods": null,
    "publication_date": "2017-09-15",
    "pubmed_id": "28910146",
    "results": "We enrolled 664 patients: 222 (33%) with moderate and 442 (67%) with severe ARDS. On Study Day 1, mean Vt was 7.5 (SD\u2009=\u20092.1) ml/kg predicted body weight (n\u2009=\u2009625); 80% (n\u2009=\u2009501) received Vt greater than 6 ml/kg. Mean positive end-expiratory pressure (PEEP) was 10.5 (3.7) cm H",
    "title": "Management of Acute Respiratory Distress Syndrome and Refractory Hypoxemia. A Multicenter Observational Study.",
    "xml": "<Element 'PubmedArticle' at 0x788505644900>"
}