title: An approach to the treatment of severe adult respiratory failure.
abstract: OBJECTIVE
  The purpose of this article is to evaluate outcome in adult patients with severe respiratory failure managed with an approach using (1) limitation of end inspiratory pressure, (2) inverse ratio ventilation, (3) titration of PEEP by SvO2, (4) intermittent prone positioning, (5) limitation of FiO2, (6) diuresis, (7) transfusion, and (8) extracorporeal life support (ECLS) if patients failed to respond.
  
  
  METHODS
  This study was designed as a retrospective review in the intensive care unit of a tertiary referral hospital. One-hundred forty-one consecutive patients with hypoxic (n = 135) or hypercarbic (n = 6) respiratory failure referred for consideration of ECLS between 1990 and 1996. Overall, initial PaO2/FiO2 (P/F) ratio was 75+/-5 (median = 66).
  
  
  RESULTS
  Lung recovery occurred in 67% of patients and 62% survived. Forty-one patients improved without ECLS (83% survived); 100 did not and were supported with ECLS (54% survived). Survival was greater in patients cannulated within 12 hours of arrival (59%) compared with those cannulated after 12 hours (40%, P < .05). Multiple logistic regression identified age, duration of mechanical ventilation before transfer, four or more dysfunctional organs, and the requirement for ECLS as independent predictors of mortality.
  
  
  CONCLUSIONS
  An approach that emphasizes lung protection and early implementation of extracorporeal life support is associated with high rates of survival in patients with severe respiratory failure.
authors.affiliation: Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0331, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Rich
authors.forename: S S
authors.initials: SS
authors.lastname: Awad
authors.forename: S
authors.initials: S
authors.lastname: Kolla
authors.forename: G
authors.initials: G
authors.lastname: Annich
authors.forename: R J
authors.initials: RJ
authors.lastname: Schreiner
authors.forename: R B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: R H
authors.initials: RH
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008020:Life Support Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome