Please watch the following video and answer the questions to complete this lesson.

Changing the Outcomes in ARDS Proning and Paralysis


Question 1

This video is about which of the following interventions that have been found to improve outcomes in patients with ARDS?

This talk is about proning and paralysis, the two interventions that have been found to improve outcomes in patients with ARDS.

Question 2

The biggest trial that studied prone ventilation and showed improvement in outcomes was:

The 2013 PROSEVA trial was the largest trial at that time that studied prone ventilation and showed improvement in outcomes.

Question 3

Imagine the lungs to be a sponge, and they are fluid filled as in a patient with ARDS. If you put the sponge vertically, the fluid is going to seep down, some of it is going to go away, and some of it is going to remain in the dependent part of the sponge. So, there is an unequal distribution of fluid, and the upper part of the sponge still has some pores which are going to be better aerated. If you tilt it across as would happen with prone positioning, all the fluid is going to go down to the bottom.

The sponge model basically explains three things:

(1) The loss of lung aeration in gravity-dependent lung regions. (2) The shifting of lung densities from the dorsal to the ventral regions. (3) PEEP could _________ the collapsing and compressing forces in these dependent areas.

PEEP could counteract the collapsing and compressing forces in these dependent areas.

Question 4

The initial ARDS trials showed improvement in oxygenation but they were not able to show any mortality benefit. What’s claimed is that the patient selection was probably not appropriate, the duration of prone ventilation was not long enough, and patients were being proned without:

In the last 15 years, there have been five large randomized control trials completed and the outcome has gradually shifted from improvement in oxygenation to actual mortality benefit. The initial trials showed improvement in oxygenation but they were not able to show any mortality benefit. Patient selection was probably not appropriate, the duration of prone ventilation was not long enough, and there was likely no provision of protective ventilation in patients that were being proned.

Question 5

What is one of the significant complications when you use muscle paralysis in these patients with ARDS?

Muscle weakness is a complication when you use muscle paralysis in patients with ARDS.