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Rationale: Choosing the best ventilation strategy for acute respiratory distress syndrome (ARDS) is complex, yet it is highly relevant to clinicians during a respiratory pandemic. Objectives: To co...

Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described.To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS, including refractory hypoxemia.This was a prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring an FiWe enrolled 664 patients: 222 (33%) with moderate and 442 (67%) with severe ARDS. On Study Day 1, mean Vt was 7.5 (SD = 2.1) ml/kg predicted body weight (n = 625); 80% (n = 501) received Vt greater than 6 ml/kg. Mean positive end-expiratory pressure (PEEP) was 10.5 (3.7) cm HPatients 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.

Disability risk groups and 1-year outcome after greater than or equal to 7 days of mechanical ventilation (MV) in medical/surgical intensive care unit (ICU) patients are unknown and may inform education, prognostication, rehabilitation, and study design.To stratify patients for post-ICU disability and recovery to 1 year after critical illness.We evaluated a multicenter cohort of 391 medical/surgical ICU patients who received greater than or equal to 1 week of MV at 7 days and 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling.The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to 1-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay. By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post-ICU healthcare use, and disposition. Patients less than 42 years with ICU length of stay less than 2 weeks had the best function and fewest deaths at 1 year compared with patients greater than 66 years with ICU length of stay greater than 2 weeks who sustained the worst disability and 40% 1-year mortality. Depressive symptoms (17%) and post-traumatic stress disorder (18%) persisted at 1 year.ICU survivors of greater than or equal to 1 week of MV may be stratified into four disability groups based on age and ICU length of stay. These groups determine 1-year recovery and healthcare use and are independent of admitting diagnosis and illness severity. Clinical trial registered with www.clinicaltrials.gov (NCT 00896220).

VENTILATION: THE TOWARDS RECOVER STUDY Herridge, Margaret; Chu, Leslie M; Matte, Andrea; Chan, Linda; Tomlinson, George; Ferguson, Niall; Mehta, Sangeeta; Friedrich, Jan; Adhikari, Neill; Fowler, Robert; Lamontagne, Francois; Rudkowski, Jill; Meggison, Hilary; Skrobik, Yoanna; Ayas, Najib; Batt, Jane; dos Santos, Claudia; Flannery, John; Abbey, Susan; Rubenfeld, Gordon; Scales, Damon; Cuthbertson, Brian; Sinuff, Tasnim; Fan, Eddy; Thomas, Claire; Slutsky, Arthur; Levasseur, Melanie; Bayley, Mark; Lee, Christie; Lo, Vincent; Mathur, Sunita; Tan, Adrienne; Wilcox, Elizabeth; Marshall, John; Cook, Deborah; Cameron, Jill University Health Network, Medicine / Critical Care, Toronto, Canada; University of Toronto, Occupational Science and Occupational Therapy, Toronto, Canada; University of Toronto, Public Health Sciences, Toronto, Canada; University of Toronto, Medicine / Critical Care, Toronto, Canada; University of Toronto, Medicine, Toronto, Canada; Hospitalier Universitaire de Sherbrooke, Critical Care, Sherbrooke, Canada; McMaster University, Medicine, Hamilton, Canada; The Ottawa Hospital, Critical Care, Ottawa, Canada; Hopital Maisonneuve Rosemont, Critical Care, Montreal, Canada; St. Paul's Hospital, Critical Care, Vancouver, Canada; University of Toronto, Physiatry, Toronto, Canada; University Health Network, Psychiatry, Toronto, Canada; University Health Network, Medicine, Toronto, Canada; Universite de Sherbrooke, Medicine & Health Science, Sherbrooke, Canada; Mt. Sinai Hospital, Critical Care, Toronto, Canada; University Health Network, Critical Care, Toronto, Canada; University of Toronto, Physical Therapy, Toronto, Canada; University of Toronto, Psychiatry, Toronto, Canada