Clinical Case Database / Category: Case Based Discussion

ARDS: When basic management fails, what happens next?

Publication details

Dr Amy Rose Davies, Dr Hannah Swinburne-Cloke, Dr Lorna Burrows
Foundation Years Journal, volume 9, issue 9, p.10 (123Doc Education, London, October 2015)


While working on the Intensive Care Unit (ICU), we came across a young trauma patient who developed ARDS secondary to fat emboli from a femoral fracture. He deteriorated rapidly despite maximal ventilatory support. An improvement was only demonstrated after proning the patient. In this article, we discuss the patient's management and reflect upon the new interventions that are being developed to manage ARDS; a condition that continues to carry a high mortality rate.

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Dr Amy Rose Davies (Corresponding author)

Foundation Year 2 Doctor
Southmead Hospital
Southmead Road, Bristol, BS10 5NB

Dr Hannah Swinburne-Cloke

Foundation Year 1 Doctor
Southmead Hospital
Southmead Road, Bristol, BS10 5NB

Dr Lorna Burrows

Consultant in Anaesthesia & Intensive Care Medicine
Southmead Hospital
Southmead Road, Bristol, BS10 5NB


1. The ARDS Definition Task Force*. Acute Respiratory Distress Syndrome: The Berlin Definition.
JAMA. 2012;307(23):2526-2533. doi:10.1001/jama.2012.5669. "
2. Ferguson ND, Fan E, Camporota L, et al. The Berlin definition of ARDS: an expanded
rationale, justification, and supplementary material. Intensive Care Med. 2012;38:1573–1582.
3. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as
compared with traditional tidal volumes for acute lung injury and the acute respiratory distress
syndrome. N Engl J Med 2000;342:1301-1308
4. Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory
pressures in patients with the acute respiratory distress syndrome. N Engl J Med.
5. Briel M, Meade M, Mercat A et al. Higher vs lower positive end-expiratory pressure in
patients with acute lung injury and acute respiratory distress syndrome: systematic review and
meta-analysis. JAMA. 2010; 303(9):865–873.
6. Vasilyev S, Schaap RN, Mortensen JD: Hospital survival rates of patients with acute
respiratory failure in modern respiratory intensive care units. Chest 1995, 107:1083-1088
7. Papazian L, Forel J-M, Gacouin A, et al. ACURASYS study investigators. Neuromuscular
blockers in early acute respiratory distress syndrome. N Engl J Med. 2010; 363:1107-16
8. Gattinoni L, Tognoni G, Pesenti A, et al Effect of prone positioning on the survival of
patients with acute respiratory failure. N Engl J Med 2001; 345:568–573
9. Beitler JR, Shaefi S, Montesi SB, et al. Prone positioning reduces mor-tality from acute
respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive care
medicine. 2014;40(3):332-341
10. Guérin C, Reignier J, Richard JC,et al. Prone positioning in severe acute respiratory distress
syndrome (PROSEVA). N Engl J Med. 2013; 368:2159-2168
11. ARDS referral flowchart. ICU management and referral guidelines for severe hypoxic
respiratory failure. South Wales Critical Care Network. 2011. Website:
uk/sites3/documents/962/welsh critical care net-works severe hypoxic
respiratory failure guidelines.pdf (accessed 14th July 2015)
12. Kregenow DA, Rubenfeld GD, Hudson LD, Swenson ER. Hypercapnic acidosis and mortality
in acute lung injury. Crit Care Med 2006;34:1–7.


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