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David S Hui, Malik Peiris
No abstract text is available yet for this article.
February 7, 2019: Respirology: Official Journal of the Asian Pacific Society of Respirology
Takeshi Yoshida, Marcelo B P Amato, Brian P Kavanagh, Yuji Fujino
PURPOSE OF REVIEW: Facilitating spontaneous breathing has been traditionally recommended during mechanical ventilation in acute respiratory distress syndrome (ARDS). However, early, short-term use of neuromuscular blockade appears to improve survival, and spontaneous effort has been shown to potentiate lung injury in animal and clinical studies. The purpose of this review is to describe the beneficial and deleterious effects of spontaneous breathing in ARDS, explain potential mechanisms for harm, and provide contemporary suggestions for clinical management...
January 31, 2019: Current Opinion in Critical Care
Ahilanandan Dushianthan, Rebecca Cusack, Victoria A Burgess, Michael Pw Grocott, Philip C Calder
BACKGROUND: Acute respiratory distress syndrome (ARDS) is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Pharmacotherapies that moderate inflammation in ARDS are lacking. Several trials have evaluated the effects of pharmaconutrients, given as part of a feeding formula or as a nutritional supplement, on clinical outcomes in critical illness and ARDS. OBJECTIVES: To systematically review and critically appraise available evidence on the effects of immunonutrition compared to standard non-immunonutrition formula feeding on mechanically ventilated adults (aged 18 years or older) with acute respiratory distress syndrome (ARDS)...
January 24, 2019: Cochrane Database of Systematic Reviews
Maurizio Cereda, Yi Xin, Alberto Goffi, Jacob Herrmann, David W Kaczka, Brian P Kavanagh, Gaetano Perchiazzi, Takeshi Yoshida, Rahim R Rizi
Acute respiratory distress syndrome (ARDS) consists of acute hypoxemic respiratory failure characterized by massive and heterogeneously distributed loss of lung aeration caused by diffuse inflammation and edema present in interstitial and alveolar spaces. It is defined by consensus criteria, which include diffuse infiltrates on chest imaging-either plain radiography or computed tomography. This review will summarize how imaging sciences can inform modern respiratory management of ARDS and continue to increase the understanding of the acutely injured lung...
January 17, 2019: Anesthesiology
Nicholas J Johnson, Ellen Caldwell, David J Carlbom, David F Gaieski, Matthew E Prekker, Thomas D Rea, Michael Sayre, Catherine L Hough
OBJECTIVE: To define the incidence of the acute respiratory distress syndrome (ARDS) following out-of-hospital cardiac arrest (OHCA) and characterize its impact on outcome. METHODS: This was a retrospective cohort study conducted at two urban, tertiary, academic hospitals from 2007 to 2014. We included adults with non-traumatic OHCA and survived for ≥48 h. Patients who received mechanical ventilation for ≥24 h, had 2 consecutive arterial blood gases with a ratio of the partial pressure of oxygen to the fraction of inspired oxygen ≤300, and bilateral radiographic opacities within 48 h of hospital admission were defined as having ARDS...
January 14, 2019: Resuscitation
Shahd Horie, Hector Esteban Gonzalez, John G Laffey, Claire H Masterson
Acute respiratory distress syndrome (ARDS) is driven by a severe pro-inflammatory response resulting in lung damage, impaired gas exchange and severe respiratory failure. There is no specific treatment that effectively improves outcome in ARDS. However, in recent years, cell therapy has shown great promise in preclinical ARDS studies. A wide range of cells have been identified as potential candidates for use, among these are mesenchymal stromal cells (MSCs), which are adult multi-lineage cells that can modulate the immune response and enhance repair of damaged tissue...
September 2018: Journal of Thoracic Disease
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate thereby resulting in respiratory failure. Treatment of ARDS is often a multimodal approach using both nonpharmacologic and pharmacologic treatment strategies in addition to trying to reverse the underlying cause of ARDS. Neuromuscular blocking agents (NMBAs) have been prescribed to patients with ARDS as they are thought to decrease inflammation, oxygen consumption, and cardiac output and help facilitate ventilator synchrony...
October 28, 2018: Journal of Critical Care
Hanyujie Kang, Huqin Yang, Zhaohui Tong
PURPOSE: To determine if recruitment manoeuvres (RMs) would decrease 28-day mortality of patients with acute respiratory distress syndrome (ARDS) compared with standard care. MATERIALS AND METHODS: Relevant randomized controlled trials (RCTs) published prior to April 26, 2018 were systematically searched. The primary outcome was mortality. The secondary outcomes were oxygenation, barotrauma or pneumothorax, the need for rescue therapies. Data were pooled using the random effects model...
November 3, 2018: Journal of Critical Care
Pratik Sinha, Carolyn S Calfee
PURPOSE OF REVIEW: To provide an overview of the current research in identifying homogeneous subgroups and phenotypes in ARDS. RECENT FINDINGS: In recent years, investigations have used either physiology, clinical data, biomarkers or a combination of these to stratify patients with ARDS into distinct subgroups with divergent clinical outcomes. In some studies, there has also been evidence of differential treatment response within subgroups. Physiologic approaches include stratification based on P/F ratio and ventilatory parameters; stratification based on P/F ratio is already being employed in clinical trials...
February 2019: Current Opinion in Critical Care
Aude Gibelin, Antoine Parrot, Muriel Fartoukh, Nicolas de Prost
PURPOSE OF REVIEW: A prompt identification of the cause of acute respiratory failure (ARF)/acute respiratory distress syndrome (ARDS) is required in order to initiate a targeted treatment. Yet, almost 10% of ARDS patients have no identified ARDS risk factor at ARDS diagnosis. Numerous rare causes of ARF have been reported in this setting. The purpose of this review is to delineate the main rare causes of ARF/ARDS and to provide clinicians with a pragmatic diagnostic work-up. RECENT FINDINGS: Recent epidemiological data have proposed the identification of a subgroup of ARDS patients lacking exposure to common risk factors...
December 5, 2018: Current Opinion in Critical Care
Jeremy R Beitler
PURPOSE OF REVIEW: The most effective strategies for treating the patient with acute respiratory distress syndrome center on minimizing ventilation-induced lung injury (VILI). Yet, current standard-of-care does little to modify mechanical ventilation to patient-specific risk. This review focuses on evaluation of bedside respiratory mechanics, which when interpreted in patient-specific context, affords opportunity to individualize lung-protective ventilation in patients with acute respiratory distress syndrome...
December 5, 2018: Current Opinion in Critical Care
Carlos Toufen Junior, Roberta R De Santis Santiago, Adriana S Hirota, Alysson Roncally S Carvalho, Susimeire Gomes, Marcelo Brito Passos Amato, Carlos Roberto Ribeiro Carvalho
BACKGROUND: Acute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed...
December 7, 2018: Annals of Intensive Care
Martin Ruste, Laurent Bitker, Hodane Yonis, Zakaria Riad, Aurore Louf-Durier, Floriane Lissonde, Sophie Perinel-Ragey, Claude Guerin, Jean-Christophe Richard
BACKGROUND: Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. METHODS: The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution...
December 7, 2018: Annals of Intensive Care
Gustavo A Cortes-Puentes, Richard A Oeckler, John J Marini
Skillfully implemented mechanical ventilation (MV) may prove of immense benefit in restoring physiologic homeostasis. However, since hemodynamic instability is a primary factor influencing mortality in acute respiratory distress syndrome (ARDS), clinicians should be vigilant regarding the potentially deleterious effects of MV on right ventricular (RV) function and pulmonary vascular mechanics (PVM). During both spontaneous and positive pressure MV (PPMV), tidal changes in pleural pressure (PPL ), transpulmonary pressure (PTP , the difference between alveolar pressure and PPL ), and lung volume influence key components of hemodynamics: preload, afterload, heart rate, and myocardial contractility...
September 2018: Annals of Translational Medicine
Fernanda Ferreira Cruz, Lorenzo Ball, Patricia Rieken Macedo Rocco, Paolo Pelosi
Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-induced lung injury (VILI). Areas covered: Several mechanisms of VILI have been described, such as: inspiratory and/or expiratory stress inducing overdistension (volutrauma); interfaces between collapsed or edema-filled alveoli with surrounding open alveoli, acting as stress raisers; alveoli that repetitively open and close during tidal breathing (atelectrauma); and peripheral airway dynamics...
May 2018: Expert Review of Respiratory Medicine
Matthias Derwall, Lukas Martin, Rolf Rossaint
More than fifty years after the first description of acute respiratory distress syndrome (ARDS) by Ashbaugh and colleagues, no specific treatment of the underlying pathophysiological processes is available. The current therapeutic regime is comprised of supportive measures such as lung protective ventilation, restrictive fluid management, paralyzing drugs, and prone positioning. Although vast improvements have been made in ARDS-treatment during the last five decades, mortality among patients with severe ARDS remains at an unacceptable rate of 45%...
December 2018: Expert Review of Respiratory Medicine
Matthieu Schmidt, Guillaume Franchineau, Alain Combes
PURPOSE OF REVIEW: To summarize results of the most recent trials on venovenous extracorporeal membrane oxygenation (VV-ECMO) in severe acute respiratory distress syndrome (ARDS) and to elaborate on the unmet needs regarding VV-ECMO management in this setting. RECENT FINDINGS: Although it was terminated early for futility (i.e., failure to demonstrate a difference in 60-day mortality of 20%), the ECMO to Rescue Lung Injury in Severe ARDS trial of VV-ECMO for severe ARDS reported a nonsignificant, but clinically important, reduction in mortality (35 vs...
February 2019: Current Opinion in Critical Care
Tài Pham, Ary Serpa Neto, Paolo Pelosi, John Gerard Laffey, Candelaria De Haro, Jose Angel Lorente, Giacomo Bellani, Eddy Fan, Laurent Jean Brochard, Antonio Pesenti, Marcus Josephus Schultz, Antonio Artigas
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected WHAT THIS ARTICLE TELLS US THAT IS NEW: Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses BACKGROUND:: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes...
February 2019: Anesthesiology
Matthieu Schmidt, Samir Jaber, Elie Zogheib, Thomas Godet, Gilles Capellier, Alain Combes
BACKGROUND: Extracorporeal carbon-dioxide removal (ECCO2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (Pplat ) (< 30 cmH2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS)...
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Edward J Schenck, Clara Oromendia, Lisa K Torres, David A Berlin, Augustine M K Choi, Ilias I Siempos
BACKGROUND: Observational studies suggest that some patients meeting criteria for ARDS no longer fulfill the oxygenation criterion early in the course of their illness. This subphenotype of rapidly improving ARDS has not been well characterized. We attempted to assess the prevalence, characteristics, and outcomes of rapidly improving ARDS and to identify which variables are useful to predict it. METHODS: A secondary analysis was performed of patient-level data from six ARDS Network randomized controlled trials...
October 22, 2018: Chest
2018-11-13 14:56:05
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