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Vivian Rotman, Alysson Roncally Carvalho, Rosana Souza Rodrigues, Denise Machado Medeiros, Eduardo Costa Pinto, Fernando Augusto Bozza, Carlos Roberto Ribeiro Carvalho
BACKGROUND: Ventilation with low tidal volume (VT) is well recognized as a protective approach to patients with acute respiratory distress syndrome (ARDS), but the optimal level of positive end-expiratory pressure (PEEP) remains uncertain. This study aims to evaluate two protective ventilatory strategies sequentially applied in patients with early ARDS. METHODS: In this prospective cohort study, fifteen patients were ventilated during 24 h with positive end-expiratory pressure (PEEP) adjusted according to the ARDSnet low-PEEP table (ARDSnet-24 h)...
2016: BMC Anesthesiology
Chun Pan, Lu Chen, Yun-Hang Zhang, Wei Liu, Rosario Urbino, V Marco Ranieri, Hai-Bo Qiu, Yi Yang
BACKGROUND: Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients. However, airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance. This study was to evaluate the Pawstress index on lung mechanics and the correlation between Pawstress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients...
July 20, 2016: Chinese Medical Journal
Niki D J Ubags, Renee D Stapleton, Juanita H J Vernooy, Elianne Burg, Jenna Bement, Catherine M Hayes, Sebastian Ventrone, Lennart Zabeau, Jan Tavernier, Matthew E Poynter, Polly E Parsons, Anne E Dixon, Matthew J Wargo, Benjamin Littenberg, Emiel F M Wouters, Benjamin T Suratt
We have previously reported that obesity attenuates pulmonary inflammation in both patients with acute respiratory distress syndrome (ARDS) and in mouse models of the disease. We hypothesized that obesity-associated hyperleptinemia, and not body mass per se, drives attenuation of the pulmonary inflammatory response and that this e_ect could also impair the host response to pneumonia. We examined the correlation between circulating leptin levels and risk, severity, and outcome of pneumonia in 2 patient cohorts (NHANES III and ARDSNet-ALVEOLI) and in mouse models of diet-induced obesity and lean hyperleptinemia...
June 2, 2016: JCI Insight
Elias Baedorf Kassis, Stephen H Loring, Daniel Talmor
PURPOSE: The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure [plateau pressure-positive end-expiratory pressure (PEEP)] does not account for variable chest wall compliance. Esophageal manometry can be utilized to determine transpulmonary driving pressure. We have examined the relationships between respiratory system and transpulmonary driving pressure, pulmonary mechanics and 28-day mortality...
August 2016: Intensive Care Medicine
J Retamal, J B Borges, A Bruhn, R Feinstein, G Hedenstierna, F Suarez-Sipmann, A Larsson
BACKGROUND: We recently reported that a high respiratory rate was associated with less inflammation than a low respiratory rate, but caused more pulmonary edema in a model of ARDS when an ARDSNet ventilatory strategy was used. We hypothesized that an open lung approach (OLA) strategy would neutralize the independent effects of respiratory rate on lung inflammation and edema. This hypothesis was tested in an ARDS model using two clinically relevant respiratory rates during OLA strategy...
September 2016: Acta Anaesthesiologica Scandinavica
Kitty S Chan, Lisa Aronson Friedman, Victor D Dinglas, Catherine L Hough, Peter E Morris, Pedro A Mendez-Tellez, James C Jackson, E Wesley Ely, Ramona O Hopkins, Dale M Needham
OBJECTIVE: To examine the reliability, validity, responsiveness, and minimal important difference of the 4-m gait speed test in acute respiratory distress syndrome survivors. DESIGN: Secondary analyses of data from two longitudinal follow-up studies of acute respiratory distress syndrome survivors. Test-retest and inter-rater reliability, construct validity (convergent, discriminant, and known group), predictive validity, and responsiveness were examined. The minimal important difference was estimated using anchor- and distribution-based approaches...
May 2016: Critical Care Medicine
Suman Yadam, Eric Bihler, Marvin Balaan
Acute respiratory distress syndrome (ARDS) is a serious inflammatory disorder with high mortality. Its main pathologic mechanism seems to result from increased alveolar permeability. Its definition has also changed since first being described according to the Berlin definition, which now classifies ARDS on a severity scale based on PaO2 (partial pressure of oxygen, arterial)/FIO2 (fraction of inspired oxygen) ratio. The cornerstone of therapy was found to be a low tidal volume strategy featuring volumes of 6 to 8 mL per kg of ideal body weight that has been shown to have decreased mortality as proven by the ARDSnet trials...
April 2016: Critical Care Nursing Quarterly
Bryan Collier, Chris Vieau, Ellen Lockhart, Eric Bradburn, Mark Hamill, Katie Love, Chris Reed, Christopher Baker
BACKGROUND: The ARDSnet (Acute Respiratory Distress Syndrome Clinical Network) study demonstrated that low tidal volume (Vt) reduces mortality from ARDS. It is unknown whether low Vt is beneficial in at-risk trauma patients. We hypothesized that Vt selection would be low in accordance with ARDSnet criteria and that subsequent outcomes would be improved. STUDY DESIGN: A 1-year retrospective observational study was conducted on all trauma patients aged 15 years and older and on mechanical ventilation for 48 hours or longer, excluding those with cardiopulmonary disease...
April 2016: Journal of the American College of Surgeons
Andreas Schwingshackl, Dai Kimura, Cynthia R Rovnaghi, Jordy S Saravia, Stephania A Cormier, Bin Teng, Alina N West, Umberto G Meduri, Kanwaljeet J S Anand
OBJECTIVE: A double-blind, randomized controlled trial showed that low-dose glucocorticoid therapy in pediatric ARDS patients is feasible and may improve both ventilation and oxygenation indices in these patients. However, the molecular mechanisms underlying potential changes in outcomes remain unclear. Based on these clinical findings, this study was designed to examine the effects of intravenous methylprednisolone on circulating inflammatory biomarkers in pediatric ARDS patients. DESIGN: Double-blind, placebo-controlled randomized trial with blood collection on study entry and day 7...
January 2016: Cytokine
Charlotte J Beurskens, Hamid Aslami, Friso M de Beer, Joris Jth Roelofs, Margreeth B Vroom, Nicole P Juffermans
BACKGROUND: Heliox has a lower density and higher diffusion capacity compared to oxygen-in-air. We hypothesized that heliox ventilation allows for a reduction in minute volume ventilation and inspiratory pressures needed for adequate gas exchange in an animal model of an acute lung injury. METHODS: After intratracheal instillation of lipopolysaccharide (10 mg/kg), adult rats were randomized to ventilation with either a gas mixture of helium/oxygen (50:50%) or oxygen/air (50:50%)...
December 2014: Intensive Care Medicine Experimental
J Retamal, J B Borges, A Bruhn, X Cao, R Feinstein, G Hedenstierna, S Johansson, F Suarez-Sipmann, A Larsson
BACKGROUND: The independent impact of respiratory rate on ventilator-induced lung injury has not been fully elucidated. The aim of this study was to investigate the effects of two clinically relevant respiratory rates on early ventilator-induced lung injury evolution and lung edema during the protective ARDSNet strategy. We hypothesized that the use of a higher respiratory rate during a protective ARDSNet ventilation strategy increases lung inflammation and, in addition, lung edema associated to strain-induced activation of transforming growth factor beta (TGF-β) in the lung epithelium...
January 2016: Acta Anaesthesiologica Scandinavica
Gagandeep Dhillon, Palepu B Gopal, Akshata S Kamat, K P Mulavisala
We report a case of 27-year-old male with lung contusions related acute respiratory distress syndrome (ARDS) managed by ARDSNet guidelines and additional hypothermia. On 4(th) day, post trauma partial pressure of oxygen dropped to 38 mm of mercury (Hg), not improving even on high positive end-expiratory pressure of 18 cm water (H2O), inverse ratio ventilation and fraction of inspired oxygen of 1. Extracorporeal membrane oxygenation was ruled out due to the risk of hemorrhage from trauma sites. Thereafter, hypothermia along with muscle paralysis was considered to reduce total body oxygen consumption...
June 2015: Indian Journal of Critical Care Medicine
Kevin K Chung, Ryan Y Rhie, Jonathan B Lundy, Robert Cartotto, Elizabeth Henderson, Melissa A Pressman, Victor C Joe, James K Aden, Ian R Driscoll, Lee D Faucher, Robert C McDermid, Ronald P Mlcak, William L Hickerson, James C Jeng
Burn injury introduces unique clinical challenges that make it difficult to extrapolate mechanical ventilator (MV) practices designed for the management of general critical care patients to the burn population. We hypothesize that no consensus exists among North American burn centers with regard to optimal ventilator practices. The purpose of this study is to examine various MV practice patterns in the burn population and to identify potential opportunities for future research. A researcher designed, 24-item survey was sent electronically to 129 burn centers...
March 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Elizabeth R Pfoh, Kitty S Chan, Victor D Dinglas, Timothy D Girard, James C Jackson, Peter E Morris, Catherine L Hough, Pedro A Mendez-Tellez, E Wesley Ely, Minxuan Huang, Dale M Needham, Ramona O Hopkins
INTRODUCTION: The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure. METHODS: This cross-sectional analysis used data from the ARDSNet Long Term Outcomes Study (ALTOS) and Awakening and Breathing Controlled Trial (ABC)...
2015: Critical Care: the Official Journal of the Critical Care Forum
Arthur S Slutsky
Mechanical ventilation is a life-saving therapy that catalyzed the development of modern intensive care units. The origins of modern mechanical ventilation can be traced back about five centuries to the seminal work of Andreas Vesalius. This article is a short history of mechanical ventilation, tracing its origins over the centuries to the present day. One of the great advances in ventilatory support over the past few decades has been the development of lung-protective ventilatory strategies, based on our understanding of the iatrogenic consequences of mechanical ventilation such as ventilator-induced lung injury...
May 15, 2015: American Journal of Respiratory and Critical Care Medicine
Stephen W Davies, Kenji L Leonard, Randall K Falls, Ronald P Mageau, Jimmy T Efird, Joseph P Hollowell, Wayne E Trainor, Hilal A Kanaan, Robert C Hickner, Robert G Sawyer, Nathaniel R Poulin, Brett H Waibel, Eric A Toschlog
BACKGROUND: Concomitant lung/brain traumatic injury results in significant morbidity and mortality. Lung protective ventilation (Acute Respiratory Distress Syndrome Network [ARDSNet]) has become the standard for managing adult respiratory distress syndrome; however, the resulting permissive hypercapnea may compound traumatic brain injury. Airway pressure release ventilation (APRV) offers an alternative strategy for the management of this patient population. APRV was hypothesized to retard the progression of acute lung/brain injury to a degree greater than ARDSNet in a swine model...
February 2015: Journal of Trauma and Acute Care Surgery
Olinto Linares-Perdomo, Thomas D East, Roy Brower, Alan H Morris
BACKGROUND: Recent recommendations for lung protective mechanical ventilation include a tidal volume target of 6 mL/kg predicted body weight (PBW). Different PBW equations might introduce important differences in tidal volumes delivered to research subjects and patients. METHODS: PBW equations use height, age, and sex as input variables. We compared National Institutes of Health (NIH) ARDS Network (ARDSNet), actuarial table (ACTUARIAL), and Stewart (STEWART) PBW equations used in clinical trials, across physiologic ranges for age and height...
July 2015: Chest
Carlos A Santacruz, Diego Orbegozo, Jean-Louis Vincent, Jean Charles Preiser
BACKGROUND: Pharmaconutrition including omega-3 and competitive analogs of omega-6 fatty acids has been used to modulate the inflammatory response during acute respiratory distress syndrome (ARDS). The clinical benefit of this approach when assessed in prospective randomized clinical trials has been inconsistent. We tried to assess the reasons for the conflicting results, including the possible influence of the composition of the control solution. METHODS: We collected data from studies listed in PubMed, Ovid, the Cochrane Database of Systematic Reviews, Embase, the U...
September 2015: JPEN. Journal of Parenteral and Enteral Nutrition
Henry J Silverman, Didier Dreyfuss
Even though the interventions were adapted from standard clinical practice, the way they were provided meant that the care given infants in the study was distinctly different from standard care, with different risk profiles. Parents should have been informed about those differences.
January 2015: Hastings Center Report
Ahilanandan Dushianthan, Rebecca Cusack, Nigel Chee, John-Oliver Dunn, Michael P W Grocott
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a potentially devastating refractory hypoxemic illness with multi-organ involvement. Although several randomised controlled trials into ventilator and fluid management strategies have provided level 1 evidence to guide supportive therapy, there are few, established guidelines on how to manage patients with ARDS. In addition, and despite their continued use, pharmacotherapies for ARDS disease modulation have no proven benefit in improving mortality...
2014: BMC Anesthesiology
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