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Ards management

J C Menon, J K Joseph, M P Jose, B L Dhananjaya, O V Oommen
INTRODUCTION: Snakebite is an occupational hazard causing considerable morbidity and mortality worldwide, particularly so in tropical countries like India. OBJECTIVE: The aim of this study is to (i) review the demographic, clinical and laboratory findings in patients (1051) admitted with venomous snakebite (ii) to correlate mortality, morbidity and duration of hospital stay with clinical signs, symptoms and laboratory parameters. METHODS: A retrospective study of 1051 patients treated for snakebite over 10 years (2000 - 2009) in Little Flower Hospital, Angamaly, Kerala...
August 2016: Journal of the Association of Physicians of India
Michele Carron
Non-invasive ventilation (NIV) has assumed an important role in the management of acute respiratory failure (ARF). NIV, compared with standard medical therapy, improves survival and reduces complications in selected patients with ARF. NIV represents the first-line intervention for some forms of ARF, such as chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The use of NIV is also well supported for immunocompromised patients who are at high risk for infectious complications from endotracheal intubation...
September 2016: Annals of Translational Medicine
Giacomo Bellani, John G Laffey, Tài Pham, Fabiana Madotto, Eddy Fan, Laurent Brochard, Andres Esteban, Luciano Gattinoni, Vesna Bumbasirevic, Lise Piquilloud, Frank van Haren, Anders Larsson, Daniel F McAuley, Philippe R Bauer, Yaseen M Arabi, Marco Ranieri, Massimo Antonelli, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS...
October 18, 2016: American Journal of Respiratory and Critical Care Medicine
Mayuresh Chaudhari, Sonu Sharma, Rajesh Kumar Jha, Ramandeep Singh Ahuja, Sandeep Bansal
Primary varicella infection in an immunocompetent young adult is very rare, but it has a high mortality rate due to serious complications. We report a rare association of varicella pneumonia presenting in acute respiratory distress with mild chest pain, however with electrocardiographic and biochemical markers suggestive of acute ST elevation myocardial infarction. Coronary angiography was done to exclude infarction, serum antibody titers confirmed varicella, acyclovir was started, and ARDS was successfully treated with steroid pulse therapy and mechanical ventilator support...
September 2016: Indian Heart Journal
Jonathan A Silversides, Emmet Major, Andrew J Ferguson, Emma E Mann, Daniel F McAuley, John C Marshall, Bronagh Blackwood, Eddy Fan
BACKGROUND: It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients. PURPOSE: To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness...
October 12, 2016: Intensive Care Medicine
Ary Serpa Neto, Carmen S V Barbas, Fabienne D Simonis, Antonio Artigas-Raventós, Jaume Canet, Rogier M Determann, James Anstey, Goran Hedenstierna, Sabrine N T Hemmes, Greet Hermans, Michael Hiesmayr, Markus W Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H Mills, Rupert M Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A Treschan, Edda M Tschernko, Marcos F V Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. METHODS: PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide...
October 4, 2016: Lancet Respiratory Medicine
M S Reich, A J Dolenc, T A Moore, H A Vallier
BACKGROUND: Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. METHODS: Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied...
September 26, 2016: Journal of Orthopaedic Surgery and Research
David Ae Imber, Massimiliano Pirrone, Changsheng Zhang, Daniel F Fisher, Robert M Kacmarek, Lorenzo Berra
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique...
September 13, 2016: Respiratory Care
Christophe Guervilly, Jean-Marie Forel, Sami Hraiech, Antoine Roch, Daniel Talmor, Laurent Papazian
BACKGROUND: High-frequency oscillatory ventilation (HFOV) has not been shown to be beneficial in the management of moderate-to-severe acute respiratory distress syndrome (ARDS). There is uncertainty about the actual pressure applied into the lung during HFOV. We therefore performed a study to compare the transpulmonary pressure (P L) during conventional mechanical ventilation (CMV) and different levels of mean airway pressure (mPaw) during HFOV. METHODS: This is a prospective randomized crossover study in a university teaching hospital...
December 2016: Annals of Intensive Care
Courtney Dean, Yeyuan Xiao, Deborah J Roberts
Little is known about the microbial communities native to surface-deposited pyritic oil sands tailings, an environment where acid rock drainage (ARD) could occur. The goal of this study was to enrich sulfur-oxidizing organisms from these tailings and determine whether different populations exist at pH levels 7, 4.5, and 2.5. Using growth-based methods provides model organisms for use in the future to predict potential activities and limitations of these organisms and to develop possible control methods. Thiosulfate-fed enrichment cultures were monitored for approximately 1 year...
October 2016: Canadian Journal of Microbiology
Gerd Flodgren, Amanda M Hall, Lucy Goulding, Martin P Eccles, Jeremy M Grimshaw, Gillian C Leng, Sasha Shepperd
BACKGROUND: The uptake of clinical practice guidelines (CPGs) is inconsistent, despite their potential to improve the quality of health care and patient outcomes. Some guideline producers have addressed this problem by developing tools to encourage faster adoption of new guidelines. This review focuses on the effectiveness of tools developed and disseminated by guideline producers to improve the uptake of their CPGs. OBJECTIVES: To evaluate the effectiveness of implementation tools developed and disseminated by guideline producers, which accompany or follow the publication of a CPG, to promote uptake...
2016: Cochrane Database of Systematic Reviews
John L Ard, Samir Kendale
A common approach to blood pressure management in the operating room is to keep the intraoperative, pressures within 20% of baseline blood pressure. One question that arises from this recommendation is; what is a patient's true baseline blood pressure? In order to get a more precise definition of baseline blood pressure, a comparison of the first operating room blood pressure was made with the blood pressure taken in a preoperative holding area before surgery, and the blood pressure taken in pre-surgical testing...
August 17, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Juliette Lucinda Hunt, Ronald A Bronicki, Nick Anas
To date, there have been several systematic reviews with meta-analysis that have shown no reduction in mortality with the use of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS). Importantly, these reports fail to make a distinction between the pediatric and adult patient. The number of adult patients in these reviews are far greater than the number of pediatric patients, which makes it difficult to interpret the data regarding the role of iNO on the pediatric population...
2016: Frontiers in Pediatrics
Karolina M Stepien, Anthony S Wierzbicki, Bwee T Poll-The, Hans R Waterham, Christian J Hendriksz
We describe the management and outcomes of pregnancy in a 27-year-old woman with infantile-onset Adult Refsum's disease (ARD). She presented in infancy but was diagnosed with ARD at the age of 10 on basis of phytanic acidaemia and later confirmed to have the phytanoyl-CoA hydroxylase ((PHYH) c.164delT, p.L55fsX12) mutation. Despite repeated plasmapheresis sessions and strict dietary surveillance for 20 years, her phytanic acid levels persistently stayed above the ideal target level of 100 μmol/L but remained below 400 μmol/L...
August 13, 2016: JIMD Reports
Nobuhiro Inatomi, Jun Matsukawa, Yuuichi Sakurai, Kazuyoshi Otake
Acid-related diseases (ARDs), such as peptic ulcers and gastroesophageal reflux disease, represent a major health-care concern. Some major milestones in our understanding of gastric acid secretion and ARD treatment reached during the last 50years include 1) discovery of histamine H2-receptors and development of H2-receptor antagonists, 2) identification of H(+),K(+)-ATPase as the parietal cell proton pump and development of proton pump inhibitors (PPIs), and 3) identification of Helicobacter pylori (H. pylori) as the major cause of peptic ulcers and development of effective eradication regimens...
August 8, 2016: Pharmacology & Therapeutics
Katie R Famous, Kevin Delucchi, Lorraine B Ware, Kirsten N Kangelaris, Kathleen D Liu, B Taylor Thompson, Carolyn S Calfee
BACKGROUND: We previously identified two ARDS subphenotypes in two separate randomized controlled trials, with differential response to positive end-expiratory pressure. The current analysis sought to identify these subphenotypes in a third ARDS cohort, to test whether subphenotypes respond differently to fluid management strategy, and to develop a practical model for subphenotype identification. METHODS:  We used latent class analysis of baseline clinical and plasma biomarker data to identify subphenotypes in the Fluid and Catheter Treatment Trial (FACTT; n=1000)...
August 11, 2016: American Journal of Respiratory and Critical Care Medicine
S Cutts, R Talboys, C Paspula, E M Prempeh, R Fanous, D Ail
Adult respiratory distress syndrome (ARDS) has now been described as a sequela to such diverse conditions as burns, amniotic fluid embolism, acute pancreatitis, trauma, sepsis and damage as a result of elective surgery in general. Patients with ARDS require immediate intubation, with the average patient now being ventilated for between 8 and 11 days. While the acute management of ARDS is conducted by the critical care team, almost any surgical patient can be affected by the condition and we believe that it is important that a broader spectrum of hospital doctors gain an understanding of the nature of the pathology and its current treatment...
August 11, 2016: Annals of the Royal College of Surgeons of England
Saowaros Suwansa-Ard, Wilairat Kankuan, Tipsuda Thongbuakaew, Jirawat Saetan, Napamanee Kornthong, Thanapong Kruangkum, Kanjana Khornchatri, Scott F Cummins, Ciro Isidoro, Prasert Sobhon
BACKGROUND: The giant freshwater prawn, Macrobrachium rosenbergii, is a decapod crustacean that is commercially important as a food source. Farming of commercial crustaceans requires an efficient management strategy because the animals are easily subjected to stress and diseases during the culture. Autophagy, a stress response process, is well-documented and conserved in most animals, yet it is poorly studied in crustaceans. RESULTS: In this study, we have performed an in silico search for transcripts encoding autophagy-related (Atg) proteins within various tissue transcriptomes of M...
2016: BMC Genomics
Yusuke Takahashi, Noriyuki Matsutani, Hitoshi Dejima, Takashi Nakayama, Ryo Okamura, Hirofumi Uehara, Masafumi Kawamura
BACKGROUND: Surgical acute respiratory distress syndrome (ARDS) is an extremely critical condition which may occur after major lung resection. Despite advances in minimally invasive surgical procedures and progress in the therapeutic management of this disease, prognosis remains poor. In this study, we investigated the contribution of high-mobility group box 1 (HMGB1) in a surgical ARDS model and evaluated the possible therapeutic effect of recombinant thrombomodulin (rTM) for the treatment of surgical ARDS...
November 2016: Journal of Trauma and Acute Care Surgery
Joel Kian Boon Lim, Jan Hau Lee, Ira M Cheifetz
INTRODUCTION: Pediatric acute respiratory distress syndrome (ARDS) remains a diagnostic and therapeutic challenge with significant mortality and morbidity. There are limited data to guide identification and management. AREAS COVERED: The Pediatric Acute Lung Injury Consensus Conference recently proposed pediatric-specific definitions for ARDS and management recommendations. In this review, we discuss aspects of pediatric ARDS that have received more attention over the past few years: high frequency oscillatory ventilation, administration of corticosteroids and functional outcomes...
October 2016: Expert Review of Respiratory Medicine
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