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Ards, shock, ventilator, sepsis, respiratory, trauma,

Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
Gary F Nieman, Louis A Gatto, Jason H T Bates, Nader M Habashi
Trauma, hemorrhagic shock, or sepsis can incite systemic inflammatory response syndrome, which can result in early acute lung injury (EALI). As EALI advances, improperly set mechanical ventilation (MV) can amplify early injury into a secondary ventilator-induced lung injury that invariably develops into overt ARDS. Once established, ARDS is refractory to most therapeutic strategies, which have not been able to lower ARDS mortality below the current unacceptably high 40%. Low tidal volume ventilation is one of the few treatments shown to have a moderate positive impact on ARDS survival, presumably by reducing ventilator-induced lung injury...
December 2015: Chest
S John, C Willam
BACKGROUND: The lungs and kidneys represent the most often affected organs (acute respiratory distress syndrome, ARDS or kidney failure) in multiple organ failure (MOF) due to shock, trauma, or sepsis with a still unacceptable high mortality for both organ failures. PATHOGENESIS AND INTERACTIONS: Although the exact pathophysiological mechanisms of MOF are not completely elucidated, it appears that the lungs and kidneys share several pathophysiologic pathways and have the potential to further harm each other (kidney-lung crosstalk)...
September 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Sarah C Christiaans, Brant M Wagener, Charles T Esmon, Jean Francois Pittet
The protein C system plays an active role in modulating severe systemic inflammatory processes such as sepsis, trauma, and acute respiratory distress syndrome (ARDS) via its anticoagulant and anti-inflammatory properties. Plasma levels of activated protein C (aPC) are lower than normal in acute inflammation in humans, except early after severe trauma when high plasma levels of aPC may play a mechanistic role in the development of posttraumatic coagulopathy. Thus, following positive results of preclinical studies, a clinical trial (PROWESS) with high continuous doses of recombinant human aPC given for 4 days demonstrated a survival benefit in patients with severe sepsis...
October 1, 2013: American Journal of Physiology. Lung Cellular and Molecular Physiology
Anniken Haavind, Olav Hevrøy, Rune Hennig, Lars Bjertnaes
Pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS) are frequent complications after head trauma. Recombinant human activated protein C (APC) reportedly improves circulation and respiration in severe sepsis, but is contraindicated after head injury because of increased risk of intracranial bleeding. A 21-year-old man with severe head injury after a car accident was endotracheally intubated, mechanically ventilated, and hemodynamically stabilized before transfer to our university hospital...
2011: International Medical Case Reports Journal
C Abreu, L Santos, R Poínhos, A Sarmento
PURPOSE AND METHODS: Acute acalculous cholecystitis (AAC) is an uncommon condition related to serious clinical conditions, such as surgery, trauma, burn injuries and sepsis. The diagnosis of AAC remains challenging to make, since it generally occurs as a secondary event in acutely ill patients with another disease. Imaging evaluation is crucial, and well-known criteria are accepted for the diagnosis. To our knowledge, only case reports of AAC related to 12 malaria adult patients have been published...
August 2013: Infection
Thomas Dienstknecht, Dieter Rixen, Peter Giannoudis, Hans-Christoph Pape
BACKGROUND: In multiply injured patients, definitive stabilization of major fractures is performed whenever feasible, depending on the clinical condition. QUESTIONS/PURPOSES: We therefore asked whether (1) any preoperative indicators predict major complications after major extremity surgery; (2) perioperative routine parameters other than those indicative of hemorrhagic shock predict postoperative complications; and (3) any postoperative clinical findings can predict major complications in the further course of the patient...
September 2013: Clinical Orthopaedics and related Research
K J P van Wessem, M Heeres, P H C Leliefeld, L Koenderman, L P H Leenen
BACKGROUND: Hemorrhagic shock (HS) and sepsis are common after trauma. These trauma patients often need ventilatory support. The resulting hyperinflammatory state can cause neutrophil-mediated complications such as adult respiratory distress syndrome. An important underlying mechanism is polymorphonuclear neutrophil (PMN) priming by damage-associated molecular patterns (DAMPs, caused by, e.g., HS and ventilation) and by pathogen-associated molecular patterns (PAMPs, e.g., lipopolysaccharide [LPS] in sepsis)...
January 2013: Journal of Trauma and Acute Care Surgery
Eric J Seeley
Acute respiratory distress syndrome (ARDS) is a major cause of hypoxemic respiratory failure in adults and can result from several predisposing factors, such as sepsis and trauma, which also predispose patients to acute kidney injury (AKI). Animal models of AKI and ARDS suggest that AKI increases inflammatory cytokines in the circulation such that IL-6 may be a direct mediator of AKI induced lung injury. When ARDS and AKI overlap, intensive care unit length of stay, resource utilization, and mortality increase dramatically...
January 2013: Advances in Chronic Kidney Disease
Tammy N Ferro, Pamela W Goslar, Andrej A Romanovsky, Scott R Petersen
BACKGROUND: There is a high percentage of smokers among trauma patients. Cigarette smoking has been associated with the development of acute lung injury and the adult respiratory distress syndrome in critically ill patients. It is also known that nicotine exerts immunosuppressive and anti-inflammatory effects with chronic use. Trauma patients who are smokers usually go through acute nicotine withdrawal after the traumatic event and during their stay in ICU. How the smoking status and acute nicotine withdrawal affect outcomes after trauma is unknown...
August 2010: Journal of Trauma
Ilias I Siempos, Konstantinos Z Vardakas, Christos E Kyriakopoulos, Theodora K Ntaidou, Matthew E Falagas
Studies exploring predictors of mortality in patients with ventilator-associated pneumonia (VAP) produced conflicting results. The present work is a meta-analysis of studies that enrolled only patients with microbiologically confirmed VAP and reported on mortality. Potentially eligible reports were searched in PubMed, EMBASE, CINAHL, and HEALTHSTAR with no language restrictions. Twenty-six reports were included. Factors associated with mortality were malignancy (odds ratio [OR], 2.20; 95% confidence interval [CI], 1...
June 2010: Shock
Marija Kojicic, Emir Festic, Ognjen Gajic
Acute lung injury and its more severe form acute respiratory distress syndrome (ARDS) are characterized by diffuse impairment of alveolocapillary membrane in the settings of different predisposing conditions such as sepsis, trauma and shock. Many intrahospital exposures, including aspiration, delayed resuscitation, high tidal volume mechanical ventilation and non critical use of transfusions may contribute or worsen ARDS. Therapy is targeted to treatment of predisposing condition, life supportive measures and prevention of nosocomial complications...
October 2009: Bosnian Journal of Basic Medical Sciences
L Wołowicka, B Tamowicz, K Wronka
Haemofiltration (HF) in perioperative period is used in order to improve the function of circulatory system by means of: elimination of cytokines in patients with increased inflammatory cascade activation; improvement of gas exchange conditions by decreasing the amount of lungs extravascular fluid; reduction of high levels of metabolism products; compensation of electrolyte disequilibrium and decreasing of right ventricle afterload as well as right and left ventricles preload. The aim of the study was clinical evaluation of usefulness of continuous vein-to-vein haemofiltration (CVVH) technique used in multiprofile adults intensive care...
2001: Folia Medica Cracoviensia
P Segers, P Van Schil, P Jorens, F Van Den Brande
A retrospective analysis of 187 cases of thoracic trauma seen between January 1, 1994 and June 30, 1999 is presented. The majority of the patients were male (male-female ratio 2.9:1) and the average age at admission was 41.1 years. Blunt trauma, especially motor vehicle accidents (72.2%) and falls (17.1%), were the most frequent causes of chest injury (95.8%). We used the injury severity score (ISS) to assess the severity of trauma. The average ISS for the total group was 27.8 (ranges: 4-75). In only 17.6% of the patients an isolated thoracic trauma was present...
November 2001: Acta Chirurgica Belgica
S G Sakka, K Reinhart, A Meier-Hellmann
OBJECTIVES: We studied the correlation between invasive (aortic fiberoptic) and noninvasive (transcutaneous sensor) measurements of indocyanine green (ICG) plasma disappearance rate (PDR) in critically ill patients. DESIGN AND SETTING: Prospective clinical study in a surgical intensive care unit of a university hospital. PATIENTS: 16 critically ill patients with adult respiratory distress syndrome (n = 8), sepsis/septic shock (n = 6), subarachnoid hemorrhage (n = 1), or severe head injury (n = 1)...
October 2000: Intensive Care Medicine
G Paret, T Ziv, A Augarten, A Barzilai, R Ben-Abraham, A Vardi, Y Manisterski, Z Barzilay
BACKGROUND: Acute respiratory distress syndrome is a well-recognized condition resulting in high permeability pulmonary edema associated with a high morbidity. OBJECTIVES: To examine a 10 year experience of predisposing factors, describe the clinical course, and assess predictors of mortality in children with this syndrome. METHODS: The medical records of all admissions to the pediatric intensive care unit over a 10 year period were evaluated to identify children with ARDS...
November 1999: Israel Medical Association Journal: IMAJ
P A Kraus, J Lipman, C C Lee, W E Wilson, J Scribante, J Barr, L R Mathivha, J M Brown
To test the expanded definition of acute lung injury (ALI), we prospectively, over a period of 8 months, studied all adult ICU admissions who fitted the definition. Our study consisted of 83 patients with the adult respiratory distress syndrome (ARDS) and 60 with mild to moderate ALI. Sepsis and trauma were the most common diagnoses on admission. The overall mortality rate was 45 percent for ARDS and 38 percent in the other group. Mortality rose significantly with associated other organ failure, the incidence of which was as follows: hepatic, 39 percent; cardiac, 38 percent; hematologic, 22 percent; renal, 21 percent; neurologic, 5 percent...
June 1993: Chest
M Antonelli, M L Moro, O Capelli, R A De Blasi, R R D'Errico, G Conti, M Bufi, A Gasparetto
STUDY OBJECTIVES: The aim of the study was to identify risk factors for early onset pneumonia (EOP) in trauma patients, in order to seek possible intervention strategies. STUDY POPULATION: Participants included 124 consecutive trauma patients admitted to a general intensive care unit (ICU) of a university hospital from December 1990 to February 1992 inclusive. DATA COLLECTION: The following data were prospectively collected for each patient: demographics, severity of trauma according to the abbreviated injury scale (AIS), severity of coma according to the Glasgow coma scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and mechanical ventilation...
January 1994: Chest
P S Barie
The catastrophic pulmonary failure that complicates management of patients with multiple trauma or sepsis syndrome with shock is recognizable to nearly all experienced surgeons. However, the spectrum of injury is broad, the distribution of lung injury may be heterogeneous within a single patient, and many patients will not develop acute respiratory distress syndrome (ARDS) even after a major predisposing insult. The lung responds stereotypically to many disparate insults, so a better conceptual construct of ARDS may be to consider it as one component of the multiple organ dysfunction syndrome...
July 1995: World Journal of Surgery
P R Holbrook, G Taylor, M M Pollack, A I Fields
Respiratory distress syndrome is the clinical manifestation of injury to the terminal alveolar-capillary unit, and may result from a variety of nonpulmonary insults including shock, sepsis, and trauma. The clinical characteristics, pathophysiology, and treatment of respiratory distress syndrome in children are reviewed.
August 1980: Pediatric Clinics of North America
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