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Ventilatory strategies ARDS

Fernando G Zampieri, Bruno Mazza
Sepsis is the main cause of close to 70% of all cases of acute respiratory distress syndromes (ARDS). In addition, sepsis increases susceptibility to ventilator-induced lung injury. Therefore, the development of a ventilatory strategy that can achieve adequate oxygenation without injuring the lungs is highly sought after for patients with acute infection and represents an important therapeutic window to improve patient care. Suboptimal ventilatory settings can not only harm the lung, but may also contribute to the cascade of organ failure in sepsis due to organ crosstalk...
July 21, 2016: Shock
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
Davide Chiumello, Matteo Brioni
BACKGROUND: Acute respiratory distress syndrome (ARDS) is characterized by a noncardiogenic pulmonary edema with bilateral chest X-ray opacities and reduction in lung compliance, and the hallmark of the syndrome is hypoxemia refractory to oxygen therapy. Severe hypoxemia (PaO2/FiO2 < 100 mmHg), which defines severe ARDS, can be found in 20-30 % of the patients and is associated with the highest mortality rate. Although the standard supportive treatment remains mechanical ventilation (noninvasive and invasive), possible adjuvant therapies can be considered...
2016: Critical Care: the Official Journal of the Critical Care Forum
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
Inderpaul Singh Sehgal, Sahajal Dhooria, Digambar Behera, Ritesh Agarwal
Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy...
March 2016: Indian Journal of Critical Care Medicine
Thomas Bein, Salvatore Grasso, Onnen Moerer, Michael Quintel, Claude Guerin, Maria Deja, Anita Brondani, Sangeeta Mehta
PURPOSE: Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. METHODS AND RESULTS: A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO2/FIO2 < 100...
May 2016: Intensive Care Medicine
Takeshi Yoshida, Ryousuke Takegawa, Hiroshi Ogura
Fifteen years have passed since lung protective strategy to the patients with acute respiratory distress syndrome (ARDS) established. Recently, the new Berlin Definition of ARDS has been developed and this classified ARDS into three stages (mild, moderate, and severe ARDS), depending on the PaO2/FiO2. After this new definition of ARDS, each treatment to the patients with ARDS should be considered, depending on the severity of lung injury, such as prone position to the patients with severe ARDS, muscle paralysis to the patients with severe ARDS...
February 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Chiara Lazzeri, Giovanni Cianchi, Manuela Bonizzoli, Stefano Batacchi, Adriano Peris, Gian Franco Gensini
Bedside use of Doppler echocardiography is being featured as a promising, clinically useful tool in assessing the pulmonary circulation in patients with acute respiratory distress syndrome (ARDS). The present review is aimed at summarizing the available evidence obtained with echocardiography on right ventricle (RV) function and pulmonary circulation in ARDS and to highlight the potential of this technique in clinical practice (only articles in English language were considered). According to the available evidence on echocardiographic findings, the following conclusions can be drawn: (a) echocardiography (transthoracic and transesophageal) has a growing role in the management ARDS patients mainly because of the strict interactions between the lung (and ventilation) and the RV and pulmonary circulation; (b) there may be a continuum of alterations in RV size and function and pulmonary circulation which may end in the development of acute cor pulmonale, probably paralleling ARDS disease severity; and (c) the detection of acute cor pulmonale should prompt intensivists to tailor their ventilatory strategy to the individual patient depending on the echocardiography findings...
April 2016: Therapeutic Advances in Respiratory Disease
François Lellouche, Mathieu Delorme, Jean Bussières, Alexandre Ouattara
Recent data promote the utilization of prophylactic protective ventilation even in patients without acute respiratory distress syndrome (ARDS), and especially after cardiac surgery. The implementation of specific perioperative ventilatory strategies in patients undergoing cardiac surgery can improve both respiratory and extra-pulmonary outcomes. Protective ventilation is not limited to tidal volume reduction. The major components of ventilatory management include assist-controlled mechanical ventilation with low tidal volumes (6-8 mL kg(-1) of predicted body weight) associated with higher positive end-expiratory pressure (PEEP), limitation of fraction of inspired oxygen (FiO2), ventilation maintenance during cardiopulmonary bypass, and finally recruitment maneuvers...
September 2015: Best Practice & Research. Clinical Anaesthesiology
Xavier Repessé, Cyril Charron, Antoine Vieillard-Baron
PURPOSE OF REVIEW: Circulatory failure is a frequent complication during acute respiratory distress syndrome (ARDS) and is associated with a poor outcome. This review aims at clarifying the mechanisms of circulatory failure during ARDS. RECENT FINDINGS: For the past decades, the right ventricle (RV) has gained a crucial interest since many authors confirmed the high incidence of acute cor pulmonale during ARDS and showed a potential role of the acute cor pulmonale in the poor outcome of ARDS patients...
February 2016: Current Opinion in Critical Care
Raquel S Santos, Pedro L Silva, Paolo Pelosi, Patricia Rm Rocco
Acute respiratory distress syndrome (ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers (RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange (functional recruitment)...
November 4, 2015: World Journal of Critical Care Medicine
A A Luo, V Fanelli, P M Spieth, S Uhlig, J Laffey, A S Slutsky, H Zhang
INTRODUCTION: The mortality rate of acute respiratory distress syndrome (ARDS) remains unacceptably high despite that lung protective ventilatory strategies have been widely used. Pharmacological therapy is required to further reduce ARDS mortality. Mechanical ventilation is associated with oxidative stress and lung fibrosis, which may contribute to increased mortality and poor quality of life in ARDS. We hypothesized that the cytokine, midkine (MK), that can be upregulated during oxidative stress, facilitates the development of ARDS- associated lung fibrosis...
October 2015: Shock
Martin Beiderlinden
Protective ventilation is a treatment strategy for patients with ARDS. The main goals are the prevention of de-recruitment and overinflation and hence development of VILI. Therefore, protective ventilation is an individualised therapy by adjusting PEEP and Vt in respect to patient' own volume-pressure-curve. Nowadays the term "protective ventilation" is reduced to ventilation with Vt 6 ml/kg only. Although protective ventilatory strategies are used in patients with severe pulmonary impairment there is a trend to transfer this strategy to healthy humans undergoing surgery...
September 2015: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Zachary N Kon, Siamak Dahi, Charles F Evans, Kimberly A Byrnes, Gregory J Bittle, Brody Wehman, Raymond P Rector, Brian M McCormick, Daniel L Herr, Pablo G Sanchez, Si M Pham, Bartley P Griffith
BACKGROUND: The use of venovenous extracorporeal membrane oxygenation (ECMO) has increased as a bridge to recovery for acute respiratory distress syndrome (ARDS) refractory to conventional support. Morbid obesity can pose a significant challenge to obtaining indexed flows, and outcomes in this population are not well described. METHODS: Patients requiring ECMO for ARDS between January 2009 and November 2012 were retrospectively reviewed. Demographics, ECMO variables, and outcomes were assessed...
November 2015: Annals of Thoracic Surgery
Zachary N Kon, Siamak Dahi, Charles F Evans, Kimberly A Byrnes, Gregory J Bittle, Brody Wehman, Raymond P Rector, Brian M McCormick, Daniel L Herr, Pablo G Sanchez, Si M Pham, Bartley P Griffith
BACKGROUND: Given substantial advances in venovenous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described, the utility and outcomes of long-term support remain unclear. METHODS: Patients requiring ECMO for ARDS between January 2009 and November 2012 were retrospectively reviewed and analyzed separately for those requiring ECMO support for less than 3 weeks or for 3 weeks or longer...
December 2015: Annals of Thoracic Surgery
Cíntia Lourenço Santos, Cynthia dos Santos Samary, Pedro Laurindo Fiorio Júnior, Bruna Lourenço Santos, Alberto Schanaider
Supporting patients with acute respiratory distress syndrome (ARDS), using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP) is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM) can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume...
March 2015: Revista do Colégio Brasileiro de Cirurgiões
Ewan C Goligher, Ghislaine Douflé, Eddy Fan
Novel approaches to the management of acute respiratory distress syndrome include strategies to enhance alveolar liquid clearance, promote epithelial cell growth and recovery after acute lung injury, and individualize ventilator care on the basis of physiological responses. The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards such as those set out by the ECMONet working group. Prognostic tools such as the RESP score can assist clinicians in predicting outcomes for patients with severe acute respiratory failure but do not predict whether ECMO will enhance survival...
June 15, 2015: American Journal of Respiratory and Critical Care Medicine
Rong Zhang, Ying Pan, Vito Fanelli, Sulong Wu, Alice Aili Luo, Diana Islam, Bing Han, Pu Mao, Mirna Ghazarian, Wenmei Zeng, Peter M Spieth, Dingyan Wang, Julie Khang, Hongyin Mo, Xiaoqing Liu, Stefan Uhlig, Mingyao Liu, John Laffey, Arthur S Slutsky, Yimin Li, Haibo Zhang
RATIONALE: Lung-protective ventilatory strategies have been widely used in patients with acute respiratory distress syndrome (ARDS), but the ARDS mortality rate remains unacceptably high and there is no proven pharmacologic therapy. OBJECTIVES: Mechanical ventilation can induce oxidative stress and lung fibrosis, which may contribute to high dependency on ventilator support and increased ARDS mortality. We hypothesized that the novel cytokine, midkine (MK), which can be up-regulated in oxidative stress, plays a key role in the pathogenesis of ARDS-associated lung fibrosis...
August 1, 2015: American Journal of Respiratory and Critical Care Medicine
Charles Sharp, Ann B Millar, Andrew R L Medford
The clinical syndrome of acute lung injury (ALI) occurs as a result of an initial acute systemic inflammatory response. This can be consequent to a plethora of insults, either direct to the lung or indirect. The insult results in increased epithelial permeability, leading to alveolar flooding with a protein-rich oedema fluid. The resulting loss of gas exchange leads to acute respiratory failure and typically catastrophic illness, termed acute respiratory distress syndrome (ARDS), requiring ventilatory and critical care support...
2015: Respiration; International Review of Thoracic Diseases
Joseph M Bednarczyk, Shravan Kethireddy, Christopher W White, Darren H Freed, Rohit K Singal, Dean Bell, Syed Zaki Ahmed, Anand Kumar, Bruce Light
PURPOSE: Blastomyces dermatitidis is a dimorphic fungus endemic to North America capable of causing fatal respiratory failure. Acute respiratory distress syndrome (ARDS) complicates up to 10% of pulmonary blastomycosis in hospitalized patients and carries a mortality of 50-90%. This report describes the clinical course of four consecutive patients with blastomycosis-related ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO) during 2009-2014. CLINICAL FEATURES: Four adults were referred from northwestern Ontario, Canada with progressive respiratory illnesses...
July 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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