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https://www.readbyqxmd.com/read/27898438/rescue-therapies-for-acute-respiratory-distress-syndrome-what-to-try-first
#1
Onnen Moerer, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure adequate oxygenation and survival. This review provides a summary and assessment of treatment options that can be beneficial when the standard approach fails. RECENT FINDINGS: 'Life-threatening' conditions or refractory hypoxemia during mechanical ventilation are more a matter of personal rating than an objective diagnosis based on defined and/or unanimously agreed thresholds that would mandate the use of rescue therapies...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27790273/clinical-practice-guideline-of-acute-respiratory-distress-syndrome
#2
REVIEW
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment...
October 2016: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/27624632/respiratory-management-of-perioperative-obese-patients
#3
REVIEW
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...
December 2016: Respiratory Care
https://www.readbyqxmd.com/read/27588065/effect-of-setting-high-aprv-guided-by-expiratory-inflection-point-of-pressure-volume-curve-on-oxygen-delivery-in-canine-models-of-severe-acute-respiratory-distress-syndrome
#4
Jia-Qiong Li, Hong-Yang Xu, Mao-Qin Li, Jing-Yu Chen
In the present study, the effect of setting high airway pressure release ventilation (APRV) pressure guided by an expiratory inflection point of pressure-volume (PV) curve following lung recruitment maneuver (RM) on oxygen delivery (DO2) in canine models of severe acute respiratory distress syndrome (ARDS) was examined. Canine models of severe ARDS were established by intravenous injection of oleic acid. After injection of sedative muscle relaxants, a PV curve plotted using the super-syringe technique, and the pressure at lower inflection point (LIP) at the inhale branch and the pressure at the point of maximum curvature (PMC) at the exhale branch were measured...
September 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27576283/-acute-respiratory-distress-syndrome
#5
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
https://www.readbyqxmd.com/read/27411451/physiological-correlation-of-airway-pressure-and-transpulmonary-pressure-stress-index-on-respiratory-mechanics-in-acute-respiratory-failure
#6
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
https://www.readbyqxmd.com/read/27410404/recruitment-maneuvers-for-acute-respiratory-distress-syndrome-the-panorama-in-2016
#7
Pedro Leme Silva, Paolo Pelosi, Patricia Rieken Macêdo Rocco
No abstract text is available yet for this article.
June 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27334879/volumetric-capnography-lessons-from-the-past-and-current-clinical-applications
#8
REVIEW
Sara Verscheure, Paul B Massion, Franck Verschuren, Pierre Damas, Sheldon Magder
Dead space is an important component of ventilation-perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside...
June 23, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27318344/-clinical-application-of-different-recruitment-maneuvers-in-children-with-congenital-heart-disease-complicated-by-acute-respiratory-distrees-syndrome-after-surgery
#9
Hu Yalan, Guo Changying, Guo Lin, Zheng Hua, Zhang Mian
OBJECTIVE: To compare the individual effects of three recruitment maneuvers (RM) in children with congenital heart disease complicated by postoperation acute respiratory distress syndrome (ARDS). METHODS: A prospective single-blind randomized controlled trial was conducted. Thirty-two children with congenital heart disease complicated with ARDS after open-heart surgery undergoing mechanical ventilation were randomized into three groups, to whom three different RM was respectively performed, namely sustained inflation (SI), progressively increased positive end expiratory pressure (IP) and pressure control ventilation (PCV)...
December 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/27289846/the-detrimental-effects-of-recruitment-maneuvers-on-mucus-clearance-in-an-animal-model-of-primary-ards
#10
G Li Bassi, C Chiurazzi, E Aguilera Xiol, D Marti, C Talitho, R Amaro, C Travierso, M Carbonara, M Rigol, O Comino-Trinidad, A Torres
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27258527/assessment-of-lung-recruitment-by-electrical-impedance-tomography-and-oxygenation-in-ards-patients
#11
Long Yun, Huai-Wu He, Knut Möller, Inéz Frerichs, Dawei Liu, Zhanqi Zhao
We hypothesized that not all patients with appreciably recruited lung tissue during a recruitment maneuver (RM) show significant improvement of oxygenation. In the present study, we combined electrical impedance tomography (EIT) with oxygenation measurements to examine the discrepancies of lung ventilation and perfusion versus oxygenation after RM.A 2-minute RM (20 cm H2O positive end-expiratory pressure [PEEP] + 20 cm H2O pressure control) was prospectively conducted in 20 acute respiratory distress syndrome patients from January 2014 to December 2014...
May 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27152255/efficacy-of-prone-position-in-acute-respiratory-distress-syndrome-patients-a-pathophysiology-based-review
#12
REVIEW
Vasilios Koulouras, Georgios Papathanakos, Athanasios Papathanasiou, Georgios Nakos
Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung" - and the "shape matching" -model...
May 4, 2016: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27110871/open-lung-approach-ventilation-abolishes-the-negative-effects-of-respiratory-rate-in-experimental-lung-injury
#13
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
https://www.readbyqxmd.com/read/27076706/a-comparison-of-clinical-efficacy-between-high-frequency-oscillatory-ventilation-and-conventional-ventilation-with-lung-volume-recruitment-in-pediatric-acute-respiratory-distress-syndrome-a-randomized-controlled-trial
#14
Rujipat Samransamruajkit, Chavisa Rassameehirun, Khemmachart Pongsanon, Sumalee Huntrakul, Jitladda Deerojanawong, Suchada Sritippayawan, Nuanchan Prapphal
PURPOSE: To determine the efficacy of lung volume recruitment maneuver (LVRM) with high frequency oscillatory ventilation (HFOV) on oxygenation, hemodynamic alteration, and clinical outcomes when compared to conventional mechanical ventilation (CV) in children with severe acute respiratory distress syndrome (ARDS). MATERIALS: We performed a randomized controlled trial and enrolled pediatric patients who were diagnosed to have severe ARDS upon pediatric intensive care unit (PICU) admission...
February 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27070486/models-of-pao2-response-to-the-continuous-distending-pressure-maneuver-during-high-frequency-oscillatory-ventilation-in-healthy-and-ards-lung-model-pigs
#15
Marianna Laviola, Jakub Rafl, Martin Rozanek, Petr Kudrna, Karel Roubik
UNLABELLED: Purpose/Aim : High-frequency oscillatory ventilation (HFOV) is a method of ventilation that theoretically achieves the goals of lung protective ventilation in acute respiratory distress syndrome (ARDS) patients. It is characterized by a rapid delivery of small tidal volumes at high frequencies oscillating around a continuous distending pressure (CDP). Optimization of CDP is not an easy task and it is titrated empirically in the clinical practice. The aim of this study is to investigate whether the level of CDP consistently affects the shape of the partial pressure of oxygen (PaO2) response to stepwise changes in CDP during HFOV of healthy and ARDS-induced pigs...
2016: Experimental Lung Research
https://www.readbyqxmd.com/read/27018314/elevated-plasma-levels-of-srage-are-associated-with-non-focal-ct-based-lung-imaging-in-ards-patients-a-prospective-multicenter-study
#16
Segolene Mrozek, Matthieu Jabaudon, Samir Jaber, Catherine Paugam-Burtz, Jean-Yves Lefrant, Jean-Jacques Rouby, Karim Asehnoune, Bernard Allaouchiche, Olivier Baldesi, Marc Leone, Qin Lu, Jean-Etienne Bazin, Laurence Roszyk, Vincent Sapin, Emmanuel Futier, Bruno Pereira, Jean-Michel Constantin
BACKGROUND: During acute respiratory distress syndrome (ARDS), computed tomography (CT) can reveal two distinct lung imaging patterns, focal or non-focal, with different responses to PEEP, recruitment maneuvers and prone position. Nevertheless, their association with plasma biomarkers and their distinct functional/pathobiological mechanisms are unknown. The objective of this study was to characterize focal and non-focal patterns of lung CT-based imaging with plasma markers of lung injury...
March 23, 2016: Chest
https://www.readbyqxmd.com/read/26955891/lung-ventilation-strategies-for-acute-respiratory-distress-syndrome-a-systematic-review-and-network-meta-analysis
#17
Changsong Wang, Xiaoyang Wang, Chunjie Chi, Libo Guo, Lei Guo, Nana Zhao, Weiwei Wang, Xin Pi, Bo Sun, Ailing Lian, Jinghui Shi, Enyou Li
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0...
2016: Scientific Reports
https://www.readbyqxmd.com/read/26919679/acute-respiratory-distress-syndrome
#18
REVIEW
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
https://www.readbyqxmd.com/read/26806959/there-is-no-cephalocaudal-gradient-of-computed-tomography-densities-or-lung-behavior-in-supine-patients-with-acute-respiratory-distress-syndrome
#19
S A El-Dash, J B Borges, E L V Costa, M R Tucci, O T Ranzani, M P Caramez, C R R Carvalho, M B P Amato
BACKGROUND: There is debate whether pressure transmission within the lungs and alveolar collapse follow a hydrostatic pattern or the compression exerted by the weight of the heart and the diaphragm causes collapse localized in the areas adjacent to these structures. The second hypothesis proposes the existence of a cephalocaudal gradient in alveolar collapse. We aimed to define whether or not lung density and collapse follow a 'liquid-like' pattern with homogeneous isogravitational layers along the cephalocaudal axis in acute respiratory distress syndrome lungs...
July 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26761481/use-of-thoracic-electrical-impedance-tomography-as-an-auxiliary-tool-for-alveolar-recruitment-maneuvers-in-acute-respiratory-distress-syndrome-case-report-and-brief-literature-review
#20
Regis Goulart Rosa, William Rutzen, Laura Madeira, Aline Maria Ascoli, Felippe Leopoldo Dexheimer Neto, Juçara Gasparetto Maccari, Roselaine Pinheiro de Oliveira, Cassiano Teixeira
Thoracic electrical impedance tomography is a real-time, noninvasive monitoring tool of the regional pulmonary ventilation distribution. Its bedside use in patients with acute respiratory distress syndrome has the potential to aid in alveolar recruitment maneuvers, which are often necessary in cases of refractory hypoxemia. In this case report, we describe the monitoring results and interpretation of thoracic electrical impedance tomography used during alveolar recruitment maneuvers in a patient with acute respiratory distress syndrome, with transient application of high alveolar pressures and optimal positive end-expiratory pressure titration...
October 2015: Revista Brasileira de Terapia Intensiva
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