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mechanical ventilation in ARDS

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
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
Divyanshu Mohananey, Jaskaran Sethi, Pedro A Villablanca, Muhammad S Ali, Rohit Kumar, Anushka Baruah, Nirmanmoh Bhatia, Sahil Agrawal, Zeeshan Hussain, Fadi E Shamoun, John T Augoustides, Harish Ramakrishna
AIM: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. MATERIALS AND METHODS: We conducted a meta-analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials...
October 2016: Annals of Cardiac Anaesthesia
Ken-Ichiro Tanaka, Fumiya Tamura, Toshifumi Sugizaki, Masahiro Kawahara, Keiji Kuba, Yumiko Imai, Tohru Mizushima
RATIONALE: For acute respiratory distress syndrome (ARDS), mechanical ventilation (MV) is a life-saving intervention without alternative, however, MV can cause ventilator-induced lung injury (VILI). Reactive oxygen species (ROS) play important roles in the pathogenesis of both ARDS and VILI. Lecithinized superoxide dismutase (PC-SOD) has overcome limitations of SOD such as low tissue affinity and low stability in plasma. OBJECTIVES: In this study, we have examined the effect of PC-SOD on tissue injury, edema and inflammation in the lung and other organs of mice subjected to cecal ligation and puncture (CLP), lipopolysaccharide (LPS) administration or MV...
September 26, 2016: American Journal of Respiratory Cell and Molecular Biology
Wei Gao, Ying-Nan Ju
BACKGROUND AND AIMS: Patients with acute respiratory distress syndrome (ARDS) are particularly susceptible to ventilator-induced lung injury (VILI). This study investigated the effect of budesonide on VILI in a rat model of inflammatory ARDS. METHODS: Forty eight rats were randomized into three groups (n = 16 each): sham group (S), endotoxin/ventilation group (LV), endotoxin/ventilation/budesonide group (LVB). Rats in the S group received anesthesia only. Rats in the LV and LVB groups received endotoxin to simulate ARDS and were mechanically ventilated for 4 h (tidal volume 30 mL/kg)...
May 2016: Archives of Medical Research
Christopher Lotz, Norbert Roewer, Ralf M Muellenbach
Mechanical ventilation is the most commonly used form of respiratory support to restore or maintain adequate gas exchange. However, mechanical ventilation does not provide a physiological form of breathing. Neither does it provide an optimal ventilation / perfusion ratio due to passive movement of the diagphragm favoring the non-dependent parts of the lung. Furthermore, patients are in danger of ventilator-associated/induced lung injury (VALI/VILI). Hence, lung protective ventilation is mandatory in patients with an acute respiratory distress syndrome (ARDS) and should likewise be used in the operating room...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Ling Ye, Jian Wang, Xiaobo Xu, Yuanlin Song, Jinjun Jiang
[Purpose] The aim of this study was to assess the efficacy of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS). [Subjects and Methods] The clinical data of 58 patients with ARDS that required mechanical ventilation in two intensive care units (ICU) was reviewed. [Results] Endotracheal intubation was performed in 55.17% of the total patients and in 39.53% of the patients who received NIV treatment. The APACHE II score for patients who only received IV was significantly higher than those who only underwent NIV (25...
August 2016: Journal of Physical Therapy Science
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
L Gattinoni, T Tonetti, M Cressoni, P Cadringher, P Herrmann, O Moerer, A Protti, M Gotti, C Chiurazzi, E Carlesso, D Chiumello, M Quintel
PURPOSE: We hypothesized that the ventilator-related causes of lung injury may be unified in a single variable: the mechanical power. We assessed whether the mechanical power measured by the pressure-volume loops can be computed from its components: tidal volume (TV)/driving pressure (∆P aw), flow, positive end-expiratory pressure (PEEP), and respiratory rate (RR). If so, the relative contributions of each variable to the mechanical power can be estimated. METHODS: We computed the mechanical power by multiplying each component of the equation of motion by the variation of volume and RR: [Formula: see text]where ∆V is the tidal volume, ELrs is the elastance of the respiratory system, I:E is the inspiratory-to-expiratory time ratio, and R aw is the airway resistance...
October 2016: Intensive Care Medicine
Tyler J Wellman, Nicolas de Prost, Mauro Tucci, Tilo Winkler, Rebecca M Baron, Piotr Filipczak, Benjamin Raby, Jen-Hwa Chu, R Scott Harris, Guido Musch, Luiz F Dos Reis Falcao, Vera Capelozzi, Jose G Venegas, Marcos F Vidal Melo
BACKGROUND: Acute respiratory distress syndrome (ARDS) is an inflammatory condition comprising diffuse lung edema and alveolar damage. ARDS frequently results from regional injury mechanisms. However, it is unknown whether detectable inflammation precedes lung edema and opacification and whether topographically differential gene expression consistent with heterogeneous injury occurs in early ARDS. The authors aimed to determine the temporal relationship between pulmonary metabolic activation and density in a large animal model of early ARDS and to assess gene expression in differentially activated regions...
November 2016: Anesthesiology
Benjamin Kasenda, Willi Sauerbrei, Patrick Royston, Alain Mercat, Arthur S Slutsky, Deborah Cook, Gordon H Guyatt, Laurent Brochard, Jean-Christophe M Richard, Thomas E Stewart, Maureen Meade, Matthias Briel
OBJECTIVES: A recent individual patient data (IPD) meta-analysis suggested that patients with moderate or severe acute respiratory distress syndrome (ARDS) benefit from higher positive end-expiratory pressure (PEEP) ventilation strategies. However, thresholds for continuous variables (eg, hypoxaemia) are often arbitrary and linearity assumptions in regression approaches may not hold; the multivariable fractional polynomial interaction (MFPI) approach can address both problems. The objective of this study was to apply the MFPI approach to investigate interactions between four continuous patient baseline variables and higher versus lower PEEP on clinical outcomes...
September 8, 2016: BMJ Open
Rakesh Bhadade, Rosemarie de'Souza, Minal Harde, Dileep Asgaonkar, Nilesh Tuplondhe
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a clinical syndrome of severe dyspnoea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure in the absence of cardiac failure. We did the study to asses various aetiologies of ARDS, to determine the correlation between the diagnostic criteria, mortality predictors, need of mechanical ventilation and the outcome of patients. This was an observational, prospective study in medical intensive care unit (MICU) of a tertiary care hospital, over a period of 15 months...
November 2015: Journal of the Association of Physicians of India
Chakor S Vora, Niteen D Karnik, Vishal Gupta, Milind Y Nadkar, Jaimala V Shetye
INTODUCTION: An increasing number of patients require mechanical ventilation and there has been a proportional increase in patients needing prolonged mechanical ventilation (ventilated for ≥ 21 days, for atleast 6 hours per day). It accounts for about 10% of all mechanically ventilated patients. Although these patients represent a smaller proportion of intensive care unit (ICU) patients, they consume substantial ICU resources. We studied etiology, metabolic and clinical profile, complications and outcome of these patients...
October 2015: Journal of the Association of Physicians of India
Jerry A Nick, Silvia M Caceres, Jennifer E Kret, Katie R Poch, Matthew Strand, Anna V Faino, David P Nichols, Milene T Saavedra, Jennifer L Taylor-Cousar, Mark W Geraci, Ellen L Burnham, Michael B Fessler, Benjamin T Suratt, Edward Abraham, Marc Moss, Kenneth C Malcolm
Acute Respiratory Distress Syndrome (ARDS) severity may be influenced by heterogeneity of neutrophil activation. Interferon-stimulated genes (ISG) are a broad gene family induced by Type I interferons, often as a response to viral infections, which evokes extensive immunomodulation. We tested the hypothesis that over- or under-expression of immunomodulatory ISG by neutrophils is associated with worse clinical outcomes in patients with ARDS. Genome-wide transcriptional profiles of circulating neutrophils isolated from patients with sepsis-induced ARDS (n = 31) and healthy controls (n = 19) were used to characterize ISG expression...
2016: PloS One
Juan B Figueroa-Casas, Ricardo Montoya
RATIONALE: Although increasingly recommended, compliance with low tidal volume ventilation remains suboptimal. Dyssynchrony induced by low tidal volumes may be a reason for it. OBJECTIVES: To determine the effect of tidal volume size, and of the ventilator mode used for its delivery (volume vs pressure control), on the magnitude of patient-ventilator dyssynchrony in patients with or at risk for acute respiratory distress syndrome (ARDS). METHODS: Nineteen mechanically ventilated patients underwent 6 consecutive ventilatory conditions...
September 6, 2016: Annals of the American Thoracic Society
Ary Serpa Neto, Matthieu Schmidt, Luciano C P Azevedo, Thomas Bein, Laurent Brochard, Gernot Beutel, Alain Combes, Eduardo L V Costa, Carol Hodgson, Christian Lindskov, Matthias Lubnow, Catherina Lueck, Andrew J Michaels, Jose-Artur Paiva, Marcelo Park, Antonio Pesenti, Tài Pham, Michael Quintel, V Marco Ranieri, Michael Ried, Roberto Roncon-Albuquerque, Arthur S Slutsky, Shinhiro Takeda, Pier Paolo Terragni, Marie Vejen, Steffen Weber-Carstens, Tobias Welte, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. METHODS: In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality...
September 1, 2016: Intensive Care Medicine
Smruti B Vaishnav, Bhalendu Vaishnav, Kailas N Desai, Nitin S Raithatha, Neeta S Bose
BACKGROUND: There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. METHODS: We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality...
March 2016: National Medical Journal of India
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
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
Hernan Aguirre-Bermeo, Indalecio Morán, Maurizio Bottiroli, Stefano Italiano, Francisco José Parrilla, Eugenia Plazolles, Ferran Roche-Campo, Jordi Mancebo
BACKGROUND: End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO2. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. METHODS: The investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases...
December 2016: Annals of Intensive Care
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