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Ards; pulmonary mechanics; sepsis;

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
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
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
Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW...
2016: Frontiers in Pediatrics
Christelle Joffre, Fabrice Lesage, Olivier Bustarret, Philippe Hubert, Mehdi Oualha
AIM: To investigate clinical course and mortality-associated factors in children with Down syndrome (DS) managed in a medical paediatric intensive care unit. METHODS: A single-centre, retrospective study conducted between 2001 and 2010 in DS children aged 1 month to 16 years. RESULTS: Sixty-six patients with a median age of 24 months (1-192) and a male/female ratio of 1.5 were analysed. Patients presented with history of congenital heart disease (n = 52, 78...
June 2016: Journal of Paediatrics and Child Health
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Nadir Yehya, Neal J Thomas, Susan S Margulies
Mechanisms underlying pediatric acute respiratory distress syndrome (PARDS) are poorly understood. The recent implication of circulating nucleosomes as pathogenic in sepsis and trauma-associated ARDS in adults led us to investigate the significance of nucleosomes in PARDS. We conducted a prospective, observational study on children with PARDS at the Children's Hospital of Philadelphia between July 2014 and September 2015. Plasma was collected within 48 h of PARDS onset and nucleosomes quantified by enzyme-linked immunosorbent assay...
June 1, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
A Vieillard-Baron, M Matthay, J L Teboul, T Bein, M Schultz, S Magder, J J Marini
RATIONALE: Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. Hemodynamic effects of ventilation are due to changes in pleural pressure (Ppl) and changes in transpulmonary pressure (TP). TP affects RV afterload, whereas changes in Ppl affect venous return...
May 2016: Intensive Care Medicine
J N Gonzales, R Lucas, A D Verin
Acute Respiratory Distress Syndrome (ARDS) is a severe lung inflammatory disorder with a 30-50% mortality. Sepsis and pneumonia are the leading causes of ARDS. On the cellular level there is pulmonary capillary endothelial cell permeability and fluid leakage into the pulmonary parenchyma, followed by neutrophils, cytokines and an acute inflammatory response. When fluid increases in the interstitium then the outward movement continues and protein rich fluid floods the alveolar spaces through the tight junctions of the epithelial cells...
June 4, 2015: Austin Journal of Vascular Medicine
Chandra C Ghosh, Sascha David, Ruyang Zhang, Anthony Berghelli, Katelyn Milam, Sarah J Higgins, Jon Hunter, Aditi Mukherjee, Yongyue Wei, Mei Tran, Freeman Suber, Lester Kobzik, Kevin C Kain, Shulin Lu, Ansgar Santel, Kiichiro Yano, Prajna Guha, Daniel J Dumont, David C Christiani, Samir M Parikh
Ligands of the endothelial-enriched tunica interna endothelial cell kinase 2 (Tie2) are markedly imbalanced in severe infections associated with vascular leakage, yet regulation of the receptor itself has been understudied in this context. Here, we show that TIE2 gene expression may constitute a novel vascular barrier control mechanism in diverse infections. Tie2 expression declined rapidly in wide-ranging models of leak-associated infections, including anthrax, influenza, malaria, and sepsis. Forced Tie2 suppression sufficed to attenuate barrier function and sensitize endothelium to permeability mediators...
March 1, 2016: Proceedings of the National Academy of Sciences of the United States of America
Djillali Annane
Neuromuscular blocking agents and corticosteroids are widely used in medicine and in particular in the intensive care unit (ICU). Neuromuscular blockade is commonly used to ease tracheal intubation, to optimize mechanical ventilation and oxygenation in acute respiratory disorders such as status asthmaticus and acute respiratory distress syndrome (ARDS), to prevent shivering during therapeutic hypothermia, and also in patients with elevated intracranial pressure. In the ICU, patients with sepsis, ARDS, community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, severe asthma, or trauma may receive corticosteroids...
February 2016: Seminars in Respiratory and Critical Care Medicine
Min Shao, Song-Tao Tang, Bao Liu, Hua-Qing Zhu
The pathology of acute respiratory distress syndrome (ARDS) is closely associated with the failure of alveolar‑capillary barrier integrity and alveolar filling by high protein pulmonary edema, resulting from hyperpermeability. High mobility group box 1 (HMGB1) is a novel late mediator of sepsis, which is specifically involved in endotoxin‑induced acute lung injury and sepsis‑associated lethality. Although the role of HMGB1 in endothelial cell cytoskeletal rearrangement and vascular permeability have been investigated preliminarily, the molecular mechanisms remain to be fully elucidated...
January 2016: Molecular Medicine Reports
Philip Toner, Danny Francis McAuley, Murali Shyamsundar
Sepsis is a common condition that is associated with significant morbidity, mortality and health-care cost. Pulmonary and non-pulmonary sepsis are common causes of the acute respiratory distress syndrome (ARDS). The mortality from ARDS remains high despite protective lung ventilation, and currently there are no specific pharmacotherapies to treat sepsis or ARDS. Sepsis and ARDS are characterised by activation of the inflammatory cascade. Although there is much focus on the study of the dysregulated inflammation and its suppression, the associated activation of the haemostatic system has been largely ignored until recently...
October 23, 2015: Critical Care: the Official Journal of the Critical Care Forum
Heather A Vallier, Timothy A Moore, John J Como, Patricia A Wilczewski, Michael P Steinmetz, Karl G Wagner, Charles E Smith, Xiao-Feng Wang, Andrea J Dolenc
BACKGROUND: Our group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fewer complications than those treated at a later time. METHODS: Three hundred thirty-five patients with mean age 39...
2015: Journal of Orthopaedic Surgery and Research
M Piastra, A Tempera, E Luca, E Buffone, C Cafforio, V Briganti, O Genovese, M Marano, D Rigante, On Behalf Of The Intrepid Group
Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia...
September 13, 2015: Paediatrics and International Child Health
Matthew R Dettmer, Nicholas M Mohr, Brian M Fuller
PURPOSE: Patients with severe sepsis and septic shock are at high risk for development of pulmonary complications, including acute respiratory distress syndrome (ARDS). Serial lactate monitoring is a useful tool to gauge global tissue hypoxia in emergency department (ED) patients with sepsis. We hypothesized that patients undergoing serial lactate monitoring (SL) would demonstrate a decreased incidence of pulmonary complications. METHODS: This is a retrospective observational cohort study of adult severe sepsis and septic shock patients with elevated lactate presenting to a large academic ED...
December 2015: Journal of Critical Care
P Álvarez, R Carrasco, C Romero-Dapueto, R L Castillo
Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI...
2015: Open Respiratory Medicine Journal
Sara M Camp, Eddie T Chiang, Chaode Sun, Peter V Usatyuk, Robert Bittman, Viswanathan Natarajan, Joe G N Garcia, Steven M Dudek
Effective therapeutic agents are lacking for the prevention and reversal of vascular leak, a frequent pathophysiologic result of inflammatory processes such as acute respiratory distress syndrome (ARDS) and sepsis. We previously demonstrated the potent barrier-enhancing effects of related compounds sphingosine 1-phosphate (S1P), the pharmaceutical agent FTY720, and its analog (S)-FTY720 phosphonate (Tys) in models of inflammatory lung injury. In this study, we characterize additional novel FTY720 analogs for their potential to reduce vascular leak as well as utilize them as tools to better understand the mechanisms by which this class of agents modulates permeability...
October 2015: Chemistry and Physics of Lipids
Yuda Sutherasan, Oscar Peñuelas, Alfonso Muriel, Maria Vargas, Fernando Frutos-Vivar, Iole Brunetti, Konstantinos Raymondos, Davide D'Antini, Niklas Nielsen, Niall D Ferguson, Bernd W Böttiger, Arnaud W Thille, Andrew R Davies, Javier Hurtado, Fernando Rios, Carlos Apezteguía, Damian A Violi, Nahit Cakar, Marco González, Bin Du, Michael A Kuiper, Marco Antonio Soares, Younsuck Koh, Rui P Moreno, Pravin Amin, Vinko Tomicic, Luis Soto, Hans-Henrik Bülow, Antonio Anzueto, Andrés Esteban, Paolo Pelosi
INTRODUCTION: The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. METHODS: We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period...
2015: Critical Care: the Official Journal of the Critical Care Forum
M Melanie Lyons, Nichelle N Raj, Jesse L Chittams, Laurie Kilpatrick, Clifford S Deutschman
Sepsis, a poorly understood syndrome of disordered inflammation, is the leading cause of death in critically ill patients. Lung injury, in the form of acute respiratory distress syndrome (ARDS), is the most common form of organ injury in sepsis. The heat shock response, during which heat shock proteins (HSPs) are expressed, is an endogenous mechanism to protect cells from injury. We have found that the abundance of pulmonary HSP70 is not increased after cecal ligation and double puncture (CLP) in a rat model of sepsis-induced ARDS...
June 2015: Shock
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