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ventilator associated lung injury

Fabienne D Simonis, Carmen S V Barbas, 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 Vidal Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz, Ary Serpa Neto
BACKGROUND: The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. METHODS: The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality...
March 21, 2018: Annals of Intensive Care
Hongyan Li, Heng Weng, Changqing Lan, Hongying Zhang, Xinhang Wang, Jianguang Pan, Lulu Chen, Jinbao Huang
The aim of this study was to compare the clinical features of patients with avian influenza A (H7N9) and influenza A (H1N1) complicated by acute respiratory distress syndrome (ARDS).The clinical data of 18 cases of H7N9 and 26 cases of H1N1 with ARDS were collected and compared in the respiratory intensive care unit (RICU) of Fuzhou Pulmonary Hospital of Fujian from March 2014 to December 2016.Patients with H7N9 had a higher acute physiology and chronic health evaluation-II score (P < .05) and lung injury score (P < ...
March 2018: Medicine (Baltimore)
Emmanuel Marret, Raphael Cinotti, Laurence Berard, Vincent Piriou, Jacques Jobard, Benoit Barrucand, Dragos Radu, Samir Jaber, Francis Bonnet
BACKGROUND: Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE: To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery...
March 19, 2018: European Journal of Anaesthesiology
Penny S Reynolds, Bernard J Fisher, Jacquelyn McCarter, Christopher Sweeney, Erika J Martin, Paul Middleton, Matthew Ellenberg, Evan Fowler, Donald F Brophy, Alpha A Fowler, Bruce D Spiess, Ramesh Natarajan
BACKGROUND: Coagulopathy and inflammation induced by hemorrhagic shock and traumatic injury are associated with increased mortality and morbidity. Vitamin C (VitC) is an antioxidant with potential protective effects on the pro-inflammatory and pro-coagulant pathways. We hypothesized that high-dose VitC administered as a supplement to fluid resuscitation would attenuate inflammation, coagulation dysfunction, and end-organ tissue damage in a swine model of polytrauma and hemorrhage. METHODS: Male Sinclair swine (n = 24; mean body weight 27 kg) were anesthetized, intubated, mechanically ventilated, and instrumented for physiological monitoring...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Shota Hodono, Akihiro Shimokawa, Neil J Stewart, Yukiko Yamauchi, Renya Nishimori, Mami Yamane, Hirohiko Imai, Hideaki Fujiwara, Atsuomi Kimura
PURPOSE: High Mobility Group Box1 (HMGB1), which is one of the damage-associated molecular pattern molecules relating to various inflammatory diseases, has gained interest as a therapeutic target because of its involvement in wound healing processes. In the present study, we investigated HMGB1 as a potential therapeutic target in a model of lung fibrosis using a preclinical hyperpolarized129 Xe (HPXe) MRI system. METHODS: Lung injury was induced by intra-peritoneal injection of bleomycin (BLM) in 19 mice...
March 9, 2018: Magnetic Resonance in Medical Sciences: MRMS
Peter D Sottile, David Albers, Marc M Moss
BACKGROUND: Neuromuscular blockade (NMB) is a therapy for acute respiratory distress syndrome (ARDS). However, the mechanism by which NMB may improve outcome for ARDS patients remains unclear. We sought to determine whether NMB attenuates biomarkers of epithelial and endothelial lung injury and systemic inflammation in ARDS patients, and whether the association is dependent on tidal volume size and the initial degree of hypoxemia. METHODS: We performed a secondary analysis of patients enrolled in the ARDS network low tidal volume ventilation (ARMA) study...
March 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Cosby A Stone, Cindy T McEvoy, Judy L Aschner, Ashudee Kirk, Christian Rosas-Salazar, Joan M Cook-Mills, Paul E Moore, William F Walsh, Tina V Hartert
Vitamin E is obtained only through the diet and has a number of important biological activities, including functioning as an antioxidant. Evidence that free radicals may contribute to pathological processes such as bronchopulmonary dysplasia (BPD), a disease of prematurity associated with increased lung injury, inflammation and oxidative stress, led to trials of the antioxidant vitamin E (α-tocopherol) to prevent BPD with variable results. These trials were all conducted at supraphysiologic doses and 2 of these trials utilized a formulation containing a potentially harmful excipient...
March 7, 2018: Neonatology
M Moreira, D Fernandes, E Pereira, E Monteiro, R Pascoa, C Dias
OBJECTIVE: Severe traumatic brain injury (TBI) management has been associated with adult respiratory distress syndrome (ARDS) in previous literature. We aimed to investigate the relationships between optimal CPP-guided management, ventilation parameters over time and outcome after severe TBI. MATERIALS AND METHODS: We performed retrospective analysis of recorded data from 38 patients admitted to the NCCU after severe TBI, managed with optimal cerebral perfusion pressure (CPPopt)-guided therapy, calculated using pressure reactivity index (PRx)...
2018: Acta Neurochirurgica. Supplement
Stefan Boehme, Frédéric P R Toemboel, Erik K Hartmann, Alexander H Bentley, Oliver Weinheimer, Yang Yang, Tobias Achenbach, Michael Hagmann, Eugenijus Kaniusas, James E Baumgardner, Klaus Markstaller
BACKGROUND: Cyclic recruitment and de-recruitment of atelectasis (c-R/D) is a contributor to ventilator-induced lung injury (VILI). Bedside detection of this dynamic process could improve ventilator management. This study investigated the potential of automated lung sound analysis to detect c-R/D as compared to four-dimensional computed tomography (4DCT). METHODS: In ten piglets (25 ± 2 kg), acoustic measurements from 34 thoracic piezoelectric sensors (Meditron ASA, Norway) were performed, time synchronized to 4DCT scans, at positive end-expiratory pressures of 0, 5, 10, and 15 cmH2 O during mechanical ventilation, before and after induction of c-R/D by surfactant washout...
February 24, 2018: Critical Care: the Official Journal of the Critical Care Forum
Eddy Fan, Daniel Brodie, Arthur S Slutsky
Importance: Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75 000 deaths annually. Globally, ARDS accounts for 10% of intensive care unit admissions, representing more than 3 million patients with ARDS annually. Objective: To review advances in diagnosis and treatment of ARDS over the last 5 years. Evidence Review: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 2012 to 2017 focusing on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines...
February 20, 2018: JAMA: the Journal of the American Medical Association
Sonny Thiara, Donald E Griesdale, William R Henderson, Mypinder S Sekhon
BACKGROUND: Increased cerebral perfusion pressure (CPP)>70 mmHg has been associated with acute respiratory distress syndrome (ARDS) after traumatic brain injury (TBI). Since this reported association, significant changes in ventilation strategies and fluid management have been accepted as routine critical care. Recently, individualized perfusion targets using autoregulation monitoring suggest CPP titration>70 mmHg. Given these clinical advances, the association between ARDS and increased CPP requires further delineation...
February 19, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Kieran Borgeat, Kerry Simpson, David Reese, Helen Wilson, Joanna Potter, Daniel Ogden
Case summary: Bronchial stents may be useful to relieve clinical signs of extraluminal compression. Herein we describe a case which, to our knowledge, is the first cat where bilateral bronchial stents have been used clinically. Respiratory signs of principal bronchial compression were alleviated after the stent procedure. Minor complications occurred, specifically: severe hypoxia during stent deployment; a transient, self-limiting postoperative pneumothorax possibly associated with ventilation-induced lung injury; bronchopneumonia (possibly pre-existing); and transient worsening of cough postoperatively...
January 2018: JFMS Open Reports
Song Qin, Miao Chen, Hui Ji, Guo-Yue Liu, Hong Mei, Kang Li, Tao Chen
Hyperoxia‑induced acute lung injury (HALI) as one of the most common complications in patents on mechanical ventilation, and there are no efficient methods to overcome this at present. It was hypothesized that microRNA 21‑5p(miR‑21‑5p) can promote the survival of type II alveolar epithelial cells (AECII), alleviating HALI. The present study aimed to combine gene chip analysis with the overexpression miR‑21‑5p to develop a novel therapeutic option for HALI. It was found that AECII apoptosis was an important pathogenic event in the development of HALI, and the overexpression of miR‑21‑5p prevented HALI, associated with reducing AECII apoptosis...
February 6, 2018: Molecular Medicine Reports
Detajin Junhasavasdikul, Irene Telias, Domenico Luca Grieco, Lu Chen, Cinta Millan Gutierrez, Thomas Piraino, Laurent Brochard
Expiratory flow limitation (EFL) is present when the flow cannot rise despite an increase of the expiratory driving pressure. The mechanisms of EFL are debated but are thought to be related to the collapsibility of small airways. In mechanically ventilated patients, EFL can exist during tidal ventilation, representing an extreme situation where lung volume cannot decrease whatever the expiratory driving forces. It is a key factor for the generation of auto- or intrinsic positive end-expiratory pressure (auto-PEEP or PEEPi) and requires specific management such as positioning and adjustment of external PEEP...
February 9, 2018: Chest
Anna Geke Algera, Luigi Pisani, Renato Carneiro de Freitas Chaves, Thiago Chaves Amorim, Thomas Cherpanath, Rogier Determann, Dave A Dongelmans, Frederique Paulus, Pieter Roel Tuinman, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz, Ary Serpa Neto
It is well-known that positive end-expiratory pressure (PEEP) can prevent ventilator-induced lung injury (VILI) and improve pulmonary physiology in animals with injured lungs. It's uncertain whether PEEP has similar effects in animals with uninjured lungs. A systematic review of randomized controlled trials (RCTs) comparing different PEEP levels in animals with uninjured lungs was performed. Trials in animals with injured lungs were excluded, as were trials that compared ventilation strategies that also differed with respect to other ventilation settings, e...
January 2018: Annals of Translational Medicine
Ary Serpa Neto, Nicole P Juffermans, Sabrine N T Hemmes, Carmen S V Barbas, Martin Beiderlinden, Michelle Biehl, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Samir Jaber, Alf Kozian, Marc Licker, Wen-Qian Lin, Stavros G Memtsoudis, Dinis Reis Miranda, Pierre Moine, Domenico Paparella, Marco Ranieri, Federica Scavonetto, Thomas Schilling, Gabriele Selmo, Paolo Severgnini, Juraj Sprung, Sugantha Sundar, Daniel Talmor, Tanja Treschan, Carmen Unzueta, Toby N Weingarten, Esther K Wolthuis, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
Background: Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients. Methods: A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-operative tidal volume and airway pressure in adult patients undergoing mechanical ventilation for general surgery, as well as their interactions on the occurrence of postoperative acute respiratory distress syndrome (ARDS)...
January 2018: Annals of Translational Medicine
Rolf Dembinski, Frank Mielck
The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure due to inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of scientific research numerous issues especially regarding mechanical ventilation as the most important treatment option remain unclear. Most important, adjustment of mechanical ventilation is challenging due to desirable beneficial effects on pulmonary gas exchange on the one hand and deleterious effects in terms of ventilator-associated lung injury on the other...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Christian Bime, Nima Pouladi, Saad Sammani, Ken Batai, Nancy Casanova, Tong Zhou, Carrie L Kempf, Xiaoguang Sun, Sara M Camp, Ting Wang, Rick A Kittles, Yves A Lussier, Tiffanie K Jones, John P Reilly, Nuala J Meyer, Jason D Christie, Jason Karnes, Manuel Gonzalez-Garay, David C Christiani, Charles R Yates, Mark M Wurfel, Gianfranco U Meduri, Joe G N Garcia
RATIONALE: Genetic factors are involved in acute respiratory distress syndrome (ARDS) susceptibility. Identification of novel candidate genes associated with increased risk and severity will improve our understanding of ARDS pathophysiology and enhance efforts to develop novel preventive and therapeutic approaches. METHODS: A genome-wide association study was performed on 232 African-American patients with ARDS and 162 at-risk controls. The Identify Candidate Causal single nucleotide polymorphisms (SNPs) and Pathways platform was used to infer the association of known gene sets with the top prioritized intragenic SNPs...
February 9, 2018: American Journal of Respiratory and Critical Care Medicine
Yanru Chen, Sha Gao, Yufei Yan, Jihong Qian, Hao Chen
Bronchopulmonary dysplasia (BPD) is the most common complication in preterm newborns. It occurs due to early exposure to high-oxygen and ventilation therapy. The mechanisms of disrupted alveolarization and vascular development associated with BPD were unclear. Deferoxamine (DFO) has been reported to reduce mortality and lung injury in mice after chlorine exposure. The effect of DFO in the treatment of BPD has not been explored. This study aimed to investigate the effect of aerosolized DFO administration in a mouse model of BPD...
2018: American Journal of Translational Research
Yi Xin, Maurizio Cereda, Hooman Hamedani, Mehrdad Pourfathi, Sarmad Siddiqui, Natalie Meeder, Stephen Kadlecek, Ian Duncan, Harrilla Profka, Jennia Rajaei, Nicholas J Tustison, James C Gee, Brian P Kavanagh, Rahim R Rizi
BACKGROUND: It remains unclear how prone positioning improves survival in acute respiratory distress syndrome (ARDS). Using serial computed tomography (CT), we previously reported that 'unstable' inflation, i.e. partial aeration with large tidal density swings (indicating increased local strain) is associated with injury progression. We prospectively tested whether prone position contains the early propagation of experimental lung injury by stabilizing inflation. METHODS: Injury was induced by tracheal hydrochloric acid (HCl) in rats; after randomization to supine or prone position, injurious ventilation was commenced using high tidal volume and low PEEP...
February 8, 2018: American Journal of Respiratory and Critical Care Medicine
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