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REVIEW
Nicola Latronico, M Eikermann, E W Ely, D M Needham
Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by persistent impairments in physical, cognitive, and/or mental health status that impair quality of life over the long-term...
February 23, 2024: Critical Care: the Official Journal of the Critical Care Forum
#2
JOURNAL ARTICLE
Bertrand Pavlovsky, Christophe Desprez, Jean-Christophe Richard, Nicolas Fage, Arnaud Lesimple, Dara Chean, Antonin Courtais, Tommaso Mauri, Alain Mercat, François Beloncle
BACKGROUND: Various Positive End-Expiratory Pressure (PEEP) titration strategies have been proposed to optimize ventilation in patients with acute respiratory distress syndrome (ARDS). We aimed to compare PEEP titration strategies based on electrical impedance tomography (EIT) to methods derived from respiratory system mechanics with or without esophageal pressure measurements, in terms of PEEP levels and association with recruitability. METHODS: Nineteen patients with ARDS were enrolled...
January 5, 2024: Annals of Intensive Care
#3
JOURNAL ARTICLE
Nida Qadir, Sarina Sahetya, Laveena Munshi, Charlotte Summers, Darryl Abrams, Jeremy Beitler, Giacomo Bellani, Roy G Brower, Lisa Burry, Jen-Ting Chen, Carol Hodgson, Catherine L Hough, Francois Lamontagne, Anica Law, Laurent Papazian, Tai Pham, Eileen Rubin, Matthew Siuba, Irene Telias, Setu Patolia, Dipayan Chaudhuri, Allan Walkey, Bram Rochwerg, Eddy Fan
BACKGROUND: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). METHODS: We summarized evidence addressing four "PICO questions" (patient, intervention, comparison, and outcome)...
November 30, 2023: American Journal of Respiratory and Critical Care Medicine
#4
JOURNAL ARTICLE
Giacomo Grasselli, Carolyn S Calfee, Luigi Camporota, Daniele Poole, Marcelo B P Amato, Massimo Antonelli, Yaseen M Arabi, Francesca Baroncelli, Jeremy R Beitler, Giacomo Bellani, Geoff Bellingan, Bronagh Blackwood, Lieuwe D J Bos, Laurent Brochard, Daniel Brodie, Karen E A Burns, Alain Combes, Sonia D'Arrigo, Daniel De Backer, Alexandre Demoule, Sharon Einav, Eddy Fan, Niall D Ferguson, Jean-Pierre Frat, Luciano Gattinoni, Claude Guérin, Margaret S Herridge, Carol Hodgson, Catherine L Hough, Samir Jaber, Nicole P Juffermans, Christian Karagiannidis, Jozef Kesecioglu, Arthur Kwizera, John G Laffey, Jordi Mancebo, Michael A Matthay, Daniel F McAuley, Alain Mercat, Nuala J Meyer, Marc Moss, Laveena Munshi, Sheila N Myatra, Michelle Ng Gong, Laurent Papazian, Bhakti K Patel, Mariangela Pellegrini, Anders Perner, Antonio Pesenti, Lise Piquilloud, Haibo Qiu, Marco V Ranieri, Elisabeth Riviello, Arthur S Slutsky, Renee D Stapleton, Charlotte Summers, Taylor B Thompson, Carmen S Valente Barbas, Jesús Villar, Lorraine B Ware, Björn Weiss, Fernando G Zampieri, Elie Azoulay, Maurizio Cecconi
The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM...
June 16, 2023: Intensive Care Medicine
#5
REVIEW
Jesús Villar, Tamas Szakmany, Giacomo Grasselli, Luigi Camporota
Although the defining elements of "acute respiratory distress syndrome" (ARDS) have been known for over a century, the syndrome was first described in 1967. Since then, despite several revisions of its conceptual definition, it remains a matter of debate whether ARDS is a discrete nosological entity. After almost 60 years, it is appropriate to examine how critical care has modeled this fascinating syndrome and affected patient's outcome. Given that the diagnostic criteria of ARDS (e.g., increased pulmonary vascular permeability and diffuse alveolar damage) are difficult to ascertain in clinical practice, we believe that a step forward would be to standardize the assessment of pulmonary and extrapulmonary involvement in ARDS to ensure that each patient can receive the most appropriate and effective treatment...
October 31, 2023: Critical Care: the Official Journal of the Critical Care Forum
#6
REVIEW
Joao F F M Ferraz, Matthew T Siuba, Sudhir Krishnan, Robert L Chatburn, Eduardo Mireles-Cabodevila, Abhijit Duggal
Despite its significant limitations, the PaO2 /FIO2 remains the standard tool to classify disease severity in ARDS. Treatment decisions and research enrollment have depended on this parameter for over 50 years. In addition, several variables have been studied over the past few decades, incorporating other physiologic considerations such as ventilation efficiency, lung mechanics, and right-ventricular performance. This review describes the strengths and limitations of all relevant parameters, with the goal of helping us better understand disease severity and possible future treatment targets...
November 25, 2023: Respiratory Care
#7
JOURNAL ARTICLE
Kaitlin M Marquis, Mark M Hammer, Kacie Steinbrecher, Travis S Henry, Chieh-Yu Lin, Adrian Shifren, Constantine A Raptis
Diffuse alveolar damage (DAD), which represents the pathologic changes seen after acute lung injury, is caused by damage to all three layers of the alveolar wall and can ultimately result in alveolar collapse with loss of the normal pulmonary architecture. DAD has an acute phase that predominantly manifests as airspace disease at CT owing to filling of the alveoli with cells, plasma fluids, and hyaline membranes. DAD then evolves into a heterogeneous organizing phase, with mixed airspace and interstitial disease characterized by volume loss, architectural distortion, fibrosis, and parenchymal loss...
July 2023: Radiographics: a Review Publication of the Radiological Society of North America, Inc
#8
JOURNAL ARTICLE
Michael A Matthay, Yaseen Arabi, Alejandro C Arroliga, Gordon Bernard, Andrew D Bersten, Laurent J Brochard, Carolyn S Calfee, Alain Combes, Brian M Daniel, Niall D Ferguson, Michelle N Gong, Jeffrey E Gotts, Margaret S Herridge, John G Laffey, Kathleen D Liu, Flavia R Machado, Thomas R Martin, Danny F McAuley, Alain Mercat, Marc Moss, Richard A Mularski, Antonio Pesenti, Haibo Qiu, Nagarajan Ramakrishnan, Marco Ranieri, Elisabeth D Riviello, Eileen Rubin, Arthur Slutsky, B Taylor Thompson, Theogene Twagirumugabe, Lorraine B Ware, Katherine D Wick
BACKGROUND: Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. METHODS: A Consensus Conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021-March 2022), and subsequently obtained input from members of several critical care societies...
July 24, 2023: American Journal of Respiratory and Critical Care Medicine
#9
REVIEW
Thaïs Walter, Jean-Damien Ricard
During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizational reasons relying on a predetermined fixed duration. A recent study argued that a clinically driven extension of prone positioning beyond 24 h could be associated with reduced mortality. On a patient level, the main benefit of extending prone positioning beyond 24 h is to maintain a more homogenous distribution of the gas-tissue ratio, thus delaying the increase in overdistention observed when patients are returned to the supine position...
July 5, 2023: Critical Care: the Official Journal of the Critical Care Forum
#10
REVIEW
John C Grotberg, Daniel Reynolds, Bryan D Kraft
This narrative review explores the physiology and evidence-based management of patients with severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, with a focus on mechanical ventilation, adjunctive therapies, and veno-venous extracorporeal membrane oxygenation (V-V ECMO). Severe ARDS cases increased dramatically worldwide during the Covid-19 pandemic and carry a high mortality. The mainstay of treatment to improve survival and ventilator-free days is proning, conservative fluid management, and lung protective ventilation...
July 18, 2023: Critical Care: the Official Journal of the Critical Care Forum
#11
REVIEW
Simran Ganeriwal, Gabriele Alves Dos Anjos, Mary Schleicher, Maxwell A Hockstein, Adriano R Tonelli, Abhijit Duggal, Matthew T Siuba
OBJECTIVE: To summarize knowledge and identify gaps in evidence regarding treatment of right ventricular dysfunction (RVD) in acute respiratory distress syndrome (ARDS). DATA SOURCES: We conducted a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION: Studies were included if they reported effects of treatments on right ventricular function, whether or not the intent was to modify right ventricular function...
March 12, 2023: Critical Care: the Official Journal of the Critical Care Forum
#12
REVIEW
Lieuwe Durk Jacobus Bos, Harm Jan de Grooth, Pieter Roel Tuinman
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2023 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
March 21, 2023: Critical Care: the Official Journal of the Critical Care Forum
#13
REVIEW
Seitaro Fujishima
Acute respiratory failure (ARF) is defined by acute and progressive hypoxemia caused by various cardiorespiratory or systemic diseases in previously healthy patients. Among ARF, acute respiratory distress syndrome (ARDS) is a serious condition with bilateral lung infiltration, which develops secondary to a variety of underlying conditions, diseases, or injuries. This review summarizes the current standard of care for ARF and ARDS based on current major guidelines in this field. When administering fluid in patients with ARF, particularly ARDS, restrictive strategies need to be considered in patients without shock or multiple organ dysfunction...
March 10, 2023: Journal of Intensive Care
#14
REVIEW
Martin J Tobin
A diagnosis of ARDS serves as a pretext for several perilous clinical practices. Clinical trials demonstrated that tidal volume 12 ml/kg increases patient mortality, but 6 ml/kg has not proven superior to 11 ml/kg or anything in between. Present guidelines recommend 4 ml/kg, which foments severe air hunger, leading to prescription of hazardous (yet ineffective) sedatives, narcotics and paralytic agents. Inappropriate lowering of tidal volume also fosters double triggering, which promotes alveolar overdistention and lung injury...
December 17, 2022: Critical Care: the Official Journal of the Critical Care Forum
#15
REVIEW
Seth Kligerman
Acute lung injury (ALI) exists on a continuum that includes diffuse alveolar damage, acute fibrinous and organizing pneumonia, and organizing pneumonia. The primary site of injury in ALI is the same, which likely explains similar imaging patterns across the pathologic spectrum. Radiologic outcomes in ALI depend on the degree of injury and the subsequent healing response. Although ALI can heal without permanent injury, development of fibrosis is not uncommon and may be debilitating. ALI is associated with the usual interstitial pneumonia and nonspecific interstitial pneumonia patterns of fibrosis and repeated episodes of ALI are likely a cause of fibrosis progression...
November 2022: Radiologic Clinics of North America
#16
JOURNAL ARTICLE
Pratibha Todur, Anitha Nileshwar, Souvik Chaudhuri, Nitin Gupta, Srikant Natarajan, Shwethapriya Rao
BACKGROUND: Conventionally, PaO2 /FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2 ∗ 10/FiO2 ∗ PEEP or P/FP ∗ 10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2 ∗ 10/FiO2 ∗ PEEP (S/FP ∗ 10) to PaO2 ∗ 10/FiO2 ∗ PEEP (P/FP ∗ 10) and evaluate the utility of S/FP ∗ 10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling...
2022: Critical Care Research and Practice
#17
REVIEW
Ellen A Gorman, Cecilia M O'Kane, Daniel F McAuley
Acute respiratory distress syndrome (ARDS) is characterised by acute hypoxaemic respiratory failure with bilateral infiltrates on chest imaging, which is not fully explained by cardiac failure or fluid overload. ARDS is defined by the Berlin criteria. In this Series paper the diagnosis, management, outcomes, and long-term sequelae of ARDS are reviewed. Potential limitations of the ARDS definition and evidence that could inform future revisions are considered. Guideline recommendations, evidence, and uncertainties in relation to ARDS management are discussed...
October 1, 2022: Lancet
#18
REVIEW
Lieuwe D J Bos, Lorraine B Ware
Acute respiratory distress syndrome (ARDS) is a common clinical syndrome of acute respiratory failure as a result of diffuse lung inflammation and oedema. ARDS can be precipitated by a variety of causes. The pathophysiology of ARDS is complex and involves the activation and dysregulation of multiple overlapping and interacting pathways of injury, inflammation, and coagulation, both in the lung and systemically. Mechanical ventilation can contribute to a cycle of lung injury and inflammation. Resolution of inflammation is a coordinated process that requires downregulation of proinflammatory pathways and upregulation of anti-inflammatory pathways...
October 1, 2022: Lancet
#19
REVIEW
Katherine D Wick, Michael A Matthay, Lorraine B Ware
The diagnosis of acute respiratory distress syndrome (ARDS) traditionally requires calculation of the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) using arterial blood, which can be costly and is not possible in many resource-limited settings. By contrast, pulse oximetry is continuously available, accurate, inexpensive, and non-invasive. Pulse oximetry-based indices, such as the ratio of pulse-oximetric oxygen saturation to FiO2 (SpO2 /FiO2 ), have been validated in clinical studies for the diagnosis and risk stratification of patients with ARDS...
November 2022: Lancet Respiratory Medicine
#20
REVIEW
Alin Gragossian, Matthew T Siuba
Acute respiratory distress syndrome (ARDS) occurs in up to 10% of patients with respiratory failure admitted through the emergency department. Use of noninvasive respiratory support has proliferated in recent years; clinicians must understand the relative merits and risks of these technologies and know how to recognize signs of failure. The cornerstone of ARDS care of the mechanically ventilated patient is low-tidal volume ventilation based on ideal body weight. Adjunctive therapies, such as prone positioning and neuromuscular blockade, may have a role in the emergency department management of ARDS depending on patient and department characteristics...
August 2022: Emergency Medicine Clinics of North America
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