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ARDS

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https://www.readbyqxmd.com/read/30121847/inflammatory-and-fibrinolytic-system-in-acute-respiratory-distress-syndrome
#1
REVIEW
Mahesh Manjunath Gouda, Sadiya B Shaikh, Yashodhar Prabhakar Bhandary
Acute respiratory distress syndrome (ARDS) is the most advanced form of acute lung injury (ALI). This is characterized by bilateral pulmonary infiltrates and severe hypoxemia. According to Berlin definition of ARDS, this is defined based on the timings, radiographic changes, edema formation, and severity on the PaO2 /FiO2 ratio. During ARDS, the loss of integrity of the epithelium causes the septic shock. The degree of epithelial injury is the major prognostic marker of ARDS. In addition to this, inflammatory cell migration, fibro-proliferation, and activation of apoptosis also play an important role in the pathophysiology of ARDS...
October 2018: Lung
https://www.readbyqxmd.com/read/29066591/the-role-of-rescue-therapies-in-the-treatment-of-severe-ards
#2
REVIEW
Francesco Alessandri, Francesco Pugliese, V Marco Ranieri
ARDS is characterized by a non-cardiogenic pulmonary edema with bilateral chest radiograph opacities and hypoxemia refractory to oxygen therapy. It is a common cause of admission to the ICU due to hypoxemic respiratory failure requiring mechanical ventilation. Corticosteroids are not recommended in ARDS patients. Rescue therapies alleviate hypoxemia in patients unable to maintain reasonable oxygenation: recruitment maneuvers, prone positioning, inhaled nitric oxide, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation improve oxygenation, but their impact on mortality remains unproven...
January 2018: Respiratory Care
https://www.readbyqxmd.com/read/29367383/understanding-pulmonary-stress-strain-relationships-in-severe-ards-and-its-implications-for-designing-a-safer-approach-to-setting-the-ventilator
#3
REVIEW
Rolf D Hubmayr, Richard H Kallet
This review describes the current understanding of the lungs' response to deforming stress under conditions of both normal physiology and acute lung injury. Several limiting assumptions are needed to infer lung parenchymal stress and strain from airway pressure, volume, and flow data from mechanically ventilated patients with injured lungs. These assumptions include the effects of the chest wall on lung-surface pressure, its topographical distribution, and the effects of non-uniform tissue properties on local parenchymal stresses...
February 2018: Respiratory Care
https://www.readbyqxmd.com/read/28427745/how-to-approach-the-acute-respiratory-distress-syndrome-prevention-plan-and-prudence
#4
REVIEW
Younsuck Koh
The acute respiratory distress syndrome (ARDS) is typically manifested by refractory hypoxemia with high mortality. A correct diagnosis is the first step to achieve better outcomes. An early intervention to manage modifiable risk factors of ARDS development and the avoidance of aggravating factors that increase disease severity and progression should be carefully addressed. A management plan is necessary at an early stage of ARDS to determine the level of intensive care. It should be carefully decided which therapeutic measures should be performed depending on the patient׳s underlying clinical condition...
May 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/30053961/salvage-therapies-for-refractory-hypoxemia-in-ards
#5
REVIEW
Sujith V Cherian, Anupam Kumar, Karunakar Akasapu, Rendell W Ashton, Malaygiri Aparnath, Atul Malhotra
Acute Respiratory Distress Syndrome (ARDS) is a condition of varied etiology characterized by the acute onset (within 1 week of the inciting event) of hypoxemia, reduced lung compliance, diffuse lung inflammation and bilateral opacities on chest imaging attributable to noncardiogenic (increased permeability) pulmonary edema. Although multi-organ failure is the most common cause of death in ARDS, an estimated 10-15% of the deaths in ARDS are caused due to refractory hypoxemia, i.e.- hypoxemia despite lung protective conventional ventilator modes...
August 2018: Respiratory Medicine
https://www.readbyqxmd.com/read/29793554/acute-lung-injury-how-to-stabilize-a-broken-lung
#6
Gary F Nieman, Penny Andrews, Joshua Satalin, Kailyn Wilcox, Michaela Kollisch-Singule, Maria Madden, Hani Aiash, Sarah J Blair, Louis A Gatto, Nader M Habashi
The pathophysiology of acute respiratory distress syndrome (ARDS) results in heterogeneous lung collapse, edema-flooded airways and unstable alveoli. These pathologic alterations in alveolar mechanics (i.e. dynamic change in alveolar size and shape with each breath) predispose the lung to secondary ventilator-induced lung injury (VILI). It is our viewpoint that the acutely injured lung can be recruited and stabilized with a mechanical breath until it heals, much like casting a broken bone until it mends. If the lung can be "casted" with a mechanical breath, VILI could be prevented and ARDS incidence significantly reduced...
May 24, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29175086/re-examining-permissive-hypercapnia-in-ards-a-narrative-review
#7
REVIEW
Tavish Barnes, Vasileios Zochios, Ken Parhar
Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2 , acute cor pulmonale, and ICU mortality...
July 2018: Chest
https://www.readbyqxmd.com/read/29601320/esophageal-pressure-monitoring-why-when-and-how
#8
Takeshi Yoshida, Laurent Brochard
PURPOSE OF REVIEW: Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to describe technical tips to adequately measure esophageal pressure at the bedside, and then update the most important clinical applications of esophageal manometry in ICU...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29297365/regional-physiology-of-ards
#9
REVIEW
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29135617/lessons-to-learn-from-epidemiologic-studies-in-ards
#10
REVIEW
Bairbre A McNicholas, Grainne M Rooney, John G Laffey
PURPOSE OF REVIEW: Recent advances in our understanding of the epidemiology of ARDS has generated key insights into the incidence, risk factors, demographics, management and outcomes from this devastating clinical syndrome. RECENT FINDINGS: ARDS occurs in 10% of all ICU patients, in 23% of all mechanically ventilated patients, with 5.5 cases per ICU bed each year. Although some regional variation exists regarding ARDS incidence, this may be less than previously thought...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29176329/inflammatory-processes-during-acute-respiratory-distress-syndrome-a-complex-system
#11
REVIEW
Lucy K Reiss, Andreas Schuppert, Stefan Uhlig
PURPOSE OF REVIEW: ARDS is a severe pulmonary disease characterized by inflammation. However, inflammation-directed therapies have yet failed to improve the outcome in ARDS patients. One of the reasons may be the underestimated complexity of inflammation. Here, we summarize recent insights into the complex interrelations between inflammatory circuits. RECENT FINDINGS: Gene expression analysis from animal models or from patients with ARDS, sepsis or trauma show an enormous number of differentially expressed genes with highly significant overlaps between the various conditions...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29189296/long-term-outcome-after-the-acute-respiratory-distress-syndrome-different-from-general-critical-illness
#12
REVIEW
Thomas Bein, Steffen Weber-Carstens, Christian Apfelbacher
PURPOSE OF REVIEW: To review the current research data on long-term outcome and health-related quality of life in survivors of the acute respiratory distress syndrome (ARDS) and to compare these findings with those from non-ARDS patients surviving critical illness. RECENT FINDINGS: Between 6 months and 2 years after discharge from ICU, survivors of ARDS present with substantial impairments of the levels of body function (muscle strength, walking capacity and/or physical activity (physical SF-36 score)...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29194057/approaches-and-techniques-to-avoid-development-or-progression-of-acute-respiratory-distress-syndrome
#13
REVIEW
François Beloncle, Alain Mercat
PURPOSE OF REVIEW: Despite major improvement in ventilation strategies, hospital mortality and morbidity of the acute respiratory distress syndrome (ARDS) remain high. A lot of therapies have been shown to be ineffective for established ARDS. There is a growing interest in strategies aiming at avoiding development and progression of ARDS. RECENT FINDINGS: Recent advances in this field have explored identification of patients at high-risk, nonspecific measures to limit the risks of inflammation, infection and fluid overload, prevention strategies of ventilator-induced lung injury and patient self-inflicted lung injury, and pharmacological treatments...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28500585/systematic-review-and-meta-analysis-of-complications-and-mortality-of-veno-venous-extracorporeal-membrane-oxygenation-for-refractory-acute-respiratory-distress-syndrome
#14
REVIEW
Sergi Vaquer, Candelaria de Haro, Paula Peruga, Joan Carles Oliva, Antonio Artigas
Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28642106/extracorporeal-membrane-oxygenation-for-adult-respiratory-failure-2017-update
#15
REVIEW
Darryl Abrams, Daniel Brodie
The use of extracorporeal membrane oxygenation (ECMO) for respiratory failure in adults is growing rapidly, driven in large part by advances in technology, which have made ECMO devices easier to implement and safer and more efficient. Accompanying this increase in use is a nearly exponential increase in ECMO-related literature. However, the great majority of the literature is composed of retrospective observational data, often in the form of single-center studies with relatively small numbers of subjects. The overall lack of high-quality data, including prospective randomized trials, makes it difficult to justify the rate at which ECMO use is increasing and calls attention to the need for more rigorously designed studies...
September 2017: Chest
https://www.readbyqxmd.com/read/28684287/high-frequency-oscillatory-ventilation-in-adults-with-ards-past-present-and-future
#16
REVIEW
Michael C Sklar, Eddy Fan, Ewan C Goligher
High-frequency oscillatory ventilation (HFOV) is a unique mode of mechanical ventilation that uses nonconventional gas exchange mechanisms to deliver ventilation at very low tidal volumes and high frequencies. The properties of HFOV make it a potentially ideal mode to prevent ventilator-induced lung injury in patients with ARDS. Despite a compelling physiological basis and promising experimental data, large randomized controlled trials have not detected an improvement in survival with the use of HFOV, and its use as an early lung-protective strategy in patients with ARDS may be harmful...
December 2017: Chest
https://www.readbyqxmd.com/read/28823812/oxygenation-saturation-index-predicts-clinical-outcomes-in-ards
#17
Katherine DesPrez, J Brennan McNeil, Chunxue Wang, Julie A Bastarache, Ciara M Shaver, Lorraine B Ware
BACKGROUND: Traditional measures of ARDS severity such as Pao2 /Fio2 may not reliably predict clinical outcomes. The oxygenation index (OI [Fio2  × mean airway pressure × 100)/Pao2 ]) may more accurately reflect ARDS severity but requires arterial blood gas measurement. We hypothesized that the oxygenation saturation index (OSI [Fio2  × mean airway pressure × 100)/oxygen saturation by pulse oximetry (Spo2 )]) is a reliable noninvasive surrogate for the OI that is associated with hospital mortality and ventilator-free days (VFDs) in patients with ARDS...
December 2017: Chest
https://www.readbyqxmd.com/read/28815092/zinc-chloride-smoke-inhalation-induced-severe-acute-respiratory-distress-syndrome-first-survival-in-the-united-states-with-extended-duration-five-weeks-therapy-with-high-dose-corticosteroids-in-combination-with-lung-protective-ventilation
#18
Hafiz Mahboob, Robert Richeson Iii, Robert McCain
Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28306327/fifty-years-of-research-in-ards-respiratory-mechanics-in-acute-respiratory-distress-syndrome
#19
REVIEW
William R Henderson, Lu Chen, Marcelo B P Amato, Laurent J Brochard
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small Vt, low plateau and driving pressures, and high levels of positive end-expiratory pressure. Collectively, these interventions are termed "lung-protective ventilation." Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population-based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation...
October 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28459322/fifty-years-of-research-in-ards-is-extracorporeal-circulation-the-future-of-acute-respiratory-distress-syndrome-management
#20
REVIEW
Alain Combes, Antonio Pesenti, V Marco Ranieri
Mechanical ventilation (MV) remains the cornerstone of acute respiratory distress syndrome (ARDS) management. It guarantees sufficient alveolar ventilation, high FiO2 concentration, and high positive end-expiratory pressure levels. However, experimental and clinical studies have accumulated, demonstrating that MV also contributes to the high mortality observed in patients with ARDS by creating ventilator-induced lung injury. Under these circumstances, extracorporeal lung support (ECLS) may be beneficial in two distinct clinical settings: to rescue patients from the high risk for death associated with severe hypoxemia, hypercapnia, or both not responding to maximized conventional MV, and to replace MV and minimize/abolish the harmful effects of ventilator-induced lung injury...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
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