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46 papers 25 to 100 followers
John G Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo M Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Anders Larsson, Daniel F McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco Ranieri, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents...
October 18, 2016: Intensive Care Medicine
Surat Tongyoo, Chairat Permpikul, Wasineenart Mongkolpun, Veerapong Vattanavanit, Suthipol Udompanturak, Mehmet Kocak, G Umberto Meduri
BACKGROUND: Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome (ARDS) of multifactorial etiology. A prospective randomized trial limited to patients with sepsis-associated ARDS is lacking. The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS. METHODS: In this double-blind, single-center (Siriraj Hospital, Bangkok), randomized, placebo-controlled trial, we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria...
October 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
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
Abdullah Almotairi, Sharmistha Biswas, Jason Shahin
Background. The aim of this study was to assess the utility of open lung biopsy in patients with hypoxic respiratory failure of unknown etiology admitted to an ICU and to examine the use of steroid therapy in this patient population. Methods. A retrospective cohort study was performed of all consecutive patients admitted to three tertiary care, university-affiliated, ICUs during the period from January 2000 to January 2012 with the principal diagnosis of hypoxic respiratory failure and who underwent an open lung biopsy...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Eric L Scholten, Jeremy R Beitler, G Kim Prisk, Atul Malhotra
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in the acute respiratory distress syndrome (ARDS). Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiology mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proven challenging; several contemporary trials showed no major clinical benefits with proning...
July 8, 2016: Chest
Davide Chiumello, Matteo Brioni
BACKGROUND: Acute respiratory distress syndrome (ARDS) is characterized by a noncardiogenic pulmonary edema with bilateral chest X-ray opacities and reduction in lung compliance, and the hallmark of the syndrome is hypoxemia refractory to oxygen therapy. Severe hypoxemia (PaO2/FiO2 < 100 mmHg), which defines severe ARDS, can be found in 20-30 % of the patients and is associated with the highest mortality rate. Although the standard supportive treatment remains mechanical ventilation (noninvasive and invasive), possible adjuvant therapies can be considered...
2016: Critical Care: the Official Journal of the Critical Care Forum
Eduardo Mireles-Cabodevila, Robert M Kacmarek
Airway pressure release ventilation (APRV) was originally described as a mode to treat lung-injured patients with the goal to maintain a level of airway pressure that would not depress the cardiac function, deliver mechanical breaths without excessive airway pressure, and to allow unrestricted spontaneous ventilation. Indeed, based on its design, APRV has technological features that serve the goals of safety and comfort. Animal studies suggest that APRV leads to alveolar stability and recruitment which result in less lung injury...
June 2016: Respiratory Care
Albert P Nguyen, Ulrich H Schmidt, Neil R MacIntyre
High-frequency oscillatory ventilation (HFOV) can improve ventilation-perfusion matching without excessive alveolar tidal stretching or collapse-reopening phenomenon. This is an attractive feature in the ventilation of patients with ARDS. However, two recent large multi-center trials of HFOV failed to show benefits in this patient population. The following review addresses whether, in view of these trails, HFOV should be abandoned in the adult population?
June 2016: Respiratory Care
John J Marini, Sean A Josephs, Maggie Mechlin, William E Hurford
For the past 4 decades, the prone position has been employed as an occasional rescue option for patients with severe hypoxemia unresponsive to conventional measures applied in the supine orientation. Proning offers a high likelihood of significantly improved arterial oxygenation to well selected patients, but until the results of a convincing randomized trial were published, its potential to reduce mortality risk remained in serious doubt. Proning does not benefit patients of all disease severities and stages but may be life-saving for others...
June 2016: Respiratory Care
Jérôme Cecchini, Florence Boissier, Aude Gibelin, Nicolas de Prost, Keyvan Razazi, Guillaume Carteaux, Frederic Galacteros, Bernard Maitre, Christian Brun-Buisson, Armand Mekontso Dessap
BACKGROUND: Acute chest syndrome (ACS) is the most common cause of death among sickle cell disease (SCD) adult patients. Pulmonary vascular dysfunction (PVD) and acute cor pulmonale (ACP) are common during acute respiratory distress syndrome (ARDS) and their prevalence may be even more important during ARDS related to ACS (ACS-ARDS). The objective of this study was to evaluate the prevalence and prognosis of PVD and ACP during ACS-ARDS. PATIENTS AND METHODS: This was a retrospective analysis over a 10-year period of patients with moderate-to-severe ARDS...
October 2016: Shock
Bhakti K Patel, Krysta S Wolfe, Anne S Pohlman, Jesse B Hall, John P Kress
IMPORTANCE: Noninvasive ventilation (NIV) with a face mask is relatively ineffective at preventing endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Delivery of NIV with a helmet may be a superior strategy for these patients. OBJECTIVE: To determine whether NIV delivered by helmet improves intubation rate among patients with ARDS. DESIGN, SETTING, AND PARTICIPANTS: Single-center randomized clinical trial of 83 patients with ARDS requiring NIV delivered by face mask for at least 8 hours while in the medical intensive care unit at the University of Chicago between October 3, 2012, through September 21, 2015...
June 14, 2016: JAMA: the Journal of the American Medical Association
Vasilios Koulouras, Georgios Papathanakos, Athanasios Papathanasiou, Georgios Nakos
Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung" - and the "shape matching" -model...
May 4, 2016: World Journal of Critical Care Medicine
Rob Mac Sweeney, Daniel F McAuley
Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided...
April 28, 2016: Lancet
Davide Chiumello, Silvia Coppola, Sara Froio, Miriam Gotti
ARDS is a life-threatening organ failure due to several pulmonary and extrapulmonary injuries with an incidence between 5 and 60 cases/100,000 persons/y. Patients with ARDS have non-cardiogenic pulmonary edema and dyspnea often requiring invasive mechanical ventilation and intensive care admission. Although the short-term mortality rate has significantly decreased in the last decade, mainly due to the widespread application of lung-protective ventilation and better general support, long-term outcomes are still unsatisfactory...
May 2016: Respiratory Care
Erin S Grawe, Suzanne Bennett, William E Hurford
The use of neuromuscular blocking agents (NMBAs) early in the development of ARDS has been a strategy of interest for many years. The use of NMBAs with a concomitant deep sedation strategy can increase oxygenation and possibly decrease mortality when used in the early stages of ARDS. The mechanism by which this occurs is unclear but probably involves a combination of factors, such as improving patient-ventilator synchrony, decreasing oxygen consumption, and decreasing the systemic inflammatory response associated with ARDS...
June 2016: Respiratory Care
S Clark Berngard, Jeremy R Beitler, Atul Malhotra
Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability)...
March 2016: Journal of Thoracic Disease
Mallar Bhattacharya, Richard H Kallet, Lorraine B Ware, Michael A Matthay
Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE...
October 2016: Chest
Won-Young Kim, Sang-Bum Hong
Severe sepsis or septic shock is characterized by an excessive inflammatory response to infectious pathogens. Acute respiratory distress syndrome (ARDS) is a devastating complication of severe sepsis, from which patients have high mortality. Advances in treatment modalities including lung protective ventilation, prone positioning, use of neuromuscular blockade, and extracorporeal membrane oxygenation, have improved the outcome over recent decades, nevertheless, the mortality rate still remains high. Timely treatment of underlying sepsis and early identification of patients at risk of ARDS can help to decrease its development...
April 2016: Tuberculosis and Respiratory Diseases
Antonio Pesenti, Guido Musch, Daniel Lichtenstein, Francesco Mojoli, Marcelo B P Amato, Gilda Cinnella, Luciano Gattinoni, Michael Quintel
PURPOSE: Imaging has become increasingly important across medical specialties for diagnostic, monitoring, and investigative purposes in acute respiratory distress syndrome (ARDS). METHODS: This review addresses the use of imaging techniques for the diagnosis and management of ARDS as well as gaining knowledge about its pathogenesis and pathophysiology. The techniques described in this article are computed tomography, positron emission tomography, and two easily accessible imaging techniques available at the bedside-ultrasound and electrical impedance tomography (EIT)...
May 2016: Intensive Care Medicine
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
2016-04-07 12:33:41
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