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1.
Pneumologie ; 74(1): 46-49, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31958870

RESUMO

In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Guias de Prática Clínica como Assunto , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/diagnóstico , Doença Aguda , Humanos , Pulmão , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/fisiopatologia
2.
DNA Cell Biol ; 38(12): 1444-1451, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31651197

RESUMO

Acute respiratory distress syndrome (ARDS) is a devastating condition of acute inflammatory lung injury and causes high morbidity and mortality. Therefore, investigations on the effective biomarkers will be significant for the understanding of ARDS. In our research, the gene expression profiles of 27 samples from ARDS patients (n = 18) and healthy controls (n = 9) were analyzed and eight gene co-expression modules were identified by constructing weighted gene co-expression network. The correlation analysis of modules with phenotypes showed that genes in the yellow and black modules, which were significantly enriched in the ARDS-related pathways, such as TNF signaling pathway, Toll-like receptor signaling pathway, and NF-kappa B signaling pathway, were associated with the phenotype "time postinfection." Genes DDX58 and CXCL10, which were highly expressed after infection and significantly enriched in ARDS-related pathways, presented high score in protein-protein interaction analysis, indicating that they may be associated with ARDS and providing novel biomarkers for its diagnosis, treatment, and surveillance.


Assuntos
Biomarcadores/análise , Quimiocina CXCL10/genética , Proteína DEAD-box 58/genética , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/genética , Transcriptoma , Estudos de Casos e Controles , Humanos , Transdução de Sinais
3.
Rev Med Liege ; 74(10): 514-520, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609554

RESUMO

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity is based on the appearance of a diffuse alveolar damage associating pulmonary epithelial barrier disruption with an alveolar filling, both responsible of profound hypoxemia and important morbi-mortality. Nowadays, ARDS remains a frequent syndrome, associated with various etiologies. Diagnosis is based on the occurrence of acute hypoxic respiratory failure not explained by cardiac insufficiency or volume overload, within 7 days after a recognized risk factor, and in the presence of bilateral pulmonary opacities not fully explained by effusions, atelectasis or nodules on the chest radiography. Survivors present an increased risk of developing cognitive decline, depression, post-traumatic stress, and typical ICU related side-effects such as polyneuropathy and sarcopenia. In this context and not withstanding significant recent progress in the field of mechanical ventilation and extra-corporeal respiratory assistance, early diagnosis remains essential to identify patients with ARDS in order to offer them the most appropriate therapy.


Assuntos
Síndrome do Desconforto Respiratório do Adulto , Humanos , Hipóxia , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/terapia , Fatores de Risco
4.
Crit Care Nurs Q ; 42(4): 344-348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449144

RESUMO

First successfully described in 1967, acute respiratory distress syndrome has since garnered much interest and debate. Extensive studies and clinical trials have been carried out in efforts to address the associated high mortality; however, it remains a significant burden on health care. Despite the heterogeneous etiologies that lead to the development of acute respiratory distress syndrome, this rapidly progressing form of respiratory failure, characterized by severe hypoxemia and nonhydrostatic pulmonary edema, has a recognizable pattern of lung injury. In this chapter, we will review the clinical manifestations, definitions, causes, and a brief overview of the pathophysiology of this complex syndrome.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Enfermagem de Cuidados Críticos , Dispneia/etiologia , Humanos , Hipóxia/etiologia , Edema Pulmonar/etiologia , Síndrome do Desconforto Respiratório do Adulto/enfermagem , Fatores de Risco
5.
Crit Care Nurs Q ; 42(4): 417-430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449152

RESUMO

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.


Assuntos
Diagnóstico Diferencial , Hipóxia/diagnóstico , Pneumonia/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/diagnóstico , Humanos
6.
Int J Mol Sci ; 20(16)2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31426444

RESUMO

The excessive hospital mortality associated with acute respiratory distress syndrome (ARDS) in adults mandates an urgent need for developing new therapies and tools for the early risk assessment of these patients. ARDS is a heterogeneous syndrome with multiple different pathogenetic processes contributing differently in different patients depending on clinical as well as genetic factors. Identifying genetic-based biomarkers holds the promise for establishing effective predictive and prognostic stratification methods and for targeting new therapies to improve ARDS outcomes. Here we provide an updated review of the available evidence supporting the presence of genetic factors that are predictive of ARDS development and of fatal outcomes in adult critically ill patients and that have been identified by applying different genomic and genetic approaches. We also introduce other incipient genomics approximations, such as admixture mapping, metagenomics and genome sequencing, among others, that will allow to boost this knowledge and likely reveal new genetic predictors of ARDS susceptibility and prognosis among critically ill patients.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/genética , Transcriptoma , Animais , Estado Terminal , Marcadores Genéticos/genética , Predisposição Genética para Doença , Genômica , Humanos , Prognóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia
7.
Anal Bioanal Chem ; 411(24): 6435-6447, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31367803

RESUMO

Acute respiratory distress syndrome (ARDS) is the most severe form of acute lung injury, responsible for high mortality and long-term morbidity. As a dynamic syndrome with multiple etiologies, its timely diagnosis is difficult as is tracking the course of the syndrome. Therefore, there is a significant need for early, rapid detection and diagnosis as well as clinical trajectory monitoring of ARDS. Here, we report our work on using human breath to differentiate ARDS and non-ARDS causes of respiratory failure. A fully automated portable 2-dimensional gas chromatography device with high peak capacity (> 200 at the resolution of 1), high sensitivity (sub-ppb), and rapid analysis capability (~ 30 min) was designed and made in-house for on-site analysis of patients' breath. A total of 85 breath samples from 48 ARDS patients and controls were collected. Ninety-seven elution peaks were separated and detected in 13 min. An algorithm based on machine learning, principal component analysis (PCA), and linear discriminant analysis (LDA) was developed. As compared to the adjudications done by physicians based on the Berlin criteria, our device and algorithm achieved an overall accuracy of 87.1% with 94.1% positive predictive value and 82.4% negative predictive value. The high overall accuracy and high positive predicative value suggest that the breath analysis method can accurately diagnose ARDS. The ability to continuously and non-invasively monitor exhaled breath for early diagnosis, disease trajectory tracking, and outcome prediction monitoring of ARDS may have a significant impact on changing practice and improving patient outcomes. Graphical abstract.


Assuntos
Testes Respiratórios/instrumentação , Cromatografia Gasosa/instrumentação , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Gasometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Prognóstico
8.
Ulus Travma Acil Cerrahi Derg ; 25(4): 350-354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297773

RESUMO

BACKGROUND: Chest injuries, accounting for 25% of all trauma-related deaths, are one of the main causes of death in young adults. Our priority is the early identification of life-threatening injuries both immediate and delayed. The role of various biomarkers, such as Clara cell protein 16, von Willebrand factor, interleukin-6, tumor necrosis factor, and angiopoietin, has been studied in trauma-related acute respiratory distress syndrome (ARDS). Serum angiotensin-converting enzyme (ACE) levels have been studied in non-trauma-related ARDS. The aim of this prospective observational study was to evaluate the role of ACE levels as a prognostic marker in thoracic trauma. METHODS: A prospective observational study was conducted to evaluate serum ACE levels in thoracic trauma patients and to explore its prognostic potential with regard to clinical outcome. A total of 48 thoracic trauma patients were included in the study. RESULTS: The mean ACE level in the study population was 66.54+-11.18. A strong positive correlation was found among serum ACE levels and Thoracic Trauma Severity Score (TTSS). CONCLUSION: Our study demonstrates that serum ACE levels are increased in thoracic trauma patients with higher levels, indicating the severe nature of trauma in concordance with increased TTSS scores.


Assuntos
Peptidil Dipeptidase A/metabolismo , Traumatismos Torácicos/enzimologia , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Biomarcadores , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/sangue , Prognóstico , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/enzimologia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/etiologia , Traumatismos Torácicos/mortalidade , Ferimentos Penetrantes/complicações , Adulto Jovem
9.
Medicine (Baltimore) ; 98(26): e16029, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261506

RESUMO

BACKGROUND: To study the occurrence and prognosis of acute respiratory distress syndrome (ARDS) using single nucleotide polymorphisms (SNPs) of TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci in the TLR4/NF-κB pathway. METHODS: Genotypes were analyzed for TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci. Plasma TNF-α and IL-6 levels and MyD88 mRNA expression in peripheral blood mononuclear cells (PBMCs) of 300 ARDS patients and 300 non-ARDS patients (control group) were examined. The patients were followed up for 60 days, and the prognosis outcome was recorded. RESULTS: The TNF-α rs1800629 locus A allele and the IL-6 rs1800796 locus G allele were found to be risk factors for ARDS (adjusted OR = 1.452, 95% CI: 1.211-1.689, P < .001 and adjusted OR = 1.205, 95% CI: 1.058-1.358, P = .005, respectively). The G allele at MyD88 rs7744 locus was a protective factor against ARDS (adjusted OR = 0.748, 95% CI: 0.631-0.876, P < .001). Compared with the other groups, homozygotes for TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 loci had higher expression levels, of which homozygotes for TNF-α rs1800629 and IL-6 rs1800796 loci had lower 60-day survival rates, while MyD88 rs7744 locus homozygotes had a higher 60-day survival rate. CONCLUSION: The effect of TNF-α rs1800629, IL-6 rs1800796, and MyD88 rs7744 SNPs on gene expression level is a likely cause of ARDS occurrence and poor prognosis.


Assuntos
NF-kappa B/genética , Polimorfismo de Nucleotídeo Único , Síndrome do Desconforto Respiratório do Adulto/genética , Receptor 4 Toll-Like/genética , Fator de Necrose Tumoral alfa/genética , Biomarcadores/sangue , Feminino , Expressão Gênica/genética , Humanos , Interleucina-6/sangue , Interleucina-6/genética , Masculino , Pessoa de Meia-Idade , Fator 88 de Diferenciação Mieloide/sangue , Fator 88 de Diferenciação Mieloide/genética , NF-kappa B/sangue , Prognóstico , RNA Mensageiro/sangue , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Transdução de Sinais , Análise de Sobrevida , Receptor 4 Toll-Like/sangue , Fator de Necrose Tumoral alfa/sangue
10.
Indian J Tuberc ; 66(2): 314-317, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31151503

RESUMO

Tuberculosis and sarcoidosis are chronic multisystem granulomatous conditions which have different aetiology and management but may mimic each other clinically, radiologically and pathologically. Both these diseases usually have a sub acute or chronic presentation and it is rather uncommon for them to coexist or present with acute respiratory failure. We report a case of a 57-year-old male who presented with pyrexia of unknown origin with chronic cough. He was initially diagnosed to have sarcoidosis based on clinico-radiological and histologic evidence and was started on corticosteroids. However, he presented within two weeks with acute respiratory distress and on further investigation was diagnosed with co-existing pulmonary tuberculosis.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Sarcoidose/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem
11.
BMJ Case Rep ; 12(5)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31147412

RESUMO

A 47-year-old man with a recent history of wading in floodwaters presented with a 1-week history of cough, myalgia, conjunctival suffusion and decreasing urine output. The patient had uraemia, hypotension, leukocytosis, thrombocytopenia, elevated liver enzymes and oliguria. His condition quickly worsened with haemoptysis, and respiratory distress which subsequently required intubation and mechanical ventilation. Continuous renal replacement therapy was started together with haemoperfusion (HP). The patient initially required norepinephrine and this was discontinued after the first session of HP. He was referred for veno-venous extracorporeal membrane oxygenation (ECMO) due to severe hypoxia and pulmonary haemorrhage. Oxygenation and lung compliance improved, and serum creatinine levels continued to normalise with improved urine output. He was placed off ECMO, extubated and eventually discharged. Patient was diagnosed with severe leptospirosis, acute respiratory failure and acute kidney injury successfully treated with simultaneous ECMO and HP. Blood samples were positive for Leptospira spp. DNA via PCR assay.


Assuntos
Lesão Renal Aguda/diagnóstico , Leptospirose/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Oxigenação por Membrana Extracorpórea , Hemoperfusão , Humanos , Leptospirose/complicações , Leptospirose/terapia , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/terapia , Terapia de Salvação
12.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(3): 435-443, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31232547

RESUMO

Acute respiratory distress syndrome (ARDS) is a serious threat to human life and health disease, with acute onset and high mortality. The current diagnosis of the disease depends on blood gas analysis results, while calculating the oxygenation index. However, blood gas analysis is an invasive operation, and can't continuously monitor the development of the disease. In response to the above problems, in this study, we proposed a new algorithm for identifying the severity of ARDS disease. Based on a variety of non-invasive physiological parameters of patients, combined with feature selection techniques, this paper sorts the importance of various physiological parameters. The cross-validation technique was used to evaluate the identification performance. The classification results of four supervised learning algorithms using neural network, logistic regression, AdaBoost and Bagging were compared under different feature subsets. The optimal feature subset and classification algorithm are comprehensively selected by the sensitivity, specificity, accuracy and area under curve (AUC) of different algorithms under different feature subsets. We use four supervised learning algorithms to distinguish the severity of ARDS (P/F ≤ 300). The performance of the algorithm is evaluated according to AUC. When AdaBoost uses 20 features, AUC = 0.832 1, the accuracy is 74.82%, and the optimal AUC is obtained. The performance of the algorithm is evaluated according to the number of features. When using 2 features, Bagging has AUC = 0.819 4 and the accuracy is 73.01%. Compared with traditional methods, this method has the advantage of continuously monitoring the development of patients with ARDS and providing medical staff with auxiliary diagnosis suggestions.


Assuntos
Algoritmos , Aprendizado de Máquina , Monitorização Fisiológica/métodos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Área Sob a Curva , Gasometria , Humanos , Curva ROC , Sensibilidade e Especificidade
13.
BMC Pulm Med ; 19(1): 115, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238942

RESUMO

BACKGROUND: We aimed to evaluate whether serum activin-A levels are elevated and have any value in predicting severity and prognosis in acute respiratory distress syndrome (ARDS). METHODS: Retrospective cohort study was performed with patients who were admitted to MICU with diagnosis of ARDS and have serum samples stored within 48 h of Intensive care unit (ICU) admission between March 2013 and December 2016 at a single tertiary referral hospital. Serum activin-A levels were measured with ELISA kit, and were compared with those of normal healthy control and non-ARDS sepsis patients. RESULTS: Total 97 ARDS patients were included for the study. Levels of Activin-A were elevated in ARDS patients compared to those of healthy controls (Log-transformed activin-A levels 2.89 ± 0.36 vs. 2.34 ± 0.11, p < 0.001, absolute activin-A levels 1525.6 ± 1060.98 vs. 225.9 ± 30.1, p = 0.016) and non-ARDS sepsis patients (Log-transformed activin-A levels 2.89 ± 0.36 vs. 2.73 ± 0.34, p = 0.002, Absolute activin-A levels 1525.6 ± 1060.98 vs. 754.8 ± 123.5 pg/mL, p = 0.036). When excluding five outliers with extremely high activin-A levels, activin-A showed statistically significant correlation with in-hospital mortalities (In-hospital survivors 676.2 ± 407 vs. non-survivors 897.9 ± 561.9 pg/mL, p = 0.047). In predicting in-hospital mortality, serum activin-A concentrations showed superior area under curve compared to that of Acute physiologic and chronic health evaluation II scores (0.653; 95% CI [0541, 0.765] vs. 0.591, 95% CI [0.471, 0.710]). With cut-off level of 708 pg/mL, those with high serum activin-A levels had more than twofold increased risk of in-hospital mortalities. However, those relations were missing when outliers were in. CONCLUSIONS: Serum activin-A levels in ARDS patients are elevated. However, its levels are weakly associated with ARDS outcomes.


Assuntos
Ativinas/sangue , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Idoso , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Curva ROC , República da Coreia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Estudos Retrospectivos , Sepse/sangue , Sepse/diagnóstico , Análise de Sobrevida
14.
Biomed Res Int ; 2019: 8958069, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31111072

RESUMO

Background: Acute respiratory distress syndrome (ARDS) after living-donor liver transplantation (LDLT) is not uncommon, but it lacks the biomarkers for early detection. Club cell protein 16 (CC16), high-motility group box 1 protein (HMGB1), interleukin-1ß (IL-1ß), and IL-10 have been reported as relevant to the development of ARDS. However, they have not been investigated during LDLT. Methods: Seventy-three consecutive recipients undergoing LDLT were enrolled and received the same perioperative care plan. Perioperative serum CC16, HMGB1, IL-1ß, and IL-10 levels were measured at the pretransplant state, 30 minutes after reperfusion, postoperative day 1 (POD1), and POD3. ARDS was diagnosed according to the 2012 Berlin definition. Results: Of the 73 recipients, 13 developed ARDS with significantly longer durations of mechanical ventilation and intensive care unit stay. Serum CC16 levels on POD1 increased significantly from the pretransplant state in the ARDS group but not in the non-ARDS group. Pretransplant serum CC16 levels were also higher in the ARDS group. The area under the receiver operating characteristic curves for POD1 serum CC16 levels used to discriminate ARDS was 0.803 (95% confidence interval: 0.679 to 0.895; p < 0.001). By comparison, HMGB1, IL-1ß, and IL-10 were not associated with ARDS after LDLT. Conclusion: The higher pretransplant serum CC16 level and its increased level on POD1 were associated with the development of early ARDS after LDLT. This trial is registered with NCT01936545, 27 August 2013.


Assuntos
Biomarcadores/sangue , Transplante de Fígado , Doadores Vivos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Uteroglobina/biossíntese , Adulto , Feminino , Proteína HMGB1/sangue , Proteína HMGB1/metabolismo , Humanos , Unidades de Terapia Intensiva , Interleucina-10/sangue , Interleucina-10/metabolismo , Interleucina-1beta/sangue , Interleucina-1beta/metabolismo , Masculino , Pessoa de Meia-Idade , Curva ROC , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Taiwan , Uteroglobina/metabolismo
15.
Am J Case Rep ; 20: 705-708, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31097681

RESUMO

BACKGROUND Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is a technique used to provide prolonged cardiac and respiratory support to persons whose heart and lungs are unable to deliver adequate perfusion or gas exchange to sustain life. It is indicated in patients with severe ARDS, severe hypothermia, and cardiac and respiratory failure when other conventional methods fail. CASE REPORT We report the case of a 22-year-old gravid 2 Para 1 woman who presented to the Emergency Department with pyelonephritis, who subsequently developed sepsis that progressed to ARDS. She was managed successfully with extracorporeal membrane oxygenation [ECMO] for 5 days, with heparin used as an anticoagulant. After significant improvement, she was successfully de-cannulated and extubated. CONCLUSIONS The use of ECMO in pregnancy and post-partum can be associated with several complications to both mother and fetus. With appropriate patient selection, good knowledge of the procedure, and early initiation, successful outcomes can be attained.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações na Gravidez/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Adulto Jovem
16.
Vnitr Lek ; 65(3): 193-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31088096

RESUMO

Acute respiratory distress syndrome (ARDS) is a type of acute diffuse lung injury associated with a predisposing risk factor, characterized by inflammation leading to increased pulmonary vascular permeability and loss of aerated lung tissue. The hallmarks of the clinical syndrome are hypoxemia and bilateral radiographic opacities, associated with several physiological derangements including: increased pulmonary venous admixture, increased physiological dead space, and decreased respiratory system compliance. No pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and the management remains supportive. Lung-protective mechanical ventilation remains the key supportive intervention in ARDS patients, although extracorporeal lung support may extend its role in the near future.


Assuntos
Síndrome do Desconforto Respiratório do Adulto , Previsões , Humanos , Inflamação , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/terapia , Fatores de Risco
17.
Eur Respir Rev ; 28(152)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-30996041

RESUMO

Airway pressure release ventilation (APRV) is a ventilator mode that has previously been considered a rescue mode, but has gained acceptance as a primary mode of ventilation. In clinical series and experimental animal models of extrapulmonary acute respiratory distress syndrome (ARDS), the early application of APRV was able to prevent the development of ARDS. Recent experimental evidence has suggested mechanisms by which APRV, using the time-controlled adaptive ventilation (TCAV) protocol, may reduce lung injury, including: 1) an improvement in alveolar recruitment and homogeneity; 2) reduction in alveolar and alveolar duct micro-strain and stress-risers; 3) reduction in alveolar tidal volumes; and 4) recruitment of the chest wall by combating increased intra-abdominal pressure. This review examines these studies and discusses our current understanding of the pleiotropic mechanisms by which TCAV protects the lung. APRV set according to the TCAV protocol has been misunderstood and this review serves to highlight the various protective physiological and mechanical effects it has on the lung, so that its clinical application may be broadened.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Alvéolos Pulmonares/fisiopatologia , Respiração Artificial/métodos , Respiração , Síndrome do Desconforto Respiratório do Adulto/prevenção & controle , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Animais , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesão Pulmonar Induzida por Ventilação Mecânica/diagnóstico , Lesão Pulmonar Induzida por Ventilação Mecânica/epidemiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/fisiopatologia
18.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30992308

RESUMO

BACKGROUND AND OBJECTIVES: The use of Pediatric Early Warning Scores is becoming widespread to identify and rapidly respond to patients with deteriorating conditions. The ability of Pediatric Early Warning Scores to identify children at high risk of deterioration or death has not, however, been established in resource-limited settings. METHODS: We developed the Pediatric Early Warning Score for Resource-Limited Settings (PEWS-RL) on the basis of expert opinion and existing scores. The PEWS-RL was derived from 6 equally weighted variables, producing a cumulative score of 0 to 6. We then conducted a case-control study of admissions to the pediatrics department of the main public referral hospital in Kigali, Rwanda between November 2016 and March 2017. We defined case patients as children fulfilling the criteria for clinical deterioration, who were then matched with controls of the same age and hospital ward. RESULTS: During the study period, 627 children were admitted, from whom we selected 79 case patients and 79 controls. For a PEWS-RL of ≥3, sensitivity was 96.2%, and specificity was 87.3% for identifying patients at risk for clinical deterioration. A total PEWS-RL of ≥3 was associated with a substantially increased risk of clinical deterioration (odds ratio 129.3; 95% confidence interval 38.8-431.6; P <.005). CONCLUSIONS: This study reveals that the PEWS-RL, a simple score based on vital signs, mental status, and presence of respiratory distress, was feasible to implement in a resource-limited setting and was able to identify children at risk for clinical deterioration.


Assuntos
Recursos em Saúde/normas , Unidades de Terapia Intensiva Pediátrica/normas , Pediatria/normas , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Sinais Vitais , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Lactente , Masculino , Pediatria/métodos , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Ruanda/epidemiologia
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