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1.
Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Síndrome do Desconforto Respiratório do Adulto/terapia
2.
Medicine (Baltimore) ; 99(1): e18586, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895807

RESUMO

BACKGROUND: The acute respiratory distress syndrome (ARDS) is a critical illness with high mortality and a worse prognosis. Mechanical ventilation (MV) is currently considered to be one of the most effective methods of treating ARDS. In this meta-analysis, we discussed the efficacy of airway pressure release ventilation (APRV) in treating ARDS. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), Ovid Medline, Embase, and PubMed were systematically searched with the keywords of "ARDS" and "APRV". The studies containing the treatment of APRV in ARDS were included. According to the MV protocol used in the studies, the comparison was undertaken between the APRV group vs low tidal volume (LTV) group and synchronized intermittent mandatory ventilation (SIMV) group. The relative risk (RR) and the standard mean difference with 95% confidence intervals (CI) were used for the comparison between groups. RESULTS: Fourteen studies with 2096 patients were included in the meta-analysis. The average increasing rate of PaO2/FiO2 was 75.4% in the APRV group vs 44.1% in the non-APRV group. No significant differences were found in mortality and duration of ICU stay between APRV vs LTV (P = .073 and P = .404) and APRV vs SIMV (P = .370 and P = .894). CONCLUSION: The APRV protocol would have a higher increase in the PaO2/FiO2 ratio, which was a safe protocol with a compatible effect comparing to LTV and SIMV.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Síndrome do Desconforto Respiratório do Adulto/terapia , Humanos
3.
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
4.
Wiad Lek ; 72(9 cz 2): 1822-1828, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622273

RESUMO

Extracorporeal membrane oxygenation (ECMO) is a technique involving oxygenation of blood and elimination of carbon dioxide in patients with life-threatening, but potentially reversible conditions. Thanks to the modification of extracorporeal circulation used during cardiac surgeries, this technique can be used in intensive care units. Venovenous ECMO is used as a respiratory support, while venoarterial ECMO as a cardiac and/or respiratory support. ECMO does not cure the heart and/or lungs, but it gives the patient a chance to survive a period when these organs are inefficient. In addition, extracorporeal membrane oxygenation reduces or eliminates the risk of lung damage associated with invasive mechanical ventilation in patients with severe ARDS (acute respiratory distress syndrome). ECMO is a very invasive therapy, therefore it should only be used in patients with extremely severe respiratory failure, who failed to respond to conventional therapies. According to the Extracorporeal Life Support Organization (ELSO) Guidelines, inclusion criteria are: PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours. Proper ECMO management requires advanced medical care. This article discusses the history of ECMO development, clinical indications, contraindications, clinical complications and treatment outcomes.


Assuntos
Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Humanos , Respiração Artificial , Resultado do Tratamento
5.
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
6.
Medicine (Baltimore) ; 98(38): e17284, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568012

RESUMO

BACKGROUND: This study will assess the efficacy and safety of blood purification (BP) for severe pancreatitis (SP) and acute respiratory distress syndrome (ARDS). METHODS: We will search the following electronic databases of Ovid MEDLINE, EMBASE, Web of Science, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANGFANG from inception to the present without language restriction. A systematic review and data synthesis will be carried out of randomized controlled trials of BP for the treatment of patients with SP and ARDS. RevMan 5.3 software will be used for statistical analysis. RESULTS: This systematic review will evaluate the efficacy and safety of BP for the treatment of patients with SP and ARDS. The primary outcome includes respiratory indexes, blood biochemical and inflammatory factors. The secondary outcomes consist of complications, sepsis, abdominal hemorrhage, renal failure, length of hospital stay, and mortality. CONCLUSION: This study will provide up-to-date evidence of BP for the treatment of patients with SP and ARDS. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139467.


Assuntos
Hemofiltração , Pancreatite/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Doença Aguda , Hemofiltração/métodos , Humanos , Pancreatite/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Resultado do Tratamento
7.
Med. intensiva (Madr., Ed. impr.) ; 43(7): 402-409, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-ET2-3449

RESUMO

Objective: To evaluate the clinical outcomes of patients with severe acute respiratory distress syndrome (ARDS) subjected to prone positioning before extracorporeal membrane oxygenation (ECMO). Design: A retrospective analysis of a multicenter cohort was carried out. Setting: Patients admitted to the Intensive Care Units of 11 hospitals in Korea. Patients: Patients were divided into those who underwent prone positioning before ECMO (n=28) and those who did not (n=34). Interventions: None. Variables of interest: Thirty-day mortality, ECMO weaning failure rate, mechanical ventilation weaning success rate, mechanical ventilation-free days at day 60. Results: The prone group had lower median peak inspiratory pressure and lower median dynamic driving pressure before ECMO. Thirty-day mortality was 21% in the prone group and 41% in the non-prone group (p=0.098). The prone group also showed a lower ECMO weaning failure rate, and a higher mechanical ventilation weaning success rate and more mechanical ventilation-free days at day 60. In the non-prone group, median dynamic compliance marginally decreased shortly after ECMO, but no significant change was observed in the prone group. Conclusions: Prone positioning before ECMO was not associated to increased mortality and tended to exert a protective effect


Objetivo: Evaluar los resultados clínicos de pacientes con síndrome de dificultad respiratoria aguda (SDRA) quienes fueron colocados en decúbito prono previo a la oxigenación con membrana extracorpórea (ECMO). Diseño: Análisis retrospectivo de una cohorte multicéntrico. Escenario: Pacientes admitidos en las unidades de cuidado intensivo de 11 hospitales en Corea. Pacientes: Los pacientes fueron divididos en aquellos que fueron colocados en decúbito prono antes de la ECMO (n=28) y aquellos que no fueron colocados en decúbito prono antes de la ECMO (n=34). Intervenciones: Ninguna. Variables de interés principales: Mortalidad a los 30 días, tasa de fracaso de retirada gradual de la ECMO, tasa de éxito de retirada gradual de la ventilación mecánica, días sin ventilación mecánica a los 60 días. Resultados: El grupo prono tuvo una mediana más baja de la presión inspiratoria máxima y una mediana más baja de la presión de conducción dinámica antes de la ECMO. La mortalidad a los 30 días fue 21% en el grupo prono y 41% en el grupo no prono (P = 0.098). El grupo prono también mostró un valor numérico menor de tasa de fracaso de retirada progresiva de la ECMO, y valores más altos de tasa de éxito de destete de la ventilación mecánica y días sin ventilación mecánica a los 60 días. En el grupo no prono, la mediana del cumplimiento dinámico descendió marginalmente, poco después de ECMO, pero no se observó un cambio significativo en el grupo prono. Conclusiones: La colocación en decúbito prono antes de la ECMO no se asoció con un incremento en mortalidad y tendió a ser de protección


Assuntos
Humanos , Decúbito Ventral/fisiologia , Oxigenação por Membrana Extracorpórea/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Posicionamento do Paciente/métodos , Estudos de Coortes , Estudos Retrospectivos , Fatores de Risco , Análise Multivariada , Síndrome do Desconforto Respiratório do Adulto/mortalidade
8.
J Ayub Med Coll Abbottabad ; 31(3): 469-471, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535532

RESUMO

A 39-year-old gentleman presented to emergency department with a few hours' history of acute shortness of breath, cough and haemoptysis that developed whilst welding a steel tank in a closed container. He was welder by profession for thirteen years with no significant past medical history. The arterial blood gas showed severe oxygenation impairment and he was intubated for mechanical ventilation. The radiographs showed bilateral widespread interstitial shadowing. The echocardiography showed normal heart and ruled out cardiogenic pulmonary oedemic. The microbiological investigations were all normal. He was treated as Acute Respiratory Distress Syndrome (ARDS) secondary to exposure to welding metal fumes in a closed container. He was given limited tidal volume invasive ventilation, extubated successfully after twelve days, transferred to respiratory ward for rehabilitation and discharged few days later. Exposure to welding metal fumes at work place is a major occupational health hazard worldwide. It can cause ARDS and other respiratory illnesses such as bronchitis, metal fumes fever and chronic pneumonitis. The pathogenesis of ARDS due to welding metal fumes involves direct inhalational injury and/or immune system dysfunction. Welding metal fumes related ARDS remains the diagnosis of exclusion and all other causes must be ruled out. The key to treatment is ventilation support with early endotracheal intubation. Appropriate precautionary measures are advised to avoid occupational health hazards in welding profession.


Assuntos
Gases/efeitos adversos , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Soldagem , Adulto , Humanos , Masculino , Doenças Profissionais/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia
10.
Z Rheumatol ; 78(10): 955-966, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31485728

RESUMO

Severe, organ-threatening and life-threatening manifestations of inflammatory rheumatic diseases, such as diffuse alveolar hemorrhage in the context of small vessel vasculitis, sometimes inadequately respond to immunosuppressive treatment. In the case of an immanent or already occurring organ failure, immunosuppressive treatment may need to be supplemented with rapidly effective rescue treatment procedures. Due to the rarity of many rheumatic diseases, the evidence for the use of rescue treatment, such as plasmapheresis, extracorporeal membrane oxygenation (ECMO) and the administration of intravenous immunoglobulins (IVIG), is relatively low for many indications. The use of plasmapheresis is considered useful in acute anti-glomerular basement membrane (GBM) disease (Goodpasture's syndrome) or catastrophic antiphospholipid antibody syndrome (APS). The use of ECMO treatment may be considered for persistent respiratory failure despite mechanical ventilation due to diffuse alveolar hemorrhage or acute respiratory distress syndrome (ARDS). Administration of IVIG is indicated for acute cardiac involvement in Kawasaki's disease and may be considered in catastrophic APS and refractory myositis.


Assuntos
Doença Antimembrana Basal Glomerular , Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório do Adulto , Doenças Reumáticas , Humanos , Unidades de Terapia Intensiva , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/terapia , Doenças Reumáticas/complicações , Doenças Reumáticas/terapia
11.
Crit Care Nurs Q ; 42(4): 371-375, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449147

RESUMO

Adult respiratory distress syndrome (ARDS) is a clinical entity characterized by hypoxemic respiratory failure in the setting of noncardiogenic pulmonary edema. It is associated with significant morbidity and mortality. Prone positioning is a beneficial strategy in patients with severe ARDS because it improves alveolar recruitment, ventilation/perfusion (V/Q) ratio, and decreases lung strain. The outcome is improved oxygenation, decreased severity of lung injury, and, subsequently, mortality benefit. In this article, we discuss the physiology of prone positioning on chest mechanics and V/Q ratio, the placement and maintenance of patients in the prone position with use of a prone bed and the current literature regarding benefits of prone positioning in patients with ARDS.


Assuntos
Decúbito Ventral/fisiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Humanos , Hipóxia/etiologia , Alvéolos Pulmonares/fisiologia , Edema Pulmonar/etiologia , Respiração Artificial/efeitos adversos
12.
Crit Care Nurs Q ; 42(4): 392-399, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449149

RESUMO

Mechanical ventilation is the primary supportive, invasive measure utilized in patients with acute respiratory distress syndrome. Throughout the years, many large multicenter randomized controlled trials and observational studies were analyzed to determine what ventilator parameters to use that would produce a mortality benefit after initial diagnosis. This article discusses the concepts of ventilator-induced lung injury, permissive hypercapnia, high-versus-low peep strategies, oxygenation goals, and recruitment strategies from a physiologic perspective and the major studies that produced recommendations for each. Newer concepts, such as driving pressure, are also discussed.


Assuntos
Respiração Artificial/normas , Síndrome do Desconforto Respiratório do Adulto/terapia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Ensaios Clínicos como Assunto/normas , Humanos , Hipercapnia/fisiopatologia , Hipóxia , Respiração Artificial/mortalidade , Volume de Ventilação Pulmonar/fisiologia
13.
Crit Care Nurs Q ; 42(4): 400-410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449150

RESUMO

Extracorporeal membrane oxygenation (ECMO) has become a key tool in the management of cardiac and/or respiratory failure refractory to conventional management. Although ECMO has multiple indications, it has been widely studied for the management of acute respiratory distress syndrome in adults. ECMO provides rest and support while the damaged lungs heal. It is an invasive modality with risks of serious complications; therefore, clinicians should be vigilant during patient selection. Furthermore, users should be familiar with different components of the ECMO machinery and the management of different organ systems while patients are on the circuit. ECMO is a relatively new modality that has shown good results when used in certain circumstance, and its use is becoming more popular across the United States.


Assuntos
Oxigenação por Membrana Extracorpórea , Guias como Assunto/normas , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Oxigenação por Membrana Extracorpórea/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Pessoa de Meia-Idade
14.
Crit Care Nurs Q ; 42(4): 411-416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449151

RESUMO

Acute respiratory distress syndrome (ARDS) was first described in 1967. Since then, several landmark studies have been published that have greatly influenced the way we diagnose and treat patients with ARDS. Despite extensive research and advancements in ventilator strategies, moderate-severe ARDS has been associated with high mortality rates. Current treatment remains primarily supportive with lung-protective ventilation strategies. Pharmacological therapies that reduce the severity of lung injury in vivo and in vitro have not yet translated into effective clinical treatment options. Currently, the mortality rate of severe ARDS remains in the range of 30% to 40%. To review, the mainstay of ARDS management includes mechanical ventilation with low tidal volumes to decrease barotrauma, prone ventilation, conservative fluid management, and neuromuscular blockade. ARDS survivors tend to have long-term and potentially permanent neuromuscular, cognitive, and psychological symptoms, affecting patient's quality of life posthospitalization. These long-term effects are likely secondary to prolonged hospitalizations, prolonged mechanical ventilation, utilization of prone strategies, utilization of paralytic drugs, and occasionally steroids. Therefore, several novel therapies outside the realm of advanced ventilation and prone positioning methods are being studied. In this article, we discuss a few of these novel therapies including prophylactic aspirin, inhaled nitric oxide, mesenchymal stem cells, and intravenous ß-agonists. Steroids and extracorporeal membrane oxygenation have been discussed in a previous article.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/terapia , Administração por Inalação , Aspirina/administração & dosagem , Humanos , Células-Tronco Mesenquimais , Óxido Nítrico , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia
15.
Crit Care Nurs Q ; 42(4): 448-458, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449154

RESUMO

Acute respiratory distress syndrome is a heterogenous condition with significant mortality and limited therapeutic options. Although hypoxic respiratory failure tends to be the hallmark of the disease, there can be significant cardiac compromise, particularly in the right ventricle. Echocardiography plays an important role in the early diagnosis and recognition of right ventricular dysfunction. Treatment of said dysfunction with mechanical ventilation strategies and therapies such as inhaled nitric oxide or extracorporeal membrane oxygenation remain poorly studied but offer potential salvage strategies.


Assuntos
Cardiopatias , Hipertensão Pulmonar , Síndrome do Desconforto Respiratório do Adulto , Função Ventricular Direita , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Hipóxia , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/terapia
16.
Khirurgiia (Mosk) ; (8): 5-11, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31464267

RESUMO

OBJECTIVE: To evaluate incidence, causes and outcomes of acute respiratory failure (ARF) in patients after cardiac and aortic surgery. MATERIAL AND METHODS: A retrospective trial included 3972 patients after elective cardiovascular procedures for the period 2013-2017. Inclusion criterion: sustained reduction of pulmonary function (PaO2/FiO2<300 mm Hg) in the postoperative period required mechanical ventilation or non-invasive positive pressure mask ventilation for at least 24 h. RESULTS: ARF developed in 138 (3.5%) cases. It was observed after aortic surgery as a rule (11.2%). Other operations were followed by ARF in 1-3.5% of cases. Incidence of ARF was less after off-pump coronary artery bypass surgery compared with on-pump interventions (1.6 vs. 3.5%, p=0.0469). Acute respiratory distress syndrome was the main reason of ARF (n=37, 26.8%). ARF as a consequence of neurological complications were observed in 25 (18.1%) patients. Exacerbation of COPD and bronchial asthma occurred in 23 (16.1%) patients, paresis of the diaphragm - in 15 (11.7%). In 15 (10.8%) patients, ARF was caused by pneumonia, in 12 (8.7%) cases - pulmonary congestion, in 10 (7.2%) patients - lung injury and haemothorax. Overall ARDS-associated mortality was 21.6%; 15.1% of patients with mild and moderate ARDS died. Severe ARDS was followed by unfavorable outcome in 75% of patients. Nosocomial pneumonia was found in 40.6%, there were no fatal outcomes from this complication. CONCLUSION: Acute respiratory failure developed in 3.5% of cardiac patients and was common thoracic and thoracoabdominal aortic surgery. The leading cause of mortality was ARDS (mortality rate 15.1% in mild and moderate syndrome, 75% in severe course of ARDS). Nosocomial pneumonia was diagnosed in 1.4% of patients and was not fatal.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/mortalidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Doença Aguda , Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/mortalidade , Humanos , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/mortalidade
17.
Anesthesiology ; 131(3): 594-604, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31335543

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Higher driving pressure during controlled mechanical ventilation is known to be associated with increased mortality in patients with acute respiratory distress syndrome.Whereas patients with acute respiratory distress syndrome are initially managed with controlled mechanical ventilation, as they improve, they are transitioned to assisted ventilation. Whether higher driving pressure assessed during pressure support (assisted) ventilation can be reliably assessed and whether higher driving pressure is associated with worse outcomes in patients with acute respiratory distress syndrome has not been well studied. WHAT THIS ARTICLE TELLS US THAT IS NEW: This study shows that in the majority of adult patients with acute respiratory distress syndrome, both driving pressure and respiratory system compliance can be reliably measured during pressure support (assisted) ventilation.Higher driving pressure measured during pressure support (assisted) ventilation significantly associates with increased intensive care unit mortality, whereas peak inspiratory pressure does not.Lower respiratory system compliance also significantly associates with increased intensive care unit mortality. BACKGROUND: Driving pressure, the difference between plateau pressure and positive end-expiratory pressure (PEEP), is closely associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). Although this relationship has been demonstrated during controlled mechanical ventilation, plateau pressure is often not measured during spontaneous breathing because of concerns about validity. The objective of the present study is to verify whether driving pressure and respiratory system compliance are independently associated with increased mortality during assisted ventilation (i.e., pressure support ventilation). METHODS: This is a retrospective cohort study conducted on 154 patients with ARDS in whom plateau pressure during the first three days of assisted ventilation was available. Associations between driving pressure, respiratory system compliance, and survival were assessed by univariable and multivariable analysis. In patients who underwent a computed tomography scan (n = 23) during the stage of assisted ventilation, the quantity of aerated lung was compared with respiratory system compliance measured on the same date. RESULTS: In contrast to controlled mechanical ventilation, plateau pressure during assisted ventilation was higher than the sum of PEEP and pressure support (peak pressure). Driving pressure was higher (11 [9-14] vs. 10 [8-11] cm H2O; P = 0.004); compliance was lower (40 [30-50] vs. 51 [42-61] ml · cm H2O; P < 0.001); and peak pressure was similar, in nonsurvivors versus survivors. Lower respiratory system compliance (odds ratio, 0.92 [0.88-0.96]) and higher driving pressure (odds ratio, 1.34 [1.12-1.61]) were each independently associated with increased risk of death. Respiratory system compliance was correlated with the aerated lung volume (n = 23, r = 0.69, P < 0.0001). CONCLUSIONS: In patients with ARDS, plateau pressure, driving pressure, and respiratory system compliance can be measured during assisted ventilation, and both higher driving pressure and lower compliance are associated with increased mortality.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Respiração com Pressão Positiva/mortalidade , Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/terapia , Idoso , Estudos de Coortes , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Complacência Pulmonar , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume de Ventilação Pulmonar , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 98(29): e16531, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335733

RESUMO

BACKGROUND: To identify the clinical correlations between mechanical power and transforming growth factor-ß1 (TGF-ß1) and connective tissue growth factor (CTGF) in acute respiratory distress syndrome (ARDS) patients, their clinical significance in pulmonary structural remodeling in ARDS patients was investigated. METHODS: Ninety-five patients with moderate or severe ARDS, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from January 2017 to February 2019. Their mechanical power was monitored and recorded, the TGF-ß1 and CTGF levels were detected by enzyme-linked immunosorbent assay (ELISA), their relevance was analyzed, and the relationship between mechanical power and 28-day survival rate was investigated. According to the high-resolution computed tomography (HRCT) examination, the patients were divided into an ARDS group and an ARDS pulmonary fibrosis (ARDS-PF) group. The differences in mechanical power, TGF-ß1, and CTGF between the 2 groups were compared, and the significance of TGF-ß1 and CTGF in the diagnosis of ARDS pulmonary interstitial fibrosis were evaluated. RESULTS: A significant positive correlation between mechanical power and serum TGF-ß1 and CTGF in patients with ARDS was found and the correlation coefficients were 0.424 and 0.581, respectively. The difference between mechanical power and 28-day survival rate was statistically significant (P < .05), while the area under the receiver operating characteristic curves of TGF-ß1 and CTGF for the diagnosis of ARDS pulmonary fibrosis was 0.838 and 0.884, respectively (P < .05). CONCLUSION: A significant correlation between mechanical power and serum fibrosis biomarkers TGF-ß1 and CTGF in ARDS patients was found, and its level was related to the survival prognosis of patients. Mechanical power, TGF-ß1, and CTGF were clinically evaluated for the assessment of lung structural remodeling, such as ARDS pulmonary fibrosis. This study has particular significance to the early prevention of ventilator-induced lung injury and pulmonary fibrosis in patients with ARDS receiving mechanical ventilation.


Assuntos
Fator de Crescimento do Tecido Conjuntivo/sangue , Fibrose Pulmonar/diagnóstico , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/terapia , Fator de Crescimento Transformador beta1/sangue , Ensaio de Imunoadsorção Enzimática , Humanos , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/patologia , Tomografia Computadorizada por Raios X , Lesão Pulmonar Induzida por Ventilação Mecânica/diagnóstico
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 694-698, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315725

RESUMO

OBJECTIVE: To investigate the prognostic value of microRNA-122 (miR-122) combined with acute physiology and chronic health evaluation II (APACHE II) score in patient with acute respiratory distress syndrome (ARDS), and to provide evidence for the diagnosis and treatment of ARDS. METHODS: ARDS patients admitted to the Third People's Hospital of Haikou City from January 2016 to December 2018 were enrolled. The general data, serum miR-122 expression level and APACHE II score within 24 hours were collected. The patients were divided into survival group and death group according to the survival status of ARDS patients. ARDS patients were divided into low-risk group (< 10 scores), medium-risk group (10-20 scores) and high-risk group (> 20 scores) according to APACHE II score. Predictive values of miR-122 and APACHE II scores on prognosis in ARDS patients were evaluated by the receiver operating characteristic (ROC) curve. The correlation between the serum miR-122 expression and APACHE II score in patients with ARDS was calculated by Pearson correlation analysis. RESULTS: A total of 142 ARDS patients were selected, 94 male and 48 female; with age (56.80±11.30) years old; 55 deaths and 87 survivors; 67 of high-risk, 48 of medium-risk and 27 of low-risk. The expression of serum miR-122 and APACHE II score in the death group were significantly higher than those in the survival group [miR-122 (2-ΔΔCt): 0.26±0.12 vs. 0.07±0.03, APACHE II: 31.84±4.25 vs. 15.30±2.60, both P < 0.01]. With the severity increase of the disease, the serum miR-122 expression level, APACHE II score, and mortality rate of ARDS patients gradually elevated, and the difference between the two groups was significant in the low-risk group, medium-risk group, and high-risk group [miR-122 (2-ΔΔCt): 0.05±0.02, 0.14±0.06, 0.23±0.09; APACHE II: 12.30±2.15, 20.62±3.40, 28.90±3.60; mortality rate: 11.1%, 31.2%, 55.2%, respectively, all P < 0.05]. ROC curve analysis showed that miR-122 and APACHE II score could predict the death of ARDS patients, and the area under the ROC curve (AUC) was 0.835 [95% confidence interval (95%CI) = 0.776-0.893] and 0.790 (95%CI = 0.732-0.854); the predicted value of the miR-122 combined with APACHE II score (AUC = 0.918, 95%CI = 0.857-0.972) was higher than the single miR-122 and APACHE II score (both P < 0.05), with sensitivity and specificity were 91.3% and 86.4% respectively. The correlation analysis showed that the expression of serum miR-122 was positively correlated with APACHE II score in death patient with ARDS (r = 0.825, P < 0.01). CONCLUSIONS: Elevated serum miR-122 expression level is associated with disease severity and prognosis of ARDS patients; miR-122 combination with APACHE II score has a high evaluation value on prognosis of ARDS patients.


Assuntos
MicroRNAs/sangue , Síndrome do Desconforto Respiratório do Adulto/terapia , APACHE , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Síndrome do Desconforto Respiratório do Adulto/sangue
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 704-708, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315727

RESUMO

OBJECTIVE: To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). METHODS: Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. RESULTS: At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHE II and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHE II was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. CONCLUSIONS: There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.


Assuntos
Pulmão/diagnóstico por imagem , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Curva ROC , Ultrassonografia
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