Tag: ARDS

Upvote Story 8
We developed a computerized algorithm that accurately detects three types of ventilator dyssynchrony. Double-triggered and flow-limited breaths are associated with the frequent delivery of tidal volumes of greater than 10 mL/kg. Although ventilator dyssynchrony is reduced by deep sedation, potentially deleterious tidal volumes may still be delivered. However, neuromuscular blockade effectively eliminates ventilator dyssynchrony. A total of 4.26 million breaths were recorded from 62 ventilated patients.... Read More | Comment
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Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). In a large, global observational study of patients with AHRF,... Read More | Comment
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Patients who develop vasodilatory shock, particularly when caused by an inflammatory condition like sepsis or pancreatitis, have evidence of significant endothelial injury as manifested by coagulation disorders and increased capillary permeability. Endothelial injury during shock may lead to ACE defects, which in turn may cause an increase in vasodilatory mediators that are normally metabolized by ACE and a relative or absolute decrease in ANG-2. These... Read More | Comment
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Acute respiratory distress syndrome (ARDS) is a clinical entity that acutely affects the lung parenchyma, and is characterized by diffuse alveolar damage and increased pulmonary vascular permeability. Currently, computed tomography (CT) is commonly used for classifying and prognosticating ARDS. However, performing this examination in critically ill patients is complex, due to the need to transfer these patients to the CT room. Fortunately, new technologies have... Read More | Comment
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In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance. Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the... Read More | Comment
Upvote Story 11
This book covers all clinical aspects of acute respiratory distress syndrome (ARDS), from definition to treatment, focusing on the more recent recommendations and evidence-based medicine. The addressed topics are the various ventilation strategies, the impact of prone positioning, the use of partial and total extracorporeal support, the value of vasodilators, the weaning from mechanical ventilation, the pharmacological interventions, noninvasive ventilation, and the strategies using anti-inflammatory... Read More | Comment
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Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by... Read More | Comment
Upvote Story 11
Despite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement. Tidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg... Read More | Comment
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Prone position, inhaled nitric oxide, high frequency oscillation, extra corporeal life support. The mortality of severe acute respiratory distress syndrome (ARDS), defined with a PaO2/FiO2 ratio of 100 mmHg or less with at least 5 cm H2O of PEEP, still exceeds 40%. Furthermore, although it is true that more ARDS patients die from multi-organ failure than hypoxemia per se, an important subgroup of severe ARDS... Read More | Comment
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Since the description in the 1970s of external positive end-expiratory pressure for acute respiratory distress syndrome (ARDS), the optimum level of external positive end-expiratory pressure remains unresolved. In the 1990s, the lower inflection point, an inspiratory phenomenon on the low-flow pressure–volume curve, was defined as the point above which external positive end-expiratory pressure should be set to ensure full opening of the lung, e.g., open... Read More | Comment
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With an emphasis on the pathophysiologic basis of pulmonary disease, Principles of Pulmonary Medicine, 7th Edition, by Drs. Steven E Weinberger, Barbara A Cockrill, and Jess Mandel, provides a superbly illustrated introduction to this fast-changing field. This essential text employs a concise and understandable approach, integrating clinical topics with underlying physiologic, pathophysiologic, and basic science concepts critical for medical students, trainees, and those looking for... Read More | Comment
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Mechanical ventilation and extracorporeal support are marginally integrated. The best environment for lung healing – complete lung collapse or protective ventilation strategy or fully open and immobile lung (all three conditions feasible with extracorporeal support) – remains to be defined. Recent studies provide a description on how mechanical ventilation is normally applied in combination with extracorporeal support in acute respiratory distress syndrome (ARDS). The data... Read More | Comment
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Improvements in acute respiratory distress syndrome (ARDS) outcomes in adults have been achieved along-side demonstration of the superiority of low-tidal volume ventilation, the relative advantage of a restrictive fluid strategy and the characterization of the main effectors of ventilator-induced lung injury. The heterogeneity of the group of patients defined as “ARDS” on pragmatic criteria is widely recognized. “Lumping” together patients with different ages, etiologies, time... Read More | Comment
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Mr. Jackson is a 36-year-old man whom you are caring for in the intensive care unit (ICU). Before this hospitalization, he was healthy and took no medications. He has never smoked, and he drinks three or four beers every week. A week ago, a couple of coworkers in his office had respiratory illnesses, and a day later, he started having fever, chills, cough, and generalized... Read More | Comment
Upvote Story 5
For the identification of acute respiratory distress syndrome (ARDS) using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that... Read More | Comment