Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial.

OBJECTIVE: The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure. METHODS: Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set. RESULTS: Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning. CONCLUSION: Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.

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Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Critical Care ◽

10.1186/s13054-018-2158-y ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 9

Author(s):

Andrew J. Boyle ◽

◽

Fabiana Madotto ◽

John G. Laffey ◽

Giacomo Bellani ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure

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Persistent hypoxemic respiratory failure is associated with increased mortality, with or without the acute respiratory distress syndrome: a cohort study

10.21203/rs.3.rs-45874/v1 ◽

2020 ◽

Author(s):

Neha Alhad Sathe ◽

Leila R. Zelnick ◽

Carmen Mikacenic ◽

Eric D. Morrell ◽

Pavan K. Bhatraju ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Chronic Respiratory Disease ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Plasma Biomarkers ◽

Risk Of Death

Abstract Background Identifying effective therapies in heterogeneous conditions like acute hypoxemic respiratory failure (AHRF) depends on defining sub-phenotypes with distinct prognosis or therapeutic response. Prior efforts have focused on acute respiratory distress syndrome (ARDS), although ARDS is a minority of all AHRF patients, has limited reliability in research, and is similarly heterogeneous. We propose a novel AHRF sub-phenotype called persistent hypoxemic respiratory failure (PHRF), defined by PaO2:FiO2 ratio ≤ 300 in individuals still requiring mechanical ventilation on day 3 following intubation. We hypothesized individuals with PHRF (+ PHRF) have greater mortality than individuals without PHRF (-PHRF), irrespective of ARDS (+/-ARDS). Methods We included mechanically ventilated AHRF patients (n = 768) from a single-center prospective cohort of medical and surgical ICU patients. We estimated the relative risk of 28-day inpatient mortality associated with + PHRF compared to -PHRF using generalized linear models. We also compared mortality and baseline log-transformed plasma biomarkers of inflammation and endothelial activation/dysfunction in + PHRF/-ARDS, -PHRF/+ARDS, and + PHRF/+ARDS compared to -PHRF/-ARDS. Results Cumulative incidence of + PHRF was 53% (n = 408), of whom 51% were + ARDS by ICU day 3 (n = 209). +PHRF was associated with a 1.55-fold higher risk of death (95% CI: 1.02, 2.34) compared to -PHRF, adjusting for demographics, chronic respiratory disease, and APACHE-III. Absolute mortality was higher in + PHRF/+ARDS (23%) and + PHRF/+ARDS (15%) patients than -PHRF/+ARDS (12%) and -PHRF/-ARDS (7%) patients. Interleukin-6 was 2.36-fold (95% CI: 1.47, 3.80) and 2.62-fold (1.63, 4.20) higher in + PHRF/-ARDS and + PHRF/+ARDS compared to -PHRF/-ARDS; granulocyte-colony stimulating factor was 1.96-fold (95% CI: 1.28, 3.01) and 1.82-fold (95% CI: 1.16, 2.85) higher; angiopoeitin-2 was 1.32-fold (95% CI: 1.01, 1.73) and 1.59-fold (95% CI: 1.21, 2.09) higher. In contrast, -PHRF/+ARDS patients did not have significantly different mortality or plasma biomarkers from -PHRF/-ARDS patients in adjusted models. Conclusions PHRF represents a common sub-phenotype of patients with AHRF, characterized by higher mortality and higher biomarkers of inflammation and endothelial dysfunction than -PHRF. PHRF captures many high-risk patients not included in current ARDS definition who may share biologic features with ARDS. Identifying patients with PHRF can support clinical prognostication and targeted trial enrollment for investigational therapies in the broad AHRF population.

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