Adjunctive therapy with azithromycin for moderate and severe acute respiratory distress syndrome: a retrospective, propensity score-matching analysis of prospectively collected data at a single center

2018 ◽  
Vol 51 (6) ◽  
pp. 918-924 ◽  
Author(s):  
Kodai Kawamura ◽  
Kazuya Ichikado ◽  
Makoto Takaki ◽  
Yoshitomo Eguchi ◽  
Keisuke Anan ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Adjunctive Therapy ◽  
Distress Syndrome ◽  
Single Center ◽  
Propensity Score Matching Analysis

scholarly journals Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Membranes ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 393
Author(s):  
Li-Chung Chiu ◽  
Li-Pang Chuang ◽  
Shaw-Woei Leu ◽  
Yu-Jr Lin ◽  
Chee-Jen Chang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Propensity Score ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Membrane Oxygenation

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

Lung-heart pressure index is a risk factor for acute respiratory distress syndrome (ARDS): A machine learning and propensity score-matching study.

2019 ◽  
Author(s):  
Xue-Shu Yu ◽  
Xiao-Jun Pan ◽  
Zhi-Qiang Chen ◽  
Yu-Feng Hu ◽  
Jie Shu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Random Forest ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Query Language ◽  
Pressure Index ◽  
Better Than

Abstract Background Ventilator-induced lung injury (VILI) and haemodynamic instability play vital roles in acute respiratory distress syndrome (ARDS). The principle of driving pressure (DP) is the response to “volutrauma”, and the mean arterial pressure (MAP) is a haemodynamic systemic manifestation. In this study, we explored a novel lung-heart pressure index (LHPI) based on DP and MAP and explored its prognostic value in patients with ARDS.Methods This is a retrospective study based on the MIMIC-III database. ARDS patients who had undergone mechanical ventilation for more than 48 hours were selected through structured query language. The focus of the study was whether a high LHPI was associated with 30-day mortality and whether its predictive power was better than that of DP and mechanical power (MP). We used random forest, propensity-score matching, and logistic regression to test our hypothesis.Results A total of 448 ICU ARDS patients were enrolled. The mortality rate of ARDS patients was 29.02%. The LHPI was more important than DP and MP in the random forest. A significant adverse effect of high LHPI on 30-day mortality was observed in the high-LHPI group compared to the effect observed in the low-LHPI group (OR=1.86, 95% CI 1.08–3.26, p =0.027). More importantly, LHPI was significantly better than DP (NRI=0.054, 95% CI (0.014-0.094), P=0.008; IDI=0.011, 95% CI (0.002-0.019), P=0.014) and MP (NRI=0.061, 95% CI (0.001-0.122), P=0.049; IDI=0.047, 95% CI (0.022-0.071), P<0.001) in predicting mortality.Conclusions The study showed that the LHPI was a powerful prognostic indicator of 30-day mortality in ARDS patients, and its predictive discrimination was better than that of DP and MP. Further experimental trials are needed to investigate whether adjusting treatment decisions according to the LHPI will significantly improve clinical outcomes.

scholarly journals Short-term survival of acute respiratory distress syndrome patients due to influenza virus infection alone: a cohort study

2020 ◽  
Vol 6 (4) ◽  
pp. 00587-2020
Author(s):  
Arnaud Gacouin ◽  
Mathieu Lesouhaitier ◽  
Florian Reizine ◽  
Charlotte Pronier ◽  
Murielle Grégoire ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Arterial Oxygen ◽  
Term Survival ◽  
The Impact

BackgroundInfluenza virus (IV)-related pathophysiology suggests that the prognosis of acute respiratory distress syndrome (ARDS) due to IV could be different from the prognosis of ARDS due to other causes. However, the impact of IV infection alone on the prognosis of ARDS patients compared to that of patients with other causes of ARDS has been poorly assessed.MethodsWe compared the 28-day survival from the diagnosis of ARDS with an arterial oxygen tension/inspiratory oxygen fraction ratio ≤150 mmHg between patients with and without IV infection alone. Data were collected prospectively and analysed retrospectively. We first performed survival analysis on the whole population; second, patients with IV infection alone were compared with matched pairs using propensity score matching.ResultsThe cohort admitted from October 2009 to March 2020 consisted of 572 patients, including 73 patients (13%) with IV alone. On the first 3 days of mechanical ventilation, nonpulmonary Sequential Organ Failure Assessment scores were significantly lower in patients with IV infection than in the other patients. After the adjusted analysis, IV infection alone remained independently associated with lower mortality at day 28 (hazard ratio 0.51, 95% CI 0.26–0.99, p=0.047). Mortality at day 28 was significantly lower in patients with IV infection alone than in other patients when propensity score matching was used (20% versus 38%, p=0.02).ConclusionsOur results suggest that patients with ARDS following IV infection alone have a significantly better prognosis at day 28 and less severe nonpulmonary organ dysfunction than do those with ARDS from causes other than IV infection alone.

scholarly journals Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
An-Min Hu ◽  
Xiong-Xiong Zhong ◽  
Zhen Li ◽  
Zhong-Jun Zhang ◽  
Hui-Ping Li
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Research Database ◽  
Matched Cohort

Background: Sedatives are commonly used in patients with or at risk for acute respiratory distress syndrome (ARDS) during mechanical ventilation. To systematically compare the outcomes of sedation with midazolam, propofol, and dexmedetomidine in patients with or at risk for ARDS.Methods: We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of sedatives and the associated outcomes from the MIMIC-III database and the eICU Collaborative Research database. We performed a systematic study with six cohorts to estimate the relative risks of outcomes among patients administered different sedatives. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, length of hospitalization, and likelihood of being discharged home.Results: We performed 60 calibrated analyses among all groups and outcomes with 17,410 eligible patients. Sedation with dexmedetomidine was associated with a lower in-hospital mortality rate than sedation with midazolam and propofol or sedation without dexmedetomidine (p &lt; 0.001). When compared with no sedation, the use of midazolam, propofol or dexmedetomidine was associated with a longer ICU stay and longer hospitalization duration (p &lt; 0.01). Patients treated with midazolam were relatively less likely to be discharged home (p &lt; 0.05).Conclusion: Patients treated with dexmedetomidine had a reduced risk of mortality. These data suggest that dexmedetomidine may be the preferred sedative in patients with or at risk for ARDS.

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