Care of the critically ill neonate with hypoxemic respiratory failure and acute pulmonary hypertension: framework for practice based on consensus opinion of neonatal hemodynamics working group

2022 ◽  
Author(s):  
Amish Jain ◽  
Regan E. Giesinger ◽  
Shyamala Dakshinamurti ◽  
Yasser ElSayed ◽  
Robert P. Jankov ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Working Group ◽  
Hypoxemic Respiratory Failure ◽  
Consensus Opinion ◽  
Acute Pulmonary Hypertension

Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) is Highly Associated With Mortality and Persistent Organ Dysfunction in the Critically Ill: a Cohort Study

2020 ◽  
Author(s):  
Neha Alhad Sathe ◽  
Pavan K. Bhatraju ◽  
Carmen Mikacenic ◽  
Eric D. Morrell ◽  
W. Conrad Liles ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Academic Medical Center ◽  
Myeloid Cells ◽  
Soluble Form ◽  
Hypoxemic Respiratory Failure ◽  
Study Enrollment

Abstract Background. The triggering receptor expressed on myeloid cells-1 (TREM-1) mediates fatal septic shock in murine models, but studies linking the soluble form of TREM-1 (sTREM-1) to mortality in clinical sepsis are inconclusive, and few have examined its relationship to organ dysfunction. We sought to identify associations between circulating sTREM-1 and both mortality and organ dysfunction among a broad cohort of critically ill medical, post-surgical and trauma patients. Methods. We enrolled a prospective cohort of patients who met two or more criteria for the systemic inflammatory response syndrome (SIRS) within 24 hours of intensive care unit (ICU) admission at a large academic medical center. sTREM-1 concentrations were measured at study enrollment. We used relative risk regression, adjusted for age, sex, and Charlson comorbidity index, to determine associations between sTREM-1 and the primary outcome of 28-day mortality. We also examined secondary outcomes of prevalent organ dysfunction on enrollment, and composites of persistent organ dysfunction or death at day 7. Results. Among 231 critically ill patients, non-survivors (n=19, 8%) had a higher proportion of pre-existing comorbidities, mechanical ventilation (79% vs. 44%) and shock (58% vs. 28%) compared to survivors. At study enrollment, increasing sTREM-1 was associated with a higher risk of severe acute kidney injury (AKI), shock, and acute hypoxemic respiratory failure requiring mechanical ventilation. sTREM-1 was higher among non-survivors than survivors (885 vs 336 pg/mL); each doubling of sTREM-1 concentration was associated with a 2.41-fold higher risk of 28-day mortality (95% CI 1.57, 3.72). Among 92 patients with shock on enrollment, doubling of sTREM-1 was associated with a 3.89-fold higher risk of persistent shock or death by day 7 (95% CI 1.85, 8.17). Higher sTREM-1 was also associated with a higher risk of both persistent AKI and persistent hypoxemic respiratory failure or death. Conclusions. Elevated plasma sTREM-1 is highly associated with 28-day mortality and organ dysfunction across a diverse critically ill population. These data support that early activation of the innate immune system plays a role in the development of organ dysfunction and death. Further studies should address whether modulation of the TREM-1 pathway might be beneficial in critically ill patients.

scholarly journals Challenges, priorities and novel therapies for hypoxemic respiratory failure and pulmonary hypertension in the neonate

2016 ◽  
Vol 36 (S2) ◽  
pp. S32-S36 ◽  
Author(s):  
J L Aschner ◽  
J Gien ◽  
N Ambalavanan ◽  
J P Kinsella ◽  
G G Konduri ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Failure ◽  
Novel Therapies ◽  
Hypoxemic Respiratory Failure

scholarly journals Diagnostic importance of natriuretic peptide in chronic obstructive pulmonary disease with chronic hypoxemic respiratory failure

2020 ◽  
Vol 4 (4) ◽  
pp. 174-179
Author(s):  
N.A. Kuzubova ◽  
◽  
O.N. Titova ◽  
V.A. Volchkov ◽  
D.B. Sklyarova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Natriuretic Peptide ◽  
Chronic Obstructive ◽  
Hypoxemic Respiratory Failure ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Diagnostic Importance

Background: the progression of chronic obstructive pulmonary disease (COPD) is accompanied by pulmonary hypertension and right ventricular failure as well as left ventricular failure that can be associated with the elevated levels of N-terminal pro b-type natriuretic peptide (NT-proBNP). Aim: to evaluate the diagnostic importance of NT-proBNP in COPD with chronic hypoxemic respiratory failure. Patients and Methods: 60 patients with COPD GOLD stage 3 and 4 (group D, mixed phenotype: emphysematous bronchitic) during remission were examined. Mean age was 64.78±6.9 years. The patients were divided into three groups. Group 1 included 20 COPD patients with hypoxemia who received long-term oxygen therapy (LTOT). Group 2 included 20 COPD patients with hypoxemia who did not receive LTOT. Group 3 included 20 COPD patients with normoxemia. After the primary examination, group 1 patients were prescribed with in-home LTOT (16 hours daily). Group 2 and 3 patients were not prescribed with LTOT. All patients received basic treatment, i.e., a combined drug containing an inhaled corticosteroid and β2-agonist (budesonide/formoterol 400/12 μg twice daily) and a long-acting muscarinic antagonist (tiotropium bromide 2.5 μg, 2 inhalations once daily). The patients were reexamined after 12 months. Arterial blood gases and serum NT-proBNP concentration were measured, spirometry and Doppler echocardiography were performed. Results: NT-proBNP levels in COPD patients with hypoxemia were significantly elevated. The associations between NT-proBNP and partial oxygen arterial pressure (r= -0.71, p<0.05), NT-proBNP and pulmonary artery systolic pressure (PASP) (r=0.61, p<0.05) were revealed. ROC analysis of NT-proBNP demonstrated its sensitivity and specificity in COPD patients with the different severity of respiratory failure. LTOT for COPD with hypoxemia reduces PASP, improves left ventricular diastolic function, and decreases NT-proBNP levels. Conclusions: as chronic hypoxemic respiratory failure progresses in COPD, NT-proBNP concentration increases. ROC analysis demonstrates that NT-proBNP can be considered as a promising marker of hypoxemia and pulmonary hypertension. LTOT reduces NT-proBNP levels by improving pulmonary cardiac hemodynamics. KEYWORDS: COPD, hypoxemia, natriuretic peptide, long-term oxygen therapy, pulmonary hypertension, diastolic dysfunction, right ventricle. FOR CITATION: Kuzubova N.A., Titova O.N., Volchkov V.A., Sklyarova D.B. Diagnostic importance of natriuretic peptide in chronic obstructive pulmonary disease with chronic hypoxemic respiratory failure. Russian Medical Inquiry. 2020;4(4):174–179. DOI: 10.32364/2587-6821- 2020-4-4-174-179.

scholarly journals High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19

2021 ◽  
pp. respcare.08622
Author(s):  
Luca Salvatore Menga ◽  
Luca Delle Cese ◽  
Filippo Bongiovanni ◽  
Gianmarco Lombardi ◽  
Teresa Michi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Critically Ill ◽  
Failure Rate ◽  
High Failure Rate ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure
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