PRE-HOSPITALIZATION USE OF STATINS IS NOT ASSOCIATED WITH IMPROVED ICU/HOSPITAL MORTALITY AND DEVELOPMENT OF ACUTE LUNG INJURY (ALI) IN MECHANICALLY VENTILATED (MV) PATIENTS.

Introduction. A recruitment maneuver (RM) may improve gas exchange in acute lung injury (ALI). The aim of our study was to assess the predictive value of a derecruitment test in relation to RM and to evaluate the efficacy of RM combined with surfactant instillation in patients with ALI.Materials and Methods. Thirteen adult mechanically ventilated patients with ALI were enrolled into a prospective pilot study. The patients received protective ventilation and underwent RM followed by a derecruitment test. After a repeat RM, bovine surfactant (surfactant group,n=6) or vehicle only (conventional therapy group,n=7) was instilled endobronchially. We registered respiratory and hemodynamic parameters, including extravascular lung water index (EVLWI).Results. The derecruitment test decreased the oxygenation in 62% of the patients. We found no significant correlation between the responses to the RM and to the derecruitment tests. The baseline EVLWI correlated with changes in SpO2following the derecruitment test. The surfactant did not affect gas exchange and lung mechanics but increased EVLWI at 24 and 32 hrs.Conclusions. Our study demonstrated no predictive value of the derecruitment test regarding the effects of RM. Surfactant instillation was not superior to conventional therapy and might even promote pulmonary edema in ALI.

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Impact of Acute Lung Injury and Acute Respiratory Distress Syndrome After Traumatic Brain Injury in the United States

Neurosurgery ◽

10.1227/neu.0b013e3182672ae5 ◽

2012 ◽

Vol 71 (4) ◽

pp. 795-803 ◽

Cited By ~ 66

Author(s):

Fred Rincon ◽

Sayantani Ghosh ◽

Saugat Dey ◽

Mitchell Maltenfort ◽

Matthew Vibbert ◽

...

Keyword(s):

United States ◽

Heart Failure ◽

Traumatic Brain Injury ◽

Congestive Heart Failure ◽

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Lung Injury ◽

Hospital Mortality ◽

Distress Syndrome ◽

The United States

AbstractBACKGROUND:Traumatic brain injury (TBI) is a major cause of disability, morbidity, and mortality. The effect of the acute respiratory distress syndrome and acute lung injury (ARDS/ALI) on in-hospital mortality after TBI remains controversial.OBJECTIVE:To determine the epidemiology of ARDS/ALI, the prevalence of risk factors, and impact on in-hospital mortality after TBI in the United States.METHODS:Retrospective cohort study of admissions of adult patients >18 years with a diagnosis of TBI and ARDS/ALI from 1988 to 2008 identified through the Nationwide Inpatient Sample.RESULTS:During the 20-year study period, the prevalence of ARDS/ALI increased from 2% (95% confidence interval [CI], 2.1%–2.4%) in 1988 to 22% (95% CI, 21%–22%) in 2008 (P < .001). ARDS/ALI was more common in younger age; males; white race; later year of admission; in conjunction with comorbidities such as congestive heart failure, hypertension, chronic obstructive pulmonary disease, chronic renal and liver failure, sepsis, multiorgan dysfunction; and nonrural, medium/large hospitals, located in the Midwest, South, and West continental US location. Mortality after TBI decreased from 13% (95% CI, 12%–14%) in 1988 to 9% (95% CI, 9%–10%) in 2008 (P < .001). ARDS/ALI-related mortality after TBI decreased from 33% (95% CI, 33%–34%) in 1988 to 28% (95% CI, 28%–29%) in 2008 (P < .001). Predictors of in-hospital mortality after TBI were older age, male sex, white race, cancer, chronic kidney disease, hypertension, chronic liver disease, congestive heart failure, ARDS/ALI, and organ dysfunctions.CONCLUSION:Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.

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Fluid restriction reduces pulmonary edema in a model of acute lung injury in mechanically ventilated rats

PLoS ONE ◽

10.1371/journal.pone.0210172 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0210172 ◽

Cited By ~ 3

Author(s):

Sarah A. Ingelse ◽

Jenny Juschten ◽

Martinus A. W. Maas ◽

Gustavo Matute-Bello ◽

Nicole P. Juffermans ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Pulmonary Edema ◽

Fluid Restriction ◽

Mechanically Ventilated

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Modeling the dynamics of recruitment and derecruitment in mice with acute lung injury

Journal of Applied Physiology ◽

10.1152/japplphysiol.90806.2008 ◽

2008 ◽

Vol 105 (6) ◽

pp. 1813-1821 ◽

Cited By ~ 41

Author(s):

Christopher B. Massa ◽

Gilman B. Allen ◽

Jason H. T. Bates

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Lung Recruitment ◽

Mechanically Ventilated ◽

Critical Opening ◽

Injured Lung ◽

Order Of Magnitude ◽

Opening And Closing ◽

Air Liquid Interface ◽

Insight Into

Lung recruitment and derecruitment contribute significantly to variations in the elastance of the respiratory system during mechanical ventilation. However, the decreases in elastance that occur with deep inflation are transient, especially in acute lung injury. Bates and Irvin ( 8 ) proposed a model of the lung that recreates time-varying changes in elastance as a result of progressive recruitment and derecruitment of lung units. The model is characterized by distributions of critical opening and closing pressures throughout the lung and by distributions of speeds with which the processes of opening and closing take place once the critical pressures have been achieved. In the present study, we adapted this model to represent a mechanically ventilated mouse. We fit the model to data collected in a previous study from control mice and mice in various stages of acid-induced acute lung injury ( 3 ). Excellent fits to the data were obtained when the normally distributed critical opening pressures were about 5 cmH2O above the closing pressures and when the hyperbolically distributed opening velocities were about an order of magnitude greater than the closing velocities. We also found that, compared with controls, the injured mice had markedly increased opening and closing pressures but no change in the velocities, suggesting that the key biophysical change wrought by acid injury is dysfunction of surface tension at the air-liquid interface. Our computational model of lung recruitment and derecruitment dynamics is thus capable of accurately mimicking data from mice with acute lung injury and may provide insight into the altered biophysics of the injured lung.

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Effect of Thoracentesis on Intubated Patients with Acute Lung Injury

The American Surgeon ◽

10.1177/000313481608200321 ◽

2016 ◽

Vol 82 (3) ◽

pp. 266-270

Author(s):

Matthew B. Bloom ◽

Derek Serna-Gallegos ◽

Mark Ault ◽

Ahsan Khan ◽

Rex Chung ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Blood Gases ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

Arterial Blood ◽

Tertiary Center ◽

Before And After ◽

The Impact

Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios.

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