scholarly journals Successful treatment of a critically ill patient with acute respiratory distress syndrome from COVID-19 using mechanical ventilation strategy with low levels of positive end-expiratory pressure

Medicine ◽  
2020 ◽  
Vol 99 (49) ◽  
pp. e23160
Author(s):  
Wei-guang Guo ◽  
Bin Fang ◽  
Yan-shan Xian ◽  
Zhi-hui Yu ◽  
Li-xin Zhou
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Critically Ill Patient ◽  
Ventilation Strategy ◽  
Positive End Expiratory Pressure ◽  
Low Levels

scholarly journals Pulmonary Procoagulant and Innate Immune Responses in Critically Ill COVID-19 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Esther J. Nossent ◽  
Alex R. Schuurman ◽  
Tom D.Y. Reijnders ◽  
Anno Saris ◽  
Ilse Jongerius ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Growth Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Complement System ◽  
Host Response ◽  
Distress Syndrome ◽  
Response Biomarkers

RationaleSystemic activation of procoagulant and inflammatory mechanisms has been implicated in the pathogenesis of COVID-19. Knowledge of activation of these host response pathways in the lung compartment of COVID-19 patients is limited.ObjectivesTo evaluate local and systemic activation of coagulation and interconnected inflammatory responses in critically ill COVID-19 patients with persistent acute respiratory distress syndrome.MethodsPaired bronchoalveolar lavage fluid and plasma samples were obtained from 17 patients with COVID-19 related persistent acute respiratory distress syndrome (mechanical ventilation > 7 days) 1 and 2 weeks after start mechanical ventilation and compared with 8 healthy controls. Thirty-four host response biomarkers stratified into five functional domains (coagulation, complement system, cytokines, chemokines and growth factors) were measured.Measurements and Main ResultsIn all patients, all functional domains were activated, especially in the bronchoalveolar compartment, with significantly increased levels of D-dimers, thrombin-antithrombin complexes, soluble tissue factor, C1-inhibitor antigen and activity levels, tissue type plasminogen activator, plasminogen activator inhibitor type I, soluble CD40 ligand and soluble P-selectin (coagulation), next to activation of C3bc and C4bc (complement) and multiple interrelated cytokines, chemokines and growth factors. In 10 patients in whom follow-up samples were obtained between 3 and 4 weeks after start mechanical ventilation many bronchoalveolar and plasma host response biomarkers had declined.ConclusionsCritically ill, ventilated patients with COVID-19 show strong responses relating to coagulation, the complement system, cytokines, chemokines and growth factors in the bronchoalveolar compartment. These results suggest a local pulmonary rather than a systemic procoagulant and inflammatory “storm” in severe COVID-19.

scholarly journals Positive End-Expiratory Pressure Setting in COVID-19-Related Acute Respiratory Distress Syndrome: Comparison Between Electrical Impedance Tomography, PEEP/FiO2 Tables, and Transpulmonary Pressure

2021 ◽  
Vol 8 ◽  
Author(s):  
Sébastien Gibot ◽  
Marie Conrad ◽  
Guilhem Courte ◽  
Aurélie Cravoisy
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Electrical Impedance Tomography ◽  
Electrical Impedance ◽  
Distress Syndrome ◽  
Invasive Technique ◽  
Positive End Expiratory Pressure ◽  
Impedance Tomography

Introduction: The best way to titrate the positive end-expiratory pressure (PEEP) in patients suffering from acute respiratory distress syndrome is still matter of debate. Electrical impedance tomography (EIT) is a non-invasive technique that could guide PEEP setting based on an optimized ventilation homogeneity.Methods: For this study, we enrolled the patients with 2019 coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS), who required mechanical ventilation and were admitted to the ICU in March 2021. Patients were monitored by an esophageal catheter and a 32-electrode EIT device. Within 48 h after the start of mechanical ventilation, different levels of PEEP were applied based upon PEEP/FiO2 tables, positive end-expiratory transpulmonary (PL)/ FiO2 table, and EIT. Respiratory mechanics variables were recorded.Results: Seventeen patients were enrolled. PEEP values derived from EIT (PEEPEIT) were different from those based upon other techniques and has poor in-between agreement. The PEEPEIT was associated with lower plateau pressure, mechanical power, transpulmonary pressures, and with a higher static compliance (Crs) and homogeneity of ventilation.Conclusion: Personalized PEEP setting derived from EIT may help to achieve a more homogenous distribution of ventilation. Whether this approach may translate in outcome improvement remains to be investigated.

scholarly journals Effectiveness and Outcome of Methylprednisolone versus Hydrocortisone in Treatment of Acute Respiratory Distress Syndrome(ARDS)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S A S Elbrassi ◽  
K M Maghawry ◽  
R M M Ali ◽  
R H Abdelhafiez
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Low Dose ◽  
Distress Syndrome ◽  
Patient Discharge ◽  
P Value ◽  
D Dimer

Abstract Introduction Acute respiratory distress syndrome (ARDS) is the clinical manifestation of severe acute lung injury. It is characterized by dyspnea, profound hypoxemia, diffuse bilateral infiltrates secondary to non-cardiogenic pulmonary edema on chest radiography, and decreased lung compliance and systemic inflammations are the pathophysiologic hallmarks of this syndrome and the use of low-dose corticosteroids was associated with improved mortality and morbidity outcomes without increased adverse reactions. Aim The aim of this study is to compare the outcome and effectiveness of hydrocortisone to methylprednisolone in treatment of acute respiratory distress syndrome in critically ill adult patients. Patients The current study was performed as a randomized prospective observational study on critically ill patients at age between 18-85 years. Methods Critically ill patients diagnosis with ARDS were managed with standard treatment in addition to methylprednisolone 1mg/kg as loading dose followed by an infusion of 1 mg/kg/d for one week and then gradual tapering over two weeks as following (0.5 mg/kg/d in the second week and 0.25 mg/kg/d in the third week) or hydrocortisone 50mg given every six hours for one week. Results Mean age of included patients was 65.20 years with mean BMI 28.14 kg/m2, in our result the PaO2/FIO2 ratio revealed significant statistically increase in methylprednisolone-treated patients compared to hydrocortisone -treated patients (160.49±54.75, 138.55±60.99, P value 0.029), Regarding the inflammatory marker the results of the plasma level of C-reactive protein and d-dimer showed significant difference between both group, the result of SOFA score showed no significant different from day 1 to day 3 (8.25±3.11, 8.29±2.29 P value 0.980). But with the beginning of the fifth day was observed significant change in the results, methylprednisolone-treated patients compared to hydrocortisone -treated patients (8.28±3.84, 9.8±4.23, P value 0.036), Regarding to ICU length of stay and decrease duration of mechanical ventilation, the results of our study didn’t show significant different among both groups. The two groups showed a decrease in the time spended on the mechanical ventilation and the stay in the ICU before day7. According to the number of patient discharge from ICU at day 7 and the number of extubated patient at day 7, the results of our study didn’t show significant different among both groups. Conclusion Despite the both applied drug doses show improvement regarding the finial total outcome. However, Methylprednisolone showed superior benefit compare to Hydrocortisone in improvement of PaO2/FiO2 ratio, suppress systemic inflammation (CRP and D- dimer), increase extubated patient before day 7, increase number of patient discharge from ICU before day 7, reduction of SOFA score and hospital morality rate. Recommendations The study recommends to use of low dose methylprednisolone superior to hydrocortisone in treatment of ARDS. But, still more researches are need.

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