Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network

2010 ◽  
Vol 99 (5) ◽  
pp. 715-721 ◽  
Author(s):  
X Hu ◽  
S Qian ◽  
F Xu ◽  
B Huang ◽  
D Zhou ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prospective Study ◽  
Distress Syndrome ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
A Prospective Study

Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure

1998 ◽  
Vol 7 (5) ◽  
pp. 335-345 ◽  
Author(s):  
MA Curley ◽  
JC Fackler
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Young Children ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Weaning From Mechanical Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

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.

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

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.

Acute Respiratory Distress Syndrome

2019 ◽  
pp. 137-141
Author(s):  
Richard K. Patch ◽  
James Y. Findlay
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Syndrome ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Neurocognitive Dysfunction ◽  
Psychiatric Illnesses ◽  
Pulmonary Damage

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by acute hypoxemic respiratory failure. Patients with ARDS have pulmonary damage from an acute, usually severe, diffuse inflammatory lung injury that leads to increased vascular permeability and loss of aerated tissue. Mortality from ARDS is estimated to range from 26% to 58%, and in-hospital mortality is high (46.1%) for those with severe ARDS. Survivors have extensive morbidity, including neurocognitive dysfunction, physical disabilities, and psychiatric illnesses such as depression, anxiety, and posttraumatic stress disorder. Lung function may be compromised for as long as 5 years.

scholarly journals Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1053
Author(s):  
Shayan Kassirian ◽  
Ravi Taneja ◽  
Sanjay Mehta
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Respiratory Support ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
The Right

Acute respiratory distress syndrome (ARDS) remains a serious illness with significant morbidity and mortality, characterized by hypoxemic respiratory failure most commonly due to pneumonia, sepsis, and aspiration. Early and accurate diagnosis of ARDS depends upon clinical suspicion and chest imaging. Coronavirus disease 2019 (COVID-19) is an important novel cause of ARDS with a distinct time course, imaging and laboratory features from the time of SARS-CoV-2 infection to hypoxemic respiratory failure, which may allow diagnosis and management prior to or at earlier stages of ARDS. Treatment of ARDS remains largely supportive, and consists of incremental respiratory support (high flow nasal oxygen, non-invasive respiratory support, and invasive mechanical ventilation), and avoidance of iatrogenic complications, all of which improve clinical outcomes. COVID-19-associated ARDS is largely similar to other causes of ARDS with respect to pathology and respiratory physiology, and as such, COVID-19 patients with hypoxemic respiratory failure should typically be managed as other patients with ARDS. Non-invasive respiratory support may be beneficial in avoiding intubation in COVID-19 respiratory failure including mild ARDS, especially under conditions of resource constraints or to avoid overwhelming critical care resources. Compared to other causes of ARDS, medical therapies may improve outcomes in COVID-19-associated ARDS, such as dexamethasone and remdesivir. Future improved clinical outcomes in ARDS of all causes depends upon individual patient physiological and biological endotyping in order to improve accuracy and timeliness of diagnosis as well as optimal targeting of future therapies in the right patient at the right time in their disease.

Sign in / Sign up

Export Citation Format

Share Document