PO-0301 Non-invasive Mechanical Ventilation (nimv) In A Case Of Severe Acute Respiratory Distress Syndrome (ards) Due To Fat Embolism Syndrome (fes)

Acute respiratory distress syndrome (ARDS) is characterized by a widespread inflammation of the lungs, causing severe hypoxemia. Several mediators have been associated with it and almost all of them are small enough to be filtrated through a nanomembrane. We present a case report of a 41-year-old man with myasthenia gravis in remission; he developed ARDS caused by pneumonia. Although he performed well on both non-invasive and invasive mechanical ventilation, his oxygenation continued to deteriorate. As a last resort of treatment, we decided to apply nanomembrane-based apheresis to cleanse his plasma from the harmful inflammatory mediators. After 3 sessions of plasmapheresis, his condition improved and he was successfully weaned from mechanical ventilation. The obtained results gave us ground to assume that the removal of bioactive molecules can be a useful adjunct to protective mechanical ventilation in ARDS.

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High Flow Nasal Canula (HFNC) In COVID-19 Associated Acute Respiratory Distress Syndrome (CARDS)

UMI Medical Journal ◽

10.33096/umj.v6i2.145 ◽

2021 ◽

Vol 6 (2) ◽

pp. 83-95

Author(s):

Faisal Salahuddin Sommeng ◽

Syafri Kamsul Arif ◽

Hisbullah Hisbullah ◽

Muhammad Rum

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Pasien COVID-19 related Acute Respiratory Distress Syndrome (CARDS) dengan gejala ARDS sedang hingga berat memerlukan Invasive mechanical ventilation (IMV) dan memiliki prognosis yang buruk dengan angka ARDS sekitar 75% serta 63% menerima Invasive mechanical ventilation (IMV) dengan tingkat kematian 59% . Tingginya angka kematian pasien CARDS mendapat terapi invasive mechanical ventilation (IMV) menyebabkan para praktisi kesehatan berusaha untuk menunda intubasi dan ventilasi mekanik secara dini sehingga Non Invasive Ventilation Mechanic (NIV), CPAP dan HFNC menjadi alternatif terapi dalam penanganan CARDS. Kasus: Perempuan usia 49 tahun, masuk ICU dengan diagnosa POH-4 Craniectomy evakuasi tumor sphenoid, Sepsis Syok dan Covid-19 terkonfirmasi. Pada pemeriksaan didapatkan hipoksemia dengan ARDS berat P/F ratio 112.1 mmHg dan gambaran pneumonia dextra dan efusi pleura dextra. Sebelum pindah ke ICU Covid, pasien mendapatkan terapi HFNC FiO2 40% dengan flow 35 L/menit, RR 25, Saturasi 95%, ROX index 9,5. Pemeriksaan laboratorium didapatkan Wbc : 7.800/L, Hb: 8,1mg/dl, Plt : 131.000/mm3, Bilirubin total 1,3 mg/dl, bilirubin direct 0,83 mg/dl, Na/K/cl : 143/2,9/111, Procalcitonin : 11.2. Kesimpulan: Terapi oksigen dengan HFNC pada CARDS sedang sampai berat menjadi pilihan bijaksana dimana terapi HFNC dapat menunda intubasi dan IMV dengan outcome yang baik. Sebagaimana Surviving Sepsis/Society of Critical Care Medicine merekomendasikan HFNC sebagai pendekatan lini pertama.

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Síndrome de Dificuldade Respiratória Aguda: Casuística de Dois Anos numa Unidade de Cuidados Intensivos

Acta Médica Portuguesa ◽

10.20344/amp.4266 ◽

2014 ◽

Vol 27 (2) ◽

pp. 211 ◽

Cited By ~ 1

Author(s):

Lúcia Taborda ◽

Filipa Barros ◽

Vitor Fonseca ◽

Manuel Irimia ◽

Ramiro Carvalho ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Interquartile Range ◽

The Mean

Introduction: Acute Respiratory Distress Syndrome has a significant incidence and mortality at Intensive Care Units. Therefore, more studies are necessary in order to develop new effective therapeutic strategies. The authors have proposed themselves to characterize Acute Respiratory Distress Syndrome patients admitted to an Intensive Care Unit for 2 years. Material and Methods: This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and programmation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis. Results: A 40 patients sample was obtained, with a median age of 72.5 years (interquartile range = 22) and a female:male ratio of ≈1:1.86. Fifty five percent of the Acute Respiratory Distress Syndrome cases had pulmonary etiology. The mean minimal PaO2/FiO2 was 88mmHg (CI 95%: 78.5–97.6). The mean maximal applied PEEP was 12.4 cmH2O (Standard Deviation 4.12) and the mean maximal used tidal volume was 8.2 mL/ Kg ideal body weight (CI 95%: 7.7–8.6). The median invasive mechanical ventilation days was 10. Forty seven and one half percent of the patients had been administered corticosteroids and 52.5% had been submitted to recruitment maneuvers. The most frequent complication was Ventilator Associated Pneumonia (20%). The median Intensive Care Unit stay was 10.7 days (interquartile range 10.85). The fatality rate was 60%. The probability of the favorable outcome ‘non-death in Intensive Care Unit’ was 4.4x superior for patients who were administered corticosteroids and 11x superior for patients < 65 years old. Discussion and Conclusions: Acute Respiratory Distress Syndrome is associated with long hospitalization and significant mortality. New prospective studies will be necessary to endorse the potential benefit of steroid therapy and to identify the subgroups of patients that warrant its use.

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Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome (CARDS)

Indian Journal of Critical Care Medicine ◽

10.5005/jp-journals-10071-23816 ◽

2021 ◽

Vol 25 (5) ◽

pp. 493-498

Author(s):

Kapil G Zirpe ◽

Sushma K Gurav ◽

Anand M Tiwari ◽

Abhijit M Deshmukh ◽

Prasad B Suryawanshi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation

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Effects of Cytokine Blocking Agents on 30-Day Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

10.21203/rs.3.rs-37561/v1 ◽

2020 ◽

Author(s):

Irene Coloretti ◽

Stefano Busani ◽

Emanuela Biagioni ◽

Sophie Venturelli ◽

Elena Munari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cox Model ◽

Invasive Mechanical Ventilation ◽

Blocking Agents

Abstract Background The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID19. Tocilizumab and Anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods The association between therapy with Tocilizumab or Anakinra and in-hospital mortality was assessed in consecutive adult COVID19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who receive to those who did not receive Tocilizumab or Anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with Tocilizumab or Anakinra and after patient matching. Results Sixty-six patients who received immunotherapy (49 Tocilizumab, 17 Anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0,77, 95% CI 0,56-1,05, p=0,069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0,35, 95% CI 0,16-0,77, p=0,009). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need of mechanical ventilation.

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Effects of Cytokine Blocking Agents on Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

10.21203/rs.3.rs-37561/v2 ◽

2020 ◽

Author(s):

Irene Coloretti ◽

Stefano Busani ◽

Emanuela Biagioni ◽

Sophie Venturelli ◽

Elena Munari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cox Model ◽

Invasive Mechanical Ventilation ◽

Blocking Agents

Abstract Background The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID19. Tocilizumab and Anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods The association between therapy with Tocilizumab or Anakinra and in-hospital mortality was assessed in consecutive adult COVID19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who receive to those who did not receive Tocilizumab or Anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with Tocilizumab or Anakinra and after patient matching. Results Sixty-six patients who received immunotherapy (49 Tocilizumab, 17 Anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0,77, 95% CI 0,56-1,05, p=0,069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0,35, 95% CI 0,16-0,77, p=0,009). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need of mechanical ventilation.

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