Acute respiratory distress syndrome or pulmonary oedema?

This chapter describes the ultrasound appearances of common pathology involving the lung parenchyma. The features of consolidation and atelectasis are described and differentiated. The alveolar-interstitial syndrome is outlined, and the ultrasound characteristics that allow acute respiratory distress syndrome and cardiogenic pulmonary oedema to be differentiated are listed. The advanced section describes the use of ultrasound to assess diaphragmatic function.

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A quantitative CT parameter for the assessment of pulmonary oedema in patients with acute respiratory distress syndrome

PLoS ONE ◽

10.1371/journal.pone.0241590 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241590

Author(s):

Patrick Leiser ◽

Thomas Kirschning ◽

Christel Weiß ◽

Michael Hagmann ◽

Jochen Schoettler ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Distress Syndrome ◽

Quantitative Ct ◽

Lung Weight ◽

Saps Ii ◽

Saps Ii Score

Objectives The aim of this study was to establish quantitative CT (qCT) parameters for pathophysiological understanding and clinical use in patients with acute respiratory distress syndrome (ARDS). The most promising parameter is introduced. Materials and methods 28 intubated patients with ARDS obtained a conventional CT scan in end-expiratory breathhold within the first 48 hours after admission to intensive care unit (ICU). Following manual segmentation, 137 volume- and lung weight-associated qCT parameters were correlated with 71 clinical parameters such as blood gases, applied ventilation pressures, pulse contour cardiac output measurements and established status and prognosis scores (SOFA, SAPS II). Results Of all examined qCT parameters, excess lung weight (ELW), i.e. the difference between a patient’s current lung weight and the virtual lung weight of a healthy person at the same height, displayed the most significant results. ELW correlated significantly with the amount of inflated lung tissue [%] (p<0.0001; r = -0.66) and was closely associated with the amount of extravascular lung water (EVLW) (p<0.0001; r = 0.72). More substantially than the oxygenation index (PaO2/FiO2) or any other clinical parameter it correlated with the patients’ mean SOFA- (p<0.0001, r = 0.69) and SAPS II-Score (p = 0.0005, r = 0.62). Patients who did not survive intensive care treatment displayed higher values of ELW in the initial CT scans. Conclusions ELW could serve as a non-invasive method to quantify the amount of pulmonary oedema. It might serve as an early radiological marker of severity in patients with ARDS.

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Assessment of a Novel Method for Non-invasive Sampling of the Distal Airspace in Acute Respiratory Distress Syndrome Patients Receiving Inhaled Sedation with Sevoflurane: the ANAISS Study Protocol

10.1101/2020.10.05.20207217 ◽

2020 ◽

Author(s):

Pierre-Antoine Tronche ◽

Robin Lalande ◽

Raiko Blondonnet ◽

Laurence Roszyk ◽

Ruoyang Zhai ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Study Protocol ◽

Distress Syndrome ◽

Non Invasive ◽

Tnf Α ◽

Distal Airspace ◽

Oedema Fluid

ABSTRACTIntroductionRecently, fluid collected from the heat-and-moisture-exchange filters, which are commonly used in most mechanically ventilated patients under intravenous sedation, has been reported as a potential surrogate for fluid in the distal airspace. Therefore, collection of this fluid represents a promising, non-invasive method for sampling the distal airspace in patients with acute respiratory distress syndrome (ARDS) and for facilitating a mechanistic understanding of this devastating disease. The current study protocol was constructed to assess whether this fluid could be sampled from a dedicated device (Anaesthetic Conserving Device [AnaConDa-S], Sedana Medical, Danderyd, Sweden) used to deliver inhaled sevoflurane for sedation in patients with ARDS.Methods and analysisA total of 30 adult patients within 24 hours of meeting the Berlin criteria for moderate-severe ARDS and receiving inhaled sevoflurane as standard sedation in participating centres will be eligible for inclusion into this investigator-initiated, exploratory, prospective, bicentre study. After at least 12 h of inhaled sedation, a sample of directly aspirated, undiluted pulmonary oedema fluid will be collected concurrently with fluid from the AnaConDa-S device. Levels of proinflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α and sTNFr-1) and markers of lung endothelial (Ang-2) and epithelial (sRAGE) injury will be measured in both fluids by Multiplex. The primary endpoint is the correlation between protein markers (IL-1β, IL-6, IL-8, TNF-α, sTNFr-1, Ang-2 and sRAGE) measured in the undiluted pulmonary oedema fluid versus the AnaConDa-S fluid.Ethics and disseminationThe study was approved by the appropriate ethics committee (CPP Est I). Informed consent is required. The fluid collection from the AnaConDa-S has potential to foster our understanding of the potential effects of inhaled sedation in clinical ARDS and to open up novel perspectives for prognostic and predictive enrichment in future trials. The results will be published in a peer-reviewed journal.Registration numberNCT03964155.

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Pathophysiology of acute respiratory distress syndrome

10.1093/med/9780199600830.003.0108 ◽

2016 ◽

Author(s):

Lorraine B. Ware

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Molecular Mechanisms ◽

Distress Syndrome ◽

Cigarette Smoke Exposure ◽

Alveolar Epithelial ◽

Severe Traumatic Injury

The acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure characterized by the acute onset of non-cardiogenic pulmonary oedema due to increased lung endothelial and alveolar epithelial permeability. Common predisposing clinical conditions include sepsis, pneumonia, severe traumatic injury, and aspiration of gastric contents. Environmental factors, such as alcohol abuse and cigarette smoke exposure may increase the risk of developing ARDS in those at risk. Pathologically, ARDS is characterized by diffuse alveolar damage with neutrophilic alveolitis, haemorrhage, hyaline membrane formation, and pulmonary oedema. A variety of cellular and molecular mechanisms contribute to the pathophysiology of ARDS, including exuberant inflammation, neutrophil recruitment and activation, oxidant injury, endothelial activation and injury, lung epithelial injury and/or necrosis, and activation of coagulation in the airspace. Mechanical ventilation can exacerbate lung inflammation and injury, particularly if delivered with high tidal volumes and/or pressures. Resolution of ARDS is complex and requires coordinated activation of multiple resolution pathways that include alveolar epithelial repair, clearance of pulmonary oedema through active ion transport, apoptosis, and clearance of intra-alveolar neutrophils, resolution of inflammation and fibrinolysis of fibrin-rich hyaline membranes. In some patients, activation of profibrotic pathways leads to significant lung fibrosis with resultant prolonged respiratory failure and failure of resolution.

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Advanced echocardiography: sepsis

Focused Intensive Care Ultrasound ◽

10.1093/med/9780198749080.003.0025 ◽

2019 ◽

pp. 211-216

Author(s):

Susanna Price ◽

Guido Tavazzi

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pulmonary Artery ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Distress Syndrome ◽

Heart Function ◽

Right Heart Function ◽

Key Features ◽

Extracorporeal Support

This chapter will introduce the key features to address in sepsis using echocardiography, including: volaemic status (requirement for, and tolerance to, volume); alteration in myocardial function; when sepsis is associated with acute respiratory distress syndrome and assessment of right heart function for potential extracorporeal support; differentiation of pulmonary oedema from acute respiratory distress syndrome; changes in pulmonary artery systolic pressures and/or pulmonary vascular resistance; and exclusion/diagnosis of the underlying cause of sepsis, including endocarditis.

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Acute Respiratory Distress Syndrome Caused by Methadone Syrup

Archives of Industrial Hygiene and Toxicology ◽

10.2478/10004-1254-64-2013-2347 ◽

2013 ◽

Vol 64 (3) ◽

pp. 439-443 ◽

Cited By ~ 5

Author(s):

Abbas Aghabiklooei ◽

Shahin Shadnia ◽

Hossein Hassanian-Moghaddam ◽

Nasim Zamani

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Case Report ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Distress Syndrome ◽

Close Monitoring ◽

Respiratory Complications

Abstract Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

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