B53. ACUTE LUNG INJURY, ARDS, SLEEP, AND BEYOND: CLINICAL STUDIES AND CASE REPORTS

2021 ◽  
Vol 15 (58) ◽  
pp. 410-426
Author(s):  
Hermínia Moreira Coelho da Costa

Lesão pulmonar aguda relacionada à transfusão (TRALI –Transfusion Related Acute Lung Injury) é uma complicação grave da transfusão sanguínea que cursa essencialmente com desconforto respiratório durante ou dentro de 6 horas depois de completada a transfusão. Apesar de ser considerada rara e a lesão pulmonar ser geralmente transitória, traz preocupação aos profissionais da área da saúde, visto que está associada à alta morbidade dos pacientes que necessitaram de suporte ventilatório, assim como a alta mortalidade. Sua incidência não está bem estabelecida, muito devido à falta de preparo para identificar os casos suspeitos. Assim, os relatos de casos ganham relevância tanto para contribuir que o diagnóstico desta patologia seja alcançado com mais facilidade quanto para estimular que os casos sejam notificados. O presente relato descreve a ocorrência de TRALI em paciente no segundo dia de pós-operatório de cesárea por pré- eclâmpsia e síndrome Hellp que evoluiu com suspeita de hemoperitônio sendo submetida a laparotomia exploratória (LE).---Transfusion related acute lung injury (TRALI) is a serious complication of blood transfusion that evolves mainly with respiratory distress during or within 6 hours after transfusion. Although considered rare and is usually transient lung injury, she brings concern to health professionals, as it is associated with high morbidity of patients requiring ventilatory support, as well as the high mortality. Its incidence is not well established, much due to lack of preparation to identify suspected cases. Thus, case reports gain relevance to contribute to the diagnosis of this condition is more easily achieved as to stimulate the cases are reported. This report describes the occurrence of TRALI in a patient on the second day after surgery by cesarean preeclampsia and HELLP syndrome who developed suspected hemoperitoneum and underwent exploratory laparotomy (LE).


2017 ◽  
Vol 33 (6) ◽  
pp. 335-345 ◽  
Author(s):  
Andrew C. Miller ◽  
Paula A. Ferrada ◽  
Sameer S. Kadri ◽  
Krupa Nataraj-Bhandari ◽  
Amir Vahedian-Azimi ◽  
...  

Background: Smoke inhalation–associated acute lung injury (SI-ALI) is a major cause of morbidity and mortality in victims of fire tragedies. To date, there are no evidence-based guidelines on ventilation strategies in acute respiratory distress syndrome (ARDS) after smoke inhalation. We reviewed the existing literature for clinical studies of salvage mechanical ventilation (MV) strategies in patients with SI-ALI, focusing on mortality and pneumonia as outcomes. Methods: A systematic search was designed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias assessment was performed using the Newcastle-Ottawa Quality Assessment Scale (NOS; 0 to 9 stars), with a score ≥7 being the threshold for inclusion in the meta-analysis. A systematic search strategy was used to search 10 databases. Clinical studies were included in which patients: (1) experienced smoke inhalation, (2) treated with MV, and (3) described a concurrent or historical control group. Results: A total of 226 potentially relevant studies were identified, of which 7 studies on high-frequency percussive ventilation (HFPV) met inclusion criteria. No studies met inclusion for meta-analysis (NOS ≥ 7). In studies comparing HFPV to conventional mechanical ventilation (CMV), mortality and pneumonia incidence improved in 3 studies and remained unchanged in 3 others. No change in ventilator days or ICU length of stay was observed; however, oxygenation and work of breathing improved with HFPV. Conclusions: Mechanical ventilation in patients with SI-ALI has not been well studied. High-frequency percussive ventilation may decrease in-hospital mortality and pneumonia incidence when compared to CMV. The absence of “good” quality evidence precluded meta-analysis. Based upon low-quality evidence, there was a very weak recommendation that HFPV use may be associated with lower mortality and pneumonia rates in patients with SI-ALI. Given SI-ALI’s unique underlying pathophysiology, and its potential implications on therapy, randomized controlled studies are required to ensure that patients receive the safest and most effective care. Trial Registration: The study was registered with PROSPERO International prospective register of systematic reviews (#47015).


2019 ◽  
Vol 13 ◽  
pp. 175346661984790 ◽  
Author(s):  
Bingxin Guo ◽  
Yichun Bai ◽  
Yana Ma ◽  
Cong Liu ◽  
Song Wang ◽  
...  

Smoke-inhalation-induced acute lung injury (SI-ALI) is a leading cause of morbidity and mortality in victims of fire tragedies. SI-ALI contributes to an estimated 30% of burn-caused patient deaths, and recently, more attention has been paid to the specific interventions for this devastating respiratory illness. In the last decade, much progress has been made in the understanding of SI-ALI patho-mechanisms and in the development of new therapeutic strategies in both preclinical and clinical studies. This article reviews the recent progress in the treatment of SI-ALI, based on pathophysiology, thermal damage, airway obstruction, the nuclear-factor kappa-B signaling pathway, and oxidative stress. Preclinical therapeutic strategies include use of mesenchymal stem cells, hydrogen sulfide, peroxynitrite decomposition catalysts, and proton-pump inhibitors. Clinical interventions include high-frequency percussive ventilation, perfluorohexane, inhaled anticoagulants, and nebulized epinephrine. The animal model, dose, clinical application, and pharmacology of these medications are summarized. Future directions and further needs for developing innovative therapies are discussed. The reviews of this paper are available via the supplementary material section.


Author(s):  
Zahid Hussain Khan ◽  
Kasra Karvandian ◽  
Sajjad Mohammed Maher

Background: With the outbreak of COVID19, acute lung injury has been detected as the main etiology for intensive care admission and high mortality rate. Among the infected population, there is some percentage of those who tend to develop acute respiratory distress syndrome and respiratory failure. Thus, the intensivist and anesthesiologist must be aware of the of incidence rate of ARDS, risk factors, and try to take measures to reduce its incidence. To define the rate of incidence of acute lung injury and ARDS among COVID 19 patient. Methods: We performed a narrative review via searching in three databases PubMed, Google Scholar and Embase for all studies that mentioned the incidence of acute lung injury among infected patients with COVID19, manual searching also completed. All the selected reviews were limited to the English language and data also. Results: Five searches referred to the exact number of patients and the percentage rate of incidence of ARDS related to COVID 19 infection, other articles are merely reviews and case reports. Conclusion: Incidence of acute lung injury among COVID19 patient was highly reported, and some percentage of these cases tend to develop ARDS especially in those who have preexisting diseases and obesity.


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