Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study

Abstract Background Right ventricular (RV) failure is a common complication in moderate-to-severe acute respiratory distress syndrome (ARDS). RV failure is exacerbated by hypercapnic acidosis and overdistension induced by mechanical ventilation. Veno-venous extracorporeal CO2 removal (ECCO2R) might allow ultraprotective ventilation with lower tidal volume (VT) and plateau pressure (Pplat). This study investigated whether ECCO2R therapy could affect RV function. Methods This was a quasi-experimental prospective observational pilot study performed in a French medical ICU. Patients with moderate-to-severe ARDS with PaO2/FiO2 ratio between 80 and 150 mmHg were enrolled. An ultraprotective ventilation strategy was used with VT at 4 mL/kg of predicted body weight during the 24 h following the start of a low-flow ECCO2R device. RV function was assessed by transthoracic echocardiography (TTE) during the study protocol. Results The efficacy of ECCO2R facilitated an ultraprotective strategy in all 18 patients included. We observed a significant improvement in RV systolic function parameters. Tricuspid annular plane systolic excursion (TAPSE) increased significantly under ultraprotective ventilation compared to baseline (from 22.8 to 25.4 mm; p < 0.05). Systolic excursion velocity (S’ wave) also increased after the 1-day protocol (from 13.8 m/s to 15.1 m/s; p < 0.05). A significant improvement in the aortic velocity time integral (VTIAo) under ultraprotective ventilation settings was observed (p = 0.05). There were no significant differences in the values of systolic pulmonary arterial pressure (sPAP) and RV preload. Conclusion Low-flow ECCO2R facilitates an ultraprotective ventilation strategy thatwould improve RV function in moderate-to-severe ARDS patients. Improvement in RV contractility appears to be mainly due to a decrease in intrathoracic pressure allowed by ultraprotective ventilation, rather than a reduction of PaCO2.

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Exogenous Surfactant Therapy for Pediatric Patients with Acute Respiratory Distress Syndrome

Canadian Respiratory Journal ◽

10.1155/1997/903459 ◽

1997 ◽

Vol 4 (1) ◽

pp. 21-26 ◽

Cited By ~ 13

Author(s):

James F Lewis ◽

Jasvinder S Dhillon ◽

Ram N Singh ◽

Craig C Johnson ◽

Timothy C Frewen

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pilot Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pediatric Patients ◽

Distress Syndrome ◽

Exogenous Surfactant ◽

Lung Dysfunction ◽

Surfactant Administration ◽

Severe Lung

Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.

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Statistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial

Revista Brasileira de Terapia Intensiva ◽

10.5935/0103-507x.20170024 ◽

2017 ◽

Vol 29 (2) ◽

Cited By ~ 1

Author(s):

Lucas Petri Damiani ◽

Otavio Berwanger ◽

Denise Paisani ◽

Ligia Nasi Laranjeira ◽

Erica Aranha Suzumura ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Acute Respiratory Distress Syndrome ◽

Statistical Analysis ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Controlled Trial ◽

Statistical Analysis Plan ◽

Alveolar Recruitment ◽

Randomized Controlled

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Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) versus low PEEP on patients with moderate–severe acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619858228 ◽

2019 ◽

Vol 13 ◽

pp. 175346661985822 ◽

Cited By ~ 1

Author(s):

Xi Zheng ◽

Yijia Jiang ◽

Huimiao Jia ◽

Wenliang Ma ◽

Yue Han ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Length Of Stay ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Randomized Controlled Trials ◽

Distress Syndrome ◽

Controlled Trials ◽

Positive End Expiratory Pressure ◽

Icu Mortality ◽

Randomized Controlled

Background: Setting a positive end-expiratory pressure (PEEP) on patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation has been an issue of great contention. Therefore, we aimed to determine effects of lung recruitment maneuver (RM) and titrated PEEP versus low PEEP on adult patients with moderate–severe ARDS. Methods: Data sources and study selection proceeded as follows: PubMed, Ovid, EBSCO, and Cochrane Library databases were searched from 2003 to May 2018. Original clinical randomized controlled trials which met the eligibility criteria were included. To compare the prognosis between the titrated PEEP and low PEEP groups on patients with moderate–severe ARDS (PaO2/FiO2 < 200 mmHg). Heterogeneity was quantified through the I2 statistic. Egger’s test and funnel plots were used to assess publication bias. Results: No difference was found in 28-day mortality and ICU mortality (OR = 0.97, 95% CI (0.61–1.52), p = 0.88; OR = 1.14, 95% CI (0.91–1.43), p = 0.26, respectively). Only ventilator-free days, length of stay in the ICU, length of stay in hospital, and incidence of barotrauma could be systematically reviewed owing to bias and extensive heterogeneity. Conclusion: No difference was observed in the RM between the titrated PEEP and the low PEEP in 28-day mortality and ICU mortality on patients with moderate–severe ARDS.

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