Glucocorticoid Rescue for Late-Phase Acute Respiratory Distress Syndrome in Trauma/Surgical Critical Care Patients

2006 ◽  
Vol 72 (7) ◽  
pp. 644-648
Author(s):  
Curt S. Koontz ◽  
K. Kye Higdon ◽  
Troy L. Ploger ◽  
Benjamin W. Dart ◽  
Charles M. Richart ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
High Dose ◽  
Surgical Critical Care ◽  
Before And After ◽  
Critical Care Patients

High-dose glucocorticoid therapy (GCT) for the late fibroproliferative phase of acute respiratory distress syndrome (ARDS) is controversial and has shown mixed results in medical patients. No studies have evaluated GCT in trauma/surgical critical care patients. The purpose of this study is to review the outcomes of trauma/surgical critical care patients with refractory ARDS treated with GCT. From January 2001 through September 2005, a pharmacy log was used to identify critically ill trauma/surgical patients in refractory ARDS (7 males and 2 females) who received GCT in an attempt to salvage them. GCT consisted of 200 mg intravenous methylprednisolone bolus for one dose and then 3 mg/kg per day divided every 6 hours for 6 weeks or until weaned off the ventilator. All patients as well as the survivors were analyzed. Outcome data was analyzed with SPSS (Chicago, IL) and the paired sample test. A P value ≤0.05 was considered significant. Data is presented as mean ± standard deviation. The Institutional Review Board approved this retrospective chart review. Seven patients (6 males and 1 female; age, 31 ± 16 years) survived (78%), weaned off of the ventilator, and were discharged from the hospital. The 2 deaths were secondary to refractory respiratory failure as well as cardiac arrest (n = 1) and anoxic brain injury from septic hypotension (n = 1). In survivors (n = 7), hospital length of stay (LOS) and intensive care unit LOS was 71 ± 30 days and 53 ± 16 days, respectively. Duration of GCT administration was 17 ± 6.4 days (range, 11–30 days). Ventilator time before GCT, during GCT, and after GCT was 22 ± 8.4, 15 ± 7.5, and 1.6 ± 6.0 days, respectively. During GCT, 8 patients developed pneumonia, 5 had urinary tract infection, and 3 had bacteremia. All infections were effectively treated with broad-spectrum antibiotics, except in one patient who died of sepsis. PaO2/FIO2 ratio just before and after GCT was 100 ± 36 and 247 ± 56, respectively (n = 7; P < 0.001). Sequential organ failure assessment score just before and after GCT was 9.1 ± 2.3 and 5.0 ± 1.6, respectively (n = 7; P < 0.001). GCT rescue may have a role in salvaging critically ill trauma/surgical critical care patients in late-stage ARDS. More patients, however, need to be studied.

A Pneumatic Compression Vest for Transthoracic Manipulation of Ventilation-Perfusion in Critical Care Patients with Acute Respiratory Distress Syndrome Caused by COVID-19

2020 ◽  
Author(s):  
Alexander B. Ambrose ◽  
Lucas Tiziani ◽  
Donald J. Ward ◽  
Maxwell Weinmann ◽  
Frank L. Hammond
Keyword(s):  
Blood Flow ◽  
Critical Care ◽  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Exchange Process ◽  
Significant Risk ◽  
Critical Care Patients

Abstract Critical Care patients who experience symptoms of Acute Respiratory Distress Syndrome (ARDS) are commonly placed on mechanical ventilators to increase the oxygen being supplied to their pulmonary system. If patients’ pulmonary inflammation is severe, they can experience ventilation-perfusion mismatch (V/Q mismatch) where blood flow and gas exchange are mismatched such that oxygen uptake is greatly impaired. In these cases, patients are typically rotated into a prone position to facilitate improved blood flow to segments of the lung that were not previously participating in the gas exchange process. However, proning a patient has a significant risk of complications. The low-cost vest presented in this work is designed to be used as a surrogate to patient proning while also requiring less hospital staff to operate than the proning process. The vest was preliminarily tested on 6 patients with Coronavirus disease 2019 (COVID-19) who experienced ARDS and presumptive V/Q mismatch. The results from this preliminary testing show that 5 out of 6 patients showed a significant increase in ventilation-perfusion similar to the effects of proning.

An Update on the Diagnosis of Adrenal Insufficiency and the Use of Corticotherapy in Critical Illness

2007 ◽  
Vol 41 (9) ◽  
pp. 1456-1465 ◽  
Author(s):  
Zachariah Thomas ◽  
Gilles L Fraser
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Large Scale ◽  
Distress Syndrome ◽  
Data Extraction ◽  
High Dose ◽  
Routine Administration

Objective: To examine recent literature regarding corticotherapy in critically ill patients suffering from sepsis, acute respiratory distress syndrome (ARDS), and severe community-acquired pneumonia (SCAP). Data Sources: Literature was identified through MEDLINE (1966–April 2007) using combinations of the key words hydrocortisone, adrenal insufficiency, acute respiratory distress syndrome, pneumonia, sepsis, and cortisol. Bibliographies of relevant articles were reviewed for additional citations. Presentations at recent critical care meetings were also incorporated. Study Selection and Data Extraction: Articles were chosen based upon their relevance to the topics covered. Data Synthesis: Earlier studies using high-dose corticotherapy in the intensive care unit have shown treatment to be ineffective. Recent studies using extended courses of low-to-moderate doses of steroids have found favorable results; however, these results must be interpreted with caution due to limitations in the data. One trial of steroids in septic shock found a survival benefit in patients who failed to increase their baseline cortisol by greater than 9 μg/dL in response to adrenocorticotropic hormone, but these results were not reproduced in a subsequent Phase 3 trial. Recently, inaccuracies in measuring cortisol have been identified, making interpretation of cortisol concentrations difficult. A large-scale study failed to confirm a previously reported mortality benefit of corticotherapy in late ARDS, but preliminary data suggest a role for steroid treatment in early ARDS. Finally, a pilot study has found that hydrocortisone lowers morbidity and mortality in SCAP. Conclusions: Corticotherapy may be beneficial to some patients with sepsis. The decision to administer steroids in sepsis cannot be based on biochemical markers of adrenal function; rather, treatment should be considered in septic patients with vasopressor refractory hypotension. Although preliminary evidence suggests a role for steroids in early ARDS and SCAP, there are not enough data to suggest routine administration of steroids in these conditions. Additional studies are needed to assess corticotherapy in the critically ill.

First reported case of Weissella confusa abundance in the lung microbiota of a critically ill trauma patient with acute respiratory distress syndrome - caution warranted in the use of the Weissella genus as a probiotic

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Joint Infection ◽  
Starter Cultures ◽  
Trauma Patients ◽  
Virulence Determinants ◽  
Prosthetic Joint

Weissella strains are currently being used for biotechnological and probiotic purposes [1]. While, Weissella hellenica found in flounder intestine had probiotic effects [2], certain species from this genus are opportunistic pathogens in humans. Apart from being implicated in disease in farmed rainbow trout [3], Weissella has been found to cause the following disease in humans.1. endocarditis [4,5]2. bacteraemia [6]3. prosthetic joint infection [7]Whole genome sequences ‘find several virulence determinants such as collagen adhesins, aggregation sub- stances, mucus-binding proteins, and hemolysins in some species’, as well as antibiotic resistance-encoding genes [8]. Caution is warranted in selecting of Weissella strains as starter cultures or probiotics, if at all, since the other option, Lactobacillus, are rarely involved in human disease.Here, the analysis of the lung microbiota in critically ill trauma patients suffering from acute respiratory distress syndrome [9] shows (Accid:ERR1992912) shows complete colonization of Weissella (Fig 1). While, the study mentions ‘significant enrichment of potential pathogens including Streptococcus, Fusobacterium, Prevotella, Haemophilus and Treponema’, there is no reference to the Weissella genus. The percentages of Weissella strains are :confusa=81, soli=7 ,hellenica=5 ,diestrammenae=2. I believe this is the first reported case of Weissella causing ARDS in humans.

scholarly journals Acute Respiratory Distress Syndrome and Time to Weaning Off the Invasive Mechanical Ventilator among Patients with COVID-19 Pneumonia

2021 ◽  
Vol 10 (13) ◽  
pp. 2935
Author(s):  
Jose Bordon ◽  
Ozan Akca ◽  
Stephen Furmanek ◽  
Rodrigo Silva Cavallazzi ◽  
Sally Suliman ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Critical Illness ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Overall Mortality

Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) pneumonia is the main cause of the pandemic’s death toll. The assessment of ARDS and time on invasive mechanical ventilation (IMV) could enhance the characterization of outcomes and management of this condition. This is a city-wide retrospective study of hospitalized patients with COVID-19 pneumonia from 5 March 2020 to 30 June 2020. Patients with critical illness were compared with those with non-critical illness. We examined the severity of ARDS and other factors associated with (i) weaning patients off IMV and (ii) mortality in a city-wide study in Louisville, KY. Of 522 patients with COVID-19 pneumonia, 219 (41.9%) were critically ill. Among critically ill patients, the median age was 60 years; 53% were male, 55% were White and 32% were African American. Of all critically ill patients, 52% had ARDS, and 38% of these had severe ARDS. Of the 25% of patients who were weaned off IMV, those with severe ARDS were weaned within eleven days versus five days for those without severe ARDS, p = 0.023. The overall mortality for critically ill patients was 22% versus 1% for those not critically ill. Furthermore, the 14-day mortality was 31% for patients with severe ARDS and 12% for patients without severe ARDS, p = 0.019. Patients with severe ARDS versus non-severe ARDS needed twice as long to wean off IMV (eleven versus five days) and had double the 14-day mortality of patients without severe ARDS.

Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Steven L. Shein ◽  
Aline B. Maddux ◽  
Margaret J. Klein ◽  
Anoopindar Bhalla ◽  
George Briassoulis ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Critically Ill Children ◽  
Children At Risk

scholarly journals GBT1118, a compound that increases the oxygen affinity of hemoglobin, improves survival in murine hypoxic acute lung injury

2018 ◽  
Vol 124 (4) ◽  
pp. 899-905 ◽  
Author(s):  
Nathan D. Putz ◽  
Ciara M. Shaver ◽  
Kobina Dufu ◽  
Chien-Ming Li ◽  
Qing Xu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Oxygen Affinity ◽  
High Dose ◽  
Novel Therapy ◽  
Oxygen Affinity Of Hemoglobin

Acute respiratory distress syndrome (ARDS) is characterized by lung inflammation and pulmonary edema, leading to arterial hypoxemia and death if the hypoxemia is severe. Strategies to correct hypoxemia have the potential to improve clinical outcomes in ARDS. The goal of this study was to evaluate the potential of hemoglobin modification as a novel therapy for ARDS-induced hypoxemia. The therapeutic effect of two different doses of GBT1118, a compound that increases the oxygen affinity of hemoglobin, was evaluated in a murine model of acute lung injury induced by intratracheal LPS instillation 24 h before exposure to 5% or 10% hypoxia ( n = 8–15 per group). As expected, administration of GBT1118 to mice significantly increased the oxygen affinity of hemoglobin. Compared with mice receiving vehicle control, mice treated with GBT1118 had significantly lower mortality after LPS + 5% hypoxia (47% with vehicle vs. 22% with low-dose GBT1118, 13% with high-dose GBT1118, P = 0.032 by log rank) and had reduced severity of illness. Mice treated with GBT1118 showed a sustained significant increase in SpO2 over 4 h of hypoxia exposure. Treatment with GBT1118 did not alter alveolar-capillary permeability, bronchoalveolar lavage (BAL) inflammatory cell counts, or BAL concentrations of IL-1β, TNF-α, or macrophage inflammatory protein-1α. High-dose GBT1118 did not affect histological lung injury but did decrease tissue hypoxia as measured intensity of pimonidazole (Hypoxyprobe) staining in liver ( P = 0.043) and kidney ( P = 0.043). We concluded that increasing the oxygen affinity of hemoglobin using GBT1118 may be a novel therapy for treating hypoxemia associated with acute lung injury. NEW & NOTEWORTHY In this study, we show that GBT1118, a compound that increases hemoglobin affinity for oxygen, improves survival and oxygen saturation in a two-hit lung injury model of intratracheal LPS without causing tissue hypoxia. Modulation of hemoglobin oxygen affinity represents a novel therapeutic approach to treatment of acute lung injury and acute respiratory distress syndrome, conditions characterized by hypoxemia.

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