scholarly journals Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study

2019 ◽  
Vol 54 (4) ◽  
pp. 1900609 ◽  
Author(s):  
Bairbre A. McNicholas ◽  
Fabiana Madotto ◽  
Tài Pham ◽  
Emanuele Rezoagli ◽  
Claire H. Masterson ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Hospital Length Of Stay ◽  
Lower Tidal Volume ◽  
Volume Ventilation ◽  
To Receive

RationaleWe wished to determine the influence of sex on the management and outcomes in acute respiratory distress syndrome (ARDS) patients in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE).MethodsWe assessed the effect of sex on mortality, intensive care unit and hospital length of stay, and duration of invasive mechanical ventilation (IMV) in patients with ARDS who underwent IMV, adjusting for plausible clinical and geographic confounders.FindingsOf 2377 patients with ARDS, 905 (38%) were female and 1472 (62%) were male. There were no sex differences in clinician recognition of ARDS or critical illness severity profile. Females received higher tidal volumes (8.2±2.1 versus 7.2±1.6 mL·kg−1; p<0.0001) and higher plateau and driving pressures compared with males. Lower tidal volume ventilation was received by 50% of females compared with 74% of males (p<0.0001). In shorter patients (height ≤1.69 m), females were significantly less likely to receive lower tidal volumes. Surviving females had a shorter duration of IMV and reduced length of stay compared with males. Overall hospital mortality was similar in females (40.2%) versus males (40.2%). However, female sex was associated with higher mortality in patients with severe confirmed ARDS (OR for sex (male versus female) 0.35, 95% CI 0.14–0.83).ConclusionsShorter females with ARDS are less likely to receive lower tidal volume ventilation, while females with severe confirmed ARDS have a higher mortality risk. These data highlight the need for better ventilatory management in females to improve their outcomes from ARDS.

scholarly journals Methylprednisolone Treatment Versus Standard Supportive Care for Adult Covid19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients

2021 ◽  
Author(s):  
Masood Ur Rahman ◽  
Satish Chandra Nair ◽  
Mehraj Ud Din ◽  
Mohd Dar ◽  
Murriam Masood ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Respiratory Distress Syndrome ◽  
Supportive Care ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Hospital Length Of Stay ◽  
Care Group ◽  
Mechanically Ventilated ◽  
Methylprednisolone Treatment

Abstract A myriad of symptoms presented by severely ill mechanically ventilated Covid19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. Covid19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for Covid19, the aim of the current study was to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID19 patients with severe covid pneumonia. Data was collected retrospectively from the electronic patient medical records, and inter-rater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome and the Chi-Square test used to determine association between the outcomes and other independent variables. Patients. Sixty-one percent (43/70) of the Covid19 ARDS patients received standard supportive care, and the remainder were administered. methylprednisolone (40 mg daily to 40 mg q 6 hours). A 28-day all-cause mortality rate, in the methylprednisolone group was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU-length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone treated group was significantly lower (p < 0.01), when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU LOS, and ventilator days in mechanically ventilated Covid 19 patients with respiratory distress syndrome.

scholarly journals Low Tidal Volume Ventilation Use in Acute Respiratory Distress Syndrome*

2016 ◽  
Vol 44 (8) ◽  
pp. 1515-1522 ◽  
Author(s):  
Curtis H. Weiss ◽  
David W. Baker ◽  
Shayna Weiner ◽  
Meagan Bechel ◽  
Margaret Ragland ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Low Tidal Volume ◽  
Low Tidal Volume Ventilation ◽  
Volume Ventilation

scholarly journals Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Jed Lipes ◽  
Azadeh Bojmehrani ◽  
Francois Lellouche
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Low Tidal Volume ◽  
Low Tidal Volume Ventilation ◽  
Volume Ventilation

Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

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