Drug-induced pulmonary oedema and acute respiratory distress syndrome

AbstractWe report the case of a child who was admitted to our PICU for severe acute respiratory distress syndrome (ARDS) while being treated with trimethoprim-sulfamethoxazole (TMP-SMX) for osteomyelitis. Based on the timing of exposure, lack of alternative explanations, and clinical course similar to previously described cases, we suspect that TMP-SMX may have triggered ARDS. Despite meeting criteria for extracorporeal membrane oxygenation cannulation, conservative management and lung recruitment with high-frequency percussive ventilation could avoid the latter.

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Lung assessment

Focused Intensive Care Ultrasound ◽

10.1093/med/9780198749080.003.0016 ◽

2019 ◽

pp. 141-150

Author(s):

Andrew Walden

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Oedema ◽

Distress Syndrome ◽

Lung Parenchyma ◽

Cardiogenic Pulmonary Oedema ◽

Interstitial Syndrome ◽

Diaphragmatic Function

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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Drug-induced pulmonary edema and acute respiratory distress syndrome

Clinics in Chest Medicine ◽

10.1016/s0272-5231(03)00128-x ◽

2004 ◽

Vol 25 (1) ◽

pp. 95-104 ◽

Cited By ~ 34

Author(s):

Teofilo Lee-Chiong ◽

Richard A Matthay

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Distress Syndrome ◽

Drug Induced

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Use of Anti-Interleukin-6 Receptor Monoclonal Antibody in Drug-Induced Acute Respiratory Distress Syndrome

Case Reports in Critical Care ◽

10.1155/2020/8832986 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Alessandra Petrillo ◽

Noa Biran ◽

Sean Sadikot

Keyword(s):

Monoclonal Antibody ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Interleukin 6 ◽

Distress Syndrome ◽

Standard Of Care ◽

Drug Induced ◽

Immunological Mechanisms ◽

Interleukin 6 Receptor

Acute respiratory distress syndrome (ARDS) is a disorder that involves the activation of alveolar macrophages triggering the innate immune system. The parenchymal lung injury seen in ARDS is a result of many proinflammatory elevations including interleukin-6. There remains no effective standard of care of ARDS, and current treatments at this time currently do not target the immunological mechanisms or pathways involved. Treatments involving this pathway should be further investigated as targeted treatment. We discuss a case of a patient with multiple myeloma who was hospitalized with drug-induced ARDS who had a rapid response to an anti-interleukin-6 monoclonal antibody.

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