scholarly journals Making sense of the pressure of arterial oxygen to fractional inspired oxygen concentration ratio in patients with acute respiratory distress syndrome

2013 ◽  
Vol 1 (1) ◽  
Author(s):  
AF Broccard
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Oxygen Concentration ◽  
Concentration Ratio ◽  
Distress Syndrome ◽  
Arterial Oxygen ◽  
Making Sense ◽  
Inspired Oxygen

Pneumothorax and Pneumomediastinum in Infants With ldiopathic Respiratory Distress Syndrome Receiving Continuous Positive Airway Pressure

PEDIATRICS ◽  
1975 ◽  
Vol 55 (4) ◽  
pp. 493-496
Author(s):  
Robert T. Hall ◽  
Philip G. Rhodes
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Oxygen Concentration ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Underlying Mechanism ◽  
Treated Group ◽  
Controlled Study ◽  
Idiopathic Respiratory Distress Syndrome ◽  
Inspired Oxygen

A review of infants with idiopathic respiratory distress syndrome developing pneumomediastinum and pneumothorax reveals (1) an incidence of 20% in patients receiving CPAP with an 11% incidence in comparable infants not receiving this mode of therapy; (2) in the CAPA-treated group the occurrence was at a stage in the illness when the inspired oxygen concentration was being lowered and when ventilation was stable; (3) the inspired oxygen concentration in the CPAP group at the time of the PM and/or PT was 52% (± S.D. 15%) at a mean age of 33 hours (± S.D. 23 hr). These observations suggest that distending airway pressure creates excessive alveolar distention as an underlying mechanism of the air leak. It is recommended that distending airway pressure be lowered prior to achieving an inspired oxygen concentration of 60%. A controlled study is in progress to delineate the optimum distending airway pressures at specific inspired oxygen concentrations in order to reduce the incidence of alveolar rupture to a minimum.

scholarly journals Efficacity of Ventilator strategy in A.R.D.S (Acute Respiratory Distress Syndrome).

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Alma Cani ◽  
Fadil Gradica ◽  
Fahri Kokiçi ◽  
Loreta Agolli
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Gradual Increase ◽  
Peep Level ◽  
Arterial Oxygen Tension ◽  
Experimental Models ◽  
Arterial Oxygen ◽  
Significance Level

Background: ARDS is defined as pulmonary inflammatory process characterized by increased capillary permeability associated with acute severe hypoxemia and bilateral  infiltrates on the chest radiograph. Chlinical manifestations of ARDS is associated with a reduction of  functional residual capacity and  static compliance of the respiratory system.Recently,after experimental models and physiological studies have just established the principles to understand  the potential beneficial effects  of PEEP and reduction in mortality to 22%. The benefit of PEEP has been demonstrated in terms of preventing cyclic opening and collapsing alveoli in acute respiratory distress syndrome patients (ARDS). Aim of study: To determine  the appropriate PEEP level in-patients with ARDS. Objective: By using optimal PEEP:to realize the maximal alveolar recruitment.To avoid the decrease of oxygen delivery (DO2) as result of an unfavourable reduction in cardiac output. Material and methods:Retrospectiv study of 120 patients which only 63 of them are included in study with age 18-70 years old.(2012-2014 )  The entry criteria were clinically (severe dyspnoea, tachypnea, cyanosis); PaO2/FiO2 <200mmHG, the presence of bilateral chest infiltrates. The exclusion criteria were: aged < 18 yrs, COPD in history of diseases, heart attack; PEEP was set the level that provided the greatest improvement in oxygenation. The optimal PEEP came as a result of gradual increase of PEEP from 2-5 cmH2O every 6 hours, depended on gas analyses. The right PEEP level is the PEEP allowing the highest PaO2 value without causing hemodynamic compromise. Results: During this study we conclude that the gradual increase of PEEP improves significantly arterial oxygen tension (PaO2). Per value of PEEP 9.6-15.8, CI 95% is 145.9-191.8. The  Pearson test  with a significant correlation coefficient of level 0.995 and significance level 0.000 shows also a very important result. It was considered significant statistically the value of P≤ 0.05.  Also  the value of Chi ² of PaO2 and of PEEP, has resulted significant in 0.950 with P < 0.001. Conclusion: Mechanical ventilation using optimal PEEP increases the value of PaO2. As a matter of fact 88% of cases with PaO2 > 220 mmHg survive. The role of PEEP in clinical practice is still debated but, in selected categories of patients with a careful monitoring, it may play an important role in improving outcome.

scholarly journals Effects of PDE3 Inhibitor Olprinone on the Respiratory Parameters, Inflammation, and Apoptosis in an Experimental Model of Acute Respiratory Distress Syndrome

2020 ◽  
Vol 21 (9) ◽  
pp. 3382
Author(s):  
Petra Kosutova ◽  
Pavol Mikolka ◽  
Sona Balentova ◽  
Marian Adamkov ◽  
Andrea Calkovska ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Arterial Oxygen Saturation ◽  
Oxygenation Index ◽  
Arterial Oxygen ◽  
Arterial Blood ◽  
Respiratory Parameters ◽  
Pde3 Inhibitor

This study aimed to investigate whether a selective phosphodiesterase-3 (PDE3) inhibitor olprinone can positively influence the inflammation, apoptosis, and respiratory parameters in animals with acute respiratory distress syndrome (ARDS) model induced by repetitive saline lung lavage. Adult rabbits were divided into 3 groups: ARDS without therapy (ARDS), ARDS treated with olprinone i.v. (1 mg/kg; ARDS/PDE3), and healthy ventilated controls (Control), and were oxygen-ventilated for the following 4 h. Dynamic lung–thorax compliance (Cdyn), mean airway pressure (MAP), arterial oxygen saturation (SaO2), alveolar-arterial gradient (AAG), ratio between partial pressure of oxygen in arterial blood to a fraction of inspired oxygen (PaO2/FiO2), oxygenation index (OI), and ventilation efficiency index (VEI) were evaluated every hour. Post mortem, inflammatory and oxidative markers (interleukin (IL)-6, IL-1β, a receptor for advanced glycation end products (RAGE), IL-10, total antioxidant capacity (TAC), 3-nitrotyrosine (3NT), and malondialdehyde (MDA) and apoptosis (apoptotic index and caspase-3) were assessed in the lung tissue. Treatment with olprinone reduced the release of inflammatory mediators and markers of oxidative damage decreased apoptosis of epithelial cells and improved respiratory parameters. The results indicate a future potential of PDE3 inhibitors also in the therapy of ARDS.

Can the Tomographic Aspect Characteristics of Patients Presenting with Acute Respiratory Distress Syndrome Predict Improvement in Oxygenation-related Response to the Prone Position?

2002 ◽  
Vol 97 (3) ◽  
pp. 599-607 ◽  
Author(s):  
Laurent Papazian ◽  
Marie-Héléne Paladini ◽  
Fabienne Bregeon ◽  
Xavier Thirion ◽  
Olivier Durieux ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prone Position ◽  
Supine Position ◽  
Distress Syndrome ◽  
Arterial Oxygen ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
A Prospective Study

Background In some patients with acute respiratory distress syndrome, the prone position is able to improve oxygenation, whereas in others it is not. It could be hypothesized that the more opacities that are present in dependent regions of the lung when the patient is in the supine position, the better the improvement in oxygenation is observed when the patients are turned prone. Therefore, we conducted a prospective study to identify computed tomographic scan aspects that could accurately predict who will respond to the prone position. Methods We included 46 patients with acute respiratory distress syndrome (31 responders and 15 nonresponders). Computed tomographic scan was performed in the 6-h period preceding prone position. Blood gas analyses were performed before and at the end of the first 6-h period of prone position. Results Arterial oxygen partial pressure/fraction of inspired oxygen increased from 117 +/- 42 (mean +/- SD) in the supine position to 200 +/- 76 mmHg in the prone position (P &lt; 0.001). There were 31 responders and 15 nonresponders. There was a vertebral predominance of the opacities (P &lt; 0.0001). However, there was no difference between responders and nonresponders. When only the amount of consolidated lung located under the heart was evaluated, there was more consolidated tissue under the heart relative to total lung area in nonresponders than in responders (P = 0.01). Conclusions There are no distinctive morphologic features in the pattern of lung disease measured by computed tomographic scanning performed with the patient in the supine position that can predict response to the prone position.

scholarly journals Clinical characteristics and prognosis of drug-associated acute respiratory distress syndrome compared with non-drug-associated acute respiratory distress syndrome: a single-centre retrospective study in Japan

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e015330 ◽  
Author(s):  
Keisuke Anan ◽  
Kazuya Ichikado ◽  
Kodai Kawamura ◽  
Takeshi Johkoh ◽  
Kiminori Fujimoto ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Arterial Oxygen Tension ◽  
Ventilator Weaning ◽  
Serum Lactate ◽  
Lung Damage ◽  
Arterial Oxygen ◽  
Serum Lactate Dehydrogenase

ObjectivesTo report the clinical features and prognosis of drug-associatedacute respiratory distress syndrome (ARDS).DesignA retrospective analysis of data collected during a prospective cohort study.SettingIntensive care unit in a teaching hospital.ParticipantsA total of 197 Japanese patients with ARDS diagnosed by the Berlin definition who were admitted to the Division of Respiratory Medicine from October 2004 to December 2015 were enrolled in the study and were classified as two groups according to their causes: a drug-associated ARDS group (n=27) and a non-drug-associated ARDS group (n=170). Primary outcome measure is 28-day mortality, and the secondaryoutcome measure is ventilator-free days.ResultsThe Acute Physiology and Chronic Health Evaluation II scores were significantly lower in the drug-associated ARDS group than in the non-drug-associated ARDS group (median (IQR): 18.0 (16.5–21.0) vs 23.0 (18.0–26.0), p<0.001), and the arterial oxygen tension/fractional inspired oxygen ratio was higher (148.0 (114.1–177.5) vs 101.0 (71.5–134.0), p=0.003). In the drug-associated ARDS group, although high-resolution CT scores indicative of the extent of fibroproliferation (301.6 (244.1–339.8) vs 208.3 (183.4–271.6), p<0.001), serum lactate dehydrogenase levels (477 (365–585) vs 322 (246–434), p=0.003) and the McCabe scores (score 1/2/3, n (%): 20 (74)/4 (15)/3 (11)vs154 (91)/7 (4)/9 (5), p=0.04) were significantly higher, ventilator weaning was earlier (p<0.001) and 28-day mortality was better (p=0.043). After adjusting for potentially confounding covariates, drug-associated ARDS group was associated with lower 28-day mortality (adjusted HR (HR) 0.275; 95% CI 0.106 to 0.711; p=0.008).ConclusionsAlthough more severe lung damage with fibroproliferation was observed in patients with drug-associated ARDS, ventilator weaning was earlier, and their prognosis was better than the others. Further well-designed prospective studies are needed.

scholarly journals High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation?

2021 ◽  
Vol 15 ◽  
pp. 175346662110195
Author(s):  
Agathe Delbove ◽  
Ambroise Foubert ◽  
François Mateos ◽  
Tiphaine Guy ◽  
Marie Gousseff
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Healthcare Workers ◽  
Distress Syndrome ◽  
High Flow ◽  
Nasal Cannula ◽  
Arterial Oxygen ◽  
High Flow Nasal Cannula

Backgrounds: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. Methods: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st–3rd) interquartile range. Results: From 26 February to 30 June 2020, 46 patients of median age 75 (70–79) years were included. In the HFNC-DNIO group ( n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102–172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients ( n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34–41) versus 33 (24–34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103–169) versus 191 (162–219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% ( n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% ( n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. Conclusions: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation. The reviews of this paper are available via the supplemental material section.

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