scholarly journals Utility of Endobronchial Valves in a Patient with Bronchopleural Fistula in the Setting of COVID-19 Infection: A Case Report and Brief Review

2021 ◽  
Vol 23 (4) ◽  
pp. 109-114
Author(s):  
Nazanin Sheikhan ◽  
◽  
Elizabeth Benge ◽  
Amanpreet Kaur ◽  
Jerome Hruska ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Case Report ◽  
Distress Syndrome ◽  
Bronchopleural Fistula ◽  
Invasive Mechanical Ventilation ◽  
Air Leak ◽  
Mechanically Ventilated ◽  
Growing Body ◽  
Endobronchial Valve

Patients with COVID-19 pneumonia frequently develop acute respiratory distress syndrome (ARDS), and in severe cases, require invasive mechanical ventilation. One complication that can develop in patients with ARDS who are mechanically ventilated is a bronchopleural fistula (BPF). Although rare, the frequency of BPF in patients with COVID-19 pneumonia is increasingly recognized. Here, we present a 48-year old man with BPF associated with COVID-19 pneumonia. Treatment with a commercial endobronchial valve (EBV) system resulted in reduced air leak allowing for tracheostomy placement. Our case adds to a growing body of evidence suggesting that the presence of COVID-19 pneumonia does not hinder the utility of EBV’s in the treatment of BPF’s.

Nanomembrane-Based Therapeutic Plasmapheresis after Non-Invasive Ventilation Failure for Treatment of a Patient with Acute Respiratory Distress Syndrome and Myasthenia Gravis: A Case Report

2019 ◽  
Vol 48 (4) ◽  
pp. 382-384 ◽  
Author(s):  
Yordanka Yamakova ◽  
Viktoria Asenova Ilieva ◽  
Rosen Petkov ◽  
Georgi Yankov
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Case Report ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Myasthenia Gravis ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Bioactive Molecules ◽  
Non Invasive

Acute respiratory distress syndrome (ARDS) is characterized by a widespread inflammation of the lungs, causing severe hypoxemia. Several mediators have been associated with it and almost all of them are small enough to be filtrated through a nanomembrane. We present a case report of a 41-year-old man with myasthenia gravis in remission; he developed ARDS caused by pneumonia. Although he performed well on both non-invasive and invasive mechanical ventilation, his oxygenation continued to deteriorate. As a last resort of treatment, we decided to apply nanomembrane-based apheresis to cleanse his plasma from the harmful inflammatory mediators. After 3 sessions of plasmapheresis, his condition improved and he was successfully weaned from mechanical ventilation. The obtained results gave us ground to assume that the removal of bioactive molecules can be a useful adjunct to protective mechanical ventilation in ARDS.

scholarly journals Effectiveness of Prone Positioning in Patients with COVID-19-Related Acute Respiratory Distress Syndrome Undergoing Invasive Mechanical Ventilation

2021 ◽  
Vol 11 (21) ◽  
pp. 10263
Author(s):  
Álvaro Astasio-Picado ◽  
María del Rocío Sánchez-Sánchez
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prone Position ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Invasive Technique ◽  
Eligibility Criteria ◽  
Mechanically Ventilated

The prone position is a non-invasive technique resulting from the mobilization of the patient, where the person is lying horizontally face down. This technique has been used since the 1970s, but it has gained great relevance in the last year owing to the COVID-19 pandemic with the use of invasive mechanical ventilation. Objectives: To evaluate the effectiveness of the prone position in patients with acute respiratory distress syndrome as a consequence of the COVID-19 disease who are mechanically ventilated and admitted to the intensive care unit. To demonstrate the nursing care carried out and to identify the respiratory benefits of the prone position in this type of patient. Data sources, study eligibility criteria: The search for articles was carried out from January 2018 to June 2021, in five databases (Pubmed, Google Scholar, Scielo, Dialnet, and WOS), based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT”, and “OR”. The search was limited to publications from the last 6 years, in English. Results: After applying the selection criteria and evaluating the quality of the methodology, 12.14% (n = 21) of the 173 results were included with filters: 3 bibliographic reviews, 1 narrative review, 2 systematic review, 7 descriptive (4 series of cases and 3 of cross section), and 8 analytical (6 of cohorts and 2 of cases and controls). Conclusions and implications of key findings: The prone position in adults with acute respiratory distress syndrome improves oxygenation, in conjunction with invasive mechanical ventilation, from the second cycle and in prolonged pronation episodes. This technique improves oxygenation by increasing alveolar recruitment and inspiratory capacity in the dorsal pulmonary areas.

scholarly journals Bronchopleural Fistula Resolution with Endobronchial Valve Placement and Liberation from Mechanical Ventilation in Acute Respiratory Distress Syndrome: A Case Series

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Haris Kalatoudis ◽  
Meena Nikhil ◽  
Fuad Zeid ◽  
Yousef Shweihat
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Severe Respiratory Failure ◽  
Air Leak ◽  
Endobronchial Valve ◽  
Valve Placement ◽  
Persistent Air Leak

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve placement is a safe method treating persistent air leak with severe respiratory failure and may reduce days on mechanical ventilation.

scholarly journals Síndrome de Dificuldade Respiratória Aguda: Casuística de Dois Anos numa Unidade de Cuidados Intensivos

2014 ◽  
Vol 27 (2) ◽  
pp. 211 ◽  
Author(s):  
Lúcia Taborda ◽  
Filipa Barros ◽  
Vitor Fonseca ◽  
Manuel Irimia ◽  
Ramiro Carvalho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Interquartile Range ◽  
The Mean

<strong>Introduction:</strong> Acute Respiratory Distress Syndrome has a significant incidence and mortality at Intensive Care Units. Therefore, more studies are necessary in order to develop new effective therapeutic strategies. The authors have proposed themselves to characterize Acute Respiratory Distress Syndrome patients admitted to an Intensive Care Unit for 2 years.<br /><strong>Material and Methods:</strong> This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and programmation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at<br />Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis.<br /><strong>Results:</strong> A 40 patients sample was obtained, with a median age of 72.5 years (interquartile range = 22) and a female:male ratio of ≈1:1.86. Fifty five percent of the Acute Respiratory Distress Syndrome cases had pulmonary etiology. The mean minimal PaO2/FiO2 was 88mmHg (CI 95%: 78.5–97.6). The mean maximal applied PEEP was 12.4 cmH2O (Standard Deviation 4.12) and the mean maximal used tidal volume was 8.2 mL/ Kg ideal body weight (CI 95%: 7.7–8.6). The median invasive mechanical ventilation days was 10. Forty seven and one half percent of the patients had been administered corticosteroids and 52.5% had been submitted to recruitment maneuvers. The most frequent complication was Ventilator Associated Pneumonia (20%). The median Intensive Care Unit stay was 10.7 days (interquartile range 10.85). The fatality rate was 60%. The probability of the favorable outcome ‘non-death in Intensive Care Unit’ was 4.4x superior for patients who were administered corticosteroids and 11x superior for patients &lt; 65 years old.<br /><strong>Discussion and Conclusions:</strong> Acute Respiratory Distress Syndrome is associated with long hospitalization and significant mortality. New prospective studies will be necessary to endorse the potential benefit of steroid therapy and to identify the subgroups of patients that warrant its use.

scholarly journals Effects of dexamethasone on immune dysfunction and ventilator-associated pneumonia in COVID-19 acute respiratory distress syndrome: an observational study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Martin Cour ◽  
Marie Simon ◽  
Laurent Argaud ◽  
Guillaume Monneret ◽  
Fabienne Venet
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Human Leukocyte ◽  
Immune Dysfunction ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated

AbstractDexamethasone improves survival of patients with COVID-19 acute respiratory distress syndrome, but might shorten the delay between the start of invasive mechanical ventilation and the occurrence of ventilator-associated pneumonia, suggesting possible worsening of COVID-19-induced immune dysfunction with this treatment. In a prospective observational study, we found that mechanically ventilated patients with COVID-19 treated with dexamethasone presented earlier ventilator-associated pneumonia, had significantly lower monocyte Human Leukocyte Antigen-DR expression and number of circulating CD4 + cells after ICU admission, than those not treated with corticoids.

scholarly journals Higher Versus Lower Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tommaso Pettenuzzo ◽  
Annalisa Boscolo ◽  
Alessandro De Cassai ◽  
Nicolò Sella ◽  
Francesco Zarantonello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Controlled Trials ◽  
Positive End Expiratory Pressure ◽  
Randomized Controlled ◽  
Duration Of Ventilation

Abstract Background: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the association of higher positive end-expiratory pressure (PEEP), as opposed to lower PEEP, with hospital mortality in adult intensive care unit (ICU) patients undergoing invasive mechanical ventilation for reasons other than acute respiratory distress syndrome (ARDS). Methods: We performed an electronic search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science from inception until December 18, 2020 with no language restrictions. In addition, a research-in-progress database and grey literature were searched. Results: We identified 22 RCTs (2225 patients) comparing higher PEEP (1007 patients) with lower PEEP (991 patients). No statistically significant association between higher PEEP and hospital mortality was observed (risk ratio 1.02, 95% confidence interval 0.89-1.16; I2 = 0%, p = 0.62; low certainty of evidence). Among secondary outcomes, higher PEEP was associated with better oxygenation, higher respiratory system compliance, and lower risk of hypoxemia and ARDS occurrence. Furthermore, barotrauma, hypotension, duration of ventilation, lengths of stay, and ICU mortality were similar between the two groups. Conclusions: In our meta-analysis of RCTs, higher PEEP, compared with lower PEEP, was not associated with mortality or duration of ventilation in patients without ARDS receiving invasive mechanical ventilation, despite being associated with improved oxygenation and lower occurrence of ARDS.

scholarly journals Effects of Methylprednisolone on Ventilator-Free Days in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome and COVID-19

2021 ◽  
Author(s):  
Mohamed Badr ◽  
Bruno De Oliveira ◽  
Khaled Abdallah ◽  
Ashraf Nadeem ◽  
Yeldho Varghese ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Length Of Stay ◽  
Competing Risks ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone increases the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study Setting: Intensive care unit Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included Interventions: None Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) during the first 28 days, defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray&rsquo;s proportional subhazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg.kg-1 (IQR: 1-1.3 mg.kg-1) and median duration of 5 days (IQR:5-7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6-20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6-16.7) in patients who did not receive methylprednisolone (difference, 4.61; 95% CI, 1.10-8.12; P = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95%CI: 0.02-0.45; p=0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p=0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR:15-41 days] vs. 37 days [IQR:23-52 days], p=0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p=0.052). However, 91% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

Sign in / Sign up

Export Citation Format

Share Document