scholarly journals The role of point-of-care ultrasound in pediatric acute respiratory distress syndrome: emerging evidence for its use

2019 ◽  
Vol 7 (19) ◽  
pp. 507-507
Author(s):  
Samantha K. Potter ◽  
Michael J. Griksaitis
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Point Of Care ◽  
Point Of Care Ultrasound

scholarly journals Application of Thoracic Ultrasonography for Acute Cor Pulmonale in Acute Respiratory Distress Syndrome Patients

2020 ◽  
Author(s):  
You Shang ◽  
Ting Zhou
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Right Ventricle ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Point Of Care ◽  
Cor Pulmonale ◽  
Point Of Care Ultrasound ◽  
Acute Cor Pulmonale ◽  
Protective Strategies

Beneficial therapeutic interventions for acute respiratory distress syndrome (ARDS) include lung protective ventilation; however, ventilator may cause or sometimes worsen acute cor pulmonale (ACP) induced by pulmonary gas exchange disorder and pulmonary vascular dysfunction due to ARDS. The incidence of ACP was 22–50% in mechanically ventilated patients. Currently, point-of-care ultrasound has been widely used in ARDS patients, which becomes much more important in the early detection and management of ARDS and its complications. Application of lung ultrasound combined with echocardiography could monitor respiratory status, hemodynamics, and cardiac function and optimize the ventilation setting in order to protect both lung and right ventricle. This chapter will discuss the pathophysiology of ACP associated with ARDS and the use of point-of-care ultrasound to make protective strategies for lung and right ventricle in detail.

scholarly journals Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Johannes Herrmann ◽  
Quirin Notz ◽  
Tobias Schlesinger ◽  
Jan Stumpner ◽  
Markus Kredel ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Platelet Function ◽  
Distress Syndrome ◽  
Point Of Care ◽  
Retrospective Observational Study ◽  
Bleeding Complications ◽  
Thromboembolic Events

Abstract Background Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT. Methods This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020. Results Median age was 61 years (IQR: 51–69). Median PaO2/FiO2 on admission was 122 mmHg (IQR: 87–189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3–10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications. Conclusions Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..

Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Monika Janagill ◽  
Puneet Aulakh Pooni ◽  
Siddharth Bhargava ◽  
Shibba Takkar Chhabra
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Inclusion Criteria ◽  
Northern India ◽  
Pulmonary Vasodilator ◽  
Pulmonary Arterial

AbstractAcute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Cardiologist performed a detailed echocardiogram to determine pulmonary arterial pressure (PAP). Patients with persistent hypoxemia were started on oral sildenafil. The majority (77%) patients had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO2/FiO2 ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.

scholarly journals The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
M. García de Acilu ◽  
S. Leal ◽  
B. Caralt ◽  
O. Roca ◽  
J. Sabater ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Acute Respiratory Distress Syndrome ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acids ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Acute Onset ◽  
Omega 3

Acute respiratory distress syndrome (ARDS) is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process. Recent report on the prognostic value of eicosanoids in patients with ARDS suggests that modulating the inflammatory response through the use of polyunsaturated fatty acids may be a useful strategy for ARDS treatment. The use of enteral diets enriched with eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) has reported promising results, showing an improvement in respiratory variables and haemodynamics. However, the interpretation of the studies is limited by their heterogeneity and methodology and the effect ofω-3 fatty acid-enriched lipid emulsion or enteral diets on patients with ARDS remains unclear. Therefore, the routine use ofω-3 fatty acid-enriched nutrition cannot be recommended and further large, homogeneous, and high-quality clinical trials need to be conducted to clarify the effectiveness ofω-3 polyunsaturated fatty acids.

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