scholarly journals Pharmacological therapies for acute respiratory distress syndrome

2019 ◽  
Vol 2 (1) ◽  
pp. 37-47
Author(s):  
Robert Ivaşcu ◽  
Ligia Torsin ◽  
Darius Morlova ◽  
Alina Stanca ◽  
Mihai Neguţu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Fluid Balance ◽  
Distress Syndrome ◽  
Severe Disease ◽  
Specific Treatment ◽  
Review Article ◽  
Effective Therapy ◽  
Positive Fluid Balance

AbstractAcute respiratory distress syndrome (ARDS) has no specific treatment, the only effective therapy currently being limited to minimizing potentially harmful ventilation and avoiding a positive fluid balance. These treatments could not be completely effective in severe disease and several measures must be undertaken simultaneously, including pharmacological therapies aimed at correcting the etiology or targeting the pathogenesis. In this review article we provide update on pharmacological therapies in ARDS, showing their effect on outcome in recent trials.

scholarly journals Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2307
Author(s):  
François Arrivé ◽  
Rémi Coudroy ◽  
Arnaud W. Thille
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Early Identification ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Specific Treatment ◽  
Diagnostic Approach ◽  
Adequate Treatment ◽  
Work Up

Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.

scholarly journals Clinical outcomes of acute respiratory distress syndrome in a university hospital

2019 ◽  
Vol 12 (6) ◽  
pp. 263-271
Author(s):  
Natthawan Sanguanwong ◽  
Napplika Kongpolprom
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Fluid Balance ◽  
Distress Syndrome ◽  
Ideal Body Weight ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Apache Ii Score ◽  
Cumulative Fluid Balance

AbstractBackgroundMortality rates of acute respiratory distress syndrome (ARDS) are different, depending on severity, etiology, and management.ObjectiveTo determine 7-day and 28-day mortalities, hospital length of stay (LOS), duration of mechanical ventilation (MV) of ARDS patients, and factors associated with poor outcomes.MethodsA retrospective study was conducted to review the database of ARDS patients admitted in medical intensive care units (ICUs) at a university hospital between 2010 and 2014. The cases were identified by using International Classification of Diseases, 10th Revision (ICD-10) code-J80 ARDS.ResultsOf 266 patients, 11.7%, 44.4%, and 44% fulfilled mild, moderate, and severe ARDS criteria, respectively. The main cause of ARDS was pneumonia. The 7-day and 28-day mortalities, median LOS, and median MV duration were 31.1%, 69.3%, 18, and 11 days, respectively. Pressure control was the most favorite mode, used with average tidal volume (TV) of 8.63 (2.16) mL/kg ideal body weight (IBW). Recruitment maneuver was most frequently used as adjunctive intervention, whereas prone position was applied to 3.75% of the patients. One-third of the patients received neuromuscular blockades. The median 7-day fluid balance was +6,600 mL. The mean PaO2/FiO2 ratio during the first 3 days, cumulative fluid balance on day 3, and average daily calories during the first week were independent predictors for adjusted 7-day mortality, whereas Acute Physiology and Chronic Health Evaluation (APACHE II) score, fluid balance on day 1, cumulative fluid balance, and average daily calories during the first week were independent predictors for adjusted 28-day mortality.ConclusionsThe 28-day mortality of ARDS was high. In addition, TV and fluid balance were greater than protective limits. These findings indicated the potential improvement of ARDS outcomes in our hospital.

scholarly journals Large scale cytokine profiling uncovers elevated IL12-p70 and IL-17A in severe pediatric acute respiratory distress syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Judith Ju Ming Wong ◽  
Herng Lee Tan ◽  
Jieliang Zhou ◽  
Jan Hau Lee ◽  
Jing Yao Leong ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
T Cell Activation ◽  
Large Scale ◽  
Cell Activation ◽  
Distress Syndrome ◽  
Severe Disease ◽  
Oxygenation Index ◽  
Mitogen Activated Protein Kinase

AbstractThe specific cytokines that regulate pediatric acute respiratory distress syndrome (PARDS) pathophysiology remains unclear. Here, we evaluated the respiratory cytokine profile in PARDS to identify the molecular signatures associated with severe disease. A multiplex suspension immunoassay was used to profile 45 cytokines, chemokines and growth factors. Cytokine concentrations were compared between severe and non-severe PARDS, and correlated with oxygenation index (OI). Partial least squares regression modelling and regression coefficient plots were used to identify a composite of key mediators that differentially segregated severe from non-severe disease. The mean (standard deviation) age and OI of this cohort was 5.2 (4.9) years and 17.8 (11.3), respectively. Early PARDS patients with severe disease exhibited a cytokine signature that was up-regulated for IL-12p70, IL-17A, MCP-1, IL-4, IL-1β, IL-6, MIP-1β, SCF, EGF and HGF. In particular, pro-inflammatory cytokines (IL-6, MCP-1, IP-10, IL-17A, IL-12p70) positively correlated with OI early in the disease. Whereas late PARDS was characterized by a differential lung cytokine signature consisting of both up-regulated (IL-8, IL-12p70, VEGF-D, IL-4, GM-CSF) and down-regulated (IL-1β, EGF, Eotaxin, IL-1RA, and PDGF-BB) profiles segregating non-severe and severe groups. This cytokine signature was associated with increased transcription, T cell activation and proliferation as well as activation of mitogen-activated protein kinase pathway that underpin PARDS severity.

scholarly journals Identification of three classes of acute respiratory distress syndrome using latent class analysis

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4592 ◽  
Author(s):  
Zhongheng Zhang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Latent Class Analysis ◽  
Fluid Balance ◽  
Latent Class ◽  
Distress Syndrome ◽  
Class Analysis ◽  
Class 1

Acute respiratory distress syndrome (ARDS) is a highly heterogeneous syndrome that can exhibit significant differences in the underlying causes, leading to different responses to treatment. It is required to identify subtypes of ARDS to guideline clinical treatment and trial design. The study aimed to identify subtypes of ARDS using latent class analysis (LCA). The study was a secondary analysis of the EDEN study, which was a randomized, controlled, multicenter trial conducted from January 2, 2008 to April 12, 2011. The primary study endpoint was death through 90-day follow up. LCA was performed incorporating variables on day 0 before randomization. The number of classes was chosen by a bootstrapped likelihood ratio test, Bayesian information criterion and the number of patients in each class. A total of 943 patients were enrolled in the study, including 219 (23.2%) non-survivors and 724 (76.8%) survivors. The LCA identified three classes of ARDS. Class 1 (hemodynamically unstable type) had significantly higher mortality rate (p = 0.003) than class 2 (intermediate type) and 3 (stable type) through 90 days follow up. There was significant interaction between cumulative fluid balance and the class (p = 0.02). While more fluid balance was beneficial for class 1, it was harmful for class 2 and 3. In conclusion, the study identified three classes of ARDS, which showed different clinical presentations, responses to fluid therapy and prognosis. The classification system used simple clinical variables and could help to design ARDS trials in the future.

scholarly journals Pneumatocele after Acute Respiratory Distress Syndrome in an Adult Patient: A Case Report

2020 ◽  
Vol 3 (3) ◽  
pp. 73-78
Author(s):  
Gouthami Chennu ◽  
Paulina Przydzial ◽  
Yee Tchao ◽  
Anthony Isedeh ◽  
Nikhil Madan
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Specific Treatment ◽  
Check Valve ◽  
Lung Parenchyma ◽  
Positive Pressure ◽  
Valve Mechanism

Pulmonary pneumatocele is a cystic, air-filled lesion in the lung parenchyma. It results from underlying inflammation or bronchial injury. It is seen in several lung pathologies including bacterial pneumonia, positive-pressure ventilation, chest trauma, chemical pneumonitis, and is most often seen in infants and children. On imaging, pneumatoceles appear as rounded, thin-walled, air-filled spaces in the lung parenchyma. The exact mechanism for forming pneumatoceles is not fully understood but thought to be due to a check-valve mechanism due to obstruction by inflammation causing air trapping in the damaged lung. These lesions are asymptomatic and transient in most patients and disappear by about 6 weeks. They usually do not require any specific treatment or intervention. Surgical intervention is only necessary when pneumatoceles cause cardiopulmonary compromise or rupture into the pleural space. We describe a case of a young adult who developed a pneumatocele after developing acute respiratory distress syndrome from community-acquired pneumonia treated with positive-pressure ventilation. He was managed conservatively with complete resolution of symptoms.

scholarly journals Cumulative Fluid Balance during Extracorporeal Membrane Oxygenation and Mortality in Patients with Acute Respiratory Distress Syndrome

Membranes ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 567
Author(s):  
Li-Chung Chiu ◽  
Li-Pang Chuang ◽  
Shih-Wei Lin ◽  
Yu-Ching Chiou ◽  
Hsin-Hsien Li ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Fluid Balance ◽  
Distress Syndrome ◽  
Fluid Overload ◽  
Membrane Oxygenation ◽  
Cumulative Fluid Balance

Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in cases of severe acute respiratory distress syndrome (ARDS) with profound hypoxemia. However, the need for high-volume fluid resuscitation and blood transfusions after ECMO initiation introduces a risk of fluid overload. Positive fluid balance is associated with mortality in critically ill patients, and conservative fluid management for ARDS patients has been shown to shorten both the duration of mechanical ventilation and time spent in intensive care, albeit without a significant effect on survival. Nonetheless, few studies have addressed the influence of fluid balance on clinical outcomes in severe ARDS patients undergoing ECMO. In the current retrospective study, we examined the impact of cumulative fluid balance (CFB) on hospital mortality in 152 cases of severe ARDS treated using ECMO. Overall hospital mortality was 53.3%, and we observed a stepwise positive correlation between CFB and the risk of death. Cox regression models revealed that CFB during the first 3 days of ECMO was independently associated with higher hospital mortality (adjusted hazard ratio 1.110 [95% CI 1.027–1.201]; p = 0.009). Our findings indicate the benefits of a conservative treatment approach to avoid fluid overload during the early phase of ECMO when dealing with severe ARDS patients.

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