Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Background: Sedatives are commonly used in patients with or at risk for acute respiratory distress syndrome (ARDS) during mechanical ventilation. To systematically compare the outcomes of sedation with midazolam, propofol, and dexmedetomidine in patients with or at risk for ARDS.Methods: We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of sedatives and the associated outcomes from the MIMIC-III database and the eICU Collaborative Research database. We performed a systematic study with six cohorts to estimate the relative risks of outcomes among patients administered different sedatives. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, length of hospitalization, and likelihood of being discharged home.Results: We performed 60 calibrated analyses among all groups and outcomes with 17,410 eligible patients. Sedation with dexmedetomidine was associated with a lower in-hospital mortality rate than sedation with midazolam and propofol or sedation without dexmedetomidine (p < 0.001). When compared with no sedation, the use of midazolam, propofol or dexmedetomidine was associated with a longer ICU stay and longer hospitalization duration (p < 0.01). Patients treated with midazolam were relatively less likely to be discharged home (p < 0.05).Conclusion: Patients treated with dexmedetomidine had a reduced risk of mortality. These data suggest that dexmedetomidine may be the preferred sedative in patients with or at risk for ARDS.

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Comparative Efficacy of Fentanyl and Morphine in Patients with or At Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Drugs in R&D ◽

10.1007/s40268-021-00338-3 ◽

2021 ◽

Author(s):

An-Min Hu ◽

Zhi-Ming Shan ◽

Zhong-Jun Zhang ◽

Hui-Ping Li

Keyword(s):

At Risk ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Propensity Score ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Matched Cohort ◽

Comparative Efficacy ◽

Matched Cohort Study

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Effects of Cytokine Blocking Agents on 30-Day Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

10.21203/rs.3.rs-37561/v1 ◽

2020 ◽

Author(s):

Irene Coloretti ◽

Stefano Busani ◽

Emanuela Biagioni ◽

Sophie Venturelli ◽

Elena Munari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cox Model ◽

Invasive Mechanical Ventilation ◽

Blocking Agents

Abstract Background The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID19. Tocilizumab and Anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods The association between therapy with Tocilizumab or Anakinra and in-hospital mortality was assessed in consecutive adult COVID19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who receive to those who did not receive Tocilizumab or Anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with Tocilizumab or Anakinra and after patient matching. Results Sixty-six patients who received immunotherapy (49 Tocilizumab, 17 Anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0,77, 95% CI 0,56-1,05, p=0,069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0,35, 95% CI 0,16-0,77, p=0,009). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need of mechanical ventilation.

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Effects of Cytokine Blocking Agents on Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome by SARS-CoV2 Infection: An Observational Cohort Study

10.21203/rs.3.rs-37561/v2 ◽

2020 ◽

Author(s):

Irene Coloretti ◽

Stefano Busani ◽

Emanuela Biagioni ◽

Sophie Venturelli ◽

Elena Munari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cox Model ◽

Invasive Mechanical Ventilation ◽

Blocking Agents

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Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Membranes ◽

10.3390/membranes11060393 ◽

2021 ◽

Vol 11 (6) ◽

pp. 393

Author(s):

Li-Chung Chiu ◽

Li-Pang Chuang ◽

Shaw-Woei Leu ◽

Yu-Jr Lin ◽

Chee-Jen Chang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Mortality Rate ◽

Propensity Score ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Propensity Score Matching ◽

Distress Syndrome ◽

Membrane Oxygenation

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

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Epidemiology and Outcomes of Acute Respiratory Distress Syndrome Following Isolated Severe Traumatic Brain Injury

Journal of Intensive Care Medicine ◽

10.1177/0885066620972001 ◽

2020 ◽

pp. 088506662097200

Author(s):

Jordan M. Komisarow ◽

Fangyu Chen ◽

Monica S. Vavilala ◽

Daniel Laskowitz ◽

Michael L. James ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Brain Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Severe Tbi

Patients with traumatic brain injury (TBI) are at risk for extra-cranial complications, such as the acute respiratory distress syndrome (ARDS). We conducted an analysis of risk factors, mortality, and healthcare utilization associated with ARDS following isolated severe TBI. The National Trauma Data Bank (NTDB) dataset files from 2007-2014 were used to identify adult patients who suffered isolated [other body region-specific Abbreviated Injury Scale (AIS) < 3] severe TBI [admission total Glasgow Coma Scale (GCS) from 3 to 8 and head region-specific AIS >3]. In-hospital mortality was compared between patients who developed ARDS and those who did not. Utilization of healthcare resources (ICU length of stay, hospital length of stay, duration of mechanical ventilation, and frequency of tracheostomy and gastrostomy tube placement) was also examined. This retrospective cohort study included 38,213 patients with an overall ARDS occurrence of 7.5%. Younger age, admission tachycardia, pre-existing vascular and respiratory diseases, and pneumonia were associated with the development of ARDS. Compared to patients without ARDS, patients that developed ARDS experienced increased in-hospital mortality (OR 1.13, 95% CI 1.01-1.26), length of stay (p = <0.001), duration of mechanical ventilation (p = < 0.001), and placement of tracheostomy (OR 2.70, 95% CI 2.34-3.13) and gastrostomy (OR 2.42, 95% CI 2.06-2.84). After isolated severe TBI, ARDS is associated with increased mortality and healthcare utilization. Future studies should focus on both prevention and management strategies specific to TBI-associated ARDS.

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Adverse In-Hospital Events Are Associated With Increased In-Hospital Mortality and Length of Stay in Patients With or at Risk of Acute Respiratory Distress Syndrome

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2014.12.015 ◽

2015 ◽

Vol 90 (3) ◽

pp. 321-328 ◽

Cited By ~ 10

Author(s):

Adil H. Ahmed ◽

Charat Thongprayoon ◽

Louis A. Schenck ◽

Michael Malinchoc ◽

Andrea Konvalinová ◽

...

Keyword(s):

At Risk ◽

Acute Respiratory Distress Syndrome ◽

Length Of Stay ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome

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Early high dose corticosteroid therapy in hematopoietic stem cell transplantation patients with acute respiratory distress syndrome: a propensity score matched study

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211009397 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110093

Author(s):

Yan Hu ◽

Jiawei Shen ◽

Youzhong An ◽

Shuang Liu

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Propensity Score ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Original Study ◽

High Dose ◽

Study Cohort ◽

Matched Cohort ◽

New Onset

Background: Acute respiratory distress syndrome (ARDS) is one of the pulmonary complications after hematopoietic cell transplantation (HSCT) with a poor prognosis. The effects of corticosteroid therapy in HSCT patients with ARDS have never been described. In this study, we aim to evaluate the effect of corticosteroid on hospital mortality and other outcomes in patients with HSCT and ARDS. Methods: In this bicenter retrospective study, data were collected from patients diagnosed with ARDS and HSCT. Patients were divided into an early high dose steroids group (receiving a cumulative dose ⩾480 mg of methylprednisolone or its equivalent within the first 3 days after ARDS onset) and a no early high dose steroids group. Univariate and multivariate analyses were used to determine the risk factors of hospital mortality. Cox regression was performed to assess the effect of early high dose steroids on patient survival. A propensity score matched cohort was built to validate the results from the original study cohort. Results: Two hundred and sixty-four patients were included in the original study cohort; 89 (33.71%) patients received early high dose steroids; these patients had higher ventilator free days at day 28 (7.68 ± 4.32 versus 6.48 ± 4.76, p = 0.046); there was no difference in hospital mortality (64.04% versus 53.14%, p = 0.091). Patients with early high dose steroids had a higher incidence of new onset bacteremia (17.98% versus 4%, p < 0.001) and viremia (13.48% versus 3.43%, p = 0.002). The results were further confirmed in the propensity score matched cohort, except for the improvement of ventilator free days (6.02 ± 5.51 versus 5.57 ± 5.54, p = 0.643). Conclusion: In this cohort of HSCT patients with ARDS, early high dose coticosteroids had no effect on hospital mortality. In addition, the incidences of new onset bacteremia and viremia were increased after early high dose steroids. The reviews of this paper are available via the supplemental material section.

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Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2021.737 ◽

2021 ◽

Vol 16 ◽

Author(s):

Irene Coloretti ◽

Stefano Busani ◽

Emanuela Biagioni ◽

Sophie Venturelli ◽

Elena Munari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Blocking Agents

Background: The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.Methods: The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.Results: Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.Conclusions: Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation. *Modena Covid-19 Working Group (MoCo19): Intensive Care Unit: Massimo Girardis, Alberto Andreotti, Emanuela Biagioni, Filippo Bondi, Stefano Busani, Giovanni Chierego, Marzia Scotti, Lucia Serio, Annamaria Ghirardini, Marco Sita, Stefano De Julis, Lara Donno, Lorenzo Dall’Ara, Fabrizio Di Salvo, Carlotta Farinelli, Laura Rinaldi, Ilaria Cavazzuti, Andrea Ghidoni, Antonio Buono, Elena Ferrari, Daniela Iseppi, Anna Maria Ardito, Irene Coloretti, Sophie Venturelli, Elena Munari, Martina Tosi, Erika Roat, Ilenia Gatto, Marco Sarti.Immuno-Lab: Andrea Cossarizza, Caterina Bellinazzi, Rebecca Borella, Sara De Biasi, Anna De Gaetano, Lucia Fidanza, Lara Gibellini, Anna Iannone, Domenico Lo Tartaro, Marco Mattioli, Milena Nasi, Annamaria Paolini, Marcello Pinti. Infectious Disease Unit: Cristina Mussini, Giovanni Guaraldi, Marianna Meschiari, Alessandro Cozzi-Lepri, Jovana Milic, Marianna Menozzi, Erica Franceschini, Gianluca Cuomo, Gabriella Orlando, Vanni Borghi, Antonella Santoro, Margherita Di Gaetano, Cinzia Puzzolante, Federica Carli, Andrea Bedini, Luca Corradi. Respiratory Diseases Unit: Enrico Clini, Roberto Tonelli, Riccardo Fantini, Ivana Castaniere, Luca Tabbì, Giulia Bruzzi, Chiara Nani, Fabiana Trentacosti, Pierluigi Donatelli, Maria Rosaria Pellegrino, Linda Manicardi, Antonio Moretti, Morgana Vermi, Caterina Cerbone.Virology and Molecular Microbiology Unit: Monica Pecorari, William Gennari, Antonella Grottola, Giulia Fregni Serpini.

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Prone Position Ventilation for Pediatric Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation: A Propensity Score-Matched Retrospective Multicenter Cohort Study

10.21203/rs.3.rs-129358/v1 ◽

2020 ◽

Author(s):

Zhe Zhao ◽

Guoping Lu ◽

Shuanglei Li ◽

Baowang Yang ◽

Huiling Zhang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Propensity Score ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prone Position ◽

Distress Syndrome ◽

Membrane Oxygenation ◽

Oxygen State

Abstract Background: Extracorporeal membrane oxygen (ECMO) has used for rescuing severe pediatric acute respiratory distress syndrome (PARDS) for half a century. Prone position ventilation (PPV) has been suggested according to the surviving sepsis campaign (SSC) guideline in children in 2020. We aimed to compare the outcomes and effect of PARDS patients with ECMO+PPV and ECMO only.Design: Retrospective Multicenter pair-matched StudySetting: In the present study, propensity score matching was conducted and the outcomes of severe PARDS patients were analyzed. The effect of PPV was compared as well. The efficiency of PPV included PaO2, Oxygen Index (OI), PaO2/FiO2, compliance of respiratory system and resistance of airway. The primary outcome was hospital mortality. Secondary outcomes included ECMO running time, PICU time, hospital days and mechanical ventilation time of survivors. Patients: 137 PARDS patients with criteria of ECMO from 11 hospitals in 5 years.Interventions: No interventions.Measurements and Main Results: Among 137 patients, 93 patients received ECMO+PPV at the same time and 44 patients didn’t. After matching, we got 34 pairs. For the survivors receiving ECMO+PPV, the PaO2, OI and PaO2/FiO2 increased significantly during the PPV period (P<0.01) and sustained for 4 hours at least. However, the hospital mortality of both groups showed no significant difference (50.0 vs. 55.9%, P=0.808). Conclusions: By far, there has been no ECMO+PPV efficiency study in PARDS patients. This study found that PPV was associated with improved oxygen state during ECMO. However, PPV was not associated with survival rate with PARDS patients on ECMO. Clinical Trial Registration: This study was registered at http://www.chictr.org.cn/index.aspx (chiCTR.gov; Identifier: ChiCTR1800019555). Registered 18 November 2018. Name of the registry: Extracorporeal membrane oxygenation in critical ill children with severe acute respiratory distress syndrome - A multicenter study.Take Home Message:1. Our study investigated prone position ventilation (PPV) could improve the oxygen state during ECMO for patients with severe PARDS.2. The results indicated PPV had no influence on the mortality of PARDS with ECMO.

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