scholarly journals Ventilator Parameters in the Diagnosis and Prognosis of Acute Respiratory Distress Syndrome in Postoperative Patients: A Preliminary Study

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 648
Author(s):  
Chew-Teng Kor ◽  
Kai-Huang Lin ◽  
Chen-Hsu Wang ◽  
Jui-Feng Lin ◽  
Cheng-Deng Kuo
Keyword(s):  
Esophageal Cancer ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mechanical Work ◽  
Volume Index ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Expiration Time

This study investigated the usefulness of ventilator parameters in the prediction of development and outcome of acute respiratory distress syndrome (ARDS) in postoperative patients with esophageal or lung cancer on admission to the surgical intensive care unit (SICU). A total of 32 post-operative patients with lung or esophageal cancer from SICU in a tertiary medical center were retrospectively analyzed. The study patients were divided into an ARDS group (n = 21) and a non-ARDS group (n = 11). The ARDS group contained the postoperative patients who developed ARDS after lung or esophageal cancer surgery. The ventilator variables were analyzed in this study. Principal component analysis (PCA) was performed to reduce the correlated ventilator variables to a small set of variables. The top three ventilator variables with large coefficients, as determined by PCA, were considered as sensitive variables and included in the analysis model based on the rule of 10 events per variable. Firth logistic regression with selective stepwise elimination procedure was performed to identify the most important predictors of morbidity and mortality in patients with ARDS. Ventilator parameters, including rapid shallow breath index during mechanical ventilation (RSBIv), rate pressure product of ventilation (RPPv), rate pressure volume index (RPVI), mechanical work (MW), and inspiration to expiration time ratio (IER), were analyzed in this study. It was found that the ARDS patients had significantly greater respiratory rate (RR), airway resistance (Raw), RSBIv, RPPv, RPVI, positive end-expiratory pressure (PEEP), and IER and significantly lower respiratory interval (RI), expiration time (Te), flow rate (V˙), tidal volume (VT), dynamic compliance (Cdyn), mechanical work of ventilation (MW), and MW/IER ratio than the non-ARDS patients. The non-survivors of ARDS had significantly greater peak inspiratory pressure above PEEP (PIP), RSBIv, RPPv, and RPVI than the survivors of ARDS. By using PCA, the MW/IER was found to be the most important predictor of the development of ARDS, and both RPPv and RPVI were significant predictors of mortality in patients with ARDS. In conclusion, some ventilator parameters, such as RPPv, RPVI, and MW/IER defined in this study, can be derived from ventilator readings and used to predict the development and outcome of ARDS in mechanically ventilated patients on admission to the SICU.

scholarly journals The use of Ventilator Parameters in the Prediction of Development and Outcome of Acute Respiratory Distress Syndrome in Postoperative Patients

2021 ◽  
Author(s):  
Chew-Ten Kor ◽  
Kai-Huang Lin ◽  
Chen-Hsu Wang ◽  
Jui-Feng Lin ◽  
Cheng-Deng Kuo
Keyword(s):  
Esophageal Cancer ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Volume Index ◽  
Rate Pressure Product ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Abstract Background: To investigate the usefulness of ventilator parameters in the prediction of development and outcome of acute respiratory distress syndrome (ARDS) in postoperative patients with esophageal or lung cancer on admission to the surgical intensive care unit (SICU). Methods: A total of 32 post-operative patients with lung or esophageal cancer from SICU in a tertiary medical center were retrospectively analyzed. The study patients was divided into ARDS group (n = 21) and non-ARDS group (n = 11). ARDS group were the post-operative patients who developed ARDS after lung or esophageal cancer surgery. The ventilator variables were analyzed in this study. Principal component analysis (PCA) was performed to reduce the correlated ventilator variables to a small set of variables. By using the PCA selection method, top three ventilator variables with large coefficients can be considered as sensitive variables and were included in the analysis model based on the rule of 10 events per variable. Firth logistic regression with selective stepwise elimination procedure was performed to identify the most important predictors of morbidity and mortality in patients with ARDS. The ventilator parameters including rapid shallow breath index during mechanical ventilation (RSBIv), rate pressure product of ventilation (RPPv), rate pressure volume index (RPVI), mechanical work (MW), and inspiration to expiration time ratio (IER) were analyzed in this studyResults: The newly defined parameter MW/IER was the most important predictors for the development of ARDS, and both RPPv and RPVI were the significant predictors of mortality in patients with ARDS.Conclusion: Some ventilator parameters can be derived from ventilator readings and be used to predict the development and outcome of ARDS in mechanically ventilated patients on admission to the SICU, such as RPPv, RPVI and MW/IER defined in this study.

scholarly journals Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome

2006 ◽  
Vol 124 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Heloisa Baccaro Rossetti ◽  
Flávia Ribeiro Machado ◽  
Jorge Luiz Valiatti ◽  
José Luiz Gomes do Amaral
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Prone Position ◽  
Distress Syndrome ◽  
Peep Level ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Controlled Clinical Trial ◽  
Surgical Intensive Care

CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.

scholarly journals Esophageal Balloon-Directed Ventilator Management for Postpneumonectomy Acute Respiratory Distress Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Eric Sy ◽  
Jagadish Rao ◽  
Sherma Zacharias ◽  
Juan J. Ronco ◽  
James S. Lee
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surgical Intensive Care Unit ◽  
Pressure Monitoring ◽  
Surgical Intensive Care ◽  
Esophageal Balloon ◽  
Ventilator Management

Objective. Postpneumonectomy patients may develop acute respiratory distress syndrome (ARDS). There is a paucity of data regarding the optimal management of mechanical ventilation for postpneumonectomy patients. Esophageal balloon pressure monitoring has been used in traditional ARDS patients to set positive end-expiratory pressure (PEEP) and minimize transpulmonary driving pressure ( Δ P L ), but its clinical use has not been previously described nor validated in postpneumonectomy patients. The primary objective of this report was to describe the potential clinical application of esophageal pressure monitoring to manage the postpneumonectomy patient with ARDS. Design. Case report. Setting. Surgical intensive care unit (ICU) of a university-affiliated teaching hospital. Patient. A 28-year-old patient was involved in a motor vehicle collision, with a right main bronchus injury, that required a right-sided pneumonectomy to stabilize his condition. In the perioperative phase, they subsequently developed ventilator-associated pneumonia, significant cumulative positive fluid balance, and ARDS. Interventions. Prone positioning and neuromuscular blockade were initiated. An esophageal balloon was inserted to direct ventilator management. Measurements and Main Results. V T was kept around 3.6 mL/kg PBW, Δ P L at ≤14 cm H2O, and plateau pressure at ≤30 cm H2O. Lung compliance was measured to be 37 mL/cm H2O. PEEP was optimized to maintain end-inspiratory transpulmonary pressure   P L < 15  cm H2O, and end-expiratory P L between 0 and 5 cm H2O. The maximal Δ P L was measured to be 11 cm H2O during the care of this patient. The patient improved with esophageal balloon-directed ventilator management and was eventually liberated from mechanical ventilation. Conclusions. The optimal targets for V T remain unknown in the postpneumonectomy patient. However, postpneumonectomy patients with ARDS may potentially benefit from very low V T and optimization of PEEP. We demonstrate the application of esophageal balloon pressure monitoring that clinicians could potentially use to limit injurious ventilation and improve outcomes in postpneumonectomy patients with ARDS. However, esophageal balloon pressure monitoring has not been extensively validated in this patient population.

scholarly journals Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Zachary M. Bauman ◽  
Marika Y. Gassner ◽  
Megan A. Coughlin ◽  
Meredith Mahan ◽  
Jill Watras
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Prediction Score ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Injury Prediction ◽  
Ventilated Patients

Background. Lung injury prediction score (LIPS) is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS). This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients.Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC) curve demonstrated the optimal LIPS value to statistically predict development of ARDS.Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was8.8±2.8versus5.4±2.8for those who did not (p<0.001). An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p<0.001) and odds of ICU mortality increase by 1.22 (p<0.001).Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

scholarly journals Goal-directed dehydration therapy in sepsis and acute respiratory distress syndrome guided by volumetric hemodynamic monitoring

2020 ◽  
Vol 16 (6) ◽  
pp. 6-15 ◽  
Author(s):  
N. O. Khromacheva ◽  
E. V. Fot ◽  
V. V. Kuzkov ◽  
M. Yu. Kirov
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Randomized Study ◽  
Kidney Injury ◽  
Blood Gases ◽  
Volume Index ◽  
Lung Water ◽  
Dehydration Therapy

The aim of our study was to improve results of treatment of critically ill patients with sepsis and acute respiratory distress syndrome (ARDS) using the goal-directed dehydration therapy (DT).Sixty adult patients with sepsis and ARDS receiving mechanical ventilation for at least 24 hours were enrolled into a prospective randomized study. The patients were randomized into groups of dehydration guided either by extravascular (group of extravascular lung water index ‒ EVLWI, n = 30) or intravascular (group of global end-diastolic volume index ‒ GEDVI, n = 30) compartment. Dehydration was performed over 48 hours by administering diuretics or controlled extracorporeal ultrafiltration. We measured ventilation parameters, blood gases, and parameters of volumetric monitoring. The baseline characteristics of the patients did not differ between the groups. By 48 hours, the target fluid balance was achieved in both groups. In the EVLWI group at 48 hours, we found reduction of EVLWI by 15.4% (p < 0.001) and increase in PaO2/FiO2 by 23.3% as compared with baseline (p < 0.001). In parallel, we observed decrease in creatinine and urea (p < 0.05). In the GEDVI group, PaO2/FiO2 rose by 12.5% (p = 0.021), whereas EVLWI remained unchanged (p = 0.4). Maximal decrease in EVLWI and improvement of PaO2/FiO2 were achieved in direct ARDS.Thus, in patients with sepsis and ARDS the de-escalation goal-directed therapy resulted in the improvement of arterial oxygenation and organ function. The efficacy of dehydration was increased in direct ARDS. The extravascular compartment dehydration algorithm attenuated pulmonary edema and acute kidney injury more efficiently. Therefore, sepsis-induced ARDS may require personalized therapeutic approach.

scholarly journals Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Naumovski Filip ◽  
Toleska Marija ◽  
Kuzmanovska Biljana ◽  
Kartalov Andrijan ◽  
Trposka Angela
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Surgical Intensive Care Unit ◽  
Non Invasive ◽  
Arterial Blood ◽  
B Lines

Diagnosis and following up the dynamics of Pediatric Acute Respiratory Distress Syndrome demand a more feasible, non-invasive and bedside tool, such as lung ultrasound, for monitoring the damaged lungs. We report on a 6-month-old child admitted in our Pediatric Surgical Intensive Care Unit with a clinical presentation of ileus and concomitant community acquired pneumonia. Lung ultrasound (LUS) examinations according to the BLUE Protocol were done several times during the hospital stay. A-lines were seen at admission in the upper segments, but 2–3 B-lines were present in the posterolateral segments bilaterally. Later on, separated and coalescent B-lines were seen. White lung parenchyma or milky lungs with a thickened pleural line were seen, while the worst gas exchange according to the results of Arterial Blood Gases (ABGs) has been detected. According to the findings, as many B-lines will be detected, as the severeness of lung damage and gas exchange impairement. The improvement of the gas exchange with the disappearance of the coalescent B-lines was seen later on, after ventilating the child in a prone position. Bedsides, LUS is a feasible and non-invasive point of care method that could be used for diagnosing Pediatric Acute Respiratory Distress Syndrome (PARDS) but in guiding therapy of the damaged lungs, also. The finding of diffuse, coalescent and homogenous B-lines interpreted as “Milky lungs” is consistent with the diagnosis of PARDS.

scholarly journals Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Lijun Lin ◽  
Siqing Ma ◽  
Yongli Yao ◽  
Junming Luo ◽  
Qingjun Shi ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Altitude ◽  
Extravascular Lung Water ◽  
Distress Syndrome ◽  
Volume Index ◽  
Lung Water ◽  
Capacity Limitation ◽  
Recruitment Maneuvers

To understand the improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome, 30 HARDS patients were enrolled in the study from May 2012 to October 2013 from Qinghai Provincial People’s Hospital. All the patients received recruitment maneuvers and Pulse Contour Cardiac Output, hemodynamics monitoring including intrathoracic Blood Volume Index; Global End-diastolic Volume Index; Global ejection fraction; Pulmonary Vascular Permeability Index; Extravascular Lung Water Index; Pulse indicates cardiac Index; Stroke Volume Variation; Pulse pressure variation; Maximum pressure to increase speed; Systemic Venous Resistance Index, oxygenation and hemodynamics were determined before and after 72 hours of recruitment maneuvers. The results showed that after treatment with recruitment maneuvers and capacity limitation, PaO2/FiO2 was increased significantly compared with those before treatment [PaO2/FiO2 (mmHg): 124.70±43.37 vs 186.87±41.20, t=9.43, P<0.001], ITBVI, GEDVI, PVPI, EVLWI, SVV were reduced significantly compared with those before treatment[ITBVI (ml/m2): 1031.00±275.88 vs 907.13±242.56, t=1.26, P=0.041; GEDVI (ml/m2): 822.40±143.30 vs 722.83±169.65, t=1.75, P=0.016; PVPI (ml/kg): 2.71±1.21 vs 1.98±0.65, t=2.86, P=0.001; EVLWI (ml/kg): 12.30±4.19 vs 8.12±2.94, t=8.27, P<0.001; SVV (%):17.30±5.65 vs 10.33±3.47, t=9.17, P<0.001]. Our results indicated that recruitment maneuvers and capacity limitation have been improved oxygenation in HARDS, extravascular lung water reduced, and lung capillary permeability also improved.

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