scholarly journals Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 9 (2) ◽  
pp. 527 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Muyeol Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neurological Outcome ◽  
Distress Syndrome ◽  
Plateau Pressure ◽  
Lung Compliance ◽  
Neurologic Outcome ◽  
Hospital Cardiac Arrest

(1) Background: Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aim to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA). (2) Methods: This observational study is conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ≥18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition are included. Mechanical ventilator parameters such as plateau pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance are recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome is a favorable neurological outcome defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. (3) Results: Regarding 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with a favorable outcome have a significantly higher lung compliance (38.6 mL/cm H2O versus 27.5 mL/cm H2O), lower inspiratory pressure (12.0 cm H2O versus 16.0 cm H2O), and lower plateau pressure (17.0 cm H2O versus 21.0 cm H2O) than those with a poor neurologic outcome (all p < 0.01). Concerning time-dependent cox regression models, all maximum (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02–1.09), minimum (HR 1.08, 95% CI 1.03–1.13), and median (HR 1.06, 95% CI 1.02–1.09) compliances are independently associated with a good neurologic outcome. Maximum compliance, >32.5 mL/cm H2O at day 1, has the highest area under the receiver operating characteristic curve (0.745) with a positive predictive value of 90.4%. (4) Conclusions: Lung compliance may be an early predictor of intact neurologic survival in patients with ARDS following cardiac arrest.

scholarly journals Impact of lung compliance on neurological outcome in patients with acute respiratory distress syndrome following out-of-hospital cardiac arrest

2020 ◽  
Author(s):  
June-Sung Kim ◽  
Youn-Jung Kim ◽  
Muyeol Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Neurological Outcome ◽  
Distress Syndrome ◽  
Peak Inspiratory Pressure ◽  
Lung Compliance ◽  
Inspiratory Pressure ◽  
Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aimed to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA).Methods This observational study was conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ≥18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition were included. Mechanical ventilator parameters such as peak inspiratory pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance were recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome was favorable neurological outcome defined as Cerebral Performance Category score 1 or 2 at hospital discharge.Results Of 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with favorable outcome had significantly higher lung compliance (38.6 cm H 2 O vs 27.5 cm H 2 O), lower inspiratory pressure (12.0 cm H 2 O vs 16.0 cm H 2 O), and lower peak inspiratory pressure (17.0 cm H 2 O vs 21.0 cm H 2 O) than those with poor neurologic outcome (all P <0.01). In time-dependent cox regression models, all maximum (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.08), minimum (HR 1.08, 95% CI 1.04 – 1.12), and median (HR 1.06, 95% CI 1.03-1.10) compliances were independently associated with good neurologic outcome. Median compliance > 31.4 mL/cm H 2 O at day 1 had the highest area under the receiver operating characteristic curve (0.732) with positive predictive value of 90%.Conclusion Lung compliance may be an early predictor of neurologic intact survival in patients with ARDS following cardiac arrest.

The acute respiratory distress syndrome after out-of-hospital cardiac arrest: Incidence, risk factors, and outcomes

Resuscitation ◽  
2019 ◽  
Vol 135 ◽  
pp. 37-44 ◽  
Author(s):  
Nicholas J. Johnson ◽  
Ellen Caldwell ◽  
David J. Carlbom ◽  
David F. Gaieski ◽  
Matthew E. Prekker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Incidence Risk ◽  
Hospital Cardiac Arrest

Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. e242870
Author(s):  
Meenupriya Arasu ◽  
Nagalakshmi Swaminathan ◽  
Anusha Cherian ◽  
Magesh Parthiban
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Pregnant Patient ◽  
Lung Compliance ◽  
Pcr Assay ◽  
Oxygenation Indices

A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk–benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.

Biological Impact of Transpulmonary Driving Pressure in Experimental Acute Respiratory Distress Syndrome

2015 ◽  
Vol 123 (2) ◽  
pp. 423-433 ◽  
Author(s):  
Cynthia S. Samary ◽  
Raquel S. Santos ◽  
Cíntia L. Santos ◽  
Nathane S. Felix ◽  
Maira Bentes ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Peep Level ◽  
Transpulmonary Pressure ◽  
Plateau Pressure ◽  
Driving Pressure ◽  
Ventilator Induced Lung Injury

Abstract Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (VT), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, ΔP,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomized into combinations of VT and PEEP, yielding three different ΔP,L levels: ΔP,LLOW (VT = 6 ml/kg, PEEP = 3 cm H2O); ΔP,LMEAN (VT = 13 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 9.5 cm H2O); and ΔP,LHIGH (VT = 22 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 11 cm H2O). In other groups, at low VT, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH at high VT. Results: At ΔP,LLOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At ΔP,LHIGH (VT = 6 ml/kg and PEEP = 11 cm H2O), lungs were fully open and IL-6 and RAGE were reduced compared with ΔP,LMEAN (27.4 ± 12.9 vs. 41.6 ± 14.1 and 0.6 ± 0.2 vs. 1.4 ± 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At ΔP,LMEAN (VT = 6 ml/kg and PEEP = 9.5 cm H2O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with ΔP,LLOW (41.6 ± 14.1 vs. 9.0 ± 9.8, 1.4 ± 0.3 vs. 0.6 ± 0.2, and 6.7 ± 0.8 vs. 2.2 ± 1.0, respectively). At Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH, higher VT and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilator-induced lung injury: (1) low VT and PEEP, yielding low ΔP,L and Pplat,rs; and (2) low VT associated with a PEEP level sufficient to keep the lungs open.

Abstract 9123: Plasma Biomarkers Associated With PICU Mortality in Children With Cardiac Arrest and Acute Respiratory Distress Syndrome

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Monique M Gardner ◽  
Matthew Kirschen ◽  
Jill Thompson ◽  
Adam Himebauch ◽  
Nadir Yehya ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Acute Respiratory Distress Syndrome ◽  
Critical Illness ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Granzyme B ◽  
Nonparametric Tests ◽  
Plasma Biomarkers ◽  
Inflammatory Profile

Introduction: The post-cardiac arrest state is comprised of an ischemic and reperfusion syndrome, with inflammation similar to sepsis and acute respiratory distress syndrome (ARDS). However, it is unknown whether cardiac arrest has a distinct inflammatory profile relative to these other critical illness syndromes. Using plasma biomarkers of systemic inflammation measured in children with ARDS, we aimed to evaluate identify unique biomarkers in a sub-cohort with cardiac arrest, and the association of these biomarkers with mortality. Methods: This was a retrospective single-center cohort study of 17 biomarkers prospectively collected from pediatric subjects with ARDS between 2014-2019. Biomarkers were drawn within 24 hours after both ARDS diagnosis and cardiac arrest. Clinical characteristics and biomarkers were compared between those with ARDS and those with ARDS and cardiac arrest (ARDS+CA) using nonparametric tests. In ARDS+CA subjects, associations of biomarkers with mortality were tested with univariate and bivariate logistic regression. Results: Biomarkers were measured in 333 subjects: 301 with ARDS (median age 5.3 years, 55.5% male) and 32 ARDS+CA (median age 8 years, 53.1% male). Majority of arrests (68.7%) were out-of-hospital with median 11 minutes of CPR. ARDS+CA subjects were more likely to be immunosuppressed and present after aspiration or drowning than the ARDS cohort. ARDS severity, PRISM III score, vasoactive-ionotropic score and extra-pulmonary organ failure were worse in the ARDS+CA group (p<0.05). Eight biomarkers were elevated in ARDS+CA compared to the ARDS cohort: sRAGE, nucleosomes, SP-D, CCL22, IL-6, HSP70, IL-8, and MIP-1b (p<0.05). In the ARDS+CA cohort, 3 biomarkers were associated with mortality when controlling for markers of disease and cardiac arrest severity: sRAGE (unadjusted odds ratio 3.48 [IQR 1.35, 8.99], p=0.010), IL-6 (OR 1.75 [1.13, 2.71], p=0.012) and granzyme B (OR 3.74 [1.46, 9.57], p=0.006). Conclusion: sRAGE, IL-6 and granzyme B were independently associated with mortality after pediatric cardiac arrest in ARDS. This exploratory work suggests that cardiac arrest may induce a distinct inflammatory state that differs from other critical illness syndromes and further investigation is needed.

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