Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage. New Insights on a Complex Relationship

Cardinal-Fernández, Pablo; Lorente, José A.; Ballén-Barragán, Aída; Matute-Bello, Gustavo

doi:10.1513/annalsats.201609-728ps

Cited by 145 publications

(146 citation statements)

References 33 publications

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“…Baseline characteristics are summarized in Table 1 (19)(20)(21)(22)(23)(24)(25)(26)(27); p<0.001] and positive end-expiratory pressure [12 (10-15) versus 9 (5-10); p<0.001] were greater in patients with versus without persistent severe ARDS.…”

Section: Resultsmentioning

confidence: 99%

Persistent severe acute respiratory distress syndrome for the prognostic enrichment of trials

et al. 2020

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Background Acute respiratory distress syndrome (ARDS) is heterogeneous. As an indication of the heterogeneity of ARDS, there are patients whose syndrome improves rapidly (i.e., within 24 hours), others whose hypoxemia improves gradually and still others whose severe hypoxemia persists for several days. The latter group of patients with persistent severe ARDS poses challenges to clinicians. We attempted to assess the baseline characteristics and outcomes of persistent severe ARDS and to identify which variables are useful to predict it. Methods A secondary analysis of patient-level data from the ALTA, EDEN and SAILS ARDSNet clinical trials was conducted. We defined persistent severe ARDS as a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO 2 :FiO 2) of equal to or less than 100 mmHg on the second study day following enrollment. Regularized logistic regression with an L1 penalty [Least Absolute Shrinkage and Selection Operator (LASSO)] techniques were used to identify predictive variables of persistent severe ARDS. Results Of the 1531 individuals with ARDS alive on the second study day after enrollment, 232 (15%) had persistent severe ARDS. Of the latter, 100 (43%) individuals had mild or moderate hypoxemia at baseline. Usage of vasopressors was greater [144/232 (62%) versus 623/ 1299 (48%); p<0.001] and baseline severity of illness was higher in patients with versus without persistent severe ARDS. Mortality at 60 days [95/232 (41%) versus 233/1299 (18%); p<0.001] was higher, and ventilator-free (p<0.001), intensive care unit-free [0 (0-14) versus 19 (7-23); p<0.001] and non-pulmonary organ failure-free [3 (0-21) versus 20 (1

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Section: Resultsmentioning

confidence: 99%

Persistent severe acute respiratory distress syndrome for the prognostic enrichment of trials

et al. 2020

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“…She stayed in the inflammatory phase of ARDS independent of ventilator‐induced injury. It is difficult to predict when this will happen in ARDS and inflammatory phase arrest is considered an important area of research in the pathogenesis of ARDS . Regardless, this patient was trialed on traditional low volume, high positive end‐expiratory pressure ventilation and conservative fluid therapy prior to being placed on ECMO.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation support following liver transplantation—A case series

Goussous

Akbar

LaMattina

et al. 2019

Clinical Transplantation

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| INTRODUC TI ONOnce a therapy for neonates with severe respiratory and cardiac impairment, extracorporeal membrane oxygenation (ECMO) is being utilized with greater frequency in the critically ill adult population. 1-4 ECMO has shown encouraging results as a rescue therapy that serves as a replacement for pulmonary and/or cardiovascular function while the heart and lungs recover from a catastrophic insult in the postoperative period. At our center, ECMO has been utilized with increasing frequency in the critically ill adult population. 5 Prior to transplantation, patients with liver failure often have multiple organ system impairment. Coagulopathy, portal hypertension, and an impaired immune system are chief among the maladies associated with acute and chronic liver disease. 6-8 In the perioperative period, the added stress of a rigorous surgery and subsequent liver engraftment may lead to further physiological derangements that predispose patients to cardiopulmonary failure. 9,10 These can lead to intrinsic lung conditions, such as ARDS or to cardiopulmonary failure from right heart impairment and pulmonary thrombosis. Prior to the utilization of adult ECMO, these conditions carried a high mortality rate. 11 The use of veno-venous (VV) ECMO has been Abstract Background: Postoperative severe cardiopulmonary failure carries a high rate of mortality. Extracorporeal membrane oxygenation (ECMO) can be used as a salvage therapy when conventional therapies fail. Methods: We retrospectively reviewed our experience with ECMO support in the early postoperative period after liver transplant between September 2011 and May 2016.Results: Out of 537 liver transplants performed at our institution, seven patients required ECMO support with a median age of 52 and a median MELD score of 28.Veno-venous ECMO was used in four patients with severe respiratory failure while the rest required veno-arterial ECMO for circulatory failure. The median time from transplant to cannulation was 3 days with a median duration of ECMO support of 7 days. All patients except one were successfully decannulated. The median hospital length of stay was 58 days with an in-hospital mortality of 28.6%. Conclusion:Extracorporeal membrane oxygenation can be considered a viable rescue therapy in the setting of severe postoperative cardiopulmonary failure.Extracorporeal membrane oxygenation therapy was successful in saving patients who were otherwise unsalvageable. K E Y W O R D Scardiopulmonary failure, ECMO, liver failure

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“…The presence of DAD in the histological examination may not always correlate with ARDS. For example, only one-half of patients that had DAD were clinically diagnosed with ARDS in several open lung biopsies or autopsy studies [71,122,[124][125][126]. Though histology is difficult to obtain due to the severity of illness, the histopathologic appearance of diffuse alveolar damage (DAD) is characterized by the formation of thickened alveolar membranes, hya-line membrane deposition, and infiltration with inflammatory cells (Fig.…”

Section: Clinical and Radiologic Patterns Of Pneumonitismentioning

confidence: 99%

Immune-Related Adverse Events: Pneumonitis

Zhong

Altan

Shannon

et al. 2020

Advances in Experimental Medicine and Biology

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Checkpoint inhibitors are part of the family of immunotherapies and are increasingly being used in a wide variety of cancers. Immunerelated adverse events pose a major challenge in the treatment of cancer patients. Pneumonitis is a rare immune-related adverse event that presents in distinct patterns. The goal of this chapter is to instruct readers on the incidence and clinical manifestations of pneumonitis and to offer guidance in the evaluation and treatment of patients with pneumonitis.

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Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage. New Insights on a Complex Relationship

Cited by 145 publications

References 33 publications

Persistent severe acute respiratory distress syndrome for the prognostic enrichment of trials

Persistent severe acute respiratory distress syndrome for the prognostic enrichment of trials

Extracorporeal membrane oxygenation support following liver transplantation—A case series

Immune-Related Adverse Events: Pneumonitis

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