Body Temperature and Mortality in Patients with Acute Respiratory Distress Syndrome

Schell-Chaple, Hildy; Puntillo, Kathleen; Matthay, Michael A.; Liu, Kathleen D.

doi:10.4037/ajcc2015320

Cited by 42 publications

(30 citation statements)

References 35 publications

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“…Thus, lowering the VO 2 [56,57] should be considered throughout early severe ARDS from acute cardio-ventilatory distress well into stabilization and weaning. This recommendation contrasts with the observation that a high fever in ARDS patients is associated with higher survival [60]. Possibly, patients with elevated temperatures [60] present with a high sympathetic activity and withstand major sickness].…”

Section: Pressure Support [Ps])]contrasting

confidence: 44%

See 1 more Smart Citation

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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Section: Pressure Support [Ps])]contrasting

confidence: 44%

“…This recommendation contrasts with the observation that a high fever in ARDS patients is associated with higher survival [60]. Possibly, patients with elevated temperatures [60] present with a high sympathetic activity and withstand major sickness].…”

Section: Pressure Support [Ps])]contrasting

confidence: 44%

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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“…administration of LPS induces severe lung injury, with characteristic symptoms of ALI, including excessive leukocyte accumulation, pulmonary edema, and intrapulmonary hemorrhage. ALI induced a persistent reduction of body weight and body temperature, which is known to be related to ARDS clinical outcomes . Melatonin significantly ameliorated the above symptoms, and pulmonary‐targeted melatonin provided the maximal protective effects against ALI.…”

Section: Discussionmentioning

confidence: 98%

Melatonin alleviates acute lung injury through inhibiting the NLRP3 inflammasome

Zhang

Grailer

et al. 2016

Journal of Pineal Research

261

174

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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are clinically severe respiratory disorders, and there are currently no Food and Drug Administration-approved drug therapies. Melatonin is a well-known anti-inflammatory molecule, which has proven to be effective in ALI induced by many conditions. Emerging studies suggest that the NLRP3 inflammasome plays a critical role during ALI. How melatonin directly blocks activation of the NLRP3 inflammasome in ALI remains unclear. In this study, using an LPS-induced ALI mouse model, we found intratracheal (i.t.) administration of melatonin markedly reduced the pulmonary injury and decreased the infiltration of macrophages and neutrophils into lung. During ALI, the NLRP3 inflammasome is significantly activated with a large amount of IL-1β and the activated caspase-1 occurring in the lung. Melatonin inhibits the activation of the NLRP3 inflammasome by both suppressing the release of extracellular histones and directly blocking histone-induced NLRP3 inflammasome activation. Notably, i.t. route of melatonin administration opens a more efficient therapeutic approach for treating ALI.

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“…However, another study on patients with acute respiratory distress syndrome reported contradictory results that fever in early phase may be an important factor in determining favorable outcome (21). Thus, the aim of our present study was to evaluate the association of body temperature with MV duration in a heterogenous cohort of mechanically ventilated patients.…”

Section: Introductionmentioning

confidence: 99%

The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

et al. 2016

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This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAXMV). To assess the independent association of MAXMV with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAXMV on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAXMV ≥ 37.5°C was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAXMV of 36.5°C to 37.4°C. In multivariate linear regression analysis, patients with three categories of fever (MAXMV of 37.5°C to 38.4°C, 38.5°C to 39.4°C, and ≥ 39.5°C) sustained a significantly longer duration of TVT than those with normal range of MAXMV in both categories of ICU admission. A significant association between MAXMV and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome.

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Body Temperature and Mortality in Patients with Acute Respiratory Distress Syndrome

Cited by 42 publications

References 35 publications

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Melatonin alleviates acute lung injury through inhibiting the NLRP3 inflammasome

The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

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