Clinical Characteristics and Outcomes of COVID-19 Acute Respiratory Distress Syndrome Patients Requiring Invasive Mechanical Ventilation in a Lower Middle-Income Country

Ejaz, Taymmia; Rehman, Fazal Ur; Ahmed, Arslan; Akhlaq, Safia; Saadia, Sheema; Aziz, Adil; Hussain, Erfan

doi:10.2478/jccm-2021-0044

Cited by 5 publications

(5 citation statements)

References 46 publications

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“…Ejaz et al [11] reported a high mortality rate in COVID-19 related acute respiratory distress syndrome (ARDS). The severity and the likelihood of developing ARDS and related adverse outcomes are linked with different factors including age more than 60 years, male sex, obesity, hypertension, diabetes mellitus, previous lung disease, and specific parameters such as low lymphocyte count and high D-dimer levels [12][13][14][15].…”

Section: Resultsmentioning

confidence: 99%

Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

IBRAGIMOV¹,

ALIMOVA²,

BURKHONOV³

et al. 2022

jlsb

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Aim. The aim was to analyze the results of intensive care for COVID-19 associated acute respiratory distress syndrome (ARDS) using optimized tactical aspects of respiratory support. Methods. In this prospective study, the comparison group included 436 consecutive patients admitted to the ICU of "A-block Zangiota-1" in the period from January 1, 2021 to June 30, 2021 (taking into account the representativeness of the main group), whose the therapeutic and tactical aspects of management were based on the first own experience with results analysis across organizational and therapeutic approaches. The main group included 288 patients admitted from July 1, 2021 to October 1, 2021, whose therapeutic and tactical aspects of management were developed on the basis of a fundamental revision of the differential diagnosis, pathomorphological classification and respiratory mechanics of COVID-19 associated ARDS, as well as taking into account the influence of risk factors for the severe course of the disease and various methods and technologies of respiratory support. Accordingly, adapted and optimized respiratory therapy standards have been applied in main group. Results. The frequency of intubations and transfers to mechanical ventilation had no statistical difference between the groups (p=0.362). In the main group, cases of tracheostomy (73.8%) were significantly (p<0.001) more than the comparison group (14.5%). In the comparison group, the proportion of patients with severe ARDS decreased from 29.6% to 23.8% (p=0.067), and in the main group from 31.0% to 17.0% (p<0.001). The average duration of treatment of patients in the ICU was 22 (from 7 to 32) days in the comparison group and 17 (from 9 to 27) days in the main group (p<0.05). The frequency of deaths in COVID-19 associated ARDS was 11.1% in the main group, which was significantly lower (p=0.036) than the comparison group (16.7%). Among patients on invasive mechanical ventilation (intubation and tracheostomy), the mortality rate was 96.0% in the comparison group and 76.2% in the main group of patients (p = 0.003). Conclusion. Providing respiratory support for COVID-19 associated ARDS, taking into account the individual characteristics of respiratory mechanics, can improve the results of treatment of patients with an increase in the oxygenation index, a decrease in the proportion of cases of severe ARDS, and reduce the mortality rate and the length of stay of patients in the ICU.

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Section: Resultsmentioning

confidence: 99%

Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

IBRAGIMOV¹,

ALIMOVA²,

BURKHONOV³

et al. 2022

jlsb

View full text Add to dashboard Cite

show abstract

“…[3] Due to the expanding range of indications for ECMO, its application has been enhanced in the intensive care unit as well as during emergency departments, operating rooms, cardiac catheterization laboratories, and interhospital transfers. [4] The patients who use ECMO generally have inflammatory hemodynamic abnormalities, inflammation, and pathophysiological abnormalities of various organs, which puts them at high risk of other organ failure. [4] The term "hyperthyroidism" is strange within the context of respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

“…Patients on ECMO support have inflammatory, hemodynamic, and pathophysiological abnormalities, which put them at risk for potential complications. [4] According to current literature, 20% to 100% of ECMO acute renal injury (AKI) patients receive renal replacement therapy (RRT) before or during ECMO support. Approximately 85% of patients suffer from AKI.…”

Section: Introductionmentioning

confidence: 99%

“…[4] The patients who use ECMO generally have inflammatory hemodynamic abnormalities, inflammation, and pathophysiological abnormalities of various organs, which puts them at high risk of other organ failure. [4] The term "hyperthyroidism" is strange within the context of respiratory failure. The correct term is most likely "hypercapnia," which clearly indicates increased amounts of carbon dioxide in the bloodstream and is directly related to respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Huang,

Gao,

Chen

et al. 2024

Medicine

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Background: Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute respiratory failure. ECMO’s application has expanded to ICUs, emergency departments, and operating rooms. ECMO patients are at high risk for complications, including acute kidney injury (AKI), often requiring renal replacement therapy (RRT), posing significant management challenges. Methods: From August 2015 to June 2022, 120 patients were cured with veno-venous ECMO (n = 60) or veno-arterial ECMO (VA-ECMO, n = 60) combined with CRRT in our hospital. In the control group (n = 60), the input end (arterial end) of CRRT was connected to the ECMO oxygenator. The reinfusion end (venous end) of CRRT was connected to the oxygenator of ECMO for CRRT + ECMO treatment. In the experimental group (n = 60), the input end (arterial end) of CRRT was connected to the oxygenator of ECMO, and an additional pressure regulating device was installed on the connection of the 2 lines. The observation indexes including clinical therapeutic effect, clinical therapeutic effect, the incidence of complications, and the incidence of complications were compared. Results: There was a notable decrease in serum creatinine, and the differences in blood urea nitrogen, procalcitonin, and C-reactive protein after operation were statistically significant (P < .05). The filter use time in the study group was notably longer (P < .01). There exhibited no remarkable difference in the incidences of bleeding, thrombosis, numbness of hands and feet, metabolic alkalosis, disseminated intravascular coagulation, organ dysfunction syndrome, hyperbilirubinemia, and infection. Conclusion: This study demonstrates that additional pressure regulation devices are installed at the line connection between the CRRT input end and the CRRT return end to ensure that the flow rate of ECMO does not affect the CRRT treatment. ECMO and CRRT provide a safe pressure range so that the ECMO line can be safely connected to the CRRT machine at physiological pressure, reducing the occurrence of complications related to CRRT machine interruption and improving the efficiency of CRRT without affecting the efficiency of ECMO, ensuring patient safety.

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“…Acute respiratory distress syndrome (ARDS) is the most common pulmonary complication in critically ill patients that often results in unfavorable outcomes. Approximately two out of five patients with ARDS die [ 1 ], and the recent COVID-19 pandemic taught us that outcome of patients with ARDS due to infectious causes has not changed over recent years [ 2 , 3 ], despite significant improvements in ventilatory management and various other aspects of care for critically ill ARDS patients.…”

Section: Introductionmentioning

confidence: 99%

Unilateral acute lung injury in pig: a promising animal model

et al. 2022

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Background Acute lung injury (ALI) occurs in 23% unilateral. Models of unilateral ALI were developed and used previously without clearly demonstrating the strictly unilateral nature and severity of lung injury by the key parameters characterizing ALI as defined by the American Thoracic Society (ATS). Thus, the use of unilateral ALI remained rare despite the innovative approach. Therefore, we developed a unilateral model of ALI and focused on the crucial parameters characterizing ALI. This model can serve for direct comparisons between the injured and intact lungs within single animals, thus, reducing the number of animals required for valid experimental conclusions. Methods We established the model in nine pigs, followed by an evaluation of key parameters in six pigs (main study). Pigs were ventilated using an adapted left double-lumen tube for lung separation and two ventilators. ALI was induced in the left lung with cyclic rinsing (NaCl 0.9% + Triton® X-100), after which pigs were ventilated for different time spans to test for the timing of ALI onset. Ventilatory and metabolic parameters were evaluated, and bronchoalveolar lavage (BAL) was performed for measurements of inflammatory mediators. Finally, histopathological specimens were collected and examined in respect of characteristics defining the lung injury score (LIS) as suggested by the ATS. Results After adjustments of the model (n = 9) we were able to induce strictly left unilateral ALI in all six pigs of the evaluation study. The median lung injury score was 0.72 (IQR 0.62–0.79) in the left lung vs 0.14 (IQR 0.14–0.16; p < 0.05) in the right lung, confirming unilateral ALI. A significant and sustained drop in pulmonary compliance (Cdyn) of the left lung occurred immediately, whereas Cdyn of the right lung remained unchanged (p < 0.05). BAL fluid concentrations of interleukin-6 and -8 were increased in both lungs. Conclusions We established a model of unilateral ALI in pigs, confirmed by histopathology, and typical changes in respiratory mechanics and an inflammatory response. This thoroughly evaluated model could serve as a basis for future studies and for comparing pathophysiological and pharmacological changes in the uninjured and injured lung within the same animal.

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Clinical Characteristics and Outcomes of COVID-19 Acute Respiratory Distress Syndrome Patients Requiring Invasive Mechanical Ventilation in a Lower Middle-Income Country

Cited by 5 publications

References 46 publications

Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

Unilateral acute lung injury in pig: a promising animal model

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