Fluids in ARDS: more pros than cons

Mendes, Renata de S.; Pelosi, Paolo; Schultz, Marcus J.; Rocco, Patrícia Rieken Macêdo; Silva, Pedro L.

doi:10.1186/s40635-020-00319-x

Cited by 12 publications

(6 citation statements)

References 75 publications

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“…On the other hand, fluid therapy may worsen lung edema due to the altered permeability of pulmonary microvessels [ 17 ]. Therefore, the prediction of fluid responsiveness is important to test in patients with ARDS to prevent fluid administration in those who are fluid unresponsive and for whom harmful consequences of fluid therapy would be maximal [ 18 ]. Pulse pressure variation (PPV), passive leg raising (PLR), and end-expiratory occlusion (EEO) are dynamic variables or tests that are commonly used to predict fluid responsiveness in mechanically ventilated patients [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Tidal volume challenge to predict preload responsiveness in patients with acute respiratory distress syndrome under prone position

et al. 2022

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Background Prone position is frequently used in patients with acute respiratory distress syndrome (ARDS), especially during the Coronavirus disease 2019 pandemic. Our study investigated the ability of pulse pressure variation (PPV) and its changes during a tidal volume challenge (TVC) to assess preload responsiveness in ARDS patients under prone position. Methods This was a prospective study conducted in a 25-bed intensive care unit at a university hospital. We included patients with ARDS under prone position, ventilated with 6 mL/kg tidal volume and monitored by a transpulmonary thermodilution device. We measured PPV and its changes during a TVC (ΔPPV TVC6–8) after increasing the tidal volume from 6 to 8 mL/kg for one minute. Changes in cardiac index (CI) during a Trendelenburg maneuver (ΔCITREND) and during end-expiratory occlusion (EEO) at 8 mL/kg tidal volume (ΔCI EEO8) were recorded. Preload responsiveness was defined by both ΔCITREND ≥ 8% and ΔCI EEO8 ≥ 5%. Preload unresponsiveness was defined by both ΔCITREND < 8% and ΔCI EEO8 < 5%. Results Eighty-four sets of measurements were analyzed in 58 patients. Before prone positioning, the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen was 104 ± 27 mmHg. At the inclusion time, patients were under prone position for 11 (2–14) hours. Norepinephrine was administered in 83% of cases with a dose of 0.25 (0.15–0.42) µg/kg/min. The positive end-expiratory pressure was 14 (11–16) cmH2O. The driving pressure was 12 (10–17) cmH2O, and the respiratory system compliance was 32 (22–40) mL/cmH2O. Preload responsiveness was detected in 42 cases. An absolute change in PPV ≥ 3.5% during a TVC assessed preload responsiveness with an area under the receiver operating characteristics (AUROC) curve of 0.94 ± 0.03 (sensitivity: 98%, specificity: 86%) better than that of baseline PPV (0.85 ± 0.05; p = 0.047). In the 56 cases where baseline PPV was inconclusive (≥ 4% and < 11%), ΔPPV TVC6–8 ≥ 3.5% still enabled to reliably assess preload responsiveness (AUROC: 0.91 ± 0.05, sensitivity: 97%, specificity: 81%; p < 0.01 vs. baseline PPV). Conclusion In patients with ARDS under low tidal volume ventilation during prone position, the changes in PPV during a TVC can reliably assess preload responsiveness without the need for cardiac output measurements. Trial registration: ClinicalTrials.gov (NCT04457739). Registered 30 June 2020 —Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04457739

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Section: Introductionmentioning

confidence: 99%

Tidal volume challenge to predict preload responsiveness in patients with acute respiratory distress syndrome under prone position

et al. 2022

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“…This is achieved by reducing the messenger RNA and protein expression of myocardial nitric oxide synthase II ( 32 ). The decrease in serum albumin levels may affect the integrity of the endothelial layer of the heart, and supplementing with albumin can help maintain this important barrier and further reduce inflammatory responses ( 33 ). During the formation of atherosclerosis, the overactivity of platelets will release a variety of proinflammatory and growth factors, which will aggravate the formation of vasculitis and atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Serum albumin levels and risk of atrial fibrillation: a Mendelian randomization study

Chen,

Wang,

2024

Front. Cardiovasc. Med.

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ObjectiveAlthough several observational studies have linked serum albumin to cardiovascular disease and considered it as an important biomarker, little is known about whether increasing or maintaining serum albumin levels can effectively improve the prognosis of patients with atrial fibrillation. Therefore, this study aims to further explore the causal relationship between serum albumin and atrial fibrillation and its potential mechanism.MethodUsing data from large-scale genome-wide association studies, we conducted a two-sample Mendelian randomization (MR) analysis and a mediation MR analysis, using serum albumin as the exposure variable and atrial fibrillation as the outcome variable. We included 486 serum metabolites as potential mediating factors. To increase the robustness of the analysis, we applied five statistical methods, including inverse variance weighted, weighted median, MR-Egger, simple mode, and weighted mode. Validate the MR results using Bayesian weighted Mendelian randomization method.ResultThe results of the MR analysis indicate a significant inverse association between genetically predicted serum albumin concentration (g/L) and the risk of atrial fibrillation (Beta = −0.172, OR = 0.842, 95% CI: 0.753–0.941, p = 0.002). Further mediation MR analysis revealed that serum albumin may mediate the causal relationship with atrial fibrillation by affecting two serum metabolites, docosatrienoate and oleate/vaccenate, and the mediating effect was significant. In addition, all our instrumental variables showed no heterogeneity and level-multiplicity in the MR analysis. To verify the stability of the results, we also conducted a sensitivity analysis using the leave-one-out method, and the results further confirmed that our findings were robust and reliable. Finally, we conducted a validation using the Bayesian weighted Mendelian randomization method, which demonstrated the reliability of our causal inference results.ConclusionThis study strongly demonstrates the causal relationship between serum albumin and reduced risk of atrial fibrillation through genetic methods, and reveals the key mediating role of two serum metabolites in this relationship. These findings not only provide a new perspective for our understanding of the role of serum albumin in atrial fibrillation, but also provide new ideas for the prevention and treatment strategies of atrial fibrillation.

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“…In the lungs, albumin promotes the maintenance of the glycocalyx layer, reduces inflammation, and improves alveolar-capillary membrane permeability [27]. A study of 993 ICU patients at the Vanderbilt University Medical Center concluded that lower serum albumin was independently associated with an increased risk of ARDS and that low plasma oncotic pressure contributes to pulmonary edema formation in patients at risk for ARDS within the first 72 hours after ICU admission [28].…”

Section: Sepsis-induced Ards Preventionmentioning

confidence: 99%

Preventative Management of Sepsis-Induced Acute Respiratory Distress Syndrome in the Geriatric Population

Geyer-Roberts¹,

Lacatusu²,

Kester³

et al. 2023

Cureus

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Sepsis and its treatment are the most common etiologies of acute respiratory distress syndrome (ARDS), which has a disturbing mortality rate. Sepsis management relies heavily on the introduction of resuscitative fluids. However, when fluids are paired with the circulating inflammatory mediators of sepsis, patients are prone to lung damage. Survivors of sepsis-induced ARDS become plagued with functional and/or psychological sequelae such as impaired memory, difficulty in concentrating, and decreased mental processing speed. Specific techniques can be implemented when diagnosing and treating elderly patients with sepsis to prevent the onset of ARDS, including bed elevation and early antibiotics. Additionally, albumin infusion may be beneficial; however, more research must be conducted. Finally, inflammatory mediators, including serum mannose biomarkers and extracellular histone therapy, show a promising avenue for future treatment. Although there is limited research on osteopathic manipulative medicine (OMT) on ARDS or sepsis-induced ARDS, OMT that focuses on alleviating rib and thoracic somatic dysfunctions has been used as an adjunct therapy to treat other respiratory diseases, such as pneumonia and chronic obstructive pulmonary disease (COPD). The results of these studies may garner interest in whether the use of OMT as an adjunct therapy may be beneficial for patients with ARDS or sepsis-induced ARDS. This paper is intended to review the current guidelines for sepsis and ARDS management in elderly patients to identify measures to prevent sepsis-induced ARDS.

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Fluids in ARDS: more pros than cons

Cited by 12 publications

References 75 publications

Tidal volume challenge to predict preload responsiveness in patients with acute respiratory distress syndrome under prone position

Tidal volume challenge to predict preload responsiveness in patients with acute respiratory distress syndrome under prone position

Serum albumin levels and risk of atrial fibrillation: a Mendelian randomization study

Preventative Management of Sepsis-Induced Acute Respiratory Distress Syndrome in the Geriatric Population

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