Monitoring of lung function in acute respiratory distress syndrome

Larsson, Anders; Guérin, Claude

doi:10.21037/atm.2017.06.56

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…Unexpectedly, the driving pressure, the stronger predictor of ARDS mortality in recent studies [40,41] and shown as a risk factor for DAD in autopsied patients [37], was neither associated with DAD nor with mortality in our cohort. We speculate that this result may be related to the selection bias of the present study, which included the most severe ARDS patients with a baseline high driving pressure (Table S3).…”

Section: Discussioncontrasting

confidence: 64%

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study

Cardinal-Fernández

Ortiz

Chang

et al. 2019

JCM

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The aim of this retrospective and international study is to identify those clinical variables associated with diffuse alveolar damage (DAD), and to explore the impact of DAD on hospital mortality risk. Inclusion criteria were: adult patients with acute respiratory distress syndrome (ARDS) undergoing open lung biopsy (OLB) during their intensive care unit (ICU) management. The main end-points were: DAD and hospital mortality. In the training (n = 193) and validation cohorts (n = 65), the respiratory rate (odd ratio (OR) 0.956; confidence interval (CI) 95% 0.918; 0.995) and coronary ischemia (OR 5.974; CI95% 1.668; 21.399) on the day of ARDS had an average area under the receiver operating characteristic curve (AUROC) of 0.660 (CI95% 0.585; 0.736) and 0.562 (0.417; 0.706), respectively. PEEP (OR 1.131; CI95% 1.051; 1.218) and coronary ischemia (OR 6.820; CI95% 1.856; 25.061) on the day of OLB had an average AUROC of 0.696 (CI95% 0.621; 0.769) and 0.534 (CI95% 0.391; 0.678), respectively, to predict DAD. DAD (OR 2.296; CI95% 1.228; 4.294), diabetes mellitus requiring insulin (OR 0.081; CI95% 0.009; 0.710) and the respiratory rate (OR 1.045; CI95% 1.001; 1.091) on the day of ARDS had an average AUROC of 0.659 (CI95% 0.583; 0.737) and 0.513 (CI95% 0.361; 0.664) to predict hospital mortality and DAD (OR 2.081; CI95% 1.053; 4.114), diabetes mellitus requiring insulin (OR 0.093; CI95% 0.009; 0.956), PaCO2 (OR 1.051; CI95% 1.019; 1.084), and platelets count (OR 0.999; CI95% 0.999; 0.999) the day of OLB had an average AUROC of 0.778 (CI95% 0.710; 0.843) and 0.634 (CI95%0.481; 0.787) to predict hospital mortalty in the training and validation cohorts, respectively. In conclusion, DAD could not to be predicted clinically and was significantly associated with hospital mortality.

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Section: Discussioncontrasting

confidence: 64%

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study

Cardinal-Fernández

Ortiz

Chang

et al. 2019

JCM

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“…Inspiratory pressure and mean airway pressure required to deliver a set TV increased quickly in the severe injury group, but more modestly in the moderate injury group; only severe injury animals required an increase in PEEP to maintain adequate oxygenation. Quasi‐static compliance of the respiratory system was calculated from measured tissue elastance 22 . During postnatal adaptation while lung water is resorbed, static compliance improves as ultrasonographically detected B‐lines regress, 23 making a loss of compliance a pertinent marker of lung water in this study.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome

Elsayed

Hinton

Graham

et al. 2020

Pediatric Pulmonology

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Rationale: Point-of-care ultrasound (POCUS) is used to evaluate pulmonary edema in adults with acute respiratory distress syndrome (ARDS). Its use has not been validated in neonatal models. Objectives: We compared an in vivo lung ultrasound score against clinical and histological markers of acute lung injury, in a neonatal animal model, hypothesizing that POCUS would sensitively diagnose early acute lung injury in neonates and discern its severity. Methods: Fifteen anesthetized, ventilated 3-day-old neonatal piglets were divided into controls, moderate lung injury, or severe lung injury by graded treatment with oleic acid. Degree of lung injury was quantified at baseline, immediately after oleic acid administration, and 1 hour after the evolution of acute lung injury, by blood gases, ventilation parameters and calculated oxygenation deficit; hemodynamic indices by echocardiography, and lung ultrasound obtained in an 8-region grid of anterior and posterior zones, semi-quantitatively analyzed by a blinded observer. Lungs were inflation-fixed postmortem at last mean airway pressure, for histological assessment. Results: Acute lung injury manifested in oleic acid-treated groups as dosedependent capillary leak causing intravascular depletion and cardiac failure, hypoxemia with increasing intrapulmonary shunt fraction, decreased lung compliance, and resistance. Ultrasound scores of anterior regions distinguished moderate from severe injury; scores in posterior regions reached maximum values immediately after lung injury. POCUS score correlated with calculated intrapulmonary shunt fraction (R 2 = .65) and with histological injury score (R 2 = .61), P < .01. Conclusion: We conclude that POCUS may be valuable in neonates for early quantification of acute lung injury or ARDS; and that nondependent ultrasound regions clearly distinguish severity of pulmonary edema.

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“…Thus, improvement in respiratory status was defined as any of the following: increased PaO 2 /FiO 2 ratio, decreased FiO 2 , or decrease in flow rate in HFNC patients in the absence of escalation of respiratory support modality. 7,13 Patients' ICU and hospital lengths of stay, ICU mortality, and in-hospital mortality were also evaluated. In-hospital mortality was defined as death occurring during hospital stay, including ICU mortality.…”

Section: Discussionmentioning

confidence: 99%

Inhaled Epoprostenol Through Noninvasive Routes of Ventilator Support Systems

2018

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A total of 36 patients received iEPO through noninvasive routes: high-flow oxygen therapy through nasal cannula, n = 29 (81%) and noninvasive positive-pressure ventilation, n = 7 (19%). Sixteen patients had improvement in their respiratory status: mean decrease in fraction of inspired oxygen (FiO), 20% ± 13%; mean increase in partial pressure of arterial oxygen to FiO (PaO/FiO) ratio, 60 ± 50 mm Hg; and mean decrease in HFNC oxygen flow rate, 6 ± 3 liters per minute (LPM). Eight patients had declines in their respiratory status (mean increase in FiO, 30% ± 20%; mean decrease in PaO/FiO ratio, 38 ± 20 mm Hg; and mean increase in HFNC oxygen flow rate, 15 ± 10 LPM), and 12 patients had no change in their respiratory status. Conclusion and Relevance: This represents the first evaluation of the administration of iEPO through noninvasive routes of ventilator support systems and demonstrates that in critically ill patients, iEPO could be administered through a noninvasive route. Further evaluation is needed to determine the extent of benefit with this route of administration.

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Monitoring of lung function in acute respiratory distress syndrome

Cited by 9 publications

References 27 publications

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study

Predicting the Impact of Diffuse Alveolar Damage through Open Lung Biopsy in Acute Respiratory Distress Syndrome—The PREDATOR Study

Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome

Inhaled Epoprostenol Through Noninvasive Routes of Ventilator Support Systems

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