Redefining ARDS: a paradigm shift

Villar, Jesús; Szakmany, Tamas; Grasselli, Giacomo; Camporota, Luigi

doi:10.1186/s13054-023-04699-w

Cited by 11 publications

(2 citation statements)

References 45 publications

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“…ARDS is a pulmonary disorder defined by non-cardiogenic pulmonary edema, resulting in severe hypoxemia and is treated with protective mechanical ventilation and often requires deep levels of sedation to promote ventilation synchrony and prevent patient self-induced lung inury[ 63 , 64 ]. In 2020 with the COVID-19 pandemic, patients in ICUs across the world developed ARDS and had extremely high sedative requirements, and often required neuromuscular blocking agent administration to allow for lung protective ventilation[ 65 , 66 ].…”

Section: Applications In the Icumentioning

confidence: 99%

Inhaled volatile anesthetics in the intensive care unit

Wieruszewski,

ElSaban,

Wieruszewski

et al. 2023

World J Crit Care Med

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The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry, providing intensivists with multiple options to tailor therapy. Furthermore, their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy, mitigating risks associated with conventional sedation modalities. Despite the amounting enthusiasm for the use of these therapies, barriers to widespread utilization include expanding equipment availability, staff familiarity and training of safe use. This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology, administration considerations in intensive care settings, complication considerations, and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

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Section: Applications In the Icumentioning

confidence: 99%

Inhaled volatile anesthetics in the intensive care unit

Wieruszewski,

ElSaban,

Wieruszewski

et al. 2023

World J Crit Care Med

View full text Add to dashboard Cite

show abstract

“…It presents with non-cardiogenic pulmonary edema, sudden onset of dyspnea, refractory hypoxemia, reduced lung compliance, and widespread pulmonary in ltrates observable through X-ray and CT imaging. Recent reclassi cations have introduced distinctions based on whether patients require intubation [1][2][3]. ARDS's treatment is continuously evolving, aiming to identify and manage the primary pathology causing ARDS.…”

Section: Introductionmentioning

confidence: 99%

Visual Acuity after Prone Positioning in Acute Respiratory Distress Syndrome: An Observational Qualitative Study with a simulation model

Cappellini,

Vannucci,

Scandagli

et al. 2024

Preprint

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Background The SARS-CoV-2 pandemic has necessitated increased ICU admissions and the extensive use of prone positioning for ARDS management, prompting an examination of its broader impacts, especially on visual acuity. This study delves into the associations between prone positioning duration, gender, age, and visual outcomes in ARDS patients during the COVID-19 crisis. Methods An observational study was conducted on ARDS patients at Santo Stefano Hospital, focusing on those who underwent prone positioning. The study excluded individuals with pre-existing visual conditions unrelated to ICU treatment. A retrospective analysis of patient records provided data on demographics, ARDS management details, prone positioning frequency, visual acuity changes assessed through the Catquest-9SF questionnaire. Results 40 participants were eligible and completed the Catquest-9SF questionnaire. Analysis revealed that longer pronation duration correlated significantly with visual impairments, with increased risks associated with advancing age and the number of pronation cycles. These findings, supported by Rasch analysis and logistic regression, highlighted the importance of considering age, gender, and pronation cycles in predicting visual outcomes. Discussion The study underscores the complex interplay of physiological, biological, and treatment factors affecting visual outcomes in ARDS patients. It introduces the concept of Post-Pronation Visual Reduction (PPVR), advocating for the integration of ocular health assessments into ICU care protocols and the development of strategies to minimize visual impairment risks. Clinical trial: not applicable

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The role of the interplay between macrophage glycolytic reprogramming and NLRP3 inflammasome activation in acute lung injury/acute respiratory distress syndrome

Luo,

Zhuang,

et al. 2024

Clinical & Translational Med

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Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is a severe respiratory condition associated with elevated morbidity and mortality. Understanding their complex pathophysiological mechanisms is crucial for developing new preventive and therapeutic strategies. Recent studies highlight the significant role of inflammation involved in ALI/ARDS, particularly the hyperactivation of the NOD‐like receptor thermal protein domain‐associated protein 3 (NLRP3) inflammasome in macrophages. This activation drives pulmonary inflammation by releasing inflammatory signalling molecules and is linked to metabolic reprogramming, marked by increased glycolysis and reduced oxidative phosphorylation. However, the relationship between NLRP3 inflammasome activation and macrophage glycolytic reprogramming in ALI/ARDS, as well as the molecular mechanisms regulating these processes, remain elusive. This review provides a detailed description of the interactions and potential mechanisms linking NLRP3 inflammasome activation with macrophage glycolytic reprogramming, proposing that glycolytic reprogramming may represent a promising therapeutic target for mitigating inflammatory responses in ALI/ARDS.Key points NLRP3 inflammasome activation is pivotal in mediating the excessive inflammatory response in ALI/ARDS. Glycolytic reprogramming regulates NLRP3 inflammasome activation. Therapeutic potential of targeting glycolytic reprogramming to inhibit NLRP3 inflammasome activation in ALI/ARDS.

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Redefining ARDS: a paradigm shift

Cited by 11 publications

References 45 publications

Inhaled volatile anesthetics in the intensive care unit

Inhaled volatile anesthetics in the intensive care unit

Visual Acuity after Prone Positioning in Acute Respiratory Distress Syndrome: An Observational Qualitative Study with a simulation model

The role of the interplay between macrophage glycolytic reprogramming and NLRP3 inflammasome activation in acute lung injury/acute respiratory distress syndrome

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