Incidence Of Acute Respiratory Distress Syndrome In Patients Research Articles

Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis

ObjectiveTo describe the potential effects of ventilatory strategies on the outcome of acute brain-injured patients undergoing invasive mechanical ventilation.DesignSystematic review with an individual data meta-analysis.SettingObservational and interventional (before/after) studies published up to August 22nd, 2022, were considered for inclusion. We investigated the effects of low tidal volume Vt < 8 ml/Kg of IBW versus Vt > = 8 ml/Kg of IBW, positive end-expiratory pressure (PEEP) < or > = 5 cmH2O and protective ventilation (association of both) on relevant clinical outcomes.PopulationPatients with acute brain injury (trauma or haemorrhagic stroke) with invasive mechanical ventilation for ≥ 24 h.Main outcome measuresThe primary outcome was mortality at 28 days or in-hospital mortality. Secondary outcomes were the incidence of acute respiratory distress syndrome (ARDS), the duration of mechanical ventilation and the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio.ResultsThe meta-analysis included eight studies with a total of 5639 patients. There was no difference in mortality between low and high tidal volume [Odds Ratio, OR 0.88 (95%Confidence Interval, CI 0.74 to 1.05), p = 0.16, I2 = 20%], low and moderate to high PEEP [OR 0.8 (95% CI 0.59 to 1.07), p = 0.13, I2 = 80%] or protective and non-protective ventilation [OR 1.03 (95% CI 0.93 to 1.15), p = 0.6, I2 = 11]. Low tidal volume [OR 0.74 (95% CI 0.45 to 1.21, p = 0.23, I2 = 88%], moderate PEEP [OR 0.98 (95% CI 0.76 to 1.26), p = 0.9, I2 = 21%] or protective ventilation [OR 1.22 (95% CI 0.94 to 1.58), p = 0.13, I2 = 22%] did not affect the incidence of acute respiratory distress syndrome. Protective ventilation improved the PaO2/FiO2 ratio in the first five days of mechanical ventilation (p < 0.01).ConclusionsLow tidal volume, moderate to high PEEP, or protective ventilation were not associated with mortality and lower incidence of ARDS in patients with acute brain injury undergoing invasive mechanical ventilation. However, protective ventilation improved oxygenation and could be safely considered in this setting. The exact role of ventilatory management on the outcome of patients with a severe brain injury needs to be more accurately delineated.

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis: A retrospective analysis.

Acute respiratory distress syndrome (ARDS) is very common in patients with severe acute pancreatitis (SAP), the early interventions are essential to the prognosis of SAP patients. We aimed to evaluate the risk factors for ARDS in SAP patients, to provide insights into the management of SAP.SAP patients treated in our hospital from June 1, 2018 to May 31, 2020 were included. The characteristics and lab test results were collected and compared, and we conducted the logistic regression analyses were conducted to identify the potential risk factors for ARDS in patients with SAP.A total of 281 SAP patients were included finally, the incidence of ARDS in patients with SAP was 30.60%. There were significant differences on the respiratory rate, heart rate, APACHE II and Ranson score between 2 groups (all P < .05). And there were significant differences on the polymorphonuclear, procalcitonin, C-reactive protein, serum creatinine, albumin and PO2/FiO2 between 2 groups (all P < .05), and no significant differences on the K+, Na+, Ca+, white blood cell, neutrophils, urine and blood amylase, trypsin, lipase, alanine aminotransferase, aspartate aminotransferase, total bilirubin, triglyceride, total cholesterol, total bilirubin, fasting blood glucose, and pH were found (all P > .05). Respiratory rate >30/min (odds ratio [OR]: 2.405, 95% confidence interval[CI]: 1.163–4.642), APACHE II score >11 (OR: 1.639, 95% CI: 1.078–2.454), Ranson score >5 (OR: 1.473, 95% CI: 1.145–2.359), polymorphonuclear >14 × 109/L (OR: 1.316, 95% CI: 1.073–2.328), C-reactive protein >150 mg/L (OR: 1.127, 95% CI: 1.002–1.534), albumin ≤30 g/L (OR: 1.113, 95% CI: 1.005–1.489) were the independent risk factors for ARDS in patients with SAP (all P < .05).The incidence of ARDS in SAP patients is relatively high, and it is necessary to carry out targeted early prevention and treatment for the above risk factors.

124EMF Evaluation of Acute Respiratory Distress Syndrome from Two Study Sites of the Protocolized Care for Early Septic Shock Trial

Severe sepsis is a systemic disease that develops in as many as 3 million adults in the U.S. each year, resulting in significant morbidity and mortality. Sepsis is the most common etiology of acute respiratory distress syndrome (ARDS), which is associated with a high case-fatality rate. Over the past two decades, however, recent sepsis trials that enroll patients from ED and ICU settings do not explicitly report ARDS incidence. We conducted an ancillary study using data from two ProCESS study sites (a large randomized trial of early septic shock care) to determine the incidence of ARDS in patients with early septic shock presenting to the emergency department (ED). Using the Berlin ARDS Criteria, we identified subjects on mechanical ventilation with a PaO2/FiO2 (P/F) ratio ≤ 300. Two radiologists independently reviewed the chest radiographs from these subjects, determining if each was consistent with ARDS. In cases of disagreement, a formal adjudication by a panel of pulmonary critical care physicians occurred. Subjects who screened positive were further categorized as having mild, moderate, or severe ARDS, per the Berlin Criteria, according to their P/F ratio. In addition to ARDS incidence, we report 60-day all-cause in-hospital mortality rates of septic shock patients with or without ARDS, stratified by ARDS severity. Of 179 subjects, 47 received invasive mechanical ventilation with P/F ≤ 300 (26.3%). Of these 47 subjects, 17 had discordant radiology adjudications requiring panel adjudication (36.1%). Upon final adjudication, the incidence of ARDS was 12.3% (22/179). The median P/F ratio of ARDS patients was 122.14 mmHg (SD 51.2). The majority of ARDS cases were categorized as “moderate” (55%, P/F 100 - 200), followed by “severe” (41%, P/F <100) and “mild” (5%, P/F 201-300), with corresponding mortality rates of 33.3%, 77.8%, and 0%, respectively. Of note, ARDS was associated with a 3.8-fold higher 60-day in-hospital mortality rate (50.0% vs. 13.3%, p < 0.01). The rate of disagreement between radiographic determinations of ARDS is higher than previously reported. The incidence of ARDS in patients presenting to the ED with early septic shock is high. Compared to early septic shock patients without ARDS, those who developed ARDS have a significantly higher mortality rate.

Airway Pressure Release Ventilation Prevents Ventilator-Induced Lung Injury in Normal Lungs

Up to 25% of patients with normal lungs develop acute lung injury (ALI) secondary to mechanical ventilation, with 60% to 80% progressing to acute respiratory distress syndrome (ARDS). Once established, ARDS is treated with mechanical ventilation that can paradoxically elevate mortality. A ventilation strategy that reduces the incidence of ARDS could change the clinical paradigm from treatment to prevention. To demonstrate that (1) mechanical ventilation with tidal volume (VT) and positive end-expiratory pressure (PEEP) settings used routinely on surgery patients causes ALI/ARDS in normal rats and (2) preemptive application of airway pressure release ventilation (APRV) blocks drivers of lung injury (ie, surfactant deactivation and alveolar edema) and prevents ARDS. Rats were anesthetized and tracheostomy was performed at State University of New York Upstate Medical University. Arterial and venous lines, a peritoneal catheter, and a rectal temperature probe were inserted. Animals were randomized into 3 groups and followed up for 6 hours: spontaneous breathing ventilation (SBV, n = 5), continuous mandatory ventilation (CMV, n = 6), and APRV (n = 5). Rats in the CMV group were ventilated with Vt of 10 cc/kg and PEEP of 0.5 cm H2O. Airway pressure release ventilation was set with a P(High) of 15 to 20 cm H2O; P(Low) was set at 0 cm H2O. Time at P(High) (T(High)) was 1.3 to 1.5 seconds and a T(Low) was set to terminate at 75% of the peak expiratory flow rate (0.11-0.14 seconds), creating a minimum 90% cycle time spent at P(High). Bronchoalveolar lavage fluid and lungs were harvested for histopathologic analysis at necropsy. Acute lung injury/ARDS developed in the CMV group (mean [SE] PaO2/FiO2 ratio, 242.96 [24.82]) and was prevented with preemptive APRV (mean [SE] PaO2/FIO2 ratio, 478.00 [41.38]; P < .05). Airway pressure release ventilation also significantly reduced histopathologic changes and bronchoalveolar lavage fluid total protein (endothelial permeability) and preserved surfactant proteins A and B concentrations as compared with the CMV group. Continuous mandatory ventilation in normal rats for 6 hours with Vt and PEEP settings similar to those of surgery patients caused ALI. Preemptive application of APRV blocked early drivers of lung injury, preventing ARDS. Our data suggest that APRV applied early could reduce the incidence of ARDS in patients at risk.

Anesthesiology and the Acute Respiratory Distress Syndrome

Anesthesiology and the Acute Respiratory Distress Syndrome

The Role of Chronic Alcohol Abuse in the Development of Acute Respiratory Distress Syndrome in Adults

MOSS, MARC; BUCHER, BECKI; MOORE, FREDERICK A.; MOORE, ERNEST E.; PARSONS, POLLY E. Author Information

The Role of Chronic Alcohol Abuse in the Development of Acute Respiratory Distress Syndrome in Adults

To determine the effect of a history of chronic alcohol abuse on the incidence of acute respiratory distress syndrome (ARDS) and in-hospital mortality. Prospective cohort study. A total of 351 medical and surgical intensive care unit patients with one of seven at-risk diagnoses for the development of ARDS. The development of ARDS and in-hospital mortality. Of the 351 patients enrolled in the study, the incidence of ARDS in patients with a history of alcohol abuse was significantly higher than in patients without a history of alcohol abuse (43% vs 22%) (P < .001; relative risk [RR], 1.98; 95% confidence interval [Cl], 1.32 to 2.85). In patients with sepsis, ARDS developed in 52% of the patients with a prior history of alcohol abuse compared with only 20% in patients without a history of alcohol abuse (P < .001; RR, 2.59; 95% Cl, 1.29 to 5.12). Fifty-one percent (52/102) of the patients who developed ARDS died compared with only 14% (36/249) of patients who did not develop ARDS (P < .001). In the subset of patients who developed ARDS, the in-hospital mortality rate was 65% in patients with a prior history of alcohol abuse. This mortality rate was significantly higher (P = .003) than the mortality rate in patients without a history of alcohol abuse (36%). A prior history of chronic alcohol abuse significantly increases the risk of developing ARDS in critically ill patients with an identified at-risk diagnosis. Our results may be useful in the earlier and more accurate identification of patients at high risk for developing ARDS.

Ketoconazole in the Prevention of Acute Respiratory Distress Syndrome

Objective: To describe the pharmacology of ketoconazole and examine the use of ketoconazole in critically ill surgical patients to prevent the development of acute respiratory distress syndrome (ARDS). Data Source: An English-language literature search from 1985 to 1994 using MEDLINE-identified relevant articles. Search terms were adult, acute respiratory distress syndrome, ketoconazole, thromboxane, and leukotrienes. Study Selection: Two randomized, controlled, double-blind studies were identified that examined the use of ketoconazole in critically ill surgical patients. In vitro and animal studies were included to describe the mechanism of ketoconazole on inhibition of leukotriene and thromboxane synthesis. Data Extraction: Studies were evaluated for study design, efficacy, and toxicity. Data Synthesis: Two randomized, placebo-controlled clinical trials have been conducted in critically ill surgical patients. One study demonstrated a 6% incidence of ARDS in patients receiving ketoconazole 200 mg/d (n = 35) versus 31% on placebo (n = 36) (p &lt; 0.01). Another study demonstrated a 15% incidence of ARDS in patients receiving ketoconazole 400 mg/d (n = 26) versus 64% on placebo (n = 28) (p &lt; 0.002), and showed a statistically significant decrease in mortality in the ketoconazole group (15%) versus placebo (39%) (p &lt; 0.05). There were no reports of serious adverse events, and patients in both treatment and placebo groups were discontinued for increased liver enzyme concentrations. Conclusions: Two studies conducted at single sites using prophylactic ketoconazole therapy in dosages of 200–400 mg/d in a small population of critically ill surgical patients at risk for ARDS have demonstrated a significant decrease in the incidence of ARDS. There are no ongoing multicenter trials that would provide the power to measure the true difference between the groups and minimize the selection bias inherent in these studies.