Search

Acute respiratory distress syndrome (ARDS) can arise from a variety of causes, and manifests clinically as acute hypoxemic respiratory failure, characterized by acute, diffuse, inflammatory lung injury that leads to increased alveolar capillary permeability and development of nonhydrostatic pulmonary edema. Management of ARDS is largely focused on supportive management, lung-protective ventilation and minimizing iatrogenic forms of lung injury, with extracorporeal life support as an option for patients who continue to deteriorate despite these supportive therapies. 2017;195:438-42. 33 National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, Bernard GR. Comparison of two fluid-management strategies in acute lung injury. Theoretically, they act to decrease overall lung inflammation in ARDS, and may reduce the risk of death in severe ARDS.[24] However, the use of corticosteroids in critically ill patients is also associated with important adverse events, including hypernatremia, hyperglycemia and neuromuscular weakness. [Extracted from the article]

Prone positioning has been widely adopted into standard practice for patients with severe acute respiratory distress syndrome who are mechanically ventilated based on high-quality evidence. Because most patients are heavily sedated and usually medically paralyzed to facilitate ventilation, 3 or more trained staff are needed to turn the patient in a coordinated fashion.[12] During the COVID-19 pandemic, some institutions have attempted prone positioning among patients with hypoxia who are awake and not intubated, either in the emergency department or inpatient units. Before the COVID-19 pandemic, prone positioning was used mainly for patients with severe ARDS who were being ventilated mechanically.[13] Among patients with COVID-19 who are breathing spontaneously and not intubated, observational data suggest that prone positioning might improve oxygenation in those who can tolerate the position. [Extracted from the article]

Restrictive "no-visitor" policies were adopted in Canada during the first wave of the pandemic in an attempt to mitigate introduction and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within hospitals, and to preserve personal protective equipment (PPE) for health workers. Preliminary research has suggested that delirium is common among acute and critically ill patients with COVID-19.[8] Patients with delirium have longer hospital stays and increased risk of death. Patients transitioning to critical or end-of-life care, as well as patients with delirium, cognitive impairment, language barriers or severe psychiatric conditions, could also benefit from relaxed visitation policies. [Extracted from the article]

In the setting of acute respiratory failure, patients may generate inspiratory flow rates greater than the flow capacity of conventional oxygen devices. Clinical deterioration of a patient receiving high-flow nasal oxygen (or inadvertent oxygen disconnection) is a medical emergency given the acuity of such a patient with potentially minimal respiratory reserve.[1] 1 Rochwerg B, Granton D, Wang DX.. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis.. Intensive Care Med. [Extracted from the article]