Descriptor: "Respiration, artificial" / Topic: respiratory distress syndrome, adult - Searchworks@Jio Institute Digital Library Search Results

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137 results on '"Respiration, artificial"'

1. PEEP-induced Changed in RRI as Physiological Background of Ventilator-induced Kidney Injury (PRE-VIKI)

Author: Alberto Fogagnolo, Principal investigator
Published: 2022

2. Weaning From Mechanical Ventilation Using Permissive Hypercarbia

Author: Kane High, Associate Professor of Anesthesiology
Published: 2017

3. Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial

Author: Fabia Diniz-Silva, Henrique T. Moriya, Adriano M. Alencar, Marcelo B. P. Amato, Carlos R. R. Carvalho, and Juliana C. Ferreira
Subjects: Respiration, artificial, Respiratory distress syndrome, adult, Interactive ventilatory support, Positive-pressure respiration, Neurally adjusted ventilatory assist, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Protective mechanical ventilation is recommended for patients with acute respiratory distress syndrome (ARDS), but it usually requires controlled ventilation and sedation. Using neurally adjusted ventilatory assist (NAVA) or pressure support ventilation (PSV) could have additional benefits, including the use of lower sedative doses, improved patient–ventilator interaction and shortened duration of mechanical ventilation. We designed a pilot study to assess the feasibility of keeping tidal volume (V T) at protective levels with NAVA and PSV in patients with ARDS. Methods We conducted a prospective randomized crossover trial in five ICUs from a university hospital in Brazil and included patients with ARDS transitioning from controlled ventilation to partial ventilatory support. NAVA and PSV were applied in random order, for 15 min each, followed by 3 h in NAVA. Flow, peak airway pressure (Paw) and electrical activity of the diaphragm (EAdi) were captured from the ventilator, and a software (Matlab, Mathworks, USA), automatically detected inspiratory efforts and calculated respiratory rate (RR) and V T. Asynchrony events detection was based on waveform analysis. Results We randomized 20 patients, but the protocol was interrupted for five (25%) patients for whom we were unable to maintain V T below 6.5 mL/kg in PSV due to strong inspiratory efforts and for one patient for whom we could not detect EAdi signal. For the 14 patients who completed the protocol, V T was 5.8 ± 1.1 mL/kg for NAVA and 5.6 ± 1.0 mL/kg for PSV (p = 0.455) and there were no differences in RR (24 ± 7 for NAVA and 23 ± 7 for PSV, p = 0.661). Paw was greater in NAVA (21 ± 3 cmH2O) than in PSV (19 ± 3 cmH2O, p = 0.001). Most patients were under continuous sedation during the study. NAVA reduced triggering delay compared to PSV (p = 0.020) and the median asynchrony Index was 0.7% (0–2.7) in PSV and 0% (0–2.2) in NAVA (p = 0.6835). Conclusions It was feasible to keep V T in protective levels with NAVA and PSV for 75% of the patients. NAVA resulted in similar V T, RR and Paw compared to PSV. Our findings suggest that partial ventilatory assistance with NAVA and PSV is feasible as a protective ventilation strategy in selected ARDS patients under continuous sedation. Trial registration ClinicalTrials.gov (NCT01519258). Registered 26 January 2012, https://clinicaltrials.gov/ct2/show/NCT01519258
Published: 2020
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4. Clinical characteristics and outcomes of critically ill patients with COVID-19 in Kobe, Japan: a single-center, retrospective, observational study.

Author: Ito, Jiro, Seo, Ryutaro, Kawakami, Daisuke, Matsuoka, Yoshinori, Ouchi, Kenjiro, Nonami, Suguru, Miyoshi, Yusuke, Tatebe, Masao, Tsuchida, Takahiro, Asaka, Yoko, Yanai, Machi, Ueta, Hiroshi, Shimozono, Takahiro, Mima, Hiroyuki, Doi, Asako, Tomii, Keisuke, and Ariyoshi, Koichi
Subjects: *COVID-19, *TREATMENT effectiveness, *CRITICALLY ill, *INTENSIVE care units, *HOSPITAL admission & discharge
Abstract: Purpose: Coronavirus disease 2019 (COVID-19) has placed a great burden on critical care services worldwide. Data regarding critically ill COVID-19 patients and their demand of critical care services outside of initial COVID-19 epicenters are lacking. This study described clinical characteristics and outcomes of critically ill COVID-19 patients and the capacity of a COVID-19-dedicated intensive care unit (ICU) in Kobe, Japan. Methods: This retrospective observational study included critically ill COVID-19 patients admitted to a 14-bed COVID-19-dedicated ICU in Kobe between March 3, 2020 and June 21, 2020. Clinical and daily ICU occupancy data were obtained from electrical medical records. The last follow-up day was June 28, 2020. Results: Of 32 patients included, the median hospital follow-up period was 27 (interquartile range 19–50) days. The median age was 68 (57–76) years; 23 (72%) were men and 25 (78%) had at least one comorbidity. Nineteen (59%) patients received invasive mechanical ventilation for a median duration of 14 (8–27) days. Until all patients were discharged from the ICU on June 5, 2020, the median daily ICU occupancy was 50% (36–71%). As of June 28, 2020, six (19%) died during hospitalization. Of 26 (81%) survivors, 23 (72%) were discharged from the hospital and three (9%) remained in the hospital. Conclusion: During the first months of the outbreak in Kobe, most critically ill patients were men aged ≥ 60 years with at least one comorbidity and on mechanical ventilation; the ICU capacity was not strained, and the case-fatality rate was 19%. [ABSTRACT FROM AUTHOR]
Published: 2021
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5. Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study

Author: Cristiane Bastos-Netto, Maycon Moura Reboredo, Rodrigo Souza Vieira, Lídia Maria Carneiro da Fonseca, Erich Vidal Carvalho, Marcelo Alcantara Holanda, and Bruno Valle Pinheiro
Subjects: Respiration, artificial, Tidal volume, Respiratory distress syndrome, adult, Diseases of the respiratory system, RC705-779
Abstract: ABSTRACT Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS.
Published: 2021
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6. Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial.

Author: Diniz-Silva, Fabia, Moriya, Henrique T., Alencar, Adriano M., Amato, Marcelo B. P., Carvalho, Carlos R. R., and Ferreira, Juliana C.
Subjects: *ADULT respiratory distress syndrome, *CROSSOVER trials, *WAVE analysis
Abstract: Background: Protective mechanical ventilation is recommended for patients with acute respiratory distress syndrome (ARDS), but it usually requires controlled ventilation and sedation. Using neurally adjusted ventilatory assist (NAVA) or pressure support ventilation (PSV) could have additional benefits, including the use of lower sedative doses, improved patient–ventilator interaction and shortened duration of mechanical ventilation. We designed a pilot study to assess the feasibility of keeping tidal volume (VT) at protective levels with NAVA and PSV in patients with ARDS. Methods: We conducted a prospective randomized crossover trial in five ICUs from a university hospital in Brazil and included patients with ARDS transitioning from controlled ventilation to partial ventilatory support. NAVA and PSV were applied in random order, for 15 min each, followed by 3 h in NAVA. Flow, peak airway pressure (Paw) and electrical activity of the diaphragm (EAdi) were captured from the ventilator, and a software (Matlab, Mathworks, USA), automatically detected inspiratory efforts and calculated respiratory rate (RR) and VT. Asynchrony events detection was based on waveform analysis. Results: We randomized 20 patients, but the protocol was interrupted for five (25%) patients for whom we were unable to maintain VT below 6.5 mL/kg in PSV due to strong inspiratory efforts and for one patient for whom we could not detect EAdi signal. For the 14 patients who completed the protocol, VT was 5.8 ± 1.1 mL/kg for NAVA and 5.6 ± 1.0 mL/kg for PSV (p = 0.455) and there were no differences in RR (24 ± 7 for NAVA and 23 ± 7 for PSV, p = 0.661). Paw was greater in NAVA (21 ± 3 cmH2O) than in PSV (19 ± 3 cmH2O, p = 0.001). Most patients were under continuous sedation during the study. NAVA reduced triggering delay compared to PSV (p = 0.020) and the median asynchrony Index was 0.7% (0–2.7) in PSV and 0% (0–2.2) in NAVA (p = 0.6835). Conclusions: It was feasible to keep VT in protective levels with NAVA and PSV for 75% of the patients. NAVA resulted in similar VT, RR and Paw compared to PSV. Our findings suggest that partial ventilatory assistance with NAVA and PSV is feasible as a protective ventilation strategy in selected ARDS patients under continuous sedation. Trial registration ClinicalTrials.gov (NCT01519258). Registered 26 January 2012, https://clinicaltrials.gov/ct2/show/NCT01519258 [ABSTRACT FROM AUTHOR]
Published: 2020
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7. Adaptive Support Ventilation in Acute Respiratory Distress Syndrome (ARDS)

Author: Dr. Arjun Srinivasan, senior resident
Published: 2010

8. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

Author: Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, and Won-Il Choi
Subjects: practice guideline, respiration, artificial, respiratory distress syndrome, acute, respiratory distress syndrome, adult, ventilators, mechanical, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.
Published: 2016
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9. Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Author: Aoyama, Hiroko, Pettenuzzo, Tommaso, Aoyama, Kazuyoshi, Pinto, Ruxandra, Englesakis, Marina, and Fan, Eddy
Subjects: *INTENSIVE care patients, *ADULT respiratory distress syndrome, *ADULT respiratory distress syndrome treatment, *MORTALITY, *ARTIFICIAL respiration, *META-analysis, *PATIENTS
Abstract: Objectives: A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality for higher versus lower driving pressure.Data Sources: MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane CENTRAL from inception to February 10, 2017.Study Selection: Studies including mechanically ventilated adult patients with acute respiratory distress syndrome, reporting driving pressure and mortality.Data Extraction: Seven studies including five secondary analysis of previous randomized controlled trials and two observational studies (6,062 patients) were eligible for study. All studies were judged as having a low risk of bias. Median (interquartile range) driving pressure between higher and lower driving pressure groups was 15 cm H2O (14-16 cm H2O). Median (interquartile range) mortality of all included studies was 34% (32-38%).Data Synthesis: In the meta-analyses of four studies (3,252 patients), higher driving pressure was associated with a significantly higher mortality (pooled risk ratio, 1.44; 95% [CI], 1.11-1.88; I = 85%). A sensitivity analysis restricted to the three studies with similar driving pressure cutoffs (13-15 cm H2O) demonstrated similar results (pooled risk ratio, 1.28; 95% CI, 1.14-1.43; I = 0%).Conclusions: Our study confirmed an association between higher driving pressure and higher mortality in mechanically ventilated patients with acute respiratory distress syndrome. These findings suggest a possible range of driving pressure to be evaluated in clinical trials. Future research is needed to ascertain the benefit of ventilatory strategies targeting driving pressure in patients with acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]
Published: 2018
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10. Clinical characteristics and outcomes of critically ill patients with COVID-19 in Kobe, Japan: a single-center, retrospective, observational study

Author: Yoshinori Matsuoka, Hiroyuki Mima, Keisuke Tomii, Yoko Asaka, Masao Tatebe, Daisuke Kawakami, Yusuke Miyoshi, Jiro Ito, Takahiro Shimozono, Takahiro Tsuchida, Suguru Nonami, Asako Doi, Ryutaro Seo, Koichi Ariyoshi, Hiroshi Ueta, Machi Yanai, and Kenjiro Ouchi
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Critical Illness, Single Center, Bed occupancy, law.invention, Japan, Interquartile range, law, Anesthesiology, medicine, Severe acute respiratory syndrome coronavirus 2, Humans, Mortality, Aged, Retrospective Studies, Mechanical ventilation, Respiratory distress syndrome, adult, business.industry, SARS-CoV-2, Medical record, COVID-19, Retrospective cohort study, medicine.disease, Intensive care unit, Comorbidity, Respiration, Artificial, Coronavirus, Critical care, Intensive Care Units, Anesthesiology and Pain Medicine, Anesthesia, Emergency medicine, Original Article, business
Abstract: Purpose Coronavirus disease 2019 (COVID-19) has placed a great burden on critical care services worldwide. Data regarding critically ill COVID-19 patients and their demand of critical care services outside of initial COVID-19 epicenters are lacking. This study described clinical characteristics and outcomes of critically ill COVID-19 patients and the capacity of a COVID-19-dedicated intensive care unit (ICU) in Kobe, Japan. Methods This retrospective observational study included critically ill COVID-19 patients admitted to a 14-bed COVID-19-dedicated ICU in Kobe between March 3, 2020 and June 21, 2020. Clinical and daily ICU occupancy data were obtained from electrical medical records. The last follow-up day was June 28, 2020. Results Of 32 patients included, the median hospital follow-up period was 27 (interquartile range 19–50) days. The median age was 68 (57–76) years; 23 (72%) were men and 25 (78%) had at least one comorbidity. Nineteen (59%) patients received invasive mechanical ventilation for a median duration of 14 (8–27) days. Until all patients were discharged from the ICU on June 5, 2020, the median daily ICU occupancy was 50% (36–71%). As of June 28, 2020, six (19%) died during hospitalization. Of 26 (81%) survivors, 23 (72%) were discharged from the hospital and three (9%) remained in the hospital. Conclusion During the first months of the outbreak in Kobe, most critically ill patients were men aged ≥ 60 years with at least one comorbidity and on mechanical ventilation; the ICU capacity was not strained, and the case-fatality rate was 19%. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02897-w.
Published: 2021

11. High PEEP in acute respiratory distress syndrome: quantitative evaluation between improved arterial oxygenation and decreased oxygen delivery.

Author: Chikhani, M., Das, A., Haque, M., Wang, W., Bates, D. G., and Hardman, J. G.
Subjects: *ADULT respiratory distress syndrome, *OXYGENATION (Chemistry), *ARTIFICIAL respiration, *CARDIAC output, *CARDIOVASCULAR system, *QUANTITATIVE research, *CLINICAL trials, *ADULT respiratory distress syndrome treatment, *BLOOD gases analysis, *COMPARATIVE studies, *COMPUTER simulation, *RESEARCH methodology, *MEDICAL cooperation, *OXYGEN, *RESEARCH, *EVALUATION research, *POSITIVE end-expiratory pressure
Abstract: Background: Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and prevent alveolar collapse in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). Although PEEP improves arterial oxygenation predictably, high-PEEP strategies have demonstrated equivocal improvements in ARDS-related mortality. The effect of PEEP on tissue oxygen delivery is poorly understood and is difficult to quantify or investigate in the clinical environment.Methods: We investigated the effects of PEEP on tissue oxygen delivery in ARDS using a new, high-fidelity, computational model with highly integrated respiratory and cardiovascular systems. The model was configured to replicate published clinical trial data on the responses of 12 individual ARDS patients to changes in PEEP. These virtual patients were subjected to increasing PEEP levels during a lung-protective ventilation strategy (0-20 cm H2O). Measured variables included arterial oxygenation, cardiac output, peripheral oxygen delivery, and alveolar strain.Results: As PEEP increased, tissue oxygen delivery decreased in all subjects (mean reduction of 25% at 20 cm H2O PEEP), despite an increase in arterial oxygen tension (mean increase 6.7 kPa at 20 cm H2O PEEP). Changes in arterial oxygenation and tissue oxygen delivery differed between subjects but showed a consistent pattern. Static and dynamic alveolar strain decreased in all patients as PEEP increased.Conclusions: Incremental PEEP in ARDS appears to protect alveoli and improve arterial oxygenation, but also appears to impair tissue oxygen delivery significantly because of reduced cardiac output. We propose that this trade-off may explain the poor improvements in mortality associated with high-PEEP ventilation strategies. [ABSTRACT FROM AUTHOR]
Published: 2016
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12. Feasibility and Efficacy of the Pulmonary Rehabilitation Program in a Rehabilitation Center

Author: Irene Pietta, Jorge Hugo Villafañe, Maria Chiara Carrozza, Silvia Galeri, Simone Pancera, Luca Bianchi, and Roberto Porta
Subjects: Male, ARDS, medicine.medical_treatment, 030204 cardiovascular system & hematology, intensive care unit, Severity of Illness Index, Patient Isolation, Tracheostomy, 0302 clinical medicine, Viral, Respiratory Distress Syndrome, Rehabilitation, Respiration, Middle Aged, Respiratory Function Tests, Treatment Outcome, respiratory rehabilitation, Artificial, medicine.symptom, Coronavirus Infections, Cardiology and Cardiovascular Medicine, Ventilator Weaning, Adult, Pulmonary and Respiratory Medicine, Respiratory Therapy, medicine.medical_specialty, Weakness, acute respiratory distress syndrome, COVID-19, muscle weakness, Feasibility Studies, Humans, Pandemics, Pneumonia, Viral, Recovery of Function, Rehabilitation Centers, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Risk Assessment, 03 medical and health sciences, Intensive care, Severity of illness, medicine, Pulmonary rehabilitation, Mechanical ventilation, business.industry, Pneumonia, medicine.disease, 030228 respiratory system, Emergency medicine, business, Respiratory care
Abstract: DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.
Published: 2020

13. Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial

Author: Marcelo B. P. Amato, Adriano M. Alencar, Carlos Roberto Ribeiro de Carvalho, Juliana Carvalho Ferreira, Fabia Diniz-Silva, and Henrique Takachi Moriya
Subjects: ARDS, Respiratory rate, genetic structures, Sedation, medicine.medical_treatment, Pressure support ventilation, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Neurally adjusted ventilatory assist, Tidal volume, Mechanical ventilation, Respiratory distress syndrome, adult, Positive-pressure respiration, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, 030228 respiratory system, Anesthesia, Interactive ventilatory support, medicine.symptom, Respiration, artificial, business, Interactive Ventilatory Support, circulatory and respiratory physiology
Abstract: Background Protective mechanical ventilation is recommended for patients with acute respiratory distress syndrome (ARDS), but it usually requires controlled ventilation and sedation. Using neurally adjusted ventilatory assist (NAVA) or pressure support ventilation (PSV) could have additional benefits, including the use of lower sedative doses, improved patient–ventilator interaction and shortened duration of mechanical ventilation. We designed a pilot study to assess the feasibility of keeping tidal volume (VT) at protective levels with NAVA and PSV in patients with ARDS. Methods We conducted a prospective randomized crossover trial in five ICUs from a university hospital in Brazil and included patients with ARDS transitioning from controlled ventilation to partial ventilatory support. NAVA and PSV were applied in random order, for 15 min each, followed by 3 h in NAVA. Flow, peak airway pressure (Paw) and electrical activity of the diaphragm (EAdi) were captured from the ventilator, and a software (Matlab, Mathworks, USA), automatically detected inspiratory efforts and calculated respiratory rate (RR) and VT. Asynchrony events detection was based on waveform analysis. Results We randomized 20 patients, but the protocol was interrupted for five (25%) patients for whom we were unable to maintain VT below 6.5 mL/kg in PSV due to strong inspiratory efforts and for one patient for whom we could not detect EAdi signal. For the 14 patients who completed the protocol, VT was 5.8 ± 1.1 mL/kg for NAVA and 5.6 ± 1.0 mL/kg for PSV (p = 0.455) and there were no differences in RR (24 ± 7 for NAVA and 23 ± 7 for PSV, p = 0.661). Paw was greater in NAVA (21 ± 3 cmH2O) than in PSV (19 ± 3 cmH2O, p = 0.001). Most patients were under continuous sedation during the study. NAVA reduced triggering delay compared to PSV (p = 0.020) and the median asynchrony Index was 0.7% (0–2.7) in PSV and 0% (0–2.2) in NAVA (p = 0.6835). Conclusions It was feasible to keep VT in protective levels with NAVA and PSV for 75% of the patients. NAVA resulted in similar VT, RR and Paw compared to PSV. Our findings suggest that partial ventilatory assistance with NAVA and PSV is feasible as a protective ventilation strategy in selected ARDS patients under continuous sedation. Trial registration ClinicalTrials.gov (NCT01519258). Registered 26 January 2012, https://clinicaltrials.gov/ct2/show/NCT01519258
Published: 2020

14. Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo Association of alveolar recruitment maneuvers and prone position in acute respiratory disease syndrome patients

Author: Daniela Caetano Costa, Eduardo Rocha, and Tatiane Flores Ribeiro
Subjects: Pronação, Síndrome do desconforto respiratório do adulto, Respiração artificial, Pronation, Respiratory distress syndrome, adult, Respiration, artificial, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: A síndrome do desconforto respiratório agudo é a apresentação clínica de insuficiência respiratória aguda caracterizada por lesão alveolar difusa e pelo desenvolvimento do edema pulmonar não cardiogênico, devido ao aumento da permeabilidade da membrana alvéolo-capilar pulmonar. As manobras de recrutamento alveolar e a posição prona podem ser utilizadas no tratamento da síndrome do desconforto respiratório agudo. O objetivo deste estudo foi identificar os possíveis benefícios, indicações, complicações e cuidados na associação da manobra de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo. Realizou-se revisão de literatura científica nacional e internacional conforme os critérios estabelecidos para a pesquisa documental nas bases de dados MedLine, LILACS, SciElo, PubMed, Cochrane, no período de 1994-2008, nas linguagens portuguesa e inglesa, com os unitermos: síndrome do desconforto respiratório agudo, manobra de recrutamento alveolar e posição prona. Apesar de avanços no entendimento da fisiopatologia da síndrome do desconforto respiratório agudo, essa ainda resulta em significativa mortalidade. A manobra de recrutamento alveolar e a posição prona contribuem significativamente no tratamento desses pacientes com a finalidade de melhorar a oxigenação e reduzir as complicações decorrentes da hipoxemia refratária e diminuição da complacência pulmonar. Entretanto, na literatura, há poucos estudos que associam a manobra de recrutamento alveolar e posição prona no tratamento da síndrome do desconforto respiratório agudo, fazendo-se necessária maior investigação sobre o tema e evidências de sua aplicação clínica.The acute respiratory distress syndrome is the clinical presentation of acute lung injury characterized by diffuse alveolar damage and development of non-cardiogenic pulmonary edema due to increased pulmonary alveolar-capillary membrane permeability. Alveolar recruitment maneuvers and prone position can be used in the treatment of acute respiratory distress syndrome. The objective of this review of literature was to identify possible benefits, indications, complications and care of the associated recruitment maneuvers and prone position for treatment of the acute respiratory distress syndrome. This national and international scientific literature review was developed according to the established criteria for searching the databases MedLine, LILACS, SciElo, PubMed, Cochrane, from 1994 to 2008 in Portuguese and English, with the key words: acute respiratory distress syndrome, alveolar recruitment maneuver and prone position. Despite advances in the understanding of acute respiratory distress syndrome pathophysiology, mortality is still expressive. Alveolar recruitment maneuvers and prone position significantly contribute to treatment of acute respiratory distress syndrome patient aiming to improve oxygenation and minimizing complications of refractory hypoxemia and reduction of pulmonary compliance. However,as there are few studies in literature associating alveolar recruitment maneuvers and prone position for treatment of acute respiratory distress syndrome, additional research and evidences of clinical application are required.
Published: 2009
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15. Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome.

Author: Zhang, Yu-Jiao, Gao, Xin-Jing, Li, Zhi-Bo, Wang, Zhi-Yong, Feng, Quan-Sheng, Yin, Cheng-Fen, Lu, Xing, and Xu, Lei
Abstract: Purpose: This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO₂) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).Methods: Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction: VD/VT = 0.320 + 0.0106 (PaCO₂-ETCO₂)⁺ 0.003 (RR)⁺0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS. Here PaCO₂ is the arterial partial pressure of carbon dioxide in mmHg; ETCO₂, the end- tidal carbon dioxide measurement in mmHg; RR, respiratory rate per minute; and age in years. Once the patient had intubation, positive end expiratory pressure was adjusted and after Phigh reached a steady state, VD/VT was measured and recorded as the data for the first day. VD/VT measurement was repeated on days 2, 3, 4, 5 and 6. Meanwhile we collected dead-space fraction directly from the ventilator volu- metric CO₂ and recorded it as Vd/Vt. We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.Results: Overall, 46 patients with ARDS met the inclusion criteria and 24 of them died. During the first 6 days of intubation, VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01), day 5 (0.73 ± 0.01 vs. 0.54 ± 0.01), and day 6 (0.73 ± 0.02 vs. 0.54 ± 0.01) (all p =0.000). Vd/Vt showed no significant difference on days 1e4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs. 0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs. 0.40 ± 0.03) (both p=0.008). VD/VT on the fourth day was more accurate to predict survival than Vd/Vt. The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs. 0.701 ± 0.023, p = 0.0024) with the 95% confidence interval being 0.857-0.999 vs. 0.525-0.841.Conclusion: Compared with Vd/Vt derived from ventilator volumetric CO₂, VD/VT on day 4 calculated by Frankenfield et al's equation can more accurately predict the survival of ARDS patients. [ABSTRACT FROM AUTHOR]
Published: 2016
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16. Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition.

Author: Gibelin, Aude, Parrot, Antoine, Maitre, Bernard, Brun-Buisson, Christian, Mekontso Dessap, Armand, Fartoukh, Muriel, and de Prost, Nicolas
Subjects: *ADULT respiratory distress syndrome, *HISTOLOGY, *ARTIFICIAL respiration, *INTENSIVE care units, *BRONCHOALVEOLAR lavage, *ADULT respiratory distress syndrome treatment, *COMPARATIVE studies, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *EVALUATION research, *DISEASE prevalence, *RETROSPECTIVE studies, *DIAGNOSIS
Abstract: Purpose: Some patients presenting with acute respiratory failure and meeting the Berlin criteria for acute respiratory distress syndrome (ARDS) lack exposure to common risk factors (CRF). These so-called ARDS mimickers often lack histological diffuse alveolar damage. We aimed to describe such ARDS mimickers lacking CRF (ARDS CRF-) in comparison with others (ARDS CRF+).Methods: Retrospective study including all patients receiving invasive mechanical ventilation for ARDS admitted to the intensive care units (ICUs) of two tertiary care centers from January 2003 to December 2012.Results: The prevalence of ARDS CRF- was 7.5 % (95 % CI [5.5-9.5]; n = 50/665). On the basis of medical history, bronchoalveolar lavage fluid cytology, and chest CT scan patterns, four etiological categories were identified: immune (n = 18; 36 %), drug-induced (n = 13; 26 %), malignant (n = 7; 14 %), and idiopathic (n = 12; 24 %). Although the ARDS CRF- patients had a lower logistic organ dysfunction score (4 [3-8] vs. 10 [6-13]; p < 0.0001) and less often shock upon ICU admission (44 vs. 80 %; p < 0.0001) than their counterparts, their overall ICU mortality rate was very high (66 % [46-74]), and the absence of CRF remained associated with ICU mortality by multivariable logistic regression analysis (adjusted OR = 2.06; 95 % CI [1.02-4.18]; p = 0.044). Among ARDS CRF- patients, the presence of potentially reversible lung lesions with corticosteroids (aOR = 0.14; 95 % CI [0.03-0.62]) was associated with ICU survival.Conclusions: The absence of CRF among patients with ARDS is common and associated with a higher risk of mortality. For such atypical ARDS, a complete diagnostic workup, including bronchoalveolar lavage fluid cytology and chest CT scan patterns, should be performed to identify those patients who might benefit from specific therapies, including corticosteroids. [ABSTRACT FROM AUTHOR]
Published: 2016
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17. Adaptação metabólica diante de hipercapnia persistente aguda em pacientes submetidos à ventilação mecânica por síndrome do desconforto respiratório agudo.

Author: Romano, Thiago Gomes, Teles Correia, Mario Diego, Mendes, Pedro Vitale, Zampieri, Fernando Godinho, Maciel, Alexandre Toledo, and Park, Marcelo
Abstract: Objective: Hypercapnia resulting from protective ventilation in acute respiratory distress syndrome triggers metabolic pH compensation, which is not entirely characterized. We aimed to describe this metabolic compensation. Methods: The data were retrieved from a prospective collected database. Variables from patients' admission and from hypercapnia installation until the third day after installation were gathered. Forty-one patients with acute respiratory distress syndrome were analyzed, including twenty-six with persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15 non-hypercapnic (control group). An acid-base quantitative physicochemical approach was used for the analysis. Results: The mean ages in the hypercapnic and control groups were 48 ± 18 years and 44 ± 14 years, respectively. After the induction of hypercapnia, pH markedly decreased and gradually improved in the ensuing 72 hours, consistent with increases in the standard base excess. The metabolic acid-base adaptation occurred because of decreases in the serum lactate and strong ion gap and increases in the inorganic apparent strong ion difference. Furthermore, the elevation in the inorganic apparent strong ion difference occurred due to slight increases in serum sodium, magnesium, potassium and calcium. Serum chloride did not decrease for up to 72 hours after the initiation of hypercapnia. Conclusion: In this explanatory study, the results indicate that metabolic acid-base adaptation, which is triggered by acute persistent hypercapnia in patients with acute respiratory distress syndrome, is complex. Furthermore, further rapid increases in the standard base excess of hypercapnic patients involve decreases in serum lactate and unmeasured anions and increases in the inorganic apparent strong ion difference by means of slight increases in serum sodium, magnesium, calcium, and potassium. Serum chloride is not reduced. [ABSTRACT FROM AUTHOR]
Published: 2016
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18. Fatores associados à regulação da pressão parcial de oxigênio e da pressão parcial de gás carbônico durante suporte respiratório com oxigenação por membrana extracorpórea: dados de um modelo em suínos

Author: Park, Marcelo, Mendes, Pedro Vitale, Vieira Costa, Eduardo Leite, Santos Barbosa, Edzangela Vasconcelos, Hirota, Adriana Sayuri, and Pontes Azevedo, Luciano Cesar
Abstract: Objective: The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure. Methods: The factors associated with oxygen - and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested. Results: Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL). Conclusion: In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin. [ABSTRACT FROM AUTHOR]
Published: 2016
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19. Presentación de 1 caso con neumonía varicelosa y distrés respiratorio

Author: Carmen Remuñán Boue, Martha Ballmajó Real, Jorge Jiménez Armada, and Mario Joaquín González Fraga
Subjects: NEUMONIA VIRAL, VARICELA, SINDROME DE DIFICULTAD RESPIRATORIA DEL ADULTO, INDICADORES DE MORBIMORTALIDAD, RESPIRACION ARTIFICIAL, PNEUMONIA VIRAL, CHICKENPOX, RESPIRATORY DISTRESS SYNDROME, ADULT, INDICATORS OF MORBIDITY AND MORTALITY, RESPIRATION, ARTIFICIAL, Medicine
Abstract: Se presentó un caso de 46 años, masculino, con antecedentes de salud, que mantuvo contacto con niños portadores de varicela y que llegó a nosotros con lesiones en la piel típicas de varicela, falla respiratoria aguda y alteraciones de la coagulación. Se trató con aciclovir, intacglobin, y ventilación mecánica, a pesar de lo cual falleció antes de las 24 h de su ingreso, aunque debemos destacar que el tratamiento comenzó tardíamente y no existían antecedentes de vacunación previa. Se decidió presentar este caso, por la poca frecuencia de la varicela complicada en adultos sanos.This paper presents the case of a healthy 46 years-old man, who had been in contact with varicella-affected children. He came to the hospital with typical skin lesions from varicella, acute respiratory distress and coagulation problems. He was treated with acyclovir, intacglobin and mechanical ventilation, but unfortunately he died within 24 hours of his admission to the hospital. It should be underlined that the treatment was applied late and there was no antecedent of previous vaccination. We decided to present this case because complicated varicella is rarely seen in healthy adults.
Published: 2002

20. Acute respiratory distress syndrome: how do patients fare after the intensive care unit?

Author: Cassiano Teixeira, Roselaine Pinheiro de Oliveira, and Regis Goulart Rosa
Subjects: Quality of life, medicine.medical_specialty, Activities of daily living, Personal Satisfaction, Critical Care and Intensive Care Medicine, law.invention, law, Activities of Daily Living, Medicine, Humans, Social determinants of health, Survivors, Review Articles, Depression (differential diagnoses), Respiratory distress syndrome, adult, Respiratory Distress Syndrome, business.industry, Muscle weakness, General Medicine, Intensive care unit, Mental health, Respiration, Artificial, Intensive Care Units, Mental Health, Emergency medicine, Breathing, Anxiety, medicine.symptom, business
Abstract: Patients with acute respiratory distress syndrome require ventilation strategies that have been shown to be important for reducing short-term mortality, such as protective ventilation and prone position ventilation. However, patients who survive have a prolonged stay in both the intensive care unit and the hospital, and they experience a reduction in overall satisfaction with life (independence, acceptance and positive outlook) as well as decreased mental health (including anxiety, depression and posttraumatic stress disorder symptoms), physical health (impaired physical state and activities of daily living; fatigue and muscle weakness), social health and the ability to participate in social activities (including relationships with friends and family, hobbies and social gatherings).Os pacientes com síndrome do desconforto respiratório agudo requerem estratégias ventilatórias que demonstraram ser importantes na redução da mortalidade em curto prazo, como ventilação protetora e ventilação em posição prona. No entanto, os pacientes que sobrevivem têm permanência prolongada, tanto na unidade de terapia intensiva como no hospital, e experimentam redução na satisfação global com a vida (independência, aceitação e perspectiva positiva), na saúde mental (ansiedade, depressão e sintomas de transtorno de estresse pós-traumático), na saúde física (estado físico, atividades da vida diária, fadiga e fraqueza muscular), na saúde social e na capacidade de realização de suas atividades sociais (amigos ou relações familiares, hobbies e atividades sociais).
Published: 2019

21. Reply to Camporota : The 4DPRR Index and Mechanical Power: A Step Ahead or 4 Steps Backward?

Author: Costa, Eduardo L V, Slutsky, Arthur S, and Amato, Marcelo B P
Published: 2021
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22. A case report of individualized ventilation in a COVID-19 patient - new possibilities and caveats to consider with flow-controlled ventilation

Author: Patrick Spraider, Bernhard Glodny, Gabriel Putzer, Julia Abram, Simon Mathis, Judith Martini, and Robert Breitkopf
Subjects: medicine.medical_specialty, ARDS, medicine.medical_treatment, Case Report, Respiratory physiology, Pulmonary compliance, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, medicine, Intubation, Intratracheal, Humans, RD78.3-87.3, 030212 general & internal medicine, Expiration, Precision Medicine, Lung Compliance, Tidal volume, Mechanical ventilation, Air Pressure, Respiratory Distress Syndrome, Ventilators, Mechanical, business.industry, Respiratory Distress Syndrome, Adult, COVID-19, 030208 emergency & critical care medicine, Oxygenation, Middle Aged, medicine.disease, Respiration, Artificial, 3. Good health, Anesthesiology and Pain Medicine, Ventilation (architecture), Emergency medicine, Respiratory Mechanics, Female, Stress Mechanical, Stress, Mechanical, business, Tomography, X-Ray Computed, Compliance
Abstract: Background Flow-controlled ventilation (FCV) is a novel ventilation method increasingly being used clinically, particularly during the current COVID-19 pandemic. However, the continuous flow pattern in FCV during inspiration and expiration has a significant impact on respiratory parameters and ventilatory settings compared to conventional ventilation modes. In addition, the constant flow combined with direct intratracheal pressure measurement allows determination of dynamic compliance and ventilation settings can be adjusted accordingly, reflecting a personalized ventilation approach. Case presentation A 50-year old women with confirmed SARS-CoV-2 infection suffering from acute respiratory distress syndrome (ARDS) was admitted to a tertiary medical center. Initial ventilation occurred with best standard of care pressure-controlled ventilation (PCV) and was then switched to FCV, by adopting PCV ventilator settings. This led to an increase in oxygenation by 30 %. Subsequently, to reduce invasiveness of mechanical ventilation, FCV was individualized by dynamic compliance guided adjustment of both, positive end-expiratory pressure and peak pressure; this intervention reduced driving pressure from 18 to 12 cm H2O. However, after several hours, compliance further deteriorated which resulted in a tidal volume of only 4.7 ml/kg. Conclusions An individualized FCV approach increased oxygenation parameters in a patient suffering from severe COVID-19 related ARDS. Direct intratracheal pressure measurements allow for determination of dynamic compliance and thus optimization of ventilator settings, thereby reducing applied and dissipated energy. However, although desirable, this personalized ventilation strategy may reach its limits when lung function is so severely impaired that patient’s oxygenation has to be ensured at the expense of lung protective ventilation concepts.
Published: 2021

23. Driving pressure and mortality in trauma without acute respiratory distress syndrome: a prospective observational study

Author: Marcelo de Mello Rieder, Jairo Corrêa da Silveira Júnior, and Eder Kröeff Cardoso
Subjects: medicine.medical_specialty, Respiratory mechanics, Acute respiratory distress, Cuidados intensivos, Critical Care and Intensive Care Medicine, Trauma, medicine, Humans, Prospective Studies, Mortality, Gynecology, Respiratory Distress Syndrome, Respiratory distress syndrome, adult, Intensive care units, business.industry, Mecânica respiratória, General Medicine, Síndrome do desconforto respiratório do adulto, Respiration, Artificial, Critical care, Unidades de terapia intensiva, Respiração artificial, Mortalidade, Original Article, Blood Gas Analysis, business
Abstract: To identify the possible association between driving pressure and mechanical power values and oxygenation index on the first day of mechanical ventilation with the mortality of trauma patients without a diagnosis of acute respiratory distress syndrome.Patients under pressure-controlled or volume-controlled ventilation were included, with data collection 24 hours after orotracheal intubation. Patient follow-up was performed for 30 days to obtain the clinical outcome. The patients were admitted to two intensive care units of the Hospital de Pronto Socorro de Porto Alegre from June to September 2019.A total of 24 patients were evaluated. Driving pressure, mechanical power and oxygenation index were similar among patients who survived and those who died, with no statistically significant difference between groups.Driving pressure, mechanical power and oxygenation index values obtained on the first day of mechanical ventilation were not associated with mortality of trauma patients without acute respiratory distress syndrome.Identificar a existência de associação entre os valores de driving pressure e mechanical power e do índice de oxigenação no primeiro dia de ventilação mecânica com a mortalidade de pacientes vítimas de trauma sem diagnóstico de síndrome do desconforto respiratório agudo.Foram incluídos pacientes ventilados em modo de pressão ou volume controlado, com coleta de dados 24 horas após sua intubação orotraqueal. O acompanhamento do paciente foi realizado por 30 dias para obter o desfecho clínico. Os pacientes estiveram internados em duas unidades de terapia intensiva do Hospital de Pronto Socorro de Porto Alegre, no período de junho a setembro de 2019.Foram avaliados 24 pacientes. Os valores de driving pressure, mechanical power e do índice de oxigenação foram similares entre os pacientes que sobreviveram e os que tiveram desfecho de óbito, sem diferença estatisticamente significativa entre os grupos.Os valores de driving pressure, mechanical power e índice de oxigenação obtidos no primeiro dia de ventilação mecânica não demonstraram ter associação com a mortalidade de pacientes vítimas de trauma sem síndrome do desconforto respiratório agudo.
Published: 2021

24. Ventilação mecânica protetora em pacientes com fator de risco para SDRA: estudo de coorte prospectiva

Author: Cristiane Bastos-Netto, Maycon Moura Reboredo, Rodrigo Souza Vieira, Lídia Maria Carneiro da Fonseca, Erich Vidal Carvalho, Marcelo Alcantara Holanda, and Bruno Valle Pinheiro
Subjects: Mechanical ventilation, medicine.medical_specialty, ARDS, Respiratory distress syndrome, adult, RC705-779, Proportional hazards model, business.industry, medicine.medical_treatment, Hazard ratio, Síndrome do desconforto respiratório do adulto, medicine.disease, Tidal volume, Diseases of the respiratory system, Respiração artificial, Internal medicine, medicine, Cardiology, Volume de ventilação pulmonar, Risk factor, Simplified Acute Physiology Score, Respiration, artificial, Prospective cohort study, business
Abstract: Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS. RESUMO Objetivo: Avaliar a associação da ventilação mecânica (VM) protetora, com base no VT e na pressão de distensão máxima (PDM), com a mortalidade em pacientes com fator de risco para SDRA. Métodos: Este estudo de coorte prospectivo foi conduzido em uma UTI e incluiu 116 pacientes em VM que apresentavam pelo menos um fator de risco para o desenvolvimento de SDRA. Os parâmetros ventilatórios foram coletados duas vezes ao dia durante sete dias, e os pacientes foram divididos em dois grupos (VM protetora e VM não protetora) com base na PDM (diferença entre pressão máxima de vias aéreas e PEEP) ou no VT. Os desfechos foram mortalidade em 28 dias, mortalidade na UTI e mortalidade hospitalar. Os fatores de risco associados com a adoção da VM não protetora também foram avaliados. Resultados: A VM não protetora com base no VT e na PDM ocorreu em 49 (42,2%) e em 38 (32,8%) dos pacientes, respectivamente. A regressão multivariada de Cox mostrou que a VM protetora com base na PDM associou-se a menor mortalidade hospitalar (hazard ratio = 0,37; IC95%: 0,19-0,73) e em UTI (hazard ratio = 0,40; IC95%, 0,19-0,85), após ajuste para idade, Simplified Acute Physiology Score 3, uso de vasopressor e valores basais de PaO2/FiO2, PEEP, pH e PaCO2. Essas associações não foram observadas quando a VM não protetora foi baseada no VT. Conclusões: A PDM parece ser uma ferramenta útil, melhor do que o VT, para o ajuste da VM em pacientes sob risco para SDRA.
Published: 2021

25. Caring for patients at risk of ARDS: the role of driving pressure

Author: Glauco Cabral Marinho Plens and Eduardo Leite Vieira Costa
Subjects: ARDS, medicine.medical_specialty, MEDLINE, Patient care, Tidal volume, Positive-Pressure Respiration, Diseases of the respiratory system, Text mining, Risk Factors, medicine, Humans, Volume de ventilação pulmonar, Prospective Studies, Prospective cohort study, Intensive care medicine, Respiratory distress syndrome, adult, Respiratory Distress Syndrome, RC705-779, business.industry, Síndrome do desconforto respiratório do adulto, medicine.disease, Respiration, Artificial, Respiração artificial, Editorial, Original Article, Patient Care, business
Abstract: Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS.
Published: 2021

26. Factores de riesgo asociados a mortalidad en pacientes con SDRA por COVID-19 sometidos a terapia prono en un hospital universitario de Bogotá, Colombia

Author: Larrahondo Velasco, Jimmi, Valero Bernal, José Francisco, Pérez Cely, Jairo Antonio, and Espinosa Almanza, Carmelo José
Subjects: Respiración Artificial, Coronavirus disease 2019, Acute respiratory distress syndrome, Enfermedad por coronavirus 2019, 617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología [610 - Medicina y salud], Respiratory Distress Syndrome, Adult, Síndrome de Dificultad Respiratoria del Adulto, Terapia prono, Respiration, Artificial, Ventilación mecánica, Mechanical ventilation, Síndrome de distrés respiratorio agudo, Insuficiencia respiratoria, Infecciones por Coronavirus, Coronavirus Infections, Respiratory insufficiency, Prone therapy
Abstract: ilustraciones, gráficas, tablas Una pequeña pero considerable proporción de pacientes COVID-19 (coronavirus disease 2019) pueden desarrollar síndrome de distrés respiratorio agudo (SDRA) severo con requerimiento de ventilación mecánica invasiva, lo cual condiciona un riesgo elevado de mortalidad. La terapia prono es una de las pocas intervenciones que ha demostrado mejorar la supervivencia en pacientes con SDRA severo. Dado que es importante caracterizar nuestra población para optimizar estrategias en la atención médica, se planteó el siguiente estudio. Objetivo primario: Establecer los factores de riesgo asociados a mortalidad en pacientes con SDRA secundario a COVID-19 que son sometidos a terapia de ventilación mecánica en prono, en un hospital universitario de Bogotá. Colombia. Metodología: Estudio observacional, analítico, de cohorte retrospectiva. La información se recopiló de la base de datos de la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario Nacional de Colombia (HUN) desde marzo de 2020 a marzo de 2021. La estadística descriptiva se organizó en frecuencias y porcentajes para variables categóricas y, rangos, mediana, media y desviación estándar (DE) para variables continuas. El análisis bivariado se estableció con significancia a 2 colas con p < 0.05, T student para variables continuas y test de Chi2 para variables cualitativas. Finalmente, el análisis multivariado se llevo a cabo con un modelo de regresión logística. Resultados: Fueron analizados 242 pacientes, 171 hombres (70.6%) y 71 mujeres (29.3%). El promedio de edad fue de 62.9 años (DE 12.5). Las comorbilidades más frecuentes fueron la hipertensión arterial (HTA) con 48.7%, obesidad (39.6%) y diabetes (29.3%). Al ingreso a UCI las alteraciones en laboratorios más frecuentes fueron, elevación de dímero D y proteína C reactiva (PCR). El valor de la relación entre la PaO2 y la FiO2 (PaFi) fue considerablemente bajo (106.97, DE 32.9) al ingreso a la UCI. La mortalidad global fue de 52.5%. Los pacientes no sobrevivientes presentaron significativamente mayor edad y mayor prevalencia de HTA, así mismo presentaron niveles mayores de PCR y lactato sérico. También presentaron mayor requerimiento de soporte vasopresor y terapia de reemplazo renal. Se identificaron como factores de riesgo independientes la edad (OR 1.06 [1.03 – 1.08]), la terapia de reemplazo renal (OR 2.22 [1.08 – 4.61]) y el valor del lactato de ingreso a UCI (1.62 [1.03 – 2.6]). El valor de PaFi al tercer ciclo prono fue predictor de supervivencia (OR 0.99 [0.98 – 0.99]). Conclusión: La mortalidad en los pacientes con COVID-19 ventilados mecánicamente y sometidos a terapia prono es alta. La edad, el valor de lactato sérico al ingreso a UCI y el requerimiento de terapia de reemplazo renal son factores de riesgo asociados a mortalidad. La mejoría de la PaFi al tercer ciclo prono predice supervivencia. (Texto tomado de la fuente). Background: A small but considerable proportion of COVID-19 (coronavirus disease 2019) patients may develop severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation, which conditions a high risk of mortality. Prone therapy is one of the few interventions that have been shown to improve survival in patients with severe ARDS. Because it is important to characterize our population to optimize strategies in medical care, the following study was proposed. Primary aim: To establish the risk factors associated with mortality in patients with ARDS secondary to COVID-19 who received prone mechanical ventilation therapy in a university hospital in Bogotá. Colombia. Methods: Observational, analytical, retrospective cohort study. The information was collected from the database of the Intensive Care Unit (ICU) of the National University Hospital of Colombia (HUN) from March 2020 to March 2021. The descriptive statistics were organized in frequencies and percentages for categorical variables and, ranges, median, mean and standard deviation (SD) for continuous variables. The bivariate analysis was established with 2-tailed significance with p < 0.05, T student for continuous variables and Chi2 test for qualitative variables. Finally, the multivariate analysis was carried out with a logistic regression model. Results: A total of 242 patients were analyzed, 171 men (70.6%) and 71 women (29.3%). The average age was 62.9 years (SD 12.5). The most frequent comorbidities were hypertension (48.7%), obesity (39.6%) and diabetes (29.3%). Upon admission to the ICU, the most frequent laboratory abnormalities were elevated D-dimer and CRP. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was considerably low (106.97, SD 32.9) on admission to the ICU. Overall mortality was 52.5%. Non-surviving patients were significantly older and had a higher prevalence of hypertension, as well as higher levels of CRP and serum lactate. They also presented a higher requirement for vasopressor support and renal replacement therapy. Age (OR 1.06 [1.03 – 1.08]), renal replacement therapy (OR 2.22 [1.08 – 4.61]), and ICU admission lactate value (1.62 [1.03 – 2.6]) were identified as independent risk factors. The PaFi value at the third prone cycle was a predictor of survival (OR 0.99 [0.98 – 0.99]). Conclusions: Mortality in mechanically ventilated COVID-19 patients undergoing prone therapy is high. Age, serum lactate value at admission to the ICU and the requirement for renal replacement therapy are risk factors associated with mortality. The improvement of PaFi at the third prone cycle predicts survival. Especialidades Médicas Especialista en Anestesiología y Reanimación Estudio observacional, analítico, de cohorte retrospectiva. La información se recopiló de la base de datos de la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario Nacional de Colombia (HUN) desde marzo de 2020 a marzo de 2021. La estadística descriptiva se organizó en frecuencias y porcentajes para variables categóricas y, rangos, mediana, media y desviación estándar (DE) para variables continuas. El análisis bivariado se estableció con significancia a 2 colas con p < 0.05, T student para variables continuas y test de Chi2 para variables cualitativas. Finalmente, el análisis multivariado se llevo a cabo con un modelo de regresión logística.
Published: 2021

27. Carbon Dioxide in the Critically 111: Too Much or Too Little of a Good Thing?

Author: Marhong, Jonathan and Fan, Eddy
Subjects: BRAIN injuries, CARBON dioxide, CARDIOVASCULAR system, CENTRAL nervous system, CRITICALLY ill, HYPERCAPNIA, IMMUNE system, LUNG injuries, RESPIRATORY acidosis, PATIENTS, ADULT respiratory distress syndrome, MECHANICAL ventilators, RESPIRATORY mechanics, HYPOCAPNIA
Abstract: Hypercapnia and hypocapnia commonly complicate conditions that are present in critically ill patients. Both conditions have important physiologic effects that may impact the clinical management of these patients. For instance, hypercapnia results in bronchodilation and enhanced hypoxic vasoconstriction, leading to improved ventilation/perfusion matching. Hypocapnia reduces cerebral blood volume through arterial vasoconstriction. These effects have also been exploited for therapeutic aims. In patients with traumatic brain injury (TBI), hypocapnia is often utilized to control intracranial pressure. However, this effect is not sustained, and prolonged hypocapnia increases the risk of mortality and severe disability in patients with TBI. Hypercapnia and hypercapnic acidosis are common consequences of lung-protective ventilation in ARDS. Hypercapnic acidosis reduces ischemic lung injury and preserves lung compliance, but concern has arisen over hypercapnia-induced immunosuppression and the potential for bacterial proliferation in sepsis. Experimental studies suggest that buffering hypercapnic acidosis attenuates these effects, whereas hypocapnia appears to potentiate lung injury through increased capillary permeability and decreased lung compliance. Several areas of uncertainty surround the role of hypercapnia/hypocapnia in treating TBI and ARDS. Current data support recommendations to avoid hypocapnia in treating TBI, with the exception of emergent treatment of elevated intracranial pressure, while awaiting definitive management. Permissive hypercapnia is commonly accepted as a consequence of lung-protective ventilation in ARDS, but there is insufficient evidence to support the induction of hypercapnic acidosis in clinical practice. Buffering hypercapnic acidosis should be considered only for a specific clinical indication (eg, hemodynamic instability). For clinicians choosing to buffer hypercapnic acidosis, tris-hydroxymethyl aminomethane is recommended over sodium bicarbonate, as it is more effective in correcting pH and is not associated with increased carbon dioxide production. Future studies should aim to address these areas of uncertainty to help guide clinicians in the therapeutic use and management of hypercapnia/hypocapnia in critically ill patients. [ABSTRACT FROM AUTHOR]
Published: 2014
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28. A 29-Year-Old Male with a Fatal Case of COVID-19 Acute Respiratory Distress Syndrome (CARDS) and Ventilator-Induced Lung Injury (VILI)

Author: Arul Chandran, Anoosha Ponnapalli, Ghassan Bachuwa, Mohammed Berrou, Smit Deliwala, and Elfateh Seedahmed
Subjects: Adult, Male, ARDS, Ventilator-Induced Lung Injury, Pneumonia, Viral, 030204 cardiovascular system & hematology, Lung injury, Hypoxemia, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Fatal Outcome, medicine, Coagulopathy, Humans, Pandemics, Lung, business.industry, SARS-CoV-2, Artilces, Respiratory Distress Syndrome, Adult, COVID-19, Pneumothorax, General Medicine, medicine.disease, Respiration, Artificial, respiratory tract diseases, Coronavirus, Pneumonia, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Anesthesia, Breathing, medicine.symptom, business, Coronavirus Infections
Abstract: Patient: Male, 29-year-old Final Diagnosis: Acute respiratory distress syndrome (ARDS) • COVID-19 •multi organ failure/septic shock • pneumothorax Symptoms: Cough • dyspnea • fatigue • myalgia Medication:— Clinical Procedure: Mechanical ventilation • thoracentesis Specialty: Critical Care Medicine Objective: Unknown ethiology Background: COVID-19 patients that develop acute respiratory distress syndrome (ARDS) “CARDS” behave differently compared to patients with classic forms of ARDS. Recently 2 CARDS phenotypes have been described, Type L and Type H. Most patients stabilize at the milder form, Type L, while an unknown subset progress to Type H, resembling full-blown ARDS. If uncorrected, phenotypic conversion can induce a rapid downward spiral towards progressive lung injury, vasoplegia, and pulmonary shrinkage, risking ventilator-induced lung injury (VILI) known as the “VILI vortex”. No cases of in-hospital phenotypic conversion have been reported, while ventilation strategies in these patients differ from the lung-protective approaches seen in classic ARDS. Case Report: A 29-year old male was admitted with COVID-19 pneumonia complicated by severe ARDS, multi-organ failure, cytokine release syndrome, and coagulopathy during his admission. He initially resembled CARDS Type L case, although refractory hypoxemia, fevers, and a high viral burden prompted conversion to Type H within 8 days. Despite ventilation strategies, neuromuscular blockade, inhalation therapy, and vitamin C, he remained asynchronous to the ventilator with volumes and pressures beyond accepted thresholds, eventually developing a fatal tension pneumothorax. Conclusions: Patients that convert to Type H can quickly enter a spiral of hypoxemia, shunting, and dead-space ventilation towards full-blown ARDS. Understanding its nuances is vital to interrupting phenotypic conversion and entry into VILI vortex. Tension pneumothorax represents a poor outcome in patients with CARDS. Further research into monitoring lung dynamics, modifying ventilation strategies, and understanding response to various modes of ventilation in CARDS are required to mitigate these adverse outcomes.
Published: 2020

29. Síndrome do desconforto respiratório agudo associada à COVID-19 tratada com DEXametasona (CoDEX): delineamento e justificativa de um estudo randomizado

Author: Otavio Berwanger, Alvaro Avezum, Michele Ouriques Honorato, Luciano Cesar Pontes Azevedo, Lucas P. Damiani, Viviane Cordeiro Veiga, Eduardo L. V. Costa, Flavia Regina Bueno, Maria Vitoria Aparecida Oliveira Silva, Flávia Ribeiro Machado, Israel Silva Maia, André Nathan Costa, Regis Goulart Rosa, Bruno Martins Tomazini, Alexandre Biasi Cavalcanti, Ricardo Antonio Bonifácio Moura, Franca Pellison Baldassare, and Renato D. Lopes
Subjects: 0301 basic medicine, ARDS, Time Factors, Organ Dysfunction Scores, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Dexamethasone, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Data monitoring committee, Prospective Studies, Cuidados críticos, Respiratory Distress Syndrome, Standard treatment, General Medicine, Dexametasona, Síndrome do desconforto respiratório do adulto, Intensive care unit, Coronavírus, Intensive Care Units, 030220 oncology & carcinogenesis, Original Article, Coronavirus Infections, Adult, medicine.medical_specialty, Randomization, Pneumonia, Viral, 03 medical and health sciences, Internal medicine, medicine, Humans, Glucocorticoids, Pandemics, Gynecology, Mechanical ventilation, Respiratory distress syndrome, adult, business.industry, Adrenal cortex hormones, COVID-19, Corticosteroides, medicine.disease, Respiration, Artificial, COVID-19 Drug Treatment, Coronavirus, Clinical trial, Critical care, 030104 developmental biology, business
Abstract: RESUMO Objetivo: A infecção causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) disseminou-se por todo o mundo e foi categorizada como pandemia. As manifestações mais comuns da infecção pelo SARS-CoV-2 (doença pelo coronavírus 2019 - COVID-19) se referem a uma pneumonia viral com graus variáveis de comprometimento respiratório e até 40% dos pacientes hospitalizados, que podem desenvolver uma síndrome do desconforto respiratório agudo. Diferentes ensaios clínicos avaliaram o papel dos corticosteroides na síndrome do desconforto respiratório agudo não relacionada com COVID-19, obtendo resultados conflitantes. Delineamos o presente estudo para avaliar a eficácia da administração endovenosa precoce de dexametasona no número de dias vivo e sem ventilação mecânica nos 28 dias após a randomização, em pacientes adultos com quadro moderado ou grave de síndrome do desconforto respiratório agudo causada por COVID-19 provável ou confirmada. Métodos: Este é um ensaio pragmático, prospectivo, randomizado, estratificado, multicêntrico, aberto e controlado que incluirá 350 pacientes com quadro inicial (menos de 48 horas antes da randomização) de síndrome do desconforto respiratório agudo moderada ou grave, definida segundo os critérios de Berlim, causada por COVID-19. Os pacientes elegíveis serão alocados de forma aleatória para tratamento padrão mais dexametasona (Grupo Intervenção) ou tratamento padrão sem dexametasona (Grupo Controle). Os pacientes no Grupo Intervenção receberão dexametasona 20mg por via endovenosa uma vez ao dia, por 5 dias, e, a seguir, dexametasona por via endovenosa 10mg ao dia por mais 5 dias, ou até receber alta da unidade de terapia intensiva, o que ocorrer antes. O desfecho primário será o número de dias livres de ventilação mecânica nos 28 dias após a randomização, definido como o número de dias vivo e livres de ventilação mecânica invasiva. Os desfechos secundários serão a taxa de mortalidade por todas as causas no dia 28, a condição clínica no dia 15 avaliada com utilização de uma escala ordinal de seis níveis, a duração da ventilação mecânica desde a randomização até o dia 28, a avaliação com o Sequential Organ Failure Assessment Score após 48 horas, 72 horas e 7 dias, e o número de dias fora da unidade de terapia intensiva nos 28 dias após a randomização. Abstract Objective: The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads worldwide and is considered a pandemic. The most common manifestation of SARS-CoV-2 infection (coronavirus disease 2019 - COVID-19) is viral pneumonia with varying degrees of respiratory compromise and up to 40% of hospitalized patients might develop acute respiratory distress syndrome. Several clinical trials evaluated the role of corticosteroids in non-COVID-19 acute respiratory distress syndrome with conflicting results. We designed a trial to evaluate the effectiveness of early intravenous dexamethasone administration on the number of days alive and free of mechanical ventilation within 28 days after randomization in adult patients with moderate or severe acute respiratory distress syndrome due to confirmed or probable COVID-19. Methods: This is a pragmatic, prospective, randomized, stratified, multicenter, open-label, controlled trial including 350 patients with early-onset (less than 48 hours before randomization) moderate or severe acute respiratory distress syndrome, defined by the Berlin criteria, due to COVID-19. Eligible patients will be randomly allocated to either standard treatment plus dexamethasone (Intervention Group) or standard treatment without dexamethasone (Control Group). Patients in the intervention group will receive dexamethasone 20mg intravenous once daily for 5 days, followed by dexamethasone 10mg IV once daily for additional 5 days or until intensive care unit discharge, whichever occurs first. The primary outcome is ventilator-free days within 28 days after randomization, defined as days alive and free from invasive mechanical ventilation. Secondary outcomes are all-cause mortality rates at day 28, evaluation of the clinical status at day 15 assessed with a 6-level ordinal scale, mechanical ventilation duration from randomization to day 28, Sequential Organ Failure Assessment Score evaluation at 48 hours, 72 hours and 7 days and intensive care unit -free days within 28.
Published: 2020
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30. SARS-CoV-2 and rhinovirus/enterovirus co-infection in a critically ill young adult patient in Colombia

Author: Juan Pablo, Orozco-Hernández, Juan José, Montoya-Martínez, Manuel Conrado, Pacheco-Gallego, Mauricio, Céspedes-Roncancio, and Gloria Liliana, Porras-Hurtado
Subjects: Adult, Critical Care, Rhinovirus, Critical Illness, Pneumonia, Viral, infecciones por coronavirus, Coronavirus infections, Colombia, Antiviral Agents, Presentación De Casos, Betacoronavirus, COVID-19 Testing, case reports, Enterovirus Infections, Humans, pneumonia, Pandemics, Enterovirus, Respiratory Distress Syndrome, síndrome de dificultad respiratoria del adulto, Picornaviridae Infections, Clinical Laboratory Techniques, Coinfection, SARS-CoV-2, COVID-19, neumonía, Length of Stay, Combined Modality Therapy, Respiration, Artificial, Anti-Bacterial Agents, informes de casos, Disease Progression, Female, respiratory distress syndrome, adult
Abstract: The current SARS-CoV-2 pandemic has caused a huge global public health problem. We report the case of a young adult patient with laboratory-confirmed SARS-CoV-2. We describe the identification of the virus and the clinical course, diagnosis, and treatment of the infection including her rapid clinical deterioration from the mild initial symptoms, which progressed to multilobar pneumonia requiring admission to the intensive care unit. This case highlights the importance of establishing a diagnosis based on the clinical findings and the patient’s history bearing in mind the possibility of gastrointestinal symptoms in addition to respiratory ones. Besides, the presence of risk factors should be investigated; in this case, we proposed obesity as a possible risk factor. Furthermore, limitations in diagnostic tests and the possibility of co-infection with other respiratory pathogens are highlighted. We describe the imaging, laboratory findings, and treatment taking into account the limited current evidence.La actual pandemia por SARS-CoV-2 ha ocasionado un enorme problema de salud pública mundial. Se reporta el caso de una paciente adulta joven con SARS-CoV-2 confirmado por laboratorio. Se describe la identificación del virus y el curso clínico, el diagnóstico y el tratamiento de la infección. La paciente tuvo un rápido deterioro clínico a partir de síntomas iniciales leves que progresaron a una neumonía multilobar que requirió su hospitalización en la unidad de cuidados intensivos. Se destaca la importancia de establecer un diagnóstico basado en la clínica y los antecedentes del paciente, y considerando los posibles síntomas gastrointestinales además de los respiratorios. Asimismo, debe indagarse sobre la presencia de factores de riesgo, en este caso, la obesidad. También se señalan las limitaciones en las pruebas diagnósticas y la posibilidad de infección concomitante con otros agentes patógenos respiratorios, así como los hallazgos en las imágenes diagnósticas, los exámenes de laboratorio y el tratamiento en el marco de la limitada información con que se cuenta actualmente.
Published: 2020

31. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)

Author: Maurizio Sommariva, Giuseppe Gaudiello, Alessia Colombo, Andrea Lanza, Emilia Privitera, Pamela Frigerio, Cesare Del Monaco, Marta Lazzeri, Mara Paneroni, Francesco D'Abrosca, Simone Cecchetto, Martina Santambrogio, Veronica Rossi, Raffaella Bellini, Angela Bellofiore, and Mariangela Retucci
Subjects: Infectious Disease Transmission, medicine.medical_treatment, lcsh:Medicine, medicine.disease_cause, Patient-to-Professional, Pandemic, Medicine, Infection control, Viral, Respiratory system, Respiratory Protective Devices, Hypoxia, Coronavirus, Respiratory Distress Syndrome, Rehabilitation, Respiration, Italy, Artificial, Cardiology and Cardiovascular Medicine, Coronavirus Infections, Respiratory Insufficiency, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Respiratory Therapy, Infectious Disease Transmission, Patient-to-Professional, Critical Care, SARS-Cov-2, Pneumonia, Viral, rehabilitation, Dyspnea, Humans, Infection Control, Noninvasive Ventilation, Pandemics, Pronation, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Betacoronavirus, Physical Therapy Modalities, Intensive care, physiotherapy, business.industry, lcsh:R, COVID-19, Pneumonia, medicine.disease, infection, Emergency medicine, Position paper, business
Abstract: Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.
Published: 2020

32. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection

Author: Alejandra G. Garrido, Bárbara Vieira Carneiro, Fabricio Rodrigues Torres de Carvalho, Ana Claudia Ferraz de Almeida, Carmen Silvia Valente Barbas, Karina T. Timenetsky, Roseny dos Reis Rodrigues, Moacyr Silva Júnior, Farah Christina de La Cruz Scarin, Adriano José Pereira, Thiago Domingos Corrêa, Ricardo Luiz Cordioli, Roberto Rabello Filho, Hélio Penna Guimarães, Bruno de Arruda Bravim, Antonio Eduardo Pesaro, Carla Luciana Batista, Gustavo Faissol Janot de Matos, Marcele Liliane Pesavento, Frederico Polito Lomar, M. Assuncao, Rodrigo Martins Brandão, Marcelo Franken, João Carlos de Campos Guerra, Cilene S.D.M. Silva, Leonardo José Rolim Ferraz, Ricardo Kenji Nawa, and Raquel Afonso Caserta Eid
Subjects: medicine.medical_specialty, intensive care units, Critical Illness, Pneumonia, Viral, coronavirus, lcsh:Medicine, macromolecular substances, Severe Acute Respiratory Syndrome, Special Article, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Artigo Especial, respiratory insufficiency, medicine, Humans, 030212 general & internal medicine, Letter to the Editor, Pandemics, Gynecology, Respiratory distress syndrome, adult, Intensive care units, SARS-CoV-2, business.industry, lcsh:R, COVID-19, General Medicine, Síndrome do desconforto respiratório do adulto, Respiration, Artificial, Checklist, Coronavírus, Coronavirus, Unidades de terapia intensiva, covid-19, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Carta Ao Editor, Medicine, Insuficiência respiratória, Coronavirus Infections, business, Respiratory insufficiency, respiratory distress syndrome, adult
Abstract: In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).
Published: 2020

33. Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: Insights from the LUNG SAFE study

Author: Madotto F, Rezoagli E, Pham T, Schmidt M, McNicholas B, Protti A, Panwar R, Bellani G, Fan E, van Haren F, Brochard L, Laffey JG, Antonio Pesenti, John G Laffey, Laurent Brochard, Andres Esteban, Luciano Gattinoni, Frank van Haren, Anders Larsson, Daniel F McAuley, Marco Ranieri, Gordon Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Fernando Rios, T Sottiaux, P Depuydt, Fredy S Lora, Luciano Cesar Azevedo, Eddy Fan, Guillermo Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimir Cerny, Jonas Nielsen, Manuel Jibaja, Tài Pham, Dimitrios Matamis, Jorge Luis Ranero, Pravin Amin, S M Hashemian, Kevin Clarkson, Giacomo Bellani, Kiyoyasu Kurahashi, Asisclo Villagomez, Amine Ali Zeggwagh, Leo M Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero do Vale Fernandes, Dorel Sandesc, Yaasen Arabi, Vesna Bumbasierevic, Nicolas Nin, Jose A Lorente, Lise Piquilloud, Fekri Abroug, Lia McNamee, Javier Hurtado, Ed Bajwa, Gabriel Démpaire, Uhc Mother Theresa, Hektor Sula, Lordian Nunci, Alma Cani, Villa Maria, Alan Zazu, Christian Dellera, Carolina S Insaurralde, Risso V Alejandro, Julio Daldin, Mauricio Vinzio, Ruben O Fernandez, Luis P Cardonnet, Lisandro R Bettini, Mariano Carboni Bisso, Emilio M Osman, Mariano G Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Norberto C Pozo, Nicolas Grubissich, Gustavo A Plotnikow, Daniela N Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A Pellegrini, María G Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo E Gomez, Valeria I Cerrato, Marco G Bezzi, Silvina A Borello, Flavia A Loiacono, Adriana M Fernandez, Serena Knowles, Claire Reynolds, Deborah M Inskip, Jennene J Miller, Jing Kong, Christina Whitehead, Shailesh Bihari, Aylin Seven, Amanda Krstevski, Helen J Rodgers, Rebecca T Millar, Toni E Mckenna, Irene M Bailey, Gabrielle C Hanlon, Anders Aneman, Joan M Lynch, Raman Azad, John Neal, Paul W Woods, Brigit L Roberts, Mark R Kol, Helen S Wong, Katharina C Riss, Thomas Staudinger, Xavier Wittebole, Caroline Berghe, Pierre A Bulpa, Alain M Dive, Rik Verstraete, Herve Lebbinck, Pieter Depuydt, Joris Vermassen, Philippe Meersseman, Helga Ceunen, Jonas I Rosa, Daniel O Beraldo, Claudio Piras, Adenilton M Rampinelli, Antonio P Nassar Jr, Sergio Mataloun, Marcelo Moock, Marlus M Thompson, Claudio H Gonçalves, Ana Carolina P Antônio, Aline Ascoli, Rodrigo S Biondi, Danielle C Fontenele, Danielle Nobrega, Vanessa M Sales, Suresh Shindhe, Dk Maizatul Aiman B Pg Hj Ismail, John Laffey, Francois Beloncle, Kyle G Davies, Rob Cirone, Venika Manoharan, Mehvish Ismail, Ewan C Goligher, Mandeep Jassal, Erin Nishikawa, Areej Javeed, Gerard Curley, Nuttapol Rittayamai, Matteo Parotto, Niall D Ferguson, Sangeeta Mehta, Jenny Knoll, Antoine Pronovost, Sergio Canestrini, Alejandro R Bruhn, Patricio H Garcia, Felipe A Aliaga, Pamela A Farías, Jacob S Yumha, Claudia A Ortiz, Javier E Salas, Alejandro A Saez, Luis D Vega, Eduardo F Labarca, Felipe T Martinez, Nicolás G Carreño, Pilar Lora, Haitao Liu, Ling Liu, Rui Tang, Xiaoming Luo, Youzhong An, Huiying Zhao, Yan Gao, Zhe Zhai, Zheng L Ye, Wei Wang, Wenwen Li, Qingdong Li, Ruiqiang Zheng, Wenkui Yu, Juanhong Shen, Xinyu Li, Tao Yu, Weihua Lu, Ya Q Wu, Xiao B Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua X Wang, Shu H Qin, Bao H Zhu, Jun Zhao, Jian Liu, Bin Li, Jing L Liu, Fa C Zhou, Qiong J Li, Xing Y Zhang, Zhou Li-Xin, Qiang Xin-Hua, Liangyan Jiang, Yuan N Gao, Xian Y Zhao, Yuan Y Li, Xiao L Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Q Huang, Wei H Zhu, Ai Y Hang, Ma X Hua, Yimin Li, Yonghao Xu, Yu D Di, Long L Ling, Tie H Qin, Shou H Wang, Junping Qin, Yi Han, Suming Zhou, Monica P Vargas, Juan I Silesky Jimenez, Manuel A González Rojas, Jaime E Solis-Quesada, Christian M Ramirez-Alfaro, Jan Máca, Peter Sklienka, Jakob Gjedsted, Aage Christiansen, Boris G Villamagua, Miguel Llano, Philippe Burtin, Gautier Buzancais, Pascal Beuret, Nicolas Pelletier, Satar Mortaza, Alain Mercat, Jonathan Chelly, Sébastien Jochmans, Nicolas Terzi, Cédric Daubin, Guillaume Carteaux, Nicolas de Prost, Jean-Daniel Chiche, Fabrice Daviaud, Tai Pham, Muriel Fartoukh, Guillaume Barberet, Jerome Biehler, Jean Dellamonica, Denis Doyen, Jean-Michel Arnal, Anais Briquet, Sami Hraiech, Laurent Papazian, Arnaud Follin, Damien Roux, Jonathan Messika, Evangelos Kalaitzis, Laurence Dangers, Alain Combes, Siu-Ming Au, Gaetan Béduneau, Dorothée Carpentier, Elie H Zogheib, Herve Dupont, Sylvie Ricome, Francesco L Santoli, Sebastien L Besset, Philippe Michel, Bruno Gelée, Pierre-Eric Danin, Bernard Goubaux, Philippe J Crova, Nga T Phan, Frantz Berkelmans, Julio C Badie, Romain Tapponnier, Josette Gally, Samy Khebbeb, Jean-Etienne Herbrecht, Francis Schneider, Pierre-Louis M Declercq, Jean-Philippe Rigaud, Jacques Duranteau, Anatole Harrois, Russell Chabanne, Julien Marin, Charlene Bigot, Sandrine Thibault, Mohammed Ghazi, Messabi Boukhazna, Salem Ould Zein, Jack R Richecoeur, Daniele M Combaux, Fabien Grelon, Charlene Le Moal, Elise P Sauvadet, Adrien Robine, Virginie Lemiale, Danielle Reuter, Martin Dres, Alexandre Demoule, Dany Goldgran-Toledano, Loredana Baboi, Claude Guérin, Ralph Lohner, Jens Kraßler, Susanne Schäfer, Kai D Zacharowski, Patrick Meybohm, Andreas W Reske, Philipp Simon, Hans-Bernd F Hopf, Michael Schuetz, Thomas Baltus, Metaxia N Papanikolaou, Theonymfi G Papavasilopoulou, Giannis A Zacharas, Vasilis Ourailogloy, Eleni K Mouloudi, Eleni V Massa, Eva O Nagy, Electra E Stamou, Ellada V Kiourtzieva, Marina A Oikonomou, Luis E Avila, Cesar A Cortez, Johanna E Citalán, Sameer A Jog, Safal D Sable, Bhagyesh Shah, Mohan Gurjar, Arvind K Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura J Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal B Dixit, Rachana V Rhayakar, Nagarajan Ramakrishnan, Vallish K Bhardwaj, Heera L Mahto, Sudha V Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Mohammadreza Hashemian, Hamidreza Jamaati, Farshad Heidari, Edel A Meaney, Alistair Nichol, Karl M Knapman, Donall O'Croinin, Eimhin S Dunne, Dorothy M Breen, Kevin P Clarkson, Rola F Jaafar, Rory Dwyer, Fahd Amir, Olaitan O Ajetunmobi, Aogan C O'Muircheartaigh, Colin S Black, Nuala Treanor, Daniel V Collins, Wahid Altaf, Gianluca Zani, Maurizio Fusari, Savino Spadaro, Carlo A Volta, Romano Graziani, Barbara Brunettini, Salvatore Palmese, Paolo Formenti, Michele Umbrello, Andrea Lombardo, Elisabetta Pecci, Marco Botteri, Monica Savioli, Alessandro Protti, Alessia Mattei, Lorenzo Schiavoni, Andrea Tinnirello, Manuel Todeschini, Antonino Giarratano, Andrea Cortegiani, Sara Sher, Anna Rossi, Massimo M Antonelli, Luca M Montini, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto R Biscione, Michela M Poli, Ferdinando Raimondi, Daniela Albiero, Giulia Crapelli, Eduardo Beck, Vincenzo Pota, Vincenzo Schiavone, Alexandre Molin, Fabio Tarantino, Giacomo Monti, Elena Frati, Lucia Mirabella, Gilda Cinnella, Tommaso Fossali, Riccardo Colombo, Pierpaolo Terragni Ilaria Pattarino, Francesco Mojoli, Antonio Braschi, Erika E Borotto, Andrea N Cracchiolo, Daniela M Palma, Francesco Raponi, Giuseppe Foti, Ettore R Vascotto, Andrea Coppadoro, Luca Brazzi, Leda Floris, Giorgio A Iotti, Aaron Venti, Osamu Yamaguchi, Shunsuke Takagi, Hiroki N Maeyama, Eizo Watanabe, Yoshihiro Yamaji, Kazuyoshi Shimizu, Kyoko Shiozaki, Satoru Futami, Sekine Ryosuke, Koji Saito, Yoshinobu Kameyama, Keiko Ueno, Masayo Izawa, Nao Okuda, Hiroyuki Suzuki, Tomofumi Harasawa, Michitaka Nasu, Tadaaki Takada, Fumihito Ito, Shin-Nunomiya Kansuke-Koyama, Toshikazu Abe, Kohkichi Andoh, Kohei Kusumoto, Akira Hirata, Akihiro Takaba, Hiroyasu Kimura, Shuhei Matsumoto, Ushio Higashijima, Hiroyuki Honda, Nobumasa Aoki, Hiroshi Imai, Yasuaki Ogino, Ichiko Mizuguchi, Kazuya Ichikado, Kenichi Nitta, Katsunori Mochizuki, Tomoaki Hashida, Hiroyuki Tanaka, Tomoyuki Nakamura, Daisuke Niimi, Takeshi Ueda, Yozo Kashiwa, Akinori Uchiyama, Olegs Sabelnikovs, Peteris Oss, Youssef Haddad, Kong Y Liew, Silvio A Ñamendys-Silva, Yves D Jarquin-Badiola, Luis A Sanchez-Hurtado, Saira S Gomez-Flores, Maria C Marin, Asisclo J Villagomez, Jordana S Lemus, Jonathan M Fierro, Mavy Ramirez Cervantes, Francisco Javier Flores Mejia, Dulce Dector, Dulce M Dector, Daniel R Gonzalez, Claudia R Estrella, Jorge R Sanchez-Medina, Alvaro Ramirez-Gutierrez, Fernando G George, Janet S Aguirre, Juan A Buensuseso, Manuel Poblano, Tarek Dendane, Hicham Balkhi, Mina Elkhayari, Nacer Samkaoui, Hanane Ezzouine, Abdellatif Benslama Mourad Amor, Wajdi Maazouzi, Nedim Cimic, Oliver Beck, Monique M Bruns, Jeroen A Schouten, Myra-Rinia, Monique Raaijmakers, Hellen M Van Wezel, Serge J Heines, Ulrich Strauch, Marc P Buise, Fabienne D Simonis, Marcus J Schultz, Jennifer C Goodson, Troy S Browne, Leanlove Navarra, Anna Hunt, Robyn A Hutchison, Mathew B Bailey, Lynette Newby, Colin Mcarthur, Michael Kalkoff, Alex Mcleod, Jonathan Casement, Danielle J Hacking, Finn H Andersen, Merete S Dolva, Jon H Laake, Andreas Barratt-Due, Kim Andre L Noremark, Eldar Søreide, Brit Å Sjøbø, Anne B Guttormsen, Hector H Leon Yoshido, Ronald Zumaran Aguilar, Fredy A Montes Oscanoa, Alain U Alisasis, Joanne B Robles, Rossini Abbie B Pasanting-Lim, Beatriz C Tan, Pawel Andruszkiewicz, Karina Jakubowska, Cristina M Coxo, António M Alvarez, Bruno S Oliveira, Gustavo M Montanha, Nelson C Barros, Carlos S Pereira, António M Messias, Jorge M Monteiro, Ana M Araujo, Nuno T Catorze, Susan M Marum, Maria J Bouw, Rui M Gomes, Vania A Brito, Silvia Castro, Joana M Estilita, Filipa M Barros, Isabel M Serra, Aurelia M Martinho, Dana R Tomescu, Alexandra Marcu, Ovidiu H Bedreag, Marius Papurica, Dan E Corneci, Silvius Ioan Negoita, Evgeny Grigoriev, Alexey I Gritsan, Andrey A Gazenkampf, Ghaleb Almekhlafi, Mohamad M Albarrak, Ghanem M Mustafa, Khalid A Maghrabi, Nawal Salahuddin, Tharwat M Aisa, Ahmed S Al Jabbary, Edgardo Tabhan, Yaseen M Arabi, Olivia A Trinidad, Hasan M Al Dorzi, Edgardo E Tabhan, Stefan Bolon, Oliver Smith, Jordi Mancebo, Hernan Aguirre-Bermeo, Juan C Lopez-Delgado, Francisco Esteve, Gemma Rialp, Catalina Forteza, Candelaria De Haro, Antonio Artigas, Guillermo M Albaiceta, Sara De Cima-Iglesias, Leticia Seoane-Quiroga, Alexandra Ceniceros-Barros, Antonio L Ruiz-Aguilar, Luis M Claraco-Vega, Juan Alfonso Soler, Maria Del Carmen Lorente, Cecilia Hermosa, Federico Gordo, Miryam-Prieto-González, Juan B López-Messa, Manuel P Perez, Cesar P Perez, Raquel Montoiro Allue, Ferran Roche-Campo, Marcos Ibañez-Santacruz, Susana-Temprano, Maria C Pintado, Raul De Pablo, Pilar Ricart Aroa Gómez, Silvia Rodriguez Ruiz, Silvia Iglesias Moles, Mª Teresa Jurado, Alfons Arizmendi, Enrique A Piacentini, Nieves Franco, Teresa Honrubia, Meisy Perez Cheng, Elena Perez Losada, Javier-Blanco, Luis J Yuste, Cecilia Carbayo-Gorriz, Francisca G Cazorla-Barranquero, Javier G 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M., Rigaud, J. -P., Duranteau, J., Harrois, A., Chabanne, R., Marin, J., Bigot, C., Thibault, S., Ghazi, M., Boukhazna, M., Zein, S. O., Richecoeur, J. R., Combaux, D. M., Grelon, F., Le Moal, C., Sauvadet, E. P., Robine, A., Lemiale, V., Reuter, D., Dres, M., Demoule, A., Goldgran-Toledano, D., Baboi, L., Guerin, C., Lohner, R., Krassler, J., Schafer, S., Zacharowski, K. D., Meybohm, P., Reske, A. W., Simon, P., Hopf, H. -B. F., Schuetz, M., Baltus, T., Papanikolaou, M. N., Papavasilopoulou, T. G., Zacharas, G. A., Ourailogloy, V., Mouloudi, E. K., Massa, E. V., Nagy, E. O., Stamou, E. E., Kiourtzieva, E. V., Oikonomou, M. A., Avila, L. E., Cortez, C. A., Citalan, J. E., Jog, S. A., Sable, S. D., Shah, B., Gurjar, M., Baronia, A. K., Memon, M., Muthuchellappan, R., Ramesh, V. J., Shenoy, A., Unnikrishnan, R., Dixit, S. B., Rhayakar, R. V., Ramakrishnan, N., Bhardwaj, V. K., Mahto, H. L., Sagar, S. V., Palaniswamy, V., Ganesan, D., Jamaati, H., Heidari, F., Meaney, E. 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M., Tulaimat, A., Choudry, S., Stigler, W., Batra, H., Huff, N. G., Lamb, K. D., Oetting, T. W., Mohr, N. M., Judy, C., Saito, S., Kheir, F. M., Kheir, F., Schlichting, A. B., Delsing, A., Crouch, D. R., Elmasri, M., Ismail, D., Dreyer, K. R., Blakeman, T. C., Baron, R. M., Grijalba, C. Q., Hou, P. C., Seethala, R., Aisiku, I., Henderson, G., Frendl, G., Hou, S. -K., Owens, R. L., Schomer, A., Bumbasirevic, V., Jovanovic, B., Surbatovic, M., Veljovic, M., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, UCL - (SLuc) Service de soins intensifs, Graduate School, Intensive Care Medicine, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Madotto, F, Rezoagli, E, Pham, T, Schmidt, M, Mcnicholas, B, Protti, A, Panwar, R, Bellani, G, Fan, E, Van Haren, F, Brochard, L, Laffey, J, Pesenti, A, Esteban, A, Gattinoni, L, Larsson, A, Mcauley, D, Ranieri, M, Rubenfeld, G, Thompson, B, Wrigge, H, Slutsky, A, Rios, F, Sottiaux, T, Depuydt, P, Lora, F, Azevedo, L, Bugedo, G, Qiu, H, Gonzalez, M, Silesky, J, Cerny, V, Nielsen, J, Jibaja, M, Matamis, D, Ranero, J, Amin, P, Hashemian, S, Clarkson, K, Kurahashi, K, Villagomez, A, Zeggwagh, A, Heunks, L, Laake, J, Palo, J, Do Vale Fernandes, A, Sandesc, D, Arabi, Y, Bumbasierevic, V, Nin, N, Lorente, J, 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Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimir Cerny, Jonas Nielsen, Manuel Jibaja, Tài Pham, Dimitrios Matamis, Jorge Luis Ranero, Pravin Amin, S M Hashemian, Kevin Clarkson, Giacomo Bellani, Kiyoyasu Kurahashi, Asisclo Villagomez, Amine Ali Zeggwagh, Leo M Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero do Vale Fernandes, Dorel Sandesc, Yaasen Arabi, Vesna Bumbasierevic, Nicolas Nin, Jose A Lorente, Lise Piquilloud, Fekri Abroug, Daniel F McAuley, Lia McNamee, Javier Hurtado, Ed Bajwa, Gabriel Démpaire, Uhc Mother Theresa, Hektor Sula, Lordian Nunci, Alma Cani, Villa Maria, Alan Zazu, Christian Dellera, Carolina S Insaurralde, Risso V Alejandro, Julio Daldin, Mauricio Vinzio, Ruben O Fernandez, Luis P Cardonnet, Lisandro R Bettini, Mariano Carboni Bisso, Emilio M Osman, Mariano G Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Norberto C Pozo, Nicolas Grubissich, Gustavo A Plotnikow, Daniela N Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A Pellegrini, María G Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo E Gomez, Valeria I Cerrato, Marco G Bezzi, Silvina A Borello, Flavia A Loiacono, Adriana M Fernandez, Serena Knowles, Claire Reynolds, Deborah M Inskip, Jennene J Miller, Jing Kong, Christina Whitehead, Shailesh Bihari, Aylin Seven, Amanda Krstevski, Helen J Rodgers, Rebecca T Millar, Toni E Mckenna, Irene M Bailey, Gabrielle C Hanlon, Anders Aneman, Joan M Lynch, Raman Azad, John Neal, Paul W Woods, Brigit L Roberts, Mark R Kol, Helen S Wong, Katharina C Riss, Thomas Staudinger, Xavier Wittebole, Caroline Berghe, Pierre A Bulpa, Alain M Dive, Rik Verstraete, Herve Lebbinck, Pieter Depuydt, Joris Vermassen, Philippe Meersseman, Helga Ceunen, Jonas I Rosa, Daniel O Beraldo, Claudio Piras, Adenilton M Rampinelli, Antonio P Nassar Jr, Sergio Mataloun, Marcelo Moock, Marlus M Thompson, Claudio H Gonçalves, Ana Carolina P Antônio, Aline Ascoli, Rodrigo S Biondi, Danielle C Fontenele, Danielle Nobrega, Vanessa M Sales, Suresh Shindhe, Dk Maizatul Aiman B Pg Hj Ismail, John Laffey, Francois Beloncle, Kyle G Davies, Rob Cirone, Venika Manoharan, Mehvish Ismail, Ewan C Goligher, Mandeep Jassal, Erin Nishikawa, Areej Javeed, Gerard Curley, Nuttapol Rittayamai, Matteo Parotto, Niall D Ferguson, Sangeeta Mehta, Jenny Knoll, Antoine Pronovost, Sergio Canestrini, Alejandro R Bruhn, Patricio H Garcia, Felipe A Aliaga, Pamela A Farías, Jacob S Yumha, Claudia A Ortiz, Javier E Salas, Alejandro A Saez, Luis D Vega, Eduardo F Labarca, Felipe T Martinez, Nicolás G Carreño, Pilar Lora, Haitao Liu, Ling Liu, Rui Tang, Xiaoming Luo, Youzhong An, Huiying Zhao, Yan Gao, Zhe Zhai, Zheng L Ye, Wei Wang, Wenwen Li, Qingdong Li, Ruiqiang Zheng, Wenkui Yu, Juanhong Shen, Xinyu Li, Tao Yu, Weihua Lu, Ya Q Wu, Xiao B Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua X Wang, Shu H Qin, Bao H Zhu, Jun Zhao, Jian Liu, Bin Li, Jing L Liu, Fa C Zhou, Qiong J Li, Xing Y Zhang, Zhou Li-Xin, Qiang Xin-Hua, Liangyan Jiang, Yuan N Gao, Xian Y Zhao, Yuan Y Li, Xiao L Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Q Huang, Wei H Zhu, Ai Y Hang, Ma X Hua, Yimin Li, Yonghao Xu, Yu D Di, Long L Ling, Tie H Qin, Shou H Wang, Junping Qin, Yi Han, Suming Zhou, Monica P Vargas, Juan I Silesky Jimenez, Manuel A González Rojas, Jaime E Solis-Quesada, Christian M Ramirez-Alfaro, Jan Máca, Peter Sklienka, Jakob Gjedsted, Aage Christiansen, Boris G Villamagua, Miguel Llano, Philippe Burtin, Gautier Buzancais, Pascal Beuret, Nicolas Pelletier, Satar Mortaza, Alain Mercat, Jonathan Chelly, Sébastien Jochmans, Nicolas Terzi, Cédric Daubin, Guillaume Carteaux, Nicolas de Prost, Jean-Daniel Chiche, Fabrice Daviaud, Tai Pham, Muriel Fartoukh, Guillaume Barberet, Jerome Biehler, Jean Dellamonica, Denis Doyen, Jean-Michel Arnal, Anais Briquet, Sami Hraiech, Laurent Papazian, Arnaud Follin, Damien Roux, Jonathan Messika, Evangelos Kalaitzis, Laurence Dangers, Alain Combes, Siu-Ming Au, Gaetan Béduneau, Dorothée Carpentier, Elie H Zogheib, Herve Dupont, Sylvie Ricome, Francesco L Santoli, Sebastien L Besset, Philippe Michel, Bruno Gelée, Pierre-Eric Danin, Bernard Goubaux, Philippe J Crova, Nga T Phan, Frantz Berkelmans, Julio C Badie, Romain Tapponnier, Josette Gally, Samy Khebbeb, Jean-Etienne Herbrecht, Francis Schneider, Pierre-Louis M Declercq, Jean-Philippe Rigaud, Jacques Duranteau, Anatole Harrois, Russell Chabanne, Julien Marin, Charlene Bigot, Sandrine Thibault, Mohammed Ghazi, Messabi Boukhazna, Salem Ould Zein, Jack R Richecoeur, Daniele M Combaux, Fabien Grelon, Charlene Le Moal, Elise P Sauvadet, Adrien Robine, Virginie Lemiale, Danielle Reuter, Martin Dres, Alexandre Demoule, Dany Goldgran-Toledano, Loredana Baboi, Claude Guérin, Ralph Lohner, Jens Kraßler, Susanne Schäfer, Kai D Zacharowski, Patrick Meybohm, Andreas W Reske, Philipp Simon, Hans-Bernd F Hopf, Michael Schuetz, Thomas Baltus, Metaxia N Papanikolaou, Theonymfi G Papavasilopoulou, Giannis A Zacharas, Vasilis Ourailogloy, Eleni K Mouloudi, Eleni V Massa, Eva O Nagy, Electra E Stamou, Ellada V Kiourtzieva, Marina A Oikonomou, Luis E Avila, Cesar A Cortez, Johanna E Citalán, Sameer A Jog, Safal D Sable, Bhagyesh Shah, Mohan Gurjar, Arvind K Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura J Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal B Dixit, Rachana V Rhayakar, Nagarajan Ramakrishnan, Vallish K Bhardwaj, Heera L Mahto, Sudha V Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Mohammadreza Hashemian, Hamidreza Jamaati, Farshad Heidari, Edel A Meaney, Alistair Nichol, Karl M Knapman, Donall O'Croinin, Eimhin S Dunne, Dorothy M Breen, Kevin P Clarkson, Rola F Jaafar, Rory Dwyer, Fahd Amir, Olaitan O Ajetunmobi, Aogan C O'Muircheartaigh, Colin S Black, Nuala Treanor, Daniel V Collins, Wahid Altaf, Gianluca Zani, Maurizio Fusari, Savino Spadaro, Carlo A Volta, Romano Graziani, Barbara Brunettini, Salvatore Palmese, Paolo Formenti, Michele Umbrello, Andrea Lombardo, Elisabetta Pecci, Marco Botteri, Monica Savioli, Alessandro Protti, Alessia Mattei, Lorenzo Schiavoni, Andrea Tinnirello, Manuel Todeschini, Antonino Giarratano, Andrea Cortegiani, Sara Sher, Anna Rossi, Massimo M Antonelli, Luca M Montini, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto R Biscione, Michela M Poli, Ferdinando Raimondi, Daniela Albiero, Giulia Crapelli, Eduardo Beck, Vincenzo Pota, Vincenzo Schiavone, Alexandre Molin, Fabio Tarantino, Giacomo Monti, Elena Frati, Lucia Mirabella, Gilda Cinnella, Tommaso Fossali, Riccardo Colombo, Pierpaolo Terragni Ilaria Pattarino, Francesco Mojoli, Antonio Braschi, Erika E Borotto, Andrea N Cracchiolo, Daniela M Palma, Francesco Raponi, Giuseppe Foti, Ettore R Vascotto, Andrea Coppadoro, Luca Brazzi, Leda Floris, Giorgio A Iotti, Aaron Venti, Osamu Yamaguchi, Shunsuke Takagi, Hiroki N Maeyama, Eizo Watanabe, Yoshihiro Yamaji, Kazuyoshi Shimizu, Kyoko Shiozaki, Satoru Futami, Sekine Ryosuke, Koji Saito, Yoshinobu Kameyama, Keiko Ueno, Masayo Izawa, Nao Okuda, Hiroyuki Suzuki, Tomofumi Harasawa, Michitaka Nasu, Tadaaki Takada, Fumihito Ito, Shin-Nunomiya, Kansuke-Koyama, Toshikazu Abe, Kohkichi Andoh, Kohei Kusumoto, Akira Hirata, Akihiro Takaba, Hiroyasu Kimura, Shuhei Matsumoto, Ushio Higashijima, Hiroyuki Honda, Nobumasa Aoki, Hiroshi Imai, Yasuaki Ogino, Ichiko Mizuguchi, Kazuya Ichikado, Kenichi Nitta, Katsunori Mochizuki, Tomoaki Hashida, Hiroyuki Tanaka, Tomoyuki Nakamura, Daisuke Niimi, Takeshi Ueda, Yozo Kashiwa, Akinori Uchiyama, Olegs Sabelnikovs, Peteris Oss, Youssef Haddad, Kong Y Liew, Silvio A Ñamendys-Silva, Yves D Jarquin-Badiola, Luis A Sanchez-Hurtado, Saira S Gomez-Flores, Maria C Marin, Asisclo J Villagomez, Jordana S Lemus, Jonathan M Fierro, Mavy Ramirez Cervantes, Francisco Javier Flores Mejia, Dulce Dector, Dulce M Dector, Daniel R Gonzalez, Claudia R Estrella, Jorge R Sanchez-Medina, Alvaro Ramirez-Gutierrez, Fernando G George, Janet S Aguirre, Juan A Buensuseso, Manuel Poblano, Tarek Dendane, Hicham Balkhi, Mina Elkhayari, Nacer Samkaoui, Hanane Ezzouine, Abdellatif Benslama Mourad Amor, Wajdi Maazouzi, Nedim Cimic, Oliver Beck, Monique M Bruns, Jeroen A Schouten, Myra-Rinia, Monique Raaijmakers, Hellen M Van Wezel, Serge J Heines, Ulrich Strauch, Marc P Buise, Fabienne D Simonis, Marcus J Schultz, Jennifer C Goodson, Troy S Browne, Leanlove Navarra, Anna Hunt, Robyn A Hutchison, Mathew B Bailey, Lynette Newby, Colin Mcarthur, Michael Kalkoff, Alex Mcleod, Jonathan Casement, Danielle J Hacking, Finn H Andersen, Merete S Dolva, Jon H Laake, Andreas Barratt-Due, Kim Andre L Noremark, Eldar Søreide, Brit Å Sjøbø, Anne B Guttormsen, Hector H Leon Yoshido, Ronald Zumaran Aguilar, Fredy A Montes Oscanoa, Alain U Alisasis, Joanne B Robles, Rossini Abbie B Pasanting-Lim, Beatriz C Tan, Pawel Andruszkiewicz, Karina Jakubowska, Cristina M Coxo, António M Alvarez, Bruno S Oliveira, Gustavo M Montanha, Nelson C Barros, Carlos S Pereira, António M Messias, Jorge M Monteiro, Ana M Araujo, Nuno T Catorze, Susan M Marum, Maria J Bouw, Rui M Gomes, Vania A Brito, Silvia Castro, Joana M Estilita, Filipa M Barros, Isabel M Serra, Aurelia M Martinho, Dana R Tomescu, Alexandra Marcu, Ovidiu H Bedreag, Marius Papurica, Dan E Corneci, Silvius Ioan Negoita, Evgeny Grigoriev, Alexey I Gritsan, Andrey A Gazenkampf, Ghaleb Almekhlafi, Mohamad M Albarrak, Ghanem M Mustafa, Khalid A Maghrabi, Nawal Salahuddin, Tharwat M Aisa, Ahmed S Al Jabbary, Edgardo Tabhan, Yaseen M Arabi, Olivia A Trinidad, Hasan M Al Dorzi, Edgardo E Tabhan, Stefan Bolon, Oliver Smith, Jordi Mancebo, Hernan Aguirre-Bermeo, Juan C Lopez-Delgado, Francisco Esteve, Gemma Rialp, Catalina Forteza, Candelaria De Haro, Antonio Artigas, Guillermo M Albaiceta, Sara De Cima-Iglesias, Leticia Seoane-Quiroga, Alexandra Ceniceros-Barros, Antonio L Ruiz-Aguilar, Luis M Claraco-Vega, Juan Alfonso Soler, Maria Del Carmen Lorente, Cecilia Hermosa, Federico Gordo, Miryam-Prieto-González, Juan B López-Messa, Manuel P Perez, Cesar P Perez, Raquel Montoiro Allue, Ferran Roche-Campo, Marcos Ibañez-Santacruz, Susana-Temprano, Maria C Pintado, Raul De Pablo, Pilar Ricart Aroa Gómez, Silvia Rodriguez Ruiz, Silvia Iglesias Moles, Mª Teresa Jurado, Alfons Arizmendi, Enrique A Piacentini, Nieves Franco, Teresa Honrubia, Meisy Perez Cheng, Elena Perez Losada, Javier-Blanco, Luis J Yuste, Cecilia Carbayo-Gorriz, Francisca G Cazorla-Barranquero, Javier G Alonso, Rosa S Alda, Ángela Algaba, Gonzalo Navarro, Enrique Cereijo, Esther Diaz-Rodriguez, Diego Pastor Marcos, Laura Alvarez Montero, Luis Herrera Para, Roberto Jimenez Sanchez, Miguel Angel Blasco Navalpotro, Ricardo Diaz Abad, Raquel Montiel Gonz Á Lez, D Á Cil Parrilla Toribio, Alejandro G Castro, Maria Jose D Artiga, Oscar Penuelas, Tomas P Roser, Moreno F Olga, Elena Gallego Curto, Rocío Manzano Sánchez, Vallverdu P Imma, Garcia M Elisabet, Laura Claverias, Monica Magret, Ana M Pellicer, Lucia L Rodriguez, Jesús Sánchez-Ballesteros, Ángela González-Salamanca, Antonio G Jimenez, Francisco P Huerta, Juan Carlos J Sotillo Diaz, Esther Bermejo Lopez, David D Llinares Moya, Alec A Tallet Alfonso, Palazon Sanchez Eugenio Luis, Palazon Sanchez Cesar, Sánchez I Rafael, Corcoles G Virgilio, Noelia N Recio, Richard O Adamsson, Christian C Rylander, Bernhard Holzgraefe, Lars M Broman, Joanna Wessbergh, Linnea Persson, Fredrik Schiöler, Hans Kedelv, Anna Oscarsson Tibblin, Henrik Appelberg, Lars Hedlund, Johan Helleberg, Karin E Eriksson, Rita Glietsch, Niklas Larsson, Ingela Nygren, Silvia L Nunes, Anna-Karin Morin, Thomas Kander, Anne Adolfsson, Hervé O Zender, Corinne Leemann-Refondini, Souheil Elatrous, Slaheddine Bouchoucha, Imed Chouchene, Islem Ouanes, Asma Ben Souissi, Salma Kamoun, Oktay Demirkiran, Mustafa Aker, Emre Erbabacan, Ilkay Ceylan, Nermin Kelebek Girgin, Menekse Ozcelik, Necmettin Ünal, Basak Ceyda Meco, Onat O Akyol, Suleyman S Derman, Barry Kennedy, Ken Parhar, Latha Srinivasa, Danny McAuley, Phil Hopkins, Clare Mellis, Vivek Kakar, Dan Hadfield, Andre Vercueil, Kaushik Bhowmick, Sally K Humphreys, Andrew Ferguson, Raymond Mckee, Ashok S Raj, Danielle A Fawkes, Philip Watt, Linda Twohey, Rajeev R JhaMatthew Thomas, Alex Morton, Varsha Kadaba, Mark J Smith, Anil P Hormis, Santhana G Kannan, Miriam Namih, Henrik Reschreiter, Julie Camsooksai, Alek Kumar, Szabolcs Rugonfalvi, Christopher Nutt, Orla O'Neill, Colette Seasman, Ged Dempsey, Christopher J Scott, Helen E Ellis, Stuart Mckechnie, Paula J Hutton, Nora N Di Tomasso, Michela N Vitale, Ruth O Griffin, Michael N Dean, Julius H Cranshaw, Emma L Willett, Nicholas Ioannou, Sarah Gillis, Peter Csabi, Rosaleen Macfadyen, Heidi Dawson, Pieter D Preez, Alexandra J Williams, Owen Boyd, Laura Ortiz-Ruiz De Gordoa, Jon Bramall, Sophie Symmonds, Simon K Chau, Tim Wenham, Tamas Szakmany, Piroska Toth-Tarsoly, Katie H McCalman, Peter Alexander, Lorraine Stephenson, Thomas Collyer, Rhiannon Chapman, Raphael Cooper, Russell M Allan, Malcolm Sim, David W Wrathall, Donald A Irvine, Kim S Zantua, John C Adams, Andrew J Burtenshaw, Gareth P Sellors, Ingeborg D Welters, Karen E Williams, Robert J Hessell, Matthew G Oldroyd, Ceri E Battle, Suresh Pillai, Istvan Kajtor, Mageswaran Sivashanmugavel, Sinead C O'Kane, Adrian Donnelly, Aniko D Frigyik, Jon P Careless, Martin M May, Richard Stewart, T John Trinder, Samantha J Hagan, Matt P Wise, Jade M Cole, Caroline C MacFie, Anna T Dowling, Nicolás Nin, Edgardo Nuñez, Gustavo Pittini, Ruben Rodriguez, María C Imperio, Cristina Santos, Ana G França, Alejandro Ebeid, Alberto Deicas, Carolina Serra, Aditya Uppalapati, Ghassan Kamel, Valerie M Banner-Goodspeed, Jeremy R Beitler, Satyanarayana Reddy Mukkera, Shreedhar Kulkarni, Jarone Lee, Tomaz Mesar, John O Shinn 3rd, Dina Gomaa, Christopher Tainter, Dale J Yeatts, Jessica Warren, Michael J Lanspa, Russel R Miller, Colin K Grissom, Madotto F, Rezoagli E, Pham T, Schmidt M, McNicholas B, Protti A, Panwar R, Bellani G, Fan E, van Haren F, Brochard L, Laffey JG, and LUNG SAFE Investigators and the ESICM Trials Group, Samuel M Brown, Philippe R Bauer, Ryan J Gosselin, Barrett T Kitch, Jason E Cohen, Scott H Beegle, Renaud M Gueret, Aiman Tulaimat, Shazia Choudry, William Stigler, Hitesh Batra, Nidhi G Huff, Keith D Lamb, Trevor W Oetting, Nicholas M Mohr, Claine Judy, Shigeki Saito, Fayez M Kheir, Fayez Kheir, Adam B Schlichting, Angela Delsing, Daniel R Crouch, Mary Elmasri, Dina Ismail, Kyle R Dreyer, Thomas C Blakeman, Rebecca M Baron, Carolina Quintana Grijalba, Peter C Hou, Raghu Seethala, Imo Aisiku, Galen Henderson, Gyorgy Frendl, Sen-Kuang Hou, Robert L Owens, Ashley Schomer, Vesna Bumbasirevic, Bojan Jovanovic, Maja Surbatovic, Milic Veljovic
Subjects: ARDS, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Hyperoxemia, Hypoxemia, law.invention, 0302 clinical medicine, law, Fraction of inspired oxygen, Oxygen therapy, Prevalence, Medicine, Hypoxia, Acute respiratory distress syndrome, Hyperoxia, Invasive mechanical ventilation, Mortality, Respiratory Distress Syndrome, Hyperbaric Oxygenation, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Intensive care unit, Intensive Care Units, Anesthesia, Artificial, medicine.symptom, Human, Artificial ventilation, Intensive Care Unit, NO, 03 medical and health sciences, Intensive care, Settore MED/41 - ANESTESIOLOGIA, Humans, business.industry, Research, Respiratory Distress Syndrome, Adult, lcsh:RC86-88.9, medicine.disease, Respiration, Artificial, respiratory tract diseases, Oxygen, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], 030228 respiratory system, business
Abstract: Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55–100 mmHg) patients (P = 0.47). Conclusions Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073
Published: 2020

34. Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

Author: Madotto, F., Pham, T., Bellani, G., Bos, L. D., Simonis, F. D., Fan, E., Artigas, A., Brochard, L., Schultz, M. J., Laffey, J. G., Pesenti, A., Esteban, A., Gattinoni, L., van Haren, F., Larsson, A., McAuley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., Wrigge, H., Slutsky, A. S., Rios, F., Van Haren, F., Sottiaux, T., Depuydt, P., Lora, F. S., Azevedo, L. C., Bugedo, G., Qiu, H., Gonzalez, M., Silesky, J., Cerny, V., Nielsen, J., Jibaja, M., Matamis, D., Ranero, J. L., Amin, P., Hashemian, S. M., Clarkson, K., Kurahashi, K., Villagomez, A., Zeggwagh, A. A., Heunks, L. M., Laake, J. H., Palo, J. E., do Vale Fernandes, A., Sandesc, D., Arabi, Y., Bumbasierevic, V., Nin, N., Lorente, J. A., Piquilloud, L., Abroug, F., McNamee, L., Hurtado, J., Bajwa, E., Démpaire, G., Sula, H., Nunci, L., Cani, A., Zazu, A., Dellera, C., Alejandro, R. V., Daldin, J., Vinzio, M., Fernandez, R. O., Cardonnet, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Lovazzano, P., Alvarez, J., Villar, V., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Staudinger, T., Wittebole, X., Berghe, C., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Vermassen, J., Meersseman, P., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar A. P., Jr., Mataloun, S., Moock, M., Thompson, M. M., Gonçalves, C. H., Antônio, A. C. P., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. M., Shindhe, S., Ismail, D. M. A. B. P. H., Laffey, J., Beloncle, F., Davies, K. G., Cirone, R., Manoharan, V., Ismail, M., Goligher, E. C., Jassal, M., Nishikawa, E., Javeed, A., Curley, G., Rittayamai, N., Parotto, M., Ferguson, N. D., Mehta, S., Knoll, J., Pronovost, A., Canestrini, S., Bruhn, A. R., Garcia, P. H., Aliaga, F. A., Farías, P. A., Yumha, J. S., Ortiz, C. A., Salas, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreño, N. G., Lora, P., Liu, H., Liu, L., Tang, R., Luo, X., An, Y., Zhao, H., Gao, Y., Zhai, Z., Ye, Z. L., Wang, W., Li, W., Li, Q., Zheng, R., Yu, W., Shen, J., Li, X., Yu, T., Lu, W., Wu, Y. Q., Huang, X. B., He, Z., Lu, Y., Han, H., Zhang, F., Sun, R., Wang, H. X., Qin, S. H., Zhu, B. H., Zhao, J., Liu, J., Li, B., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Li-Xin, Z., Xin-Hua, Q., Jiang, L., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Wang, C., Yao, Q., Yu, R., Chen, K., Shao, H., Qin, B., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Li, Y., Xu, Y., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Qin, J., Han, Y., Zhou, S., Vargas, M. P., Jimenez, J. I. S., Rojas, M. A. G., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Máca, J., Sklienka, P., Gjedsted, J., Christiansen, A., Villamagua, B. G., Llano, M., Burtin, P., Buzancais, G., Beuret, P., Pelletier, N., Mortaza, S., Mercat, A., Chelly, J., Jochmans, S., Terzi, N., Daubin, C., Carteaux, G., de Prost, N., Chiche, J. -D., Daviaud, F., Fartoukh, M., Barberet, G., Biehler, J., Dellamonica, J., Doyen, D., Arnal, J. -M., Briquet, A., Hraiech, S., Papazian, L., Roux, D., Messika, J., Kalaitzis, E., Dangers, L., Combes, A., Au, S. -M., Béduneau, G., Carpentier, D., Zogheib, E. H., Dupont, H., Ricome, S., Santoli, F. L., Besset, S. L., Michel, P., Gelée, B., Danin, P. -E., Goubaux, B., Crova, P. J., Phan, N. T., Berkelmans, F., Badie, J. 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R., Sanchez-Medina, J. R., Ramirez-Gutierrez, A., George, F. G., Aguirre, J. S., Buensuseso, J. A., Poblano, M., Dendane, T., Balkhi, H., Elkhayari, M., Samkaoui, N., Ezzouine, H., Benslama, A., Amor, M., Maazouzi, W., Cimic, N., Beck, O., Bruns, M. M., Schouten, J. A., Rinia, M., Raaijmakers, M., Van Wezel, H. M., Heines, S. J., Strauch, U., Buise, M. P., Goodson, J. C., Browne, T. S., Navarra, L., Hunt, A., Hutchison, R. A., Bailey, M. B., Newby, L., Mcarthur, C., Kalkoff, M., Mcleod, A., Casement, J., Hacking, D. J., Andersen, F. H., Dolva, M. S., Barratt-Due, A., Noremark, K. A. L., Søreide, E., Sjøbø, B. Å., Guttormsen, A. B., Yoshido, H. H. L., Aguilar, R. Z., Oscanoa, F. A. M., Alisasis, A. U., Robles, J. B., Pasanting-Lim, R. A. B., Tan, B. C., Andruszkiewicz, P., Jakubowska, K., Coxo, C. M., Alvarez, A. M., Oliveira, B. S., Montanha, G. M., Barros, N. C., Pereira, C. S., Messias, A. M., Monteiro, J. M., Araujo, A. M., Catorze, N. T., Marum, S. M., Bouw, M. J., Gomes, R. M., Brito, V. A., Castro, S., Estilita, J. M., Barros, F. M., Serra, I. M., Martinho, A. M., Tomescu, D. R., Marcu, A., Bedreag, O. H., Papurica, M., Corneci, D. E., Negoita, S. L., Grigoriev, E., Gritsan, A. I., Gazenkampf, A. A., Almekhlafi, G., Albarrak, M. M., Mustafa, G. M., Maghrabi, K. A., Salahuddin, N., Aisa, T. M., Jabbary, A. S. A., Tabhan, E., Arabi, Y. M., Trinidad, O. A., Dorzi, H. M. A., Tabhan, E. E., Bolon, S., Smith, O., Mancebo, J., Aguirre-Bermeo, H., Lopez-Delgado, J. C., Esteve, F., Rialp, G., Forteza, C., De Haro, C., Albaiceta, G. M., De Cima-Iglesias, S., Seoane-Quiroga, L., Ceniceros-Barros, A., Ruiz-Aguilar, A. L., Claraco-Vega, L. M., Soler, J. A., del Carmen Lorente, M., Hermosa, C., Gordo, F., Prieto-González, M., López-Messa, J. B., Perez, M. P., Perez, C. P., Allue, R. M., Roche-Campo, F., Ibañez-Santacruz, M., Temprano, S., Pintado, M. C., De Pablo, R., Gómez, P. R. A., Ruiz, S. R., Moles, S. I., Jurado, M. ªT., Arizmendi, A., Piacentini, E. A., Franco, N., Honrubia, T., Cheng, M. P., Losada, E. P., Blanco, J., Yuste, L. J., Carbayo-Gorriz, C., Cazorla-Barranquero, F. G., Alonso, J. G., Alda, R. S., Algaba, Á., Navarro, G., Cereijo, E., Diaz-Rodriguez, E., Marcos, D. P., Montero, L. A., Para, L. H., Sanchez, R. J., Navalpotro, M. A. B., Abad, R. D., González, R. M., Toribio, D. P., Castro, A. G., Artiga, M. J. D., Penuelas, O., Roser, T. P., Olga, M. F., Curto, E. G., Sánchez, R. M., Imma, V. P., Elisabet, G. M., Claverias, L., Magret, M., Pellicer, A. M., Rodriguez, L. L., Sánchez-Ballesteros, J., González-Salamanca, Á., Jimenez, A. G., Huerta, F. P., Diaz, J. C. J. S., Lopez, E. B., Moya, D. D. L., Alfonso, A. A. T., Luis, P. S. E., Cesar, P. S., Rafael, S. I., Virgilio, C. G., Recio, N. N., Adamsson, R. O., Rylander, C. C., Holzgraefe, B., Broman, L. M., Wessbergh, J., Persson, L., Schiöler, F., Kedelv, H., Tibblin, A. O., Appelberg, H., Hedlund, L., Helleberg, J., Eriksson, K. 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L., Ioannou, N., Gillis, S., Csabi, P., Macfadyen, R., Dawson, H., Preez, P. D., Williams, A. J., Boyd, O., De Gordoa, L. O. -R., Bramall, J., Symmonds, S., Chau, S. K., Wenham, T., Szakmany, T., Toth-Tarsoly, P., McCalman, K. H., Alexander, P., Stephenson, L., Collyer, T., Chapman, R., Cooper, R., Allan, R. M., Sim, M., Wrathall, D. W., Irvine, D. A., Zantua, K. S., Adams, J. C., Burtenshaw, A. J., Sellors, G. P., Welters, I. D., Williams, K. E., Hessell, R. J., Oldroyd, M. G., Battle, C. E., Pillai, S., Kajtor, I., Sivashanmugavel, M., O’Kane, S. C., Donnelly, A., Frigyik, A. D., Careless, J. P., May, M. M., Stewart, R., Trinder, T. J., Hagan, S. J., Wise, M. P., Cole, J. M., MacFie, C. C., Dowling, A. T., Nuñez, E., Pittini, G., Rodriguez, R., Imperio, M. C., Santos, C., França, A. G., Ebeid, A., Deicas, A., Serra, C., Uppalapati, A., Kamel, G., Banner-Goodspeed, V. M., Beitler, J. R., Mukkera, S. R., Kulkarni, S., Lee, J., Mesar, T., Shinn, J. O., Gomaa, D., Tainter, C., Yeatts, D. J., Warren, J., Lanspa, M. J., Miller, R. R., Grissom, C. K., Brown, S. M., Bauer, P. R., Gosselin, R. J., Kitch, B. T., Cohen, J. E., Beegle, S. H., Gueret, R. M., Tulaimat, A., Choudry, S., Stigler, W., Batra, H., Huff, N. G., Lamb, K. D., Oetting, T. W., Mohr, N. M., Judy, C., Saito, S., Kheir, F. M., Kheir, F., Schlichting, A. B., Delsing, A., Crouch, D. R., Elmasri, M., Ismail, D., Dreyer, K. R., Blakeman, T. C., Baron, R. M., Grijalba, C. Q., Hou, P. C., Seethala, R., Aisiku, I., Henderson, G., Frendl, G., Hou, S. -K., Owens, R. L., Schomer, A., Bumbasirevic, V., Jovanovic, B., Surbatovic, M., Veljovic, M., LUNG SAFE Investigators and the ESICM Trials Group, Madotto, F., Pham, T., Bellani, G., Bos, L.D., Simonis, F.D., Fan, E., Artigas, A., Brochard, L., Schultz, M.J., Laffey, J.G., Pesenti, A., Esteban, A., Gattinoni, L., van Haren, F., Larsson, A., McAuley, D.F., Ranieri, M., Rubenfeld, G., Thompson, B.T., Wrigge, H., Slutsky, A.S., Rios, F., Van Haren, F., Sottiaux, T., Depuydt, P., Lora, F.S., Azevedo, L.C., Bugedo, G., Qiu, H., Gonzalez, M., Silesky, J., Cerny, V., Nielsen, J., Jibaja, M., Matamis, D., Ranero, J.L., Amin, P., Hashemian, S.M., Clarkson, K., Kurahashi, K., Villagomez, A., Zeggwagh, A.A., Heunks, L.M., Laake, J.H., Palo, J.E., do Vale Fernandes, A., Sandesc, D., Arabi, Y., Bumbasierevic, V., Nin, N., Lorente, J.A., Piquilloud, L., Abroug, F., McNamee, L., Hurtado, J., Bajwa, E., Démpaire, G., Sula, H., Nunci, L., Cani, A., Zazu, A., Dellera, C., Alejandro, R.V., Daldin, J., Vinzio, M., 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Toribio, D.P., Castro, A.G., Artiga, M.J.D., Penuelas, O., Roser, T.P., Olga, M.F., Curto, E.G., Sánchez, R.M., Imma, V.P., Elisabet, G.M., Claverias, L., Magret, M., Pellicer, A.M., Rodriguez, L.L., Sánchez-Ballesteros, J., González-Salamanca, Á., Jimenez, A.G., Huerta, F.P., Diaz, J.C.J.S., Lopez, E.B., Moya, D.D.L., Alfonso, A.A.T., Luis, P.S.E., Cesar, P.S., Rafael, S.I., Virgilio, C.G., Recio, N.N., Adamsson, R.O., Rylander, C.C., Holzgraefe, B., Broman, L.M., Wessbergh, J., Persson, L., Schiöler, F., Kedelv, H., Tibblin, A.O., Appelberg, H., Hedlund, L., Helleberg, J., Eriksson, K.E., Glietsch, R., Larsson, N., Nygren, I., Nunes, S.L., Morin, A.-K., Kander, T., Adolfsson, A., Zender, H.O., Leemann-Refondini, C., Elatrous, S., Bouchoucha, S., Chouchene, I., Ouanes, I., Souissi, A.B., Kamoun, S., Demirkiran, O., Aker, M., Erbabacan, E., Ceylan, I., Girgin, N.K., Ozcelik, M., Ünal, N., Meco, B.C., Akyol, O.O., Derman, S.S., Kennedy, B., Parhar, K., Srinivasa, L., McAuley, D., 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S., Kajtor, I., Sivashanmugavel, M., O’Kane, S.C., Donnelly, A., Frigyik, A.D., Careless, J.P., May, M.M., Stewart, R., Trinder, T.J., Hagan, S.J., Wise, M.P., Cole, J.M., MacFie, C.C., Dowling, A.T., Nuñez, E., Pittini, G., Rodriguez, R., Imperio, M.C., Santos, C., França, A.G., Ebeid, A., Deicas, A., Serra, C., Uppalapati, A., Kamel, G., Banner-Goodspeed, V.M., Beitler, J.R., Mukkera, S.R., Kulkarni, S., Lee, J., Mesar, T., Shinn, J.O., Gomaa, D., Tainter, C., Yeatts, D.J., Warren, J., Lanspa, M.J., Miller, R.R., Grissom, C.K., Brown, S.M., Bauer, P.R., Gosselin, R.J., Kitch, B.T., Cohen, J.E., Beegle, S.H., Gueret, R.M., Tulaimat, A., Choudry, S., Stigler, W., Batra, H., Huff, N.G., Lamb, K.D., Oetting, T.W., Mohr, N.M., Judy, C., Saito, S., Kheir, F.M., Kheir, F., Schlichting, A.B., Delsing, A., Crouch, D.R., Elmasri, M., Ismail, D., Dreyer, K.R., Blakeman, T.C., Baron, R.M., Grijalba, C.Q., Hou, P.C., Seethala, R., Aisiku, I., Henderson, G., Frendl, G., Hou, S.-K., Owens, R.L., Schomer, A., Bumbasirevic, V., Jovanovic, B., Surbatovic, M., Veljovic, M., LUNG SAFE Investigators and the ESICM Trials Group, Madotto, F, Pham, T, Bellani, G, Bos, L, Simonis, F, Fan, E, Artigas, A, Brochard, L, Schultz, M, Laffey, J, Pesenti, A, Esteban, A, Gattinoni, L, van Haren, F, Larsson, A, Mcauley, D, Ranieri, M, Rubenfeld, G, Thompson, B, Wrigge, H, Slutsky, A, Rios, F, Sottiaux, T, Depuydt, P, Lora, F, Azevedo, L, Bugedo, G, Qiu, H, Gonzalez, M, Silesky, J, Cerny, V, Nielsen, J, Jibaja, M, Matamis, D, Ranero, J, Amin, P, Hashemian, S, Clarkson, K, Kurahashi, K, Villagomez, A, Zeggwagh, A, Heunks, L, Laake, J, Palo, J, Do Vale Fernandes, A, Sandesc, D, Arabi, Y, Bumbasierevic, V, Nin, N, Lorente, J, Piquilloud, L, Abroug, F, Mcnamee, L, Hurtado, J, Bajwa, E, Démpaire, G, Sula, H, Nunci, L, Cani, A, Zazu, A, Dellera, C, Alejandro, R, Daldin, J, Vinzio, M, Fernandez, R, Cardonnet, L, Bettini, L, Bisso, M, Osman, E, Setten, M, Lovazzano, P, Alvarez, J, Villar, V, Pozo, N, Grubissich, N, Plotnikow, G, Vasquez, D, Ilutovich, S, Tiribelli, N, Chena, A, Pellegrini, C, Saenz, M, Estenssoro, E, Brizuela, M, Gianinetto, H, Gomez, P, Cerrato, V, Bezzi, M, Borello, S, Loiacono, F, Fernandez, A, Knowles, S, Reynolds, C, Inskip, D, Miller, J, Kong, J, Whitehead, C, Bihari, S, Seven, A, Krstevski, A, Rodgers, H, Millar, R, Mckenna, T, Bailey, I, Hanlon, G, Aneman, A, Lynch, J, Azad, R, Neal, J, Woods, P, Roberts, B, Kol, M, Wong, H, Riss, K, Staudinger, T, Wittebole, X, Berghe, C, Bulpa, P, Dive, A, Verstraete, R, Lebbinck, H, Vermassen, J, Meersseman, P, Ceunen, H, Rosa, J, Beraldo, D, Piras, C, Rampinelli, A, Nassar, A, Mataloun, S, Moock, M, Thompson, M, Gonçalves, C, Antônio, A, Ascoli, A, Biondi, R, Fontenele, D, Nobrega, D, Sales, V, Shindhe, S, Ismail, D, Beloncle, F, Davies, K, Cirone, R, Manoharan, V, Ismail, M, Goligher, E, Jassal, M, Nishikawa, E, Javeed, A, Curley, G, Rittayamai, N, Parotto, M, Ferguson, N, Mehta, S, Knoll, J, Pronovost, A, Canestrini, S, Bruhn, A, Garcia, P, Aliaga, F, Farías, P, Yumha, J, Ortiz, C, Salas, J, Saez, A, Vega, L, Labarca, E, Martinez, F, Carreño, N, Lora, P, Liu, H, Liu, L, Tang, R, Luo, X, An, Y, Zhao, H, Gao, Y, Zhai, Z, Ye, Z, Wang, W, Li, W, Li, Q, Zheng, R, Yu, W, Shen, J, Li, X, Yu, T, Lu, W, Wu, Y, Huang, X, He, Z, Lu, Y, Han, H, Zhang, F, Sun, R, Wang, H, Qin, S, Zhu, B, Zhao, J, Liu, J, Li, B, Zhou, F, Zhang, X, Li-Xin, Z, Xin-Hua, Q, Jiang, L, Zhao, X, Li, Y, Wang, C, Yao, Q, Yu, R, Chen, K, Shao, H, Qin, B, Huang, Q, Zhu, W, Hang, A, Hua, M, Xu, Y, Di, Y, Ling, L, Qin, T, Wang, S, Qin, J, Han, Y, Zhou, S, Vargas, M, Jimenez, J, Rojas, M, Solis-Quesada, J, Ramirez-Alfaro, C, Máca, J, Sklienka, P, Gjedsted, J, Christiansen, A, Villamagua, B, Llano, M, Burtin, P, Buzancais, G, Beuret, P, Pelletier, N, Mortaza, S, Mercat, A, Chelly, J, Jochmans, S, Terzi, N, Daubin, C, Carteaux, G, de Prost, N, Chiche, J, Daviaud, F, Fartoukh, M, Barberet, G, Biehler, J, Dellamonica, J, Doyen, D, Arnal, J, Briquet, A, Hraiech, S, Papazian, L, Roux, D, Messika, J, Kalaitzis, E, Dangers, L, Combes, A, Au, S, Béduneau, G, Carpentier, D, Zogheib, E, Dupont, H, Ricome, S, Santoli, F, Besset, S, Michel, P, Gelée, B, Danin, P, Goubaux, B, Crova, P, Phan, N, Berkelmans, F, Badie, J, Tapponnier, R, Gally, J, Khebbeb, S, Herbrecht, J, Schneider, F, Declercq, P, Rigaud, J, Duranteau, J, Harrois, A, Chabanne, R, Marin, J, Bigot, C, Thibault, S, Ghazi, M, Boukhazna, M, Zein, S, Richecoeur, J, Combaux, D, Grelon, F, Le Moal, C, Sauvadet, E, Robine, A, Lemiale, V, Reuter, D, Dres, M, Demoule, A, Goldgran-Toledano, D, Baboi, L, Guérin, C, Lohner, R, Kraßler, J, Schäfer, S, Zacharowski, K, Meybohm, P, Reske, A, Simon, P, Hopf, H, Schuetz, M, Baltus, T, Papanikolaou, M, Papavasilopoulou, T, Zacharas, G, Ourailogloy, V, Mouloudi, E, Massa, E, Nagy, E, Stamou, E, Kiourtzieva, E, Oikonomou, M, Avila, L, Cortez, C, Citalán, J, Jog, S, Sable, S, Shah, B, Gurjar, M, Baronia, A, Memon, M, Muthuchellappan, R, Ramesh, V, Shenoy, A, Unnikrishnan, R, Dixit, S, Rhayakar, R, Ramakrishnan, N, Bhardwaj, V, Mahto, H, Sagar, S, Palaniswamy, V, Ganesan, D, Jamaati, H, Heidari, F, Meaney, E, Nichol, A, Knapman, K, O’Croinin, D, Dunne, E, Breen, D, Jaafar, R, Dwyer, R, Amir, F, Ajetunmobi, O, O’Muircheartaigh, A, Black, C, Treanor, N, Collins, D, Altaf, W, Zani, G, Fusari, M, Spadaro, S, Volta, C, Graziani, R, Brunettini, B, Palmese, S, Formenti, P, Umbrello, M, Lombardo, A, Pecci, E, Botteri, M, Savioli, M, Protti, A, Mattei, A, Schiavoni, L, Tinnirello, A, Todeschini, M, Giarratano, A, Cortegiani, A, Sher, S, Rossi, A, Antonelli, M, Montini, L, Casalena, P, Scafetti, S, Panarello, G, Occhipinti, G, Patroniti, N, Pozzi, M, Biscione, R, Poli, M, Raimondi, F, Albiero, D, Crapelli, G, Beck, E, Pota, V, Schiavone, V, Molin, A, Tarantino, F, Monti, G, Frati, E, Mirabella, L, Cinnella, G, Fossali, T, Colombo, R, Pattarino, P, Mojoli, F, Braschi, A, Borotto, E, Cracchiolo, A, Palma, D, Raponi, F, Foti, G, Vascotto, E, Coppadoro, A, Brazzi, L, Floris, L, Iotti, G, Venti, A, Yamaguchi, O, Takagi, S, Maeyama, H, Watanabe, E, Yamaji, Y, Shimizu, K, Shiozaki, K, Futami, S, Ryosuke, S, Saito, K, Kameyama, Y, Ueno, K, Izawa, M, Okuda, N, Suzuki, H, Harasawa, T, Nasu, M, Takada, T, Ito, F, Nunomiya, S, Koyama, K, Abe, T, Andoh, K, Kusumoto, K, Hirata, A, Takaba, A, Kimura, H, Matsumoto, S, Higashijima, U, Honda, H, Aoki, N, Imai, H, Ogino, Y, Mizuguchi, I, Ichikado, K, Nitta, K, Mochizuki, K, Hashida, T, Tanaka, H, Nakamura, T, Niimi, D, Ueda, T, Kashiwa, Y, Uchiyama, A, Sabelnikovs, O, Oss, P, Haddad, Y, Liew, K, Ñamendys-Silva, S, Jarquin-Badiola, Y, Sanchez-Hurtado, L, Gomez-Flores, S, Marin, M, Lemus, J, Fierro, J, Cervantes, M, Mejia, F, Dector, D, Gonzalez, D, Estrella, C, Sanchez-Medina, J, Ramirez-Gutierrez, A, George, F, Aguirre, J, Buensuseso, J, Poblano, M, Dendane, T, Balkhi, H, Elkhayari, M, Samkaoui, N, Ezzouine, H, Benslama, A, Amor, M, Maazouzi, W, Cimic, N, Beck, O, Bruns, M, Schouten, J, Rinia, M, Raaijmakers, M, van Wezel, H, Heines, S, Strauch, U, Buise, M, Goodson, J, Browne, T, Navarra, L, Hunt, A, Hutchison, R, Bailey, M, Newby, L, Mcarthur, C, Kalkoff, M, Mcleod, A, Casement, J, Hacking, D, Andersen, F, Dolva, M, Barratt-Due, A, Noremark, K, Søreide, E, Sjøbø, B, Guttormsen, A, Yoshido, H, Aguilar, R, Oscanoa, F, Alisasis, A, Robles, J, Pasanting-Lim, R, Tan, B, Andruszkiewicz, P, Jakubowska, K, Coxo, C, Alvarez, A, Oliveira, B, Montanha, G, Barros, N, Pereira, C, Messias, A, Monteiro, J, Araujo, A, Catorze, N, Marum, S, Bouw, M, Gomes, R, Brito, V, Castro, S, Estilita, J, Barros, F, Serra, I, Martinho, A, Tomescu, D, Marcu, A, Bedreag, O, Papurica, M, Corneci, D, Negoita, S, Grigoriev, E, Gritsan, A, Gazenkampf, A, Almekhlafi, G, Albarrak, M, Mustafa, G, Maghrabi, K, Salahuddin, N, Aisa, T, Jabbary, A, Tabhan, E, Trinidad, O, Dorzi, H, Bolon, S, Smith, O, Mancebo, J, Aguirre-Bermeo, H, Lopez-Delgado, J, Esteve, F, Rialp, G, Forteza, C, de Haro, C, Albaiceta, G, de Cima-Iglesias, S, Seoane-Quiroga, L, Ceniceros-Barros, A, Ruiz-Aguilar, A, Claraco-Vega, L, Soler, J, Del Carmen Lorente, M, Hermosa, C, Gordo, F, Prieto-González, M, López-Messa, J, Perez, M, Perez, C, Allue, R, Roche-Campo, F, Ibañez-Santacruz, M, Temprano, S, Pintado, M, de Pablo, R, Gómez, P, Ruiz, S, Moles, S, Jurado, M, Arizmendi, A, Piacentini, E, Franco, N, Honrubia, T, Cheng, M, Losada, E, Blanco, J, Yuste, L, Carbayo-Gorriz, C, Cazorla-Barranquero, F, Alonso, J, Alda, R, Algaba, Á, Navarro, G, Cereijo, E, Diaz-Rodriguez, E, Marcos, D, Montero, L, Para, L, Sanchez, R, Navalpotro, M, Abad, R, González, R, Toribio, D, Castro, A, Artiga, M, Penuelas, O, Roser, T, Olga, M, Curto, E, Sánchez, R, Imma, V, Elisabet, G, Claverias, L, Magret, M, Pellicer, A, Rodriguez, L, Sánchez-Ballesteros, J, González-Salamanca, Á, Jimenez, A, Huerta, F, Diaz, J, Lopez, E, Moya, D, Alfonso, A, Luis, P, Cesar, P, Rafael, S, Virgilio, C, Recio, N, Adamsson, R, Rylander, C, Holzgraefe, B, Broman, L, Wessbergh, J, Persson, L, Schiöler, F, Kedelv, H, Tibblin, A, Appelberg, H, Hedlund, L, Helleberg, J, Eriksson, K, Glietsch, R, Larsson, N, Nygren, I, Nunes, S, Morin, A, Kander, T, Adolfsson, A, Zender, H, Leemann-Refondini, C, Elatrous, S, Bouchoucha, S, Chouchene, I, Ouanes, I, Souissi, A, Kamoun, S, Demirkiran, O, Aker, M, Erbabacan, E, Ceylan, I, Girgin, N, Ozcelik, M, Ünal, N, Meco, B, Akyol, O, Derman, S, Kennedy, B, Parhar, K, Srinivasa, L, Hopkins, P, Mellis, C, Kakar, V, Hadfield, D, Vercueil, A, Bhowmick, K, Humphreys, S, Ferguson, A, Mckee, R, Raj, A, Fawkes, D, Watt, P, Twohey, L, Thomas, R, Morton, A, Kadaba, V, Smith, M, Hormis, A, Kannan, S, Namih, M, Reschreiter, H, Camsooksai, J, Kumar, A, Rugonfalvi, S, Nutt, C, O’Neill, O, Seasman, C, Dempsey, G, Scott, C, Ellis, H, Mckechnie, S, Hutton, P, Di Tomasso, N, Vitale, M, Griffin, R, Dean, M, Cranshaw, J, Willett, E, Ioannou, N, Gillis, S, Csabi, P, Macfadyen, R, Dawson, H, Preez, P, Williams, A, Boyd, O, de Gordoa, L, Bramall, J, Symmonds, S, Chau, S, Wenham, T, Szakmany, T, Toth-Tarsoly, P, Mccalman, K, Alexander, P, Stephenson, L, Collyer, T, Chapman, R, Cooper, R, Allan, R, Sim, M, Wrathall, D, Irvine, D, Zantua, K, Adams, J, Burtenshaw, A, Sellors, G, Welters, I, Williams, K, Hessell, R, Oldroyd, M, Battle, C, Pillai, S, Kajtor, I, Sivashanmugavel, M, O’Kane, S, Donnelly, A, Frigyik, A, Careless, J, May, M, Stewart, R, Trinder, T, Hagan, S, Wise, M, Cole, J, Macfie, C, Dowling, A, Nuñez, E, Pittini, G, Rodriguez, R, Imperio, M, Santos, C, França, A, Ebeid, A, Deicas, A, Serra, C, Uppalapati, A, Kamel, G, Banner-Goodspeed, V, Beitler, J, Mukkera, S, Kulkarni, S, Lee, J, Mesar, T, Shinn, J, Gomaa, D, Tainter, C, Yeatts, D, Warren, J, Lanspa, M, Miller, R, Grissom, C, Brown, S, Bauer, P, Gosselin, R, Kitch, B, Cohen, J, Beegle, S, Gueret, R, Tulaimat, A, Choudry, S, Stigler, W, Batra, H, Huff, N, Lamb, K, Oetting, T, Mohr, N, Judy, C, Saito, S, Kheir, F, Schlichting, A, Delsing, A, Crouch, D, Elmasri, M, Dreyer, K, Blakeman, T, Baron, R, Grijalba, C, Hou, P, Seethala, R, Aisiku, I, Henderson, G, Frendl, G, Hou, S, Owens, R, Schomer, A, Bumbasirevic, V, Jovanovic, B, Surbatovic, M, Veljovic, M, Madotto, Fabiana, Pham, Tài, Bellani, Giacomo, Bos, Lieuwe D., Simonis, Fabienne D., Fan, Eddy, Artigas, Antonio, Brochard, Laurent, Schultz, Marcus J., Laffey, John G., Pesenti, Antonio, Esteban, Andre, Gattinoni, Luciano, van Haren, Frank, Larsson, Ander, McAuley, Daniel F., Ranieri, Marco, Rubenfeld, Gordon, Thompson, B. Taylor, Wrigge, Hermann, Slutsky, Arthur S., Rios, Fernando, Lora, Fredy S., Azevedo, Luciano Cesar, Bugedo, Guillermo, Qiu, Haibo, Gonzalez, Marco, Silesky, Juan, Cerny, Vladimir, Nielsen, Jona, Jibaja, Manuel, Matamis, Dimitrio, Ranero, Jorge Lui, Amin, Pravin, Clarkson, Kevin, Kurahashi, Kiyoyasu, Villagomez, Asisclo, Zeggwagh, Amine Ali, Heunks, Leo M., Laake, Jon Henrik, Palo, Jose Emmanuel, Do Vale Fernandes, Antero, Sandesc, Dorel, Arabi, Yaasen, Bumbasierevic, Vesna, Nin, Nicola, Lorente, Jose A., Piquilloud, Lise, Abroug, Fekri, McNamee, Lia, Hurtado, Javier, Bajwa, Ed, Démpaire, Gabriel, Sula, Hektor, Nunci, Lordian, Cani, Alma, Zazu, Alan, Dellera, Christian, Alejandro, Risso V., Daldin, Julio, Vinzio, Mauricio, Fernandez, Ruben O., Cardonnet, Luis P., Bettini, Lisandro R., Bisso, Mariano Carboni, Osman, Emilio M., Setten, Mariano G., Lovazzano, Pablo, Alvarez, Javier, Villar, Veronica, Pozo, Norberto C., Grubissich, Nicola, Plotnikow, Gustavo A., Vasquez, Daniela N., Ilutovich, Santiago, Tiribelli, Norberto, Chena, Ariel, Pellegrini, Carlos A., Saenz, María G., Estenssoro, Elisa, Brizuela, Matia, Gianinetto, Hernan, Gomez, Pablo E., Cerrato, Valeria I., Bezzi, Marco G., Borello, Silvina A., Loiacono, Flavia A., Fernandez, Adriana M., Knowles, Serena, Reynolds, Claire, Inskip, Deborah M., Miller, Jennene J., Kong, Jing, Whitehead, Christina, Bihari, Shailesh, Seven, Aylin, Krstevski, Amanda, Rodgers, Helen J., Millar, Rebecca T., Mckenna, Toni E., Bailey, Irene M., Hanlon, Gabrielle C., Aneman, Ander, Lynch, Joan M., Azad, Raman, Neal, John, Woods, Paul W., Roberts, Brigit L., Kol, Mark R., Wong, Helen S., Riss, Katharina C., Staudinger, Thoma, Wittebole, Xavier, Berghe, Caroline, Bulpa, Pierre A., Dive, Alain M., Verstraete, Rik, Lebbinck, Herve, Depuydt, Pieter, Vermassen, Jori, Meersseman, Philippe, Ceunen, Helga, Rosa, Jonas I., Beraldo, Daniel O., Piras, Claudio, Rampinelli, Adenilton M., Nassar, Antonio P., Mataloun, Sergio, Moock, Marcelo, Thompson, Marlus M., Gonçalves, Claudio H., Antônio, Ana Carolina P., Ascoli, Aline, Biondi, Rodrigo S., Fontenele, Danielle C., Nobrega, Danielle, Sales, Vanessa M., Shindhe, Suresh, Ismail, Dk Maizatul Aiman B. Pg Hj, Laffey, John, Beloncle, Francoi, Davies, Kyle G., Cirone, Rob, Manoharan, Venika, Ismail, Mehvish, Goligher, Ewan C., Jassal, Mandeep, Nishikawa, Erin, Javeed, Areej, Curley, Gerard, Rittayamai, Nuttapol, Parotto, Matteo, Ferguson, Niall D., Mehta, Sangeeta, Knoll, Jenny, Pronovost, Antoine, Canestrini, Sergio, Bruhn, Alejandro R., Garcia, Patricio H., Aliaga, Felipe A., Farías, Pamela A., Yumha, Jacob S., Ortiz, Claudia A., Salas, Javier E., Saez, Alejandro A., Vega, Luis D., Labarca, Eduardo F., Martinez, Felipe T., Carreño, Nicolás G., Lora, Pilar, Liu, Haitao, Liu, Ling, Tang, Rui, Luo, Xiaoming, An, Youzhong, Zhao, Huiying, Gao, Yan, Zhai, Zhe, Ye, Zheng L., Wang, Wei, Li, Wenwen, Li, Qingdong, Zheng, Ruiqiang, Yu, Wenkui, Shen, Juanhong, Li, Xinyu, Yu, Tao, Lu, Weihua, Wu, Ya, Huang, Xiao B., He, Zhenyang, Lu, Yuanhua, Han, Hui, Zhang, Fan, Sun, Renhua, Wang, Hua X., Qin, Shu H., Zhu, Bao H., Zhao, Jun, Liu, Jian, Li, Bin, Liu, Jing L., Zhou, Fa, Li, Qiong J., Zhang, Xing Y., Li-Xin, Zhou, Xin-Hua, Qiang, Jiang, Liangyan, Gao, Yuan N., Zhao, Xian Y., Li, Yuan Y., Li, Xiao L., Wang, Chunting, Yao, Qingchun, Yu, Rongguo, Chen, Kai, Shao, Huanzhang, Qin, Bingyu, Huang, Qing Q., Zhu, Wei H., Hang, Ai, Hua, Ma, Li, Yimin, Xu, Yonghao, Di, Yu, Ling, Long L., Qin, Tie H., Wang, Shou H., Qin, Junping, Han, Yi, Zhou, Suming, Vargas, Monica P., Jimenez, Juan I. Silesky, Rojas, Manuel A. González, Solis-Quesada, Jaime E., Ramirez-Alfaro, Christian M., Máca, Jan, Sklienka, Peter, Gjedsted, Jakob, Christiansen, Aage, Villamagua, Boris G., Llano, Miguel, Burtin, Philippe, Buzancais, Gautier, Beuret, Pascal, Pelletier, Nicola, Mortaza, Satar, Mercat, Alain, Chelly, Jonathan, Jochmans, Sébastien, Terzi, Nicola, Daubin, Cédric, Carteaux, Guillaume, de Prost, Nicola, Chiche, Jean-Daniel, Daviaud, Fabrice, Pham, Tai, Fartoukh, Muriel, Barberet, Guillaume, Biehler, Jerome, Dellamonica, Jean, Doyen, Deni, Arnal, Jean-Michel, Briquet, Anai, Hraiech, Sami, Papazian, Laurent, Roux, Damien, Messika, Jonathan, Kalaitzis, Evangelo, Dangers, Laurence, Combes, Alain, Au, Siu-Ming, Béduneau, Gaetan, Carpentier, Dorothée, Zogheib, Elie H., Dupont, Herve, Ricome, Sylvie, Santoli, Francesco L., Besset, Sebastien L., Michel, Philippe, Gelée, Bruno, Danin, Pierre-Eric, Goubaux, Bernard, Crova, Philippe J., Phan, Nga T., Berkelmans, Frantz, Badie, Julio C., Tapponnier, Romain, Gally, Josette, 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Tallet, Luis, Palazon Sanchez Eugenio, Cesar, Palazon Sanchez, Rafael, Sánchez I., Virgilio, Corcoles G., Recio, Noelia N., Adamsson, Richard O., Rylander, Christian C., Holzgraefe, Bernhard, Broman, Lars M., Wessbergh, Joanna, Persson, Linnea, Schiöler, Fredrik, Kedelv, Han, Tibblin, Anna Oscarsson, Appelberg, Henrik, Hedlund, Lar, Helleberg, Johan, Eriksson, Karin E., Glietsch, Rita, Larsson, Nikla, Nygren, Ingela, Nunes, Silvia L., Morin, Anna-Karin, Kander, Thoma, Adolfsson, Anne, Zender, Hervé O., Leemann-Refondini, Corinne, Elatrous, Souheil, Bouchoucha, Slaheddine, Chouchene, Imed, Ouanes, Islem, Souissi, Asma Ben, Kamoun, Salma, Demirkiran, Oktay, Aker, Mustafa, Erbabacan, Emre, Ceylan, Ilkay, Girgin, Nermin Kelebek, Ozcelik, Menekse, Ünal, Necmettin, Meco, Basak Ceyda, Akyol, Onat O., Derman, Suleyman S., Kennedy, Barry, Parhar, Ken, Srinivasa, Latha, McAuley, Danny, Hopkins, Phil, Mellis, Clare, Kakar, Vivek, Hadfield, Dan, Vercueil, Andre, Bhowmick, Kaushik, Humphreys, Sally K., Ferguson, Andrew, Mckee, Raymond, Raj, Ashok S., Fawkes, Danielle A., Watt, Philip, Twohey, Linda, Thomas, Rajeev R. 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John, Hagan, Samantha J., Wise, Matt P., Cole, Jade M., MacFie, Caroline C., Dowling, Anna T., Nin, Nicolá, Nuñez, Edgardo, Pittini, Gustavo, Rodriguez, Ruben, Imperio, María C., Santos, Cristina, França, Ana G., Ebeid, Alejandro, Deicas, Alberto, Serra, Carolina, Uppalapati, Aditya, Kamel, Ghassan, Banner-Goodspeed, Valerie M., Beitler, Jeremy R., Mukkera, Satyanarayana Reddy, Kulkarni, Shreedhar, Lee, Jarone, Mesar, Tomaz, Shinn, John O., Gomaa, Dina, Tainter, Christopher, Yeatts, Dale J., Warren, Jessica, Lanspa, Michael J., Miller, Russel R., Grissom, Colin K., Brown, Samuel M., Bauer, Philippe R., Gosselin, Ryan J., Kitch, Barrett T., Cohen, Jason E., Beegle, Scott H., Gueret, Renaud M., Tulaimat, Aiman, Choudry, Shazia, Stigler, William, Batra, Hitesh, Huff, Nidhi G., Lamb, Keith D., Oetting, Trevor W., Mohr, Nicholas M., Judy, Claine, Saito, Shigeki, Kheir, Fayez M., Kheir, Fayez, Schlichting, Adam B., Delsing, Angela, Crouch, Daniel R., Elmasri, Mary, Ismail, Dina, Dreyer, Kyle R., Blakeman, Thomas C., Baron, Rebecca M., Grijalba, Carolina Quintana, Hou, Peter C., Seethala, Raghu, Aisiku, Imo, Henderson, Galen, Frendl, Gyorgy, Hou, Sen-Kuang, Owens, Robert L., Schomer, Ashley, Bumbasirevic, Vesna, Jovanovic, Bojan, Surbatovic, Maja, Veljovic, Milic, Intensive Care Medicine, Graduate School, ACS - Heart failure & arrhythmias, AII - Inflammatory diseases, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Bos, L. D., Simonis, F. D., Schultz, M. J., Laffey, J. G., Mcauley, D. F., Thompson, B. T., Slutsky, A. S., Lora, F. S., Azevedo, L. C., Ranero, J. L., Hashemian, S. M., Zeggwagh, A. A., Heunks, L. M., Laake, J. H., Palo, J. E., Lorente, J. A., Mcnamee, L., Dempaire, G., Alejandro, R. V., Fernandez, R. O., Cardonnet, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Pozo, N. C., Plotnikow, G. A., Vasquez, D. N., Pellegrini, C. A., Saenz, M. G., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Inskip, D. M., Miller, J. J., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Lynch, J. M., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Bulpa, P. A., Dive, A. M., Rosa, J. I., Beraldo, D. O., Rampinelli, A. M., Nassar, A. P., Thompson, M. M., Goncalves, C. H., Antonio, A. C. P., Biondi, R. S., Fontenele, D. C., Sales, V. M., Ismail, D. M. A. B. P. H., Davies, K. G., Goligher, E. C., Ferguson, N. D., Bruhn, A. R., Garcia, P. H., Aliaga, F. A., Farias, P. A., Yumha, J. S., Ortiz, C. A., Salas, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreno, N. G., Ye, Z. L., Wu, Y. Q., Huang, X. B., Wang, H. X., Qin, S. H., Zhu, B. H., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Vargas, M. P., Jimenez, J. I. S., Rojas, M. A. G., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Maca, J., Villamagua, B. G., Chiche, J. -D., Arnal, J. -M., Au, S. -M., Beduneau, G., Zogheib, E. H., Santoli, F. L., Besset, S. L., Gelee, B., Danin, P. -E., Crova, P. J., Phan, N. T., Badie, J. C., Herbrecht, J. -E., Declercq, P. -L. M., Rigaud, J. -P., Zein, S. O., Richecoeur, J. R., Combaux, D. M., Lemoal, C., Sauvadet, E. P., Guerin, C., Krassler, J., Schafer, S., Zacharowski, K. D., Reske, A. W., Hopf, H. -B. F., Papanikolaou, M. N., Papavasilopoulou, T. G., Zacharas, G. A., Mouloudi, E. K., Massa, E. V., Nagy, E. O., Stamou, E. E., Kiourtzieva, E. V., Oikonomou, M. A., Avila, L. E., Cortez, C. A., Citalan, J. E., Jog, S. A., Sable, S. D., Baronia, A. K., Ramesh, V. J., Dixit, S. B., Rhayakar, R. V., Bhardwaj, V. K., Mahto, H. L., Sagar, S. V., Meaney, E. A., Knapman, K. M., O'Croinin, D., Dunne, E. S., Breen, D. M., Clarkson, K. P., Jaafar, R. F., Ajetunmobi, O. O., O'Muircheartaigh, A. C., Black, C. S., Collins, D. V., Volta, C. A., Antonelli, M. M., Montini, L. M., Biscione, R. R., Poli, M. M., Pattarino, P. T. I., Borotto, E. E., Cracchiolo, A. N., Palma, D. M., Vascotto, E. R., Iotti, G. A., Maeyama, H. N., Liew, K. Y., Namendys-Silva, S. A., Jarquin-Badiola, Y. D., Sanchez-Hurtado, L. A., Gomez-Flores, S. S., Marin, M. C., Villagomez, A. J., Lemus, J. S., Fierro, J. M., Cervantes, M. R., Mejia, F. J. F., Dector, D. M., Gonzalez, D. R., Estrella, C. R., Sanchez-Medina, J. 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M., Ruiz-Aguilar, A. L., Claraco-Vega, L. M., Soler, J. A., Prieto-Gonzalez, M., Lopez-Messa, J. B., Perez, M. P., Perez, C. P., Allue, R. M., Ibanez-Santacruz, M., Pintado, M. C., Depablo, R., Gomez, P. R. A., Ruiz, S. R., Moles, S. I., Jurado, M. T., Piacentini, E. A., Cheng, M. P., Losada, E. P., Yuste, L. J., Cazorla-Barranquero, F. G., Alonso, J. G., Alda, R. S., Algaba, A., Marcos, D. P., Montero, L. A., Para, L. H., Sanchez, R. J., Navalpotro, M. A. B., Abad, R. D., Gonzalez, R. M., Toribio, D. P., Castro, A. G., Artiga, M. J. D., Roser, T. P., Olga, M. F., Curto, E. G., Sanchez, R. M., Imma, V. P., Elisabet, G. M., Pellicer, A. M., Rodriguez, L. L., Sanchez-Ballesteros, J., Gonzalez-Salamanca, A., Jimenez, A. G., Huerta, F. P., Diaz, J. C. J. S., Lopez, E. B., Moya, D. D. L., Alfonso, A. A. T., Luis, P. S. E., Cesar, P. S., Rafael, S. I., Virgilio, C. G., Recio, N. N., Adamsson, R. O., Rylander, C. C., Broman, L. M., Schioler, F., Tibblin, A. O., Eriksson, K. E., Nunes, S. 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K., Brown, S. M., Bauer, P. R., Gosselin, R. J., Kitch, B. T., Cohen, J. E., Beegle, S. H., Gueret, R. M., Huff, N. G., Lamb, K. D., Oetting, T. W., Mohr, N. M., Kheir, F. M., Schlichting, A. B., Crouch, D. R., Dreyer, K. R., Blakeman, T. C., Baron, R. M., Grijalba, C. Q., Hou, P. C., Hou, S. -K., and Owens, R. L.
Subjects: Male, ARDS, medicine.medical_treatment, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], ARDS reassessment, ARDS Survival, Berlin criteria ARDS, Persisting ARDS, Critical Care and Intensive Care Medicine, assisted ventilation, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, risk factor, Adult, Tidal volume, comparative study, education.field_of_study, Respiratory Distress Syndrome, Mortality rate, Remission Induction, tidal volume, artificial ventilation, clinical trial, immunosuppressive treatment, adult respiratory distress syndrome, Middle Aged, Monte Carlo method, medicine.anatomical_structure, classification, positive end expiratory pressure, Cardiology, Disease Progression, SOFA score, disease severity, Female, Adult, medicine.medical_specialty, Population, disease classification, Article, NO, 03 medical and health sciences, remission, length of stay, Anesthesiology, Internal medicine, medicine, pneumonia, Sequential Organ Failure Assessment Score, Humans, human, education, Aged, Mechanical ventilation, hospital mortality, Lung, business.industry, Risk Factor, disease association, Respiratory Distress Syndrome, Adult, medicine.disease, major clinical study, mortality, Respiration, Artificial, breathing rate, 030228 respiratory system, disease exacerbation, business
Abstract: Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24 h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01–1.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both resolved and confirmed ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Published: 2018

35. Chest wall effect on the monitoring of respiratory mechanics in acute respiratory distress syndrome

Author: Matías Accoce, Javier Hernán Dorado, and Gustavo Plotnikow
Subjects: Insufflation, medicine.medical_specialty, Respiratory distress syndrome, Adult, medicine.medical_treatment, Respiratory mechanics, Respiratory physiology, Critical Care and Intensive Care Medicine, Thoracic wall, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Tidal Volume, Medicine, Humans, Lung volumes, Respiratory system, Review Articles, Monitoring, Physiologic, Mechanical ventilation, Ventilator-induced lung injury, Respiratory Distress Syndrome, Lung, Wall effect, business.industry, 030208 emergency & critical care medicine, General Medicine, Prognosis, Respiration, Artificial, Pulmonary Alveoli, medicine.anatomical_structure, 030228 respiratory system, Cardiology, business, Airway
Abstract: The respiratory system mechanics depend on the characteristics of the lung and chest wall and their interaction. In patients with acute respiratory distress syndrome under mechanical ventilation, the monitoring of airway plateau pressure is fundamental given its prognostic value and its capacity to assess pulmonary stress. However, its validity can be affected by changes in mechanical characteristics of the chest wall, and it provides no data to correctly titrate positive end-expiratory pressure by restoring lung volume. The chest wall effect on respiratory mechanics in acute respiratory distress syndrome has not been completely described, and it has likely been overestimated, which may lead to erroneous decision making. The load imposed by the chest wall is negligible when the respiratory system is insufflated with positive end-expiratory pressure. Under dynamic conditions, moving this structure demands a pressure change whose magnitude is related to its mechanical characteristics, and this load remains constant regardless of the volume from which it is insufflated. Thus, changes in airway pressure reflect changes in the lung mechanical conditions. Advanced monitoring could be reserved for patients with increased intra-abdominal pressure in whom a protective mechanical ventilation strategy cannot be implemented. The estimates of alveolar recruitment based on respiratory system mechanics could reflect differences in chest wall response to insufflation and not actual alveolar recruitment.La mecánica del sistema respiratorio depende de las características del pulmón, la caja torácica y su interacción. En pacientes con síndrome de distrés respiratorio agudo bajo ventilación mecánica el monitoreo de la presión meseta en la vía aérea es fundamental debido a su valor pronóstico y su capacidad de reflejar el estrés pulmonar. Sin embargo, su validez puede verse afectada por cambios en las características mecánicas de la caja torácica, y además, no otorga información para la correcta titulación de presión positiva al final de la espiración en función de restablecer el volumen pulmonar. La influencia que la caja torácica ejerce sobre la mecánica del sistema respiratorio en síndrome de distrés respiratorio agudo no ha sido completamente descripta y es probable que haya sido sobredimensionada pudiendo conducir a toma de decisiones erróneas. Ante la insuflación con presión positiva al final de la espiración, la carga impuesta por la caja torácica es despreciable. En condiciones dinámicas, desplazar esta estructura demanda un cambio de presión cuya magnitud se relaciona con sus características mecánicas, dicha carga se mantiene constante independientemente del volumen a partir del cual es insuflada. Por lo que cambios en la presión en la vía aérea reflejan modificaciones en las condiciones mecánicas del pulmón. El monitoreo avanzado podría reservarse para pacientes con incremento de la presión intra-abdominal en los que no pueda implementarse una estrategia de ventilación mecánica protectora. Las estimaciones de reclutamiento alveolar basadas en la mecánica del sistema respiratorio podrían ser reflejo del diferente comportamiento de la caja torácica a la insuflación y no verdadero reclutamiento alveolar.
Published: 2018

36. New UK guidelines for the management of adult patients with ARDS

Author: Mark J.D. Griffiths, Eddy Fan, and Simon Baudouin
Subjects: Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, ARDS, medicine.medical_treatment, Respiratory System, Psychological intervention, assisted ventilation, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Intensive care, medicine, Humans, 030212 general & internal medicine, Respiratory Care Units, ACUTE RESPIRATORY-DISTRESS, Mechanical ventilation, Respiratory Distress Syndrome, Science & Technology, business.industry, Respiratory Distress Syndrome, Adult, 1103 Clinical Sciences, Guideline, medicine.disease, Respiration, Artificial, United Kingdom, critical care, 030228 respiratory system, Practice Guidelines as Topic, Emergency medicine, Observational study, business, Life Sciences & Biomedicine
Abstract: Acute respiratory distress syndrome (ARDS) was first reported in a case series from Denver in 1967,1 and remains a major problem in the severely ill. This was highlighted by data from the recently published Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) trial, which recorded admissions over 4 weeks to 459 intensive care units (ICUs) in 50 countries and included 29 144 patients. In total, 3022 (10.4%) cases fulfilled ARDS criteria, including almost a quarter of those supported with invasive mechanical ventilation.2 ARDS was associated both with high mortality and prolonged length of stay. In addition, long-term follow-up studies of patients with ARDS indicate high long-term morbidity and decreased quality of life.3 There is therefore a real need to improve outcomes in ARDS. With this aim in mind, the Intensive Care Society (ICS)/Faculty of Intensive Care Medicine (FICM) guideline for the management of the ARDS in adults was published towards the end of 2018.4 The multidisciplinary Guideline Development Group used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.5 The group allocated selected outcomes as being either of critical (mortality up to 1 year, quality of life at 3 months) or high importance (quality of life at 6–12 months, length of ICU and hospital stay and treatment-associated harms). Ten interventions used in patients with ARDS were examined, based on existing recommendations and the experience of committee members, and informed by a survey of ICS members. The evidence-based findings are summarised in table 1. Two strong recommendations (using GRADE terminology) in favour of interventions and one strong recommendation against an intervention were made. Where mechanical ventilation is required, the use of low tidal volumes (
Published: 2019

37. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material.

Author: Ferguson, Niall, Fan, Eddy, Camporota, Luigi, Antonelli, Massimo, Anzueto, Antonio, Beale, Richard, Brochard, Laurent, Brower, Roy, Esteban, Andrés, Gattinoni, Luciano, Rhodes, Andrew, Slutsky, Arthur, Vincent, Jean-Louis, Rubenfeld, Gordon, Thompson, B., and Ranieri, V.
Subjects: *ADULT respiratory distress syndrome, *DEFINITIONS, *MEDICAL terminology, *RESPIRATION
Abstract: Purpose: Our objective was to revise the definition of acute respiratory distress syndrome (ARDS) using a conceptual model incorporating reliability and validity, and a novel iterative approach with formal evaluation of the definition. Methods: The European Society of Intensive Care Medicine identified three chairs with broad expertise in ARDS who selected the participants and created the agenda. After 2 days of consensus discussions a draft definition was developed, which then underwent empiric evaluation followed by consensus revision. Results: The Berlin Definition of ARDS maintains a link to prior definitions with diagnostic criteria of timing, chest imaging, origin of edema, and hypoxemia. Patients may have ARDS if the onset is within 1 week of a known clinical insult or new/worsening respiratory symptoms. For the bilateral opacities on chest radiograph criterion, a reference set of chest radiographs has been developed to enhance inter-observer reliability. The pulmonary artery wedge pressure criterion for hydrostatic edema was removed, and illustrative vignettes were created to guide judgments about the primary cause of respiratory failure. If no risk factor for ARDS is apparent, however, objective evaluation (e.g., echocardiography) is required to help rule out hydrostatic edema. A minimum level of positive end-expiratory pressure and mutually exclusive PaO/FiO thresholds were chosen for the different levels of ARDS severity (mild, moderate, severe) to better categorize patients with different outcomes and potential responses to therapy. Conclusions: This panel addressed some of the limitations of the prior ARDS definition by incorporating current data, physiologic concepts, and clinical trials results to develop the Berlin definition, which should facilitate case recognition and better match treatment options to severity in both research trials and clinical practice. [ABSTRACT FROM AUTHOR]
Published: 2012
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38. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Author: Fekri Abroug, Javier Hurtado, Laurent Brochard, Damian A. Violi, Jacob I. Sznajder, Arnaud W. Thille, Salvatore Maurizio Maggiore, Antonio Anzueto, Michael A. Kuiper, Younsuck Koh, Yaseen M. Arabi, Freddy Sandi, Asisclo de Jesús Villagómez, Manuel Jibaja, Fernando Rios, Hans Henrik Bülow, Dimitrios Matamis, Marco Antonio Soares, Andrew Ross Davies, Pravin Amin, Gabriel D'Empaire, Oscar Peñuelas, Amine Ali Zeggwagh, José A. Lorente, Konstantinos Raymondos, Luis Soto, Bin Du, Alfonso Muriel, Niall D. Ferguson, Nicolás Nin, Rui Moreno, Marco González, and Andrés Esteban
Subjects: Adult, Male, ARDS, Time Factors, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Severity of Illness Index, ICU mortality, Article, Hypercapnia, CHLC UCI, 03 medical and health sciences, Mechanical ventilation, 0302 clinical medicine, Intensive care, medicine, Humans, Prospective Studies, Propensity Score, Aged, Respiratory Distress Syndrome, Simplified Acute Physiology Score, Acute respiratory distress syndrome, Respiratory distress, business.industry, Respiratory Distress Syndrome, Adult, 030208 emergency & critical care medicine, Carbon Dioxide, Middle Aged, medicine.disease, Respiration, Artificial, respiratory tract diseases, 3. Good health, Intensive Care Units, Logistic Models, 030228 respiratory system, SAPS II, Anesthesia, Breathing, Female, medicine.symptom, business, Respiratory minute volume, circulatory and respiratory physiology
Abstract: PURPOSE: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. MAIN OUTCOMES: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032). CONCLUSIONS: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. info:eu-repo/semantics/publishedVersion
Published: 2017

39. Feedback and education improve physician compliance in use of lung-protective mechanical ventilation.

Author: Wolthuis, Esther K., Korevaar, Johanna C., Spronk, Peter, Kuiper, Michael A., Dzoljic, Misa, Vroom, Margreeth B., and Schultz, Marcus J.
Subjects: *ARTIFICIAL respiration, *INTENSIVE care units, *RESPIRATORY therapy, *CRITICAL care medicine, *HOSPITAL wards
Abstract: Objective: Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV.Design and Setting: Observational study in one academic and two nonacademic "closed format" ICUs.Patients: Intubated mechanically ventilated subjects.Interventions: Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW).Results: Tidal volumes declined significantly within 6 months after intervention (from 9.8+/-2.0 at baseline to 8.1+/-1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar.Conclusions: Feedback and education improve physician compliance in use of lung-protective MV. [ABSTRACT FROM AUTHOR]
Published: 2005
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40. Repeated generation of the pulmonary pressure-volume curve may lead to derecruitment in experimental lung injury.

Author: Henzler, Dietrich, Mahnken, Andreas, Dembinski, Rolf, Waskowiak, Britta, Rossaint, Rolf, and Kuhlen, Ralf
Subjects: *RESPIRATORY organs, *MECHANICAL ventilators, *PULMONARY circulation, *OXYGEN therapy, *BLOOD gases, *LABORATORY swine, *ANIMAL experimentation, *BLOOD gases analysis, *BRONCHOALVEOLAR lavage, *COMPARATIVE studies, *COMPUTED tomography, *HEMODYNAMICS, *LONGITUDINAL method, *LUNGS, *LUNG injuries, *RESEARCH methodology, *MEDICAL cooperation, *NONPARAMETRIC statistics, *PRESSURE, *PULMONARY gas exchange, *REGRESSION analysis, *RESEARCH, *SWINE, *EVALUATION research, *RESPIRATORY mechanics, *LUNG volume measurements, *POSITIVE end-expiratory pressure
Abstract: Objective: Measurements from the pulmonary pressure-volume (PV) curve have been proposed to adjust ventilator settings. We investigated the effects of repeated construction of an inflation PV curve implemented in a standard ventilator on recruitment or derecruitment in acutely injured lungs.Design and Setting: Prospective experimental animal study in eight anesthetized and mechanically ventilated pigs.Interventions: Acute lung injury was induced by lung lavage and animals were ventilated in volume controlled mode with PEEP 10 cmH(2)O. The PV curve was constructed five times repeatedly by constant pressure rise, after which ventilation with the preset PEEP was resumed immediately. Studies of hemodynamics, lung mechanics, blood gases and computed tomography were carried out before and after maneuvers.Measurements and Results: Derecruitment was assessed as an increase in nonaerated lung volume (V(NON)), and V(PEEP) was the end-expiratory volume difference between PEEP and ZEEP. There was a significant decrease in PaO(2) from 90.4+/-33.3 to 70.9+/-36.3 mmHg and a rise in venous admixture from 47.8+/-12.7 to 59.1+/-16.6%. V(PEEP) was reduced from 244 to 202 ml. A corresponding decrease in normally aerated lung volume was observed, while regression analysis revealed increase in V(NON) depending on the amount of preexisting atelectasis.Conclusions: Repeated generation of the PV curve with a readily available tool resulted in worsened oxygenation. Derecruitment of the lungs occurred with loss of PEEP at the start of the maneuver, which could not be recovered by a maximum inflation pressure of 40 cmH(2)O. Repeated use of the investigated tool should be cautioned, and users should consider measures to preserve aerated lung volumes. [ABSTRACT FROM AUTHOR]
Published: 2005
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41. Tracheal gas insufflation during late exhalation efficiently reduces PaCO2 in experimental acute lung injury.

Author: Carter, Christopher, Adams, Alexander B., Stone, Mary, Bliss, Peter, Hotchkiss, John R., and Marini, John J.
Subjects: PULMONARY gas exchange, RESPIRATION, RESPIRATORY distress syndrome, LUNG injuries, CRITICAL care medicine
Abstract: Objective: Tracheal gas insufflation (TGI) reduces PaCO2 by flushing the tracheal and mechanical deadspace, and may have its maximum benefit when TGI gas is unopposed by significant expiratory gas flow. Thus, limiting TGI to the late expiratory period may diminish tracheal exposure to TGI gas while preserving the efficacy of TGI. This study examined the gas exchange consequences of such late-expiratory TGI. Design and setting: Randomized controlled trial, animal study. Materials: Eleven pigs. Interventions: After stable lung injury was established using oleic acid 11 pigs were ventilated using a standardized lung protective strategy. Phasic expiratory TGI was applied for 30 min stages during the last 20%, 40%, 60%, and 100% of expiration in random sequence. PaCO2 was continuously measured via an indwelling blood gas analysis system. Measurements and results: PaCO2 at baseline was 86.1±4.7 mmHg, and decreased progressively with increasing TGI duration of 20%, 40%, and 60%, but not 100%, of expiration (PaCO2=75.7±5.2, 68.8±3.6, 65.1±5.3 and 65.2±5.2 mmHg, respectively). For all stages the reduction in PaCO2 relative to baseline was significant. Trends of increasing PaO2 and airway pressure with increasing TGI duration were noted and most likely associated with a TGI-induced increase in lung volume. Conclusions: Under these conditions confining TGI to the final 60% of expiration achieved effective PaCO2 reduction, not significantly different from panexpiratory TGI, while limiting exposure of the trachea to TGI gas, and reducing the potential for TGI-induced hyperinflation. These findings suggest that TGI is most effectively applied in a phasic manner in late expiration, with its duration titrated to effect. [ABSTRACT FROM AUTHOR]
Published: 2002
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42. Effect of PEEP on inspiratory resistance components in patients with acute respiratory distress syndrome ventilated at low tidal volume

Author: Sebastian, Fredes, Emilio, Steinberg, Norberto, Tiribelli, Analia Santa, Maria, Mariana, Berté, Nicolás, Segura, Diego, Noval, and Santiago, Ilutovich
Subjects: Male, Respiratory Distress Syndrome, Respiratory distress syndrome, adult, Continuous positive airway pressure, Original Articles, respiratory system, Respiration, Artificial, respiratory tract diseases, Positive-Pressure Respiration, Cross-Sectional Studies, Respiratory Mechanics, Tidal Volume, Humans, Female, therapeutics, circulatory and respiratory physiology, Retrospective Studies
Abstract: To describe the behavior of inspiratory resistance components when positive end-expiratory pressure (PEEP) increases in patients with acute respiratory distress syndrome under a protective ventilation strategy.In volume-controlled mode, at 6mL/kg and constant flow, end-inspiratory occlusions were performed at 0, 5 10, 15 and 20cmH2O PEEP. Peak, initial and plateau pressure values were assessed, calculating the maximum, minimum and differential resistances. The results were compared by repeated measures analysis of variance (ANOVA) with post hoc Bonferroni correction, considering p0.05 significant.The highest maximum resistance was observed at the lowest PEEP levels. The values for 10 and 15cmH2O PEEP significantly differed from those for 5 and 0cmH2O PEEP, whereas that for 20cmH2O PEEP only significantly differed from that for 0cmH2O PEEP (p0.05). The minimum resistance behaved similarly to the maximum resistance; the values for PEEP levels from 10cmH2O to 20cmH2O significantly differed from those for 0 and 5cmH2O PEEP (p0.05). Differential resistance showed the opposite variation to the maximum and minimum resistances. The only PEEP level that showed significant differences from 0 and 5cmH2O PEEP was 20cmH2O PEEP. Significant differences were also found between 15 and 5cmH2O PEEP (p0.05).During protective ventilation in patients with acute respiratory distress syndrome, the maximum resistance of the respiratory system decreases with PEEP, reflecting the minimum resistance response, whereas differential resistance increases with PEEP.Describir el comportamiento del componente resistivo ante el incremento de la presión positiva espiratoria final (PEEP) en pacientes con síndrome de distrés respiratorio agudo ventilados con una estrategia de ventilación protectora.En modo controlada por volumen, a 6mL/Kg y flujo constante se realizaron oclusiones teleinspiratorias a PEEP 0, 5 10, 15 y 20cmH2O. Se obtuvieron valores de presión pico, inicial, plateau y se calculó resistencias máxima, mínima y diferencial. Las comparaciones se realizaron mediante test de ANOVA para muestras relacionadas con corrección post hoc de Bonferroni. Se consideró significativo una p0,05.La resistencia máxima más elevada se observó en los niveles de PEEP más bajos. Los valores de PEEP 10 y 15cmH2O tuvieron diferencias significativas con PEEP 5 y 0cmH2O, mientras que PEEP 20cmH2O únicamente con PEEP 0cmH2O (p0,05). La resistencia mínima tuvo la misma conducta que la resistencia máxima. A partir de PEEP 10cmH2O todos tuvieron diferencias significativas con PEEP 0 y 5cmH2O (p0,05). La resistencia diferencial se expresó de manera opuesta a la resistencia máxima y mínima. El único nivel de PEEP que experimentó diferencias significativas con PEEP 0 y 5cmH2O fue PEEP 20cmH2O. También hubo diferencias entre PEEP 15 y PEEP 5cmH2O (p0,05).Durante ventilación protectora en pacientes com síndrome de distrés respiratorio agudo, la resistencia máxima del sistema respiratorio tiene un comportamiento decreciente con la PEEP y refleja la respuesta que tiene la resistencia mínima. Mientras que la resistencia diferencial mantiene su conducta creciente con los valores de PEEP.
Published: 2019

43. Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung*

Author: Mariangela Pellegrini, Loïc Dégrugilliers, João Batista Borges, Alberto Bravin, Anders Larsson, Gaetano Perchiazzi, Ludovic Broche, Göran Hedenstierna, Pauline Pisa, Sam Bayat, Liisa Porra, Biomedical Beamline (ID17), European Synchrotron Radiation Facility (ESRF), Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Université de Picardie Jules Verne (UPJV), University of Helsinki, Amiens University Hospital Centre, Centre Hospitalier Universitaire [Grenoble] (CHU), Synchrotron Radiation for Biomedicine [Grenoble] (STROBE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), CHU Amiens-Picardie, Synchrotron Radiation for Biomedicine = Rayonnement SynchroTROn pour la Recherche BiomédicalE (STROBE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Broche, L, Pisa, P, Porra, L, Degrugilliers, L, Bravin, A, Pellegrini, M, Borges, J, Perchiazzi, G, Larsson, A, Hedenstierna, G, and Bayat, S
Subjects: Respiratory rate, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, FIS/07 - FISICA APPLICATA (A BENI CULTURALI, AMBIENTALI, BIOLOGIA E MEDICINA), Lung injury, mechanical ventilation, tomography, Critical Care and Intensive Care Medicine, phase-contrast imaging, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Animals, Lung, Tidal volume, Mechanical ventilation, x-ray computed, Respiratory distress syndrome, adult, business.industry, adult, 030208 emergency & critical care medicine, ventilator-induced lung injury, respiratory system, Respiration, Artificial, 3. Good health, Peripheral, respiratory tract diseases, respiratory distress syndrome, Airway Obstruction, medicine.anatomical_structure, Anesthesia, airway closure, Breathing, Rabbits, Airway, business, Tomography, X-Ray Computed
Abstract: International audience; OBJECTIVES:Airway closure is involved in adverse effects of mechanical ventilation under both general anesthesia and in acute respiratory distress syndrome patients. However, direct evidence and characterization of individual airway closure is lacking. Here, we studied the same individual peripheral airways in intact lungs of anesthetized and mechanically ventilated rabbits, at baseline and following lung injury, using high-resolution synchrotron phase-contrast CT.DESIGN:Laboratory animal investigation.SETTING:European synchrotron radiation facility.SUBJECTS:Six New-Zealand White rabbits.INTERVENTIONS:The animals were anesthetized, paralyzed, and mechanically ventilated in pressure-controlled mode (tidal volume, 6 mL/kg; respiratory rate, 40; FIO2, 0.6; inspiratory:expiratory, 1:2; and positive end-expiratory pressure, 3 cm H2O) at baseline. Imaging was performed with a 47.5 × 47.5 × 47.5 μm voxel size, at positive end-expiratory pressure 12, 9, 6, 3, and 0 cm H2O. The imaging sequence was repeated after lung injury induced by whole-lung lavage and injurious ventilation in four rabbits. Cross-sections of the same individual airways were measured.MEASUREMENTS AND MAIN RESULTS:The airways were measured at baseline (n = 48; radius, 1.7 to 0.21 mm) and after injury (n = 32). Closure was observed at 0 cm H2O in three of 48 airways (6.3%; radius, 0.35 ± 0.08 mm at positive end-expiratory pressure 12) at baseline and five of 32 (15.6%; radius, 0.28 ± 0.09 mm) airways after injury. Cross-section was significantly reduced at 3 and 0 cm H2O, after injury, with a significant relation between the relative change in cross-section and airway radius at 12 cm H2O in injured, but not in normal lung (R = 0.60; p < 0.001).CONCLUSIONS:Airway collapsibility increases in the injured lung with a significant dependence on airway caliber. We identify "compliant collapse" as the main mechanism of airway closure in initially patent airways, which can occur at more than one site in individual airways.
Published: 2019

44. Feasibility and safety of extracorporeal CO 2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study

Author: Combes, A, Fanelli, V, Pham, T, Ranieri, Vm, Goligher, Ec, Brodie, D, Pesenti, A, Beale, R, Brochard, L, Chiche, Jd, Fan, E, de Backer, D, Francois, G, Ferguson, N, Laffey, J, Mercat, A, Mcauley, Df, Muller, T, Quintel, M, Vincent, Jl, Taccone, Fs, Peperstraete, H, Morimont, P, Schmidt, M, Levy, B, Diehl, Jl, Guervilly, C, Capelier, G, Vieillard-Baron, A, Messika, J, Karagiannidis, C, Moerer, O, Urbino, R, Antonelli, Massimo, Mojoli, F, Alessandri, F, Grasselli, G, Donker, D, Ferrer, R, Mancebo, J, Slutsky, As, Combes, Alain, Fanelli, Vito, Pham, Tai, and Ranieri, V Marco
Subjects: Male, Adult, Canada, ARDS, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Extracorporeal, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Mechanical ventilation, Settore MED/41 - ANESTESIOLOGIA, Extracorporeal carbon dioxide removal, Journal Article, Extracorporeal membrane oxygenation, medicine, Humans, Prospective Studies, Adverse effect, Acute respiratory distress syndrome, Ventilator-induced lung injury, Acidosis, Respiratory, Aged, Analysis of Variance, Carbon Dioxide, Europe, Feasibility Studies, Female, Middle Aged, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Respiratory Distress Syndrome, business.industry, Respiration, 030208 emergency & critical care medicine, medicine.disease, Confidence interval, 030228 respiratory system, Pneumothorax, Anesthesia, Artificial, Respiratory, Breathing, Acidosis, business
Abstract: Purpose: We assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO 2 R) to facilitate ultra-protective ventilation (V T 4 mL/kg and P PLAT ≤ 25 cmH 2 O) in patients with moderate acute respiratory distress syndrome (ARDS). Methods: Prospective multicenter international phase 2 study. Primary endpoint was the proportion of patients achieving ultra-protective ventilation with PaCO 2 not increasing more than 20% from baseline, and arterial pH > 7.30. Severe adverse events (SAE) and ECCO 2 R-related adverse events (ECCO 2 R-AE) were reported to an independent data and safety monitoring board. We used lower CO 2 extraction and higher CO 2 extraction devices (membrane lung cross-sectional area 0.59 vs. 1.30 m 2 ; flow 300–500 mL/min vs. 800–1000 mL/min, respectively). Results: Ninety-five patients were enrolled. The proportion of patients who achieved ultra-protective settings by 8 h and 24 h was 78% (74 out of 95 patients; 95% confidence interval 68–89%) and 82% (78 out of 95 patients; 95% confidence interval 76–88%), respectively. ECCO 2 R was maintained for 5 [3–8] days. Six SAEs were reported; two of them were attributed to ECCO 2 R (brain hemorrhage and pneumothorax). ECCO 2 R-AEs were reported in 39% of the patients. A total of 69 patients (73%) were alive at day 28. Fifty-nine patients (62%) were alive at hospital discharge. Conclusions: Use of ECCO 2 R to facilitate ultra-protective ventilation was feasible. A randomized clinical trial is required to assess the overall benefits and harms. Clinicaltrials.gov: NCT02282657.
Published: 2019

45. Bedeutung der Cystathionin-γ-Lyase für die Lungenfunktion und Entzündungsreaktion nach stumpfem Thoraxtrauma im Mausmodell

Author: Wangerin, Gregor, Radermacher, Peter, and Huber-Lang, Markus
Subjects: Respiratory distress syndrome, adult, Cystathionine gamma-lyase, Hydrogen sulfide, Cystathioninlyase, Apoptose, Thoraxtrauma, Brustkorbverletzung, Apoptosis, Maus, Künstliche Beatmung, Hypoxie, Mice, Zytokine, Cytokines, Immunreaktion, Thoracic injuries, ARDS, ddc:610, Immunantwort, Respiration, artificial, Hypoxia, Schwefelwasserstoff, DDC 610 / Medicine & health, Cytokine, %22">Cystathioninlyase
Abstract: Thoraxtraumata können subakut durch eine überschießende Entzündungsantwort Organschäden verursachen. Schwefelwasserstoff (H2S) nimmt hierauf Einfluss, die Messung seiner Konzentration im Blut ist jedoch unzuverlässig und seine externe Applikation mit Nebenwirkungen vergesellschaftet. Es wurde nun untersucht, ob ein genetischer Knockout des H2S-produzierenden Enzyms Cystathionin-γ-Lyase (CSE) Einfluss auf die lokale und systemische Entzündungsreaktion nach Thoraxtrauma nimmt. Acht Wildtyp- und acht CSE-Knockout-Mäuse wurden einem Thoraxtrauma unterzogen und für vier Stunden unter intensivstationären Bedingungen versorgt. Die anschließend entnommenen Gewebeproben wurden mittels Histopathologie, Immunhistochemie, Western Blot, Zytokinanalyse und Comet Assay untersucht. Sowohl lokal als auch systemisch wurde ein entzündungshemmender Effekt des Knockouts festgestellt, Lungenfunktion und Gasaustausch blieben bis auf eine erhöhte Compliance unbeeinflusst. Die erhöhte Hämoxygenase-1 und vermehrte DNS-Strangbrüche legen stärkeren oxidativen Stress und/oder lokale Hypoxie nahe, Apoptoserate und Endothelfunktion zeigten keine Veränderung. Der Knockout verringerte die Blutglukose, die Expression eines alternativen H2S-Produzierenden Enzyms blieb unverändert. Ob die Wirkung von H2S oder der CSE an sich ursächlich ist, ist unklar, die Ergebnisse bestätigen jedoch die Bedeutung der CSE für die akute Stressreaktion nach Thoraxtrauma unter klinisch relevanten Bedingungen.
Published: 2019
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46. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis

Author: Livia Maria Garcia Melro, Rogério Zigaib, Pedro Vitale Mendes, Marcelo Park, Ho Yeh Li, Daniel Joelsons, Bruno Adler Maccagnan Pinheiro Besen, and José Mauro da Fonseca Pestana Ribeiro
Subjects: Gynecology, Adult, medicine.medical_specialty, Respiratory Distress Syndrome, Respiratory distress syndrome, adult, Intensive care units, Extracorporeal membrane oxygenation, business.industry, 030208 emergency & critical care medicine, General Medicine, Length of Stay, Critical Care and Intensive Care Medicine, Respiration, Artificial, Hospitalization, 03 medical and health sciences, Meta-analysis, 0302 clinical medicine, RESPIRATORY DISTRESS SYNDROME ADULT, Medicine, Humans, 030212 general & internal medicine, business, Respiratory insufficiency, Review Articles, Randomized Controlled Trials as Topic
Abstract: The evidence of improved survival with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome is still uncertain.This systematic review and meta-analysis was registered in the PROSPERO database with the number CRD-42018098618. We performed a structured search of Medline, Lilacs, and ScienceDirect for randomized controlled trials evaluating the use of ECMO associated with (ultra)protective mechanical ventilation for severe acute respiratory failure in adult patients. We used the Cochrane risk of bias tool to evaluate the quality of the evidence. Our primary objective was to evaluate the effect of ECMO on the last reported mortality. Secondary outcomes were treatment failure, hospital length of stay and the need for renal replacement therapy in both groups.Two randomized controlled studies were included in the meta-analysis, comprising 429 patients, of whom 214 were supported with ECMO. The most common reason for acute respiratory failure was pneumonia (60% - 65%). Respiratory ECMO support was associated with a reduction in last reported mortality and treatment failure with risk ratios (RR: 0.76; 95%CI 0.61 - 0.95 and RR: 0.68; 95%CI 0.55 - 0.85, respectively). Extracorporeal membrane oxygenation reduced the need for renal replacement therapy, with a RR of 0.88 (95%CI 0.77 - 0.99). Intensive care unit and hospital lengths of stay were longer in ECMO-supported patients, with an additional P50th 14.84 (P25th - P75th: 12.49 - 17.18) and P50th 29.80 (P25th - P75th: 26.04 - 33.56] days, respectively.Respiratory ECMO support in severe acute respiratory distress syndrome patients is associated with a reduced mortality rate and a reduced need for renal replacement therapy but a substantial increase in the lengths of stay in the intensive care unit and hospital. Our results may help bedside decision-making regarding ECMO initiation in patients with severe respiratory distress syndrome.A evidência de melhora da sobrevivência com uso de oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo ainda permanece incerta.Esta revisão sistemática e metanálise foi registrada na base de dados PROSPERO com o número CRD-42018098618. Conduzimos uma busca estruturada nas bases Medline, LILACS e ScienceDirect visando a ensaios randomizados e controlados que tivessem avaliado o uso de oxigenação por membrana extracorpórea associada com ventilação mecânica (ultra)protetora em pacientes adultos com síndrome do desconforto respiratório agudo grave. Utilizamos a ferramenta de riscos de viés da Cochrane para avaliar a qualidade da evidência. O desfecho primário consistiu em avaliar o efeito do uso oxigenação por membrana extracorpórea no último relato de mortalidade. Os desfechos secundários foram: falha terapêutica, tempo de permanência no hospital e necessidade de terapia de substituição renal em ambos os grupos.Incluíram-se na metanálise dois ensaios randomizados e controlados, compreendendo 429 pacientes, dos quais 214 receberam suporte respiratório extracorpóreo. A razão mais comum para a insuficiência respiratória foi pneumonia (60% - 65%). O suporte respiratório com oxigenação por membrana extracorpórea foi associado a uma redução na mortalidade e redução em falha terapêutica com taxas de risco (RR: 0,76; IC95% 0,61 - 0,95; RR: 0,68; IC95% 0,55 - 0,85, respectivamente). O uso de oxigenação por membrana extracorpórea reduziu a necessidade de terapia de substituição renal com uma RR de 0,88 (IC95% 0,77 - 0,99). O tempo de permanência na unidade de terapia intensiva e no hospital foram maiores no grupo de pacientes que recebeu suporte com oxigenação por membrana extracorpórea, com acréscimo de 14,84 (P25°-P75°: 12,49 - 17,18) e 29,80 (P25°- P75°: 26,04 - 33,56) dias, respectivamente.O suporte com oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo grave está associado a uma redução da taxa de mortalidade e da necessidade de terapia de substituição renal, porém apresenta aumento substancial no tempo de permanência na unidade de terapia intensiva e no hospital. Nossos resultados podem ajudar no processo decisório junto ao leito quanto ao início do suporte com oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo grave.
Published: 2018

47. Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Author: Boyle A. J., Madotto F., Laffey J. G., Bellani G., Pham T., Pesenti A., Thompson B. T., O'Kane C. M., Deane A. M., McAuley D. 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Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Vermassen J, Philippe M, Ceunen H, Rosa JI, Beraldo DO, Piras C, Rampinelli AM, Nassar AP Jr, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Pg Hj Ismail DMAB, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Ferguson ND, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Mehta S, Knoll J, Pronovost A, Bruhn SCAR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, 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SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Ismail D, Dreyer KR, Blakeman TC, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., Boyle, A. 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G., Lovazzano, P., Alvarez, J., Villar, V., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Staudinger, T., Wittebole, X., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Vermassen, J., Philippe, M., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar, A. P., Mataloun, S., Moock, M., Thompson, M. M., Goncalves, C. H., Antonio, Acp., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. 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M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Hashemian SM, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Pattarino PTI, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Dector D, Dector DM, Gonzalez DR, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Zeggwagh AA, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Heunks LM, Van Wezel HM, Heines SJ, Strauch U, Buise MP, Simonis FD, Schultz MJ, Goodson JC, Browne TS, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Laake JH, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Leon Yoshido HH, Aguilar RZ, Montes Oscanoa FA, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan BC, Andruszkiewicz P, Jakubowska K, Coxo CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Del Carmen Lorente M, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Perez CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Cheng MP, Losada EP, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Navalpotro MAB, Abad RD, González RM, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Llinares Moya DD, Tallet Alfonso AA, Luis PSE, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Piquilloud L, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Souissi AB, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McNamee L, McAuley D, Hopkins P, Mellis C, Kakar V, Hadfield D, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, JhaMatthew Thomas RR, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, De Gordoa LO, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugavel M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, John Trinder T, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Hurtado J, Nin N, Hurtado J, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Lee J, Mesar T, Lee J, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Crouch DR, Ismail D, Dreyer KR, Blakeman TC, Dreyer KR, Gomaa D, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (SLuc) Service de soins intensifs, and UCL - (MGD) Services des soins intensifs
Subjects: Adult, Male, Diabetes mellitu, LUNG SAFE, Organ Dysfunction Scores, humanos, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Socio-culturale, Organ Dysfunction Score, Diabetes Complications, Diabetes mellitus, puntuaciones de disfunción orgánica, Risk Factors, Diabetes Complication, estudios prospectivos, Humans, factores de riesgo, Prospective Studies, Hospital Mortality, Hypoxia, mediana edad, Acute hypoxemic respiratory failure, Aged, Respiratory Distress Syndrome, anciano, Acute respiratory distress syndrome, Research, Respiration, respiración, Respiratory Distress Syndrome, Adult, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Middle Aged, Respiration, Artificial, insuficiencia respiratoria, Prospective Studie, Artificial, Diabetes Mellitus, Female, Respiratory Insufficiency, mortalidad hospitalaria, complicaciones de la diabetes, Human
Abstract: Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS., This work was supported by the European Society of Intensive Care Medicine (ESICM), Brussels, Belgium who funded the original LUNG SAFE study.
Published: 2018

48. Pulmonary Barotrauma Resulting from Mechanical Ventilation in 2 Patients with a Diagnosis of COVID-19 Pneumonia

Author: Yizhak Kupfer, Raphael Ezeagu, Titilope Olanipekun, Chanaka Seneviratne, and Ratnam Santoshi
Subjects: Male, ARDS, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, Plateau pressure, 0302 clinical medicine, Fraction of inspired oxygen, medicine, Humans, Pneumomediastinum, Mediastinal Emphysema, Aged, Mechanical ventilation, Emphysema, Respiratory Distress Syndrome, business.industry, Respiratory Distress Syndrome, Adult, COVID-19, General Medicine, Articles, Lung Injury, respiratory system, Middle Aged, medicine.disease, Respiration, Artificial, Subcutaneous Emphysema, respiratory tract diseases, Pneumothorax, Barotrauma, 030220 oncology & carcinogenesis, Anesthesia, Female, medicine.symptom, business, Subcutaneous emphysema, Transpulmonary pressure, circulatory and respiratory physiology
Abstract: Case series Patients: Male, 71-year-old • Female, 58-year-old Final Diagnosis: Pulmonary barotrauma Symptoms: Pneumomediastinum Medication: — Clinical Procedure: Chest tube Specialty: Critical Care Medicine Objective: Unusual clinical course Background: Invasive mechanical ventilation can cause pulmonary barotrauma due to elevated transpulmonary pressure and alveolar rupture. A significant proportion of COVID-19 patients with acute respiratory distress syndrome (ARDS) will require mechanical ventilation. We present 2 interesting cases that demonstrate the possibility of COVID-19-associated ARDS manifesting with pulmonary barotrauma at acceptable ventilatory pressures. Case Reports: The first patient was a 71-year-old man who was intubated and placed on mechanical ventilation due to hypoxemic respiratory failure from SARS-CoV-2 infection. His partial pressure of O2 to fraction of inspired oxygen ratio (PaO2/FiO2) was 156. He developed subcutaneous emphysema (SE) and pneumomediastinum on day 5 of mechanical ventilation at ventilatory settings of positive end-expiratory pressure (PEEP) ≤15 cmH2O, plateau pressure (Pplat) ≤25 cmH2O and pulmonary inspiratory pressure (PIP) ≤30 cmH2O. He was managed with ‘blow-hole’ incisions, with subsequent clinical resolution of subcutaneous emphysema. The second patient was a 58-year-old woman who was also mechanically ventilated due to hypoxemic respiratory failure from COVID-19, with PaO2/FiO2 of 81. She developed extensive SE with pneumomediastinum and pneumothorax while on mechanical ventilation settings PEEP 13 cmH2O and PIP 28 cmH2O, Pplat 18 cmH2O, and FiO2 90%. SE was managed with blow-hole incisions and pneumothorax with chest tube. Conclusions: Clinicians should be aware of pulmonary barotrauma as a possible complication of COVID-19 pulmonary disease, even at low ventilatory pressures.
Published: 2021

49. Intraoperative Management of Hypercapnia with an Extracorporeal Carbon Dioxide Removal Device during Giant Bullectomy

Author: Franco Stella, Alessandro Bini, Rocco D'Andrea, Carlo Alberto Mazzoli, Alberto Rocca, Andrea Dell’Amore, Guido Caroli, Rita Maria Melotti, Dell'Amore, Andrea, D'Andrea, Rocco, Caroli, Guido, Mazzoli, Carlo Alberto, Rocca, Alberto, Stella, Franco, Bini, Alessandro, and Melotti, Rita
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Extracorporeal Circulation, medicine.medical_specialty, Interventional lung assist, 030204 cardiovascular system & hematology, Lung volume reduction surgery, Extracorporeal, Hypercapnia, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Respiratory system, Emphysema, Respiratory Distress Syndrome, Intraoperative Care, business.industry, Respiration, Extracorporeal circulation, General Medicine, Carbon Dioxide, Respiration, Artificial, Surgery, Protective ventilation, Thoracic surgery, Pulmonary Emphysema, 030228 respiratory system, Cardiothoracic surgery, Anesthesia, Artificial, Breathing, Respiratory Distress Syndrome, Adult, medicine.symptom, business, Cardiology and Cardiovascular Medicine
Abstract: Extracorporeal CO2-removal devices have been introduced in clinical practice to provide protective and ultraprotective ventilation strategies in different settings to avoid retention of carbon dioxide. The need to facilitate lung-protective ventilation is required not only for the treatment of acute respiratory distress syndrome but also in thoracic surgery during complex operations, especially in respiratory compromised patients. This report describes a case of giant bullectomy for vanishing lung syndrome in which intraoperative hypercapnia secondary to protective ventilation was managed with a CO2-removal device (Decap-Hemodec s.r.l., Salerno, Italy). To the best of our knowledge, this is the first report in the literature of the intraoperative use of the Decap system for giant bullectomy.
Published: 2016

50. Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO

Author: V. Marco Ranieri, Paolo Pelosi, Laurent Brochard, Roberto Roncon-Albuquerque, Shinhiro Takeda, José Artur Paiva, Antonio Pesenti, Thomas Bein, Michael Ried, Tài Pham, Andrew J. Michaels, Gernot Beutel, Matthias Lubnow, Christian Lindskov, Marie Vejen, Marcus J. Schultz, Ary Serpa Neto, Eduardo L. V. Costa, Steffen Weber-Carstens, Catherina Lueck, Luciano Cesar Pontes Azevedo, Alain Combes, Michael Quintel, Marcelo Park, Pierpaolo Terragni, Marcelo Gama de Abreu, Matthieu Schmidt, Carol L. Hodgson, Arthur S. Slutsky, Tobias Welte, Graduate School, AII - Amsterdam institute for Infection and Immunity, Intensive Care Medicine, Serpa Neto, A., Schmidt, M., Azevedo, L.C.P., Bein, T., Brochard, L., Beutel, G., Combes, A., Costa, E.L.V., Hodgson, C., Lindskov, C., Lubnow, M., Lueck, C., Michaels, A.J., Paiva, J.-A., Park, M., Pesenti, A., Pham, T., Quintel, M., Marco Ranieri, V., Ried, M., Roncon-Albuquerque, R., Jr., Slutsky, A.S., Takeda, S., Terragni, P.P., Vejen, M., Weber-Carstens, S., Welte, T., Gama de Abreu, M., Pelosi, P., Schultz, M.J., and The ReVA Research Network and the PROVE Network Investigators
Subjects: Male, ARDS, procedure, blood carbon dioxide tension, medicine.medical_treatment, blood oxygen tension, Sex Factor, driving pressure, high risk patient, Critical Care and Intensive Care Medicine, Hypoxemia, plateau pressure, Body Mass Index, Positive-Pressure Respiration, Plateau pressure, 0302 clinical medicine, Mechanical ventilation, outcome in patients with acute respiratory distress syndrome, middle aged, ventilator settings during extracorporeal membrane oxygenation, refractory hypoxemia, outcome in patients with acute respiratory distress syndrome,Mechanical ventilation during ECMO, Age Factor, Hospital Mortality, Hypoxia, device, Tidal volume, 2. Zero hunger, oxygen breathing, respiratory tract parameter, adult, tidal volume, standard, artificial ventilation, time factor, Adult, arterial pH, 3. Good health, Mechanical ventilation during ECMO, Observational Studies as Topic, female, surgical procedures, operative, priority journal, Anesthesia, positive end expiratory pressure, medicine.symptom, ECMO, fraction of inspired oxygen, Human, circulatory and respiratory physiology, ventilator, Respiratory rate, Time Factor, sex difference, Article, lung minute volume, 03 medical and health sciences, body weight, evaluation study, Extracorporeal Membrane Oxygenation, length of stay, medicine, Extracorporeal membrane oxygenation, pneumonia, PEEP, hypoxemia, Ventilators, Mechanical, lactic acid, adult respiratory distress syndrome, extracorporeal oxygenation, meta analysi, business.industry, Respiratory Distress Syndrome, Adult, 030208 emergency & critical care medicine, mechanical ventilator, medicine.disease, mortality, Respiration, Artificial, breathing rate, respiratory tract diseases, 030228 respiratory system, age, observational study, business, ventilator settings during extracorporeal membrane oxygenation, Respiratory minute volume, body ma, Refractory hypoxemia
Abstract: Purpose: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. Methods: In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality. Results: Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure − PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO2, higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03–1.10)]. Conclusion: In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality. © 2016, Springer-Verlag Berlin Heidelberg and ESICM.
Published: 2016

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