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Nishikimi M, Ohshimo S, Fukumoto W, Hamaguchi J, Matsumura K, Fujizuka K, Hagiwara Y, Nakayama R, Bunya N, Maruyama J, Abe T, Anzai T, Ogata Y, Naito H, Amemiya Y, Ikeda T, Yagi M, Furukawa Y, Taniguchi H, Yagi T, Katsuta K, Konno D, Suzuki G, Kawasaki Y, Hattori N, Nakamura T, Kondo N, Kikuchi H, Kai S, Ichiyama S, Awai K, Takahashi K, Shime N. Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry. J Intensive Care 2024; 12:5. [PMID: 38273416 PMCID: PMC10811928 DOI: 10.1186/s40560-023-00715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Chest computed tomography findings are helpful for understanding the pathophysiology of severe acute respiratory distress syndrome (ARDS). However, there is no large, multicenter, chest computed tomography registry for patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to describe chest computed tomography findings at V-V ECMO initiation and to evaluate the association between the findings and outcomes in severe ARDS. METHODS This multicenter, retrospective cohort study enrolled patients with severe ARDS on V-V ECMO, who were admitted to the intensive care units of 24 hospitals in Japan between January 1, 2012, and December 31, 2022. RESULTS The primary outcome was 90-day in-hospital mortality. The secondary outcomes were the successful liberation from V-V ECMO and the values of static lung compliance. Among the 697 registry patients, of the 582 patients who underwent chest computed tomography at V-V ECMO initiation, 394 survived and 188 died. Multivariate Cox regression showed that traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality (hazard ratio [95% confidence interval] 1.77 [1.19-2.63], p = 0.005 and 1.97 [1.02-3.79], p = 0.044, respectively). The presence of traction bronchiectasis was also associated with decreased successful liberation from V-V ECMO (odds ratio: 0.27 [0.14-0.52], p < 0.001). Lower static lung compliance was associated with some chest computed tomography findings related to changes outside of pulmonary opacity, but not with the findings related to pulmonary opacity. CONCLUSIONS Traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality in patients with severe ARDS who required V-V ECMO.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan.
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Hamaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kazuki Matsumura
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency Medicine and Critical Care Medicine, SAISEIKAI Utsunomiya Hospital, Utsunomiya, Japan
| | - Ryuichi Nakayama
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Junichi Maruyama
- Department of Emergency Medicine and Critical Care, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yu Amemiya
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Tokuji Ikeda
- Department of Emergency Medicine and Critical Care Medicine, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Masayuki Yagi
- Emergency Medical and Acute Care Surgery, Matsudo City General Hospital, Matsudo, Japan
| | - Yutaro Furukawa
- Advanced Critical Care Center, Saga University Hospital, Saga, Japan
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tsukasa Yagi
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Ken Katsuta
- Department of Emergency and Critical Care, Tohoku University Hospital, Sendai, Japan
| | - Daisuke Konno
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Ginga Suzuki
- Emergency and Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuki Kawasaki
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Noriyuki Hattori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoyuki Nakamura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Natsuki Kondo
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan
- Department of Emergency Medicine, Koga Community Hospital, Yaizu, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Shinichi Kai
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Saaya Ichiyama
- Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 7348551, Japan
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Zhang J, Guo Y, Mak M, Tao Z. Translational medicine for acute lung injury. J Transl Med 2024; 22:25. [PMID: 38183140 PMCID: PMC10768317 DOI: 10.1186/s12967-023-04828-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024] Open
Abstract
Acute lung injury (ALI) is a complex disease with numerous causes. This review begins with a discussion of disease development from direct or indirect pulmonary insults, as well as varied pathogenesis. The heterogeneous nature of ALI is then elaborated upon, including its epidemiology, clinical manifestations, potential biomarkers, and genetic contributions. Although no medication is currently approved for this devastating illness, supportive care and pharmacological intervention for ALI treatment are summarized, followed by an assessment of the pathophysiological gap between human ALI and animal models. Lastly, current research progress on advanced nanomedicines for ALI therapeutics in preclinical and clinical settings is reviewed, demonstrating new opportunities towards developing an effective treatment for ALI.
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Affiliation(s)
- Jianguo Zhang
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yumeng Guo
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Michael Mak
- Department of Biomedical Engineering, School of Engineering and Applied Science, Yale University, New Haven, 06520, USA
| | - Zhimin Tao
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
- Department of Biomedical Engineering, School of Engineering and Applied Science, Yale University, New Haven, 06520, USA.
- Zhenjiang Key Laboratory of High Technology Research on Exosomes Foundation and Transformation Application, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
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Xu H, Sheng S, Luo W, Xu X, Zhang Z. Acute respiratory distress syndrome heterogeneity and the septic ARDS subgroup. Front Immunol 2023; 14:1277161. [PMID: 38035100 PMCID: PMC10682474 DOI: 10.3389/fimmu.2023.1277161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury characterized by the damage of alveolar epithelial cells and pulmonary capillary endothelial cells. It is mainly manifested by non-cardiogenic pulmonary edema, resulting from intrapulmonary and extrapulmonary risk factors. ARDS is often accompanied by immune system disturbance, both locally in the lungs and systemically. As a common heterogeneous disease in critical care medicine, researchers are often faced with the failure of clinical trials. Latent class analysis had been used to compensate for poor outcomes and found that targeted treatment after subgrouping contribute to ARDS therapy. The subphenotype of ARDS caused by sepsis has garnered attention due to its refractory nature and detrimental consequences. Sepsis stands as the most predominant extrapulmonary cause of ARDS, accounting for approximately 32% of ARDS cases. Studies indicate that sepsis-induced ARDS tends to be more severe than ARDS caused by other factors, leading to poorer prognosis and higher mortality rate. This comprehensive review delves into the immunological mechanisms of sepsis-ARDS, the heterogeneity of ARDS and existing research on targeted treatments, aiming to providing mechanism understanding and exploring ideas for accurate treatment of ARDS or sepsis-ARDS.
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Affiliation(s)
- Huikang Xu
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shiying Sheng
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiwei Luo
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofang Xu
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaocai Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of the Diagnosis and Treatment for Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
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Nishikimi M, Ohshimo S, Fukumoto W, Anzai T, Awai K, Ogura T, Abe T, Masuda M, Fujizuka K, Nakamura M, Kyo M, Takahashi K, Shime N. Characteristics of the pulmonary opacities on chest CT associated with difficulty in short-term liberation from veno-venous ECMO in patients with severe ARDS. Respir Res 2023; 24:128. [PMID: 37165334 PMCID: PMC10171155 DOI: 10.1186/s12931-023-02425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND It is clinically important to predict difficulty in short-term liberation from veno-venous extracorporeal membrane oxygenation (V-V ECMO) in patients with severe acute respiratory distress syndrome (ARDS) at the time of initiation of the support. The aim of this study was to identify the characteristics of pulmonary opacities on chest CT that is associated with difficulty in short-term liberation from V-V ECMO (< 14 days). METHODS This multicenter retrospective study was conducted in adult patients initiated on V-V ECMO for severe ARDS between January 2014 and June 2022. The pulmonary opacities on CT at the time of initiation of the ECMO support were evaluated in a blinded manner, focusing on the following three characteristics of the opacities: (1) their distribution (focal/diffuse on the dorso-ventral axis or unilateral/bilateral on the left-right axis); (2) their intensity (pure ground glass/pure consolidation/mixed pattern); and (3) the degree of fibroproliferation (signs of traction bronchiectasis or reticular opacities). RESULTS Among the 153 patients, 72 (47%) were successfully liberated from ECMO in the short term, while short-term liberation failed in the remaining 81 (53%) patients. Multivariate logistic regression analysis showed that the presence of mixed-pattern pulmonary opacities and signs of traction bronchiectasis, but not the distribution of the opacities, were independently associated with difficulty in short-term liberation (OR [95% CI]; 4.8 [1.4-16.5] and 3.9 [1.4-11.2], respectively). CONCLUSIONS The presence of a mixed pattern of the pulmonary opacities and signs of traction bronchiectasis on the chest CT were independently associated with difficulty in short-term liberation from V-V ECMO in severe ARDS patients.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, SAISEIKAI Utsunomiya Hospital, Utsunomiya, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamoru Masuda
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Michihito Kyo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Predictive value of computed tomography for short-term mortality in patients with acute respiratory distress syndrome: a systematic review. Sci Rep 2022; 12:9579. [PMID: 35689019 PMCID: PMC9185136 DOI: 10.1038/s41598-022-13972-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Abstract
The best available evidence and the predictive value of computed tomography (CT) findings for prognosis in patients with acute respiratory distress syndrome (ARDS) are unknown. We systematically searched three electronic databases (MEDLINE, CENTRAL, and ClinicalTrials.gov). A total of 410 patients from six observational studies were included in this systematic review. Of these, 143 patients (34.9%) died due to ARDS in short-term. As for CT grade, the CTs used ranged from 4- to 320-row. The index test included diffuse attenuations in one study, affected lung in one study, well-aerated lung region/predicted total lung capacity in one study, CT score in one study and high-resolution CT score in two studies. Considering the CT findings, pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 62% (95% confidence interval [CI] 30–88%), 76% (95% CI 57–89%), 2.58 (95% CI 2.05–2.73), 0.50 (95% CI 0.21–0.79), and 5.16 (95% CI 2.59–3.46), respectively. This systematic review revealed that there were major differences in the definitions of CT findings, and that the integration of CT findings might not be adequate for predicting short-term mortality in ARDS. Standardisation of CT findings and accumulation of further studies by CT with unified standards are warranted.
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Imai R, Nishimura N, Takahashi O, Tamura T. High-resolution computed tomography for the prediction of mortality in acute respiratory distress syndrome: A retrospective cohort study. Health Sci Rep 2021; 4:e418. [PMID: 34646945 PMCID: PMC8499594 DOI: 10.1002/hsr2.418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS Acute respiratory distress syndrome (ARDS) demonstrates several image patterns on high-resolution computed tomography (HRCT). The purpose of this study was to investigate the relationship between specific HRCT findings and the prognosis of ARDS. METHODS This was a retrospective cohort study performed in a single hospital in Japan. We categorized HRCT findings into three distribution patterns: diffuse, subpleural sparing, and dorsal patterns. All patterns were assessed at three levels of each lung. Multivariable logistic regression analysis was used to identify parameters associated with in-hospital mortality. RESULTS A total of 144 patients with ARDS (age: 72 ± 16 years, 112 men) were included in the study. The in-hospital mortality rate was 42% (survivors, n = 83; nonsurvivors, n = 61). Nonsurvivors were significantly older (70 ± 17 vs 76 ± 13, P = 0.01) and had lower serum albumin levels (P = 0.01), more traction bronchiectasis (P = 0.02), and more diffuse pattern (P < 0.001) than survivors. The presence of diffuse patterns was an independent adverse prognostic factor for predicting mortality (odds ratio, 1.32; 95% confidence interval [CI]: 1.08-1.61, P = 0.007). CONCLUSIONS HRCT distribution patterns may predict mortality in ARDS patients.
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Affiliation(s)
- Ryosuke Imai
- Department of Pulmonary MedicineThoracic Center, St. Luke's International HospitalTokyoJapan
| | - Naoki Nishimura
- Department of Pulmonary MedicineThoracic Center, St. Luke's International HospitalTokyoJapan
| | - Osamu Takahashi
- Graduate School of Public HealthSt. Luke's International UniversityTokyoJapan
| | - Tomohide Tamura
- Department of Pulmonary MedicineThoracic Center, St. Luke's International HospitalTokyoJapan
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Wang Y, Zhang L, Xi X, Zhou JX. The Association Between Etiologies and Mortality in Acute Respiratory Distress Syndrome: A Multicenter Observational Cohort Study. Front Med (Lausanne) 2021; 8:739596. [PMID: 34733862 PMCID: PMC8558376 DOI: 10.3389/fmed.2021.739596] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Lung-protective ventilation (LPV) strategies have been beneficial in patients with acute respiratory distress syndrome (ARDS). As a vital part of LPV, positive end-expiratory pressure (PEEP) can enhance oxygenation. However, randomized clinical trials of different PEEP strategies seem to show no advantages in clinical outcomes in patients with ARDS. A potential reason is that diverse etiologies and phenotypes in patients with ARDS may account for different PEEP responses, resulting in variations in mortality. We consider hospital mortality to be associated with a more specific classification of ARDS, such as sepsis induced or not, and pulmonary or extrapulmonary one. Our study aimed to compare clinical outcomes in various patients with ARDS by etiologies using the China Critical Care Sepsis Trial (CCCST) database. This was a retrospective analysis of a prospective cohort of 2,138 patients with ARDS in the CCCST database. According to ARDS induced by sepsis or not and medical history, patients were stratified into different four groups. Differences among groups were assessed in hospital mortality, ventilation-free days, and other clinical features. Results: A total of 2,138 patients with ARDS were identified in the database, including 647 patients with sepsis-induced pulmonary ARDS (30.3%), 396 patients with sepsis-induced extrapulmonary ARDS (18.5%), 536 patients with non-sepsis pulmonary ARDS (25.1%), and 559 patients with non-sepsis extrapulmonary ARDS (26.1%). The pulmonary ARDS group had higher mortality compared with the extrapulmonary group (45.9 vs. 23.0%, p < 0.01), longer intensive care unit (ICU) and hospital stays (9 vs. 6 days, p < 0.01, 20 vs. 18 days, p = 0.01, respectively), and fewer ventilation-free days (5 vs. 9 days) in the presence of sepsis. However, the mortality in ARDS without sepsis was inverted compared with extrapulmonary ARDS (pulmonary 23.5% vs. extrapulmonary 29.2%, p = 0.04). After adjusting for the Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores and other clinical features, the sepsis-induced pulmonary condition was still a risk factor for death in patients with ARDS (hazard ratio 0.66, 95% CI, 0.54–0.82, p < 0.01) compared with sepsis-induced extrapulmonary ARDS and other subphenotypes. Conclusions: In the presence of sepsis, hospital mortality in pulmonary ARDS is higher compared with extrapulmonary ARDS; however, mortality is inverted in ARDS without sepsis. Sepsis-induced pulmonary ARDS should attract more attention from ICU physicians and be cautiously treated. Trial registration: ChiCTR-ECH-13003934. Registered August 3, 2013, http://www.chictr.org.cn.
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Affiliation(s)
- Yan Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linlin Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Huang S, Wang YC, Ju S. Advances in medical imaging to evaluate acute respiratory distress syndrome. ACTA ACUST UNITED AC 2021; 5:1-9. [PMID: 34308253 PMCID: PMC8286037 DOI: 10.1007/s42058-021-00078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022]
Abstract
Acute respiratory distress syndrome is a refractory respiratory syndrome with a high prevalence in the Intensive Care Unit. Though much improvement has been achieved over the last 50 decades, the disease continues to be under-recognized and under-treated, and its mortality remains high. Since the first report, the radiologic examination has been an essential part in evaluating this disease. Chest X-ray radiography and computed tomography are conventional imaging techniques in routine clinical practice. Other image modalities, including lung ultrasound, electrical impedance tomography, positron emission tomography, have demonstrated their respective advantages over recent years but have not yet been broadly applied in clinical practice. Among these modalities, computed tomography and its quantitative analysis have shown an irreplaceable power in diagnosis, intervention evaluation and prognostic prediction. In this review, we briefly introduced the basics of acute respiratory distress syndrome and summarized imaging advances. In addition, we focused on the computed tomography modality and highlighted the value of its quantitative assessment.
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Affiliation(s)
- Shan Huang
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, School of Medicine, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China
| | - Yuan-Cheng Wang
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, School of Medicine, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China.,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Southeast University, Nanjing, 210009 China
| | - Shenghong Ju
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, School of Medicine, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao Road, Nanjing, 210009 Jiangsu China
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Radiomics score predicts acute respiratory distress syndrome based on the initial CT scan after trauma. Eur Radiol 2021; 31:5443-5453. [PMID: 33733689 PMCID: PMC8270830 DOI: 10.1007/s00330-020-07635-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/02/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Acute respiratory distress syndrome (ARDS) constitutes a major factor determining the clinical outcome in polytraumatized patients. Early prediction of ARDS is crucial for timely supportive therapy to reduce morbidity and mortality. The objective of this study was to develop and test a machine learning-based method for the early prediction of ARDS derived from the first computed tomography scan of polytraumatized patients after admission to the hospital. MATERIALS AND METHODS One hundred twenty-three patients (86 male and 37 female, age 41.2 ± 16.4) with an injury severity score (ISS) of 16 or higher (31.9 ± 10.9) were prospectively included and received a CT scan within 1 h after the accident. The lungs, including air pockets and pleural effusions, were automatically segmented using a deep learning-based algorithm. Subsequently, we extracted radiomics features from within the lung and trained an ensemble of gradient boosted trees (GBT) to predict future ARDS. RESULTS Cross-validated ARDS prediction resulted in an area under the curve (AUC) of 0.79 for the radiomics score compared to 0.66 for ISS, and 0.68 for the abbreviated injury score of the thorax (AIS-thorax). Prediction using the radiomics score yielded an f1-score of 0.70 compared to 0.53 for ISS and 0.57 for AIS-thorax. The radiomics score achieved a sensitivity and specificity of 0.80 and 0.76. CONCLUSIONS This study proposes a radiomics-based algorithm for the prediction of ARDS in polytraumatized patients at the time of admission to hospital with an accuracy that competes and surpasses conventional scores despite the heterogeneous, and therefore more realistic, scanning protocols. KEY POINTS • Early prediction of acute respiratory distress syndrome in polytraumatized patients is possible, even when using heterogenous data. • Radiomics-based prediction resulted in an area under the curve of 0.79 compared to 0.66 for the injury severity score, and 0.68 for the abbreviated injury score of the thorax. • Highlighting the most relevant lung regions for prediction facilitates the understanding of machine learning-based prediction.
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10
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Elmokadem AH, Batouty NM, Bayoumi D, Gadelhak BN, Abdel-Wahab RM, Zaky M, Abo-Hedibah SA, Ehab A, El-Morsy A. Mimickers of novel coronavirus disease 2019 (COVID-19) on chest CT: spectrum of CT and clinical features. Insights Imaging 2021; 12:12. [PMID: 33533965 PMCID: PMC7856625 DOI: 10.1186/s13244-020-00956-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19 (coronavirus disease 2019) is a recently emerged pulmonary infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It started in Wuhan, China, in December 2019 and led to a highly contagious disease. Since then COVID-19 continues to spread, causing exponential morbidity and mortality and threatening economies worldwide. While the primary diagnostic test for COVID-19 is the reverse transcriptase-polymerase chain reaction (RT-PCR) assay, chest CT has proven to be a diagnostic tool of high sensitivity. A variety of conditions demonstrates CT features that are difficult to differentiate from COVID-19 rendering CT to be of low specificity. Radiologists and physicians should be aware of imaging patterns of these conditions to prevent an erroneous diagnosis that could adversely influence management and patients' outcome. Our purpose is to provide a practical review of the conditions that mimic COVID-19. A brief description of the forementioned clinical conditions with their CT features will be included.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt.
- Department of Radiology, Farwaniya Hospital, Al Farwaniyah , Kuwait.
| | - Nihal M Batouty
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Dalia Bayoumi
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Basma N Gadelhak
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Rihame M Abdel-Wahab
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Mona Zaky
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
| | - Sherif A Abo-Hedibah
- Department of Radiology, Farwaniya Hospital, Al Farwaniyah , Kuwait
- Department of Radiology, Cairo University, Giza, Egypt
| | - Ahmed Ehab
- Pulmonary Medicine Department, Mansoura University, Mansoura, Egypt
- Pulmonary Medicine Department, Loewenstein Lung Center, Löwenstein, Germany
| | - Ahmed El-Morsy
- Department of Radiology, Mansoura University, Elgomhoria St., Mansoura, 35516, Egypt
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11
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Respiratory Mechanics, Lung Recruitability, and Gas Exchange in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome. Crit Care Med 2020; 47:792-799. [PMID: 30908313 DOI: 10.1097/ccm.0000000000003715] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). Aim of this study was to evaluate in a large database of acute respiratory distress syndrome patients, the pulmonary versus extrapulmonary form in terms of respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. DESIGN A secondary analysis of previously published data. PATIENTS One-hundred eighty-one sedated and paralyzed acute respiratory distress syndrome patients (age 60 yr [46-72 yr], body mass index 25 kg/m [22-28 kg/m], and PaO2/FIO2 184 ± 66). INTERVENTIONS Lung CT scan performed at 5 and 45 cm H2O. Two levels of positive end-expiratory pressure (5 and 15 cm H2O) were randomly applied. MEASUREMENTS AND MAIN RESULTS Ninety-seven and 84 patients had a pulmonary and extrapulmonary acute respiratory distress syndrome. The median time from intensive care admission to the CT scan and respiratory mechanics analysis was 4 days (interquartile range, 2-6). At both positive end-expiratory pressure levels, pulmonary acute respiratory distress syndrome presented a significantly lower PaO2/FIO2 and higher physiologic dead space compared with extrapulmonary acute respiratory distress syndrome. The lung and chest wall elastance were similar between groups. The intra-abdominal pressure was significantly higher in extrapulmonary compared with pulmonary acute respiratory distress syndrome (10 mm Hg [7-12 mm Hg] vs 7 mm Hg [5-8 mm Hg]). The lung weight and lung recruitability were significantly higher in pulmonary acute respiratory distress syndrome (1,534 g [1,286-1,835 g] vs 1,342 g [1,090-1,507 g] and 16% [9-25%] vs 9% [5-14%]). CONCLUSIONS In the early stage, pulmonary acute respiratory distress syndrome is characterized by a greater impairment of gas exchange and higher lung recruitability. The recognition of the origin of acute respiratory distress syndrome is important for a more customized ventilatory management.
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12
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Jagrosse ML, Dean DA, Rahman A, Nilsson BL. RNAi therapeutic strategies for acute respiratory distress syndrome. Transl Res 2019; 214:30-49. [PMID: 31401266 PMCID: PMC7316156 DOI: 10.1016/j.trsl.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
Acute respiratory distress syndrome (ARDS), replacing the clinical term acute lung injury, involves serious pathophysiological lung changes that arise from a variety of pulmonary and nonpulmonary injuries and currently has no pharmacological therapeutics. RNA interference (RNAi) has the potential to generate therapeutic effects that would increase patient survival rates from this condition. It is the purpose of this review to discuss potential targets in treating ARDS with RNAi strategies, as well as to outline the challenges of oligonucleotide delivery to the lung and tactics to circumvent these delivery barriers.
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Affiliation(s)
| | - David A Dean
- Department of Pediatrics and Neonatology, University of Rochester Medical Center, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Arshad Rahman
- Department of Pediatrics and Neonatology, University of Rochester Medical Center, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Bradley L Nilsson
- Department of Chemistry, University of Rochester, Rochester, New York.
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13
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Stefanidis K, Moser J, Vlahos I. Imaging of Diffuse Lung Disease in the Intensive Care Unit Patient. Radiol Clin North Am 2019; 58:119-131. [PMID: 31731896 DOI: 10.1016/j.rcl.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is a wide variety of causes of diffuse lung disease in the intensive care unit patient, of which adult respiratory distress syndrome is the commonest clinical consideration. Plain radiography, computed tomography, and ultrasound can be used synergistically to evaluate patients with diffuse lung disease and respiratory impairment. Imaging is not limited to characterization of the cause of diffuse lung disease but also aids in monitoring its evolution and in ventilator setting management.
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Affiliation(s)
- Konstantinos Stefanidis
- Radiology Department, King's College Hospital, NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
| | - Joanna Moser
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
| | - Ioannis Vlahos
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
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14
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Biological Response to Time-Controlled Adaptive Ventilation Depends on Acute Respiratory Distress Syndrome Etiology. Crit Care Med 2019; 46:e609-e617. [PMID: 29485489 DOI: 10.1097/ccm.0000000000003078] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare a time-controlled adaptive ventilation strategy, set in airway pressure release ventilation mode, versus a protective mechanical ventilation strategy in pulmonary and extrapulmonary acute respiratory distress syndrome with similar mechanical impairment. DESIGN Animal study. SETTING Laboratory investigation. SUBJECTS Forty-two Wistar rats. INTERVENTIONS Pulmonary acute respiratory distress syndrome and extrapulmonary acute respiratory distress syndrome were induced by instillation of Escherichia coli lipopolysaccharide intratracheally or intraperitoneally, respectively. After 24 hours, animals were randomly assigned to receive 1 hour of volume-controlled ventilation (n = 7/etiology) or time-controlled adaptive ventilation (n = 7/etiology) (tidal volume = 8 mL/kg). Time-controlled adaptive ventilation consisted of the application of continuous positive airway pressure 2 cm H2O higher than baseline respiratory system peak pressure for a time (Thigh) of 0.75-0.85 seconds. The release pressure (Plow = 0 cm H2O) was applied for a time (Tlow) of 0.11-0.18 seconds. Tlow was set to target an end-expiratory flow to peak expiratory flow ratio of 75%. Nonventilated animals (n = 7/etiology) were used for Diffuse Alveolar Damage and molecular biology markers analyses. MEASUREMENT AND MAIN RESULTS Time-controlled adaptive ventilation increased mean respiratory system pressure regardless of acute respiratory distress syndrome etiology. The Diffuse Alveolar Damage score was lower in time-controlled adaptive ventilation compared with volume-controlled ventilation in pulmonary acute respiratory distress syndrome and lower in time-controlled adaptive ventilation than nonventilated in extrapulmonary acute respiratory distress syndrome. In pulmonary acute respiratory distress syndrome, volume-controlled ventilation, but not time-controlled adaptive ventilation, increased the expression of amphiregulin, vascular cell adhesion molecule-1, and metalloproteinase-9. Collagen density was higher, whereas expression of decorin was lower in time-controlled adaptive ventilation than nonventilated, independent of acute respiratory distress syndrome etiology. In pulmonary acute respiratory distress syndrome, but not in extrapulmonary acute respiratory distress syndrome, time-controlled adaptive ventilation increased syndecan expression. CONCLUSION In pulmonary acute respiratory distress syndrome, time-controlled adaptive ventilation led to more pronounced beneficial effects on expression of biomarkers related to overdistension and extracellular matrix homeostasis.
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15
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Zhan Q, Cui P, Pan Y, Dai Z, Gong Z, Xin H, Tang F, Deng C, Huang G, Zhu F, Tong Y. Investigating the potential to assess severe lung inhalation injuries using computed tomography. Burns 2019; 45:310-316. [DOI: 10.1016/j.burns.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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16
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Abstract
Imaging in intensive care unit (ICU) is integral to patient management. The portable chest radiograph is the most commonly requested imaging examination in ICU, and, despite its limitations, it significantly contributes to the decision-making process. Multidetector CT (MDCT) is reserved for relatively complex and challenging clinical scenarios. Bedside ultrasound is emerging as a promising imaging modality as it does not subject the patients to risks and resources involved in the transportation of these patients to the CT facility. Ultrasound is an effective modality to triage patients and is being increasingly incorporated into the emergency and intensive care management algorithms.
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Affiliation(s)
- Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
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17
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Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis. Pediatr Crit Care Med 2018; 19:e504-e513. [PMID: 30036234 DOI: 10.1097/pcc.0000000000001667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome. DESIGN This is a secondary analysis of a multicenter, retrospective, cohort study. Data on epidemiology, ventilation, therapies, and outcomes were collected and analyzed. Patients were classified into two mutually exclusive groups (extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome) based on etiologies. Primary outcome was PICU mortality. Cox proportional hazard regression was used to identify risk factors for mortality. SETTING Ten multidisciplinary PICUs in Asia. PATIENTS Mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for pediatric acute respiratory distress syndrome between 2009 and 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Forty-one of 307 patients (13.4%) and 266 of 307 patients (86.6%) were classified into extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome groups, respectively. The most common causes for extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome were sepsis (82.9%) and pneumonia (91.7%), respectively. Children with extrapulmonary pediatric acute respiratory distress syndrome were older, had higher admission severity scores, and had a greater proportion of organ dysfunction compared with pulmonary pediatric acute respiratory distress syndrome group. Patients in the extrapulmonary pediatric acute respiratory distress syndrome group had higher mortality (48.8% vs 24.8%; p = 0.002) and reduced ventilator-free days (median 2.0 d [interquartile range 0.0-18.0 d] vs 19.0 d [0.5-24.0 d]; p = 0.001) compared with the pulmonary pediatric acute respiratory distress syndrome group. After adjusting for site, severity of illness, comorbidities, multiple organ dysfunction, and severity of acute respiratory distress syndrome, extrapulmonary pediatric acute respiratory distress syndrome etiology was not associated with mortality (adjusted hazard ratio, 1.56 [95% CI, 0.90-2.71]). CONCLUSIONS Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality.
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18
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Zhou Y, Fan Q, Cavus O, Zhang X. Lung ultrasound: Predictor of acute respiratory distress syndrome in intensive care unit patients. Saudi J Anaesth 2018; 12:457-461. [PMID: 30100847 PMCID: PMC6044168 DOI: 10.4103/sja.sja_73_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The purpose of the study was to review and summarize current literature concerning the validation and application of lung ultrasound (LUS) in critically ill patients with acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS An extensive literature search was conducted using PubMed, Cochrane Review, Google Scholar, and Ohio State University Link based on the question if LUS should be considered a reliable investigational technique for ARDS diagnosis, treatment, and prognosis in pediatric and adult population. RESULTS LUS has been successfully validated for facilitating early diagnosis and diagnosis of simultaneous lung conditions, predicting lung recruitment treatment effect, and evaluating the prognosis in ARDS patients. Whether lung US is a useful tool in the prediction of prone position and oxygenation response in patients with ARDS is conflicting. CONCLUSIONS LUS is a noninvasive, radiation-free, cheap, and easy to perform tool for critically ill patients with ARDS and might be a promising technique used in the Intensive Care Unit for ARDS management.
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Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qianqian Fan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Omer Cavus
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Xuezheng Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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19
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Vergani G, Cressoni M, Crimella F, L'Acqua C, Sisillo E, Gurgitano M, Liguori A, Annoni A, Carrafiello G, Chiumello D. A Morphological and Quantitative Analysis of Lung CT Scan in Patients With Acute Respiratory Distress Syndrome and in Cardiogenic Pulmonary Edema. J Intensive Care Med 2017; 35:284-292. [PMID: 29161936 DOI: 10.1177/0885066617743477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The acute respiratory distress syndrome (ARDS) and cardiogenic pulmonary edema (CPE) are both characterized by an increase in lung edema that can be measured by computed tomography (CT). The aim of this study was to compare possible differences between patients with ARDS and CPE in the morphologic pattern, the aeration, and the amount and distribution of edema within the lung. METHODS Lung CT was performed at a mean positive end-expiratory pressure level of 5 cm H2O in both groups. The morphological evaluation was performed by two radiologists, while the quantitative evaluation was performed by a dedicated software. RESULTS A total of 60 patients with ARDS (20 mild, 20 moderate, 20 severe) and 20 patients with CPE were enrolled. The ground-glass attenuation regions were similarly present among the groups, 8 (40%), 8 (40%), 14 (70%), and 10 (50%), while the airspace consolidations were significantly more present in ARDS. The lung gas volume was significantly lower in severe ARDS compared to CPE (830 [462] vs 1120 [832] mL). Moving from the nondependent to the dependent lung regions, the not inflated lung tissue significantly increased, while the well inflated tissue decreased (ρ = 0.96-1.00, P < .0001). Significant differences were found between ARDS and CPE mostly in dependent regions. In severe ARDS, the estimated edema was significantly higher, compared to CPE (757 [740] vs 532 [637] g). CONCLUSIONS Both ARDS and CPE are characterized by a similar presence of ground-glass attenuation and different airspace consolidation regions. Acute respiratory distress syndrome has a higher amount of not inflated tissue and lower amount of well inflated tissue. However, the overall regional distribution is similar within the lung.
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Affiliation(s)
- Giordano Vergani
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Massimo Cressoni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesco Crimella
- Scuola di Specialità di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Università degli Studi di Brescia, Brescia, Italy
| | - Camilla L'Acqua
- Department of Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Erminio Sisillo
- Department of Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Martina Gurgitano
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Liguori
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Andrea Annoni
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianpaolo Carrafiello
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Radiologia diagnostica e interventistica, ASST Santi Paolo e Carlo, Milan, Italy
| | - Davide Chiumello
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Milan, Italy
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20
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Lung Functional and Biologic Responses to Variable Ventilation in Experimental Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome. Crit Care Med 2017; 44:e553-62. [PMID: 26963321 DOI: 10.1097/ccm.0000000000001611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The biologic effects of variable ventilation may depend on the etiology of acute respiratory distress syndrome. We compared variable and conventional ventilation in experimental pulmonary and extrapulmonary acute respiratory distress syndrome. DESIGN Prospective, randomized, controlled experimental study. SETTINGS University research laboratory. SUBJECTS Twenty-four Wistar rats. INTERVENTIONS Acute respiratory distress syndrome was induced by Escherichia coli lipopolysaccharide administered intratracheally (pulmonary acute respiratory distress syndrome, n = 12) or intraperitoneally (extrapulmonary acute respiratory distress syndrome, n = 12). After 24 hours, animals were randomly assigned to receive conventional (volume-controlled ventilation, n = 6) or variable ventilation (n = 6). Nonventilated animals (n = 4 per etiology) were used for comparison of diffuse alveolar damage, E-cadherin, and molecular biology variables. Variable ventilation was applied on a breath-to-breath basis as a sequence of randomly generated tidal volume values (n = 600; mean tidal volume = 6 mL/kg), with a 30% coefficient of variation (normal distribution). After randomization, animals were ventilated for 1 hour and lungs were removed for histology and molecular biology analysis. MEASUREMENTS AND MAIN RESULTS Variable ventilation improved oxygenation and reduced lung elastance compared with volume-controlled ventilation in both acute respiratory distress syndrome etiologies. In pulmonary acute respiratory distress syndrome, but not in extrapulmonary acute respiratory distress syndrome, variable ventilation 1) decreased total diffuse alveolar damage (median [interquartile range]: volume-controlled ventilation, 12 [11-17] vs variable ventilation, 9 [8-10]; p < 0.01), interleukin-6 expression (volume-controlled ventilation, 21.5 [18.3-23.3] vs variable ventilation, 5.6 [4.6-12.1]; p < 0.001), and angiopoietin-2/angiopoietin-1 ratio (volume-controlled ventilation, 2.0 [1.3-2.1] vs variable ventilation, 0.7 [0.6-1.4]; p < 0.05) and increased relative angiopoietin-1 expression (volume-controlled ventilation, 0.3 [0.2-0.5] vs variable ventilation, 0.8 [0.5-1.3]; p < 0.01). In extrapulmonary acute respiratory distress syndrome, only volume-controlled ventilation increased vascular cell adhesion molecule-1 messenger RNA expression (volume-controlled ventilation, 7.7 [5.7-18.6] vs nonventilated, 0.9 [0.7-1.3]; p < 0.05). E-cadherin expression in lung tissue was reduced in volume-controlled ventilation compared with nonventilated regardless of acute respiratory distress syndrome etiology. In pulmonary acute respiratory distress syndrome, E-cadherin expression was similar in volume-controlled ventilation and variable ventilation; in extrapulmonary acute respiratory distress syndrome, however, it was higher in variable ventilation than in volume-controlled ventilation. CONCLUSIONS Variable ventilation improved lung function in both pulmonary acute respiratory distress syndrome and extrapulmonary acute respiratory distress syndrome. Variable ventilation led to more pronounced beneficial effects in biologic marker expressions in pulmonary acute respiratory distress syndrome compared with extrapulmonary acute respiratory distress syndrome but preserved E-cadherin in lung tissue only in extrapulmonary acute respiratory distress syndrome, thus suggesting lower damage to epithelial cells.
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21
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Abstract
OBJECTIVE The purpose of this study was to evaluate the lung computed tomography (CT) findings in fat embolism (FE) syndrome. METHODS We retrospectively evaluated 19 CT examinations of 18 patients with FE syndrome, diagnosed clinically using the Gurd and Wilson criteria. RESULT Fat embolism syndrome showed 3 patterns: negative examination, bilateral interstitial-alveolar involvement, and adult respiratory distress syndrome like. Frequent findings included consolidations (17 patients), mostly with gravity dependent distribution, and ground-glass opacities (17 patients), mostly with patchy distribution. Fifteen patients showed an overlapping random nodular pattern. Less common findings included lobular ground-glass opacities and lobular consolidations, smooth septal thickening, thickening of the bronchial wall, and areas of crazy paving. The extension of the consolidations correlates with the duration of assisted ventilation. CONCLUSIONS In FE syndrome, pulmonary CT findings are ground-glass opacities and dependent consolidations, associated with other variably overlapping signs, such as lobular opacities, random nodules, septal thickening, and bronchial wall thickening.
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22
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Abstract
Acute lung injury is a serious complication of major trauma occurring as a direct consequence of trauma to the lung or, more commonly, arising indirectly as a consequence of trauma elsewhere to the body. A spectrum of severity exists with acute respiratory distress syndrome (ARDS) defined as the most severe form of injury. The frequency of ARDS with severe trauma is unclear but is believed to occur in approximately 15- 25% of cases, although this is confused by the effects of multiple transfusions and associated injuries including burns and head injury. ARDS from all causes is estimated to occur with a frequency of two to 10 cases per 100 000 population. It causes a huge social and financial impact, with many survivors requiring a prolonged critical care stay and a significant number having a persisting poor quality of life a year after the injury. The mortality is, however, decreasing and stands at approximately 40%. A number of approaches are now recognized that can improve oxygenation and large trials have identified best critical care practice, leading to a reduction in ventilator-induced injury, with associated improvements in outcome.
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Affiliation(s)
- L Tomlinson
- Intensive Care Unit, UCL Hospitals, London, UK
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23
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Abstract
This review of intensive care unit (ICU) radiology has been divided into two sections. In Part 1, previously published, the discussion focused on the role of the portable radiograph in the evaluation of the critically ill patient and the impact of the introduction of digital radiography and picture-archiving communications systems on patient care. Part 2 of this review will emphasize the role of computed tomography and the increasing contribution of image-guided interventional procedures in patient management. The deleterious effects of mechanical ventilation due to barotrauma will also be discussed.
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24
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Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 2016; 42:725-738. [PMID: 27025938 DOI: 10.1007/s00134-016-4321-8] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge. Cognitive impairment in ARDS survivors ranges from 70 to 100 % at hospital discharge, 46 to 80 % at 1 year, and 20 % at 5 years, and mood disorders including depression and post-traumatic stress disorder (PTSD) are also sustained and prevalent. Robust multidisciplinary and longitudinal interventions that improve these outcomes are still uncertain and data in our literature are conflicting. Studies are needed in family members of ARDS survivors to better understand long-term outcomes of the post-ICU family syndrome and to evaluate how it affects patient recovery.
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Affiliation(s)
- Margaret S Herridge
- Critical Care and Respiratory Medicine, Toronto General Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine L Hough
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ramona O Hopkins
- Psychology Department, Brigham Young University, Provo, UT, USA.,Neuroscience Center, Brigham Young University, Provo, UT, USA.,Department of Medicine, Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.,Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Department of Medicine, Nashville, TN, USA
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elie Azoulay
- Medical ICU of the Saint-Louis Hospital, Paris Diderot Sorbonne University, Paris, France
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25
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Dalpiaz G, Piolanti M. Non-infectious Parenchymal Lung Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7121959 DOI: 10.1007/174_2016_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute dyspnea is a common presenting complaint in the emergency room, emergency medicine and intensive care. It may have a cardiovascular or a non-cardiovascular origin, the latter including pulmonary parenchymal diseases. Depending on the cause, it may be associated with fever, cough, hemoptysis, and/or chest pain, with a duration of symptoms that can range from hours to days. Prompt identification of the underlying cause of acute dyspnea is essential in guiding appropriate therapy and management, as patients may rapidly progress to acute respiratory failure. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities, which may require further assessment with computed tomography (HRCT). Acute non-infectious parenchymal lung diseases are often overlooked and may be under-diagnosed. Their diagnosis requires the evaluation, along with the HRCT pattern, of the clinical and laboratory features and of the bronchoalveolar lavage. Biopsy may be necessary in more complex cases. Although the most frequent cause of diffuse non-infectious parenchymal lung involvement is acute hydrostatic pulmonary edema, there is a wide variety of diseases that may be encountered, including acute drug toxicity, hypersensitivity pneumonitis (HP), acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage (DAH). In trauma patients, fat embolism syndrome (FES) must be taken into account. Acute respiratory failure is an eventuality that can occur during the course of chronic lung diseases (UIP for example), which may have been unknown until then.
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26
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Nair A, Walsh SLF, Desai SR. Imaging of pulmonary involvement in rheumatic disease. Rheum Dis Clin North Am 2015; 41:167-96. [PMID: 25836636 DOI: 10.1016/j.rdc.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung disease commonly occurs in connective tissue diseases (CTD) and is an important cause of morbidity and mortality. Imaging is central to the evaluation of CTD-associated pulmonary complications. In this article, a general discussion of radiologic considerations is followed by a description of the pulmonary appearances in individual CTDs, and the imaging appearances of acute and nonacute pulmonary complications. The contribution of imaging to monitoring disease, evaluating treatment response, and prognostication is reviewed. Finally, we address the role of imaging in the challenging multidisciplinary evaluation of interstitial lung disease where there is an underlying suspicion of an undiagnosed CTD.
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Affiliation(s)
- Arjun Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Simon L F Walsh
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Sujal R Desai
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Algieri I, Gotti M, Nikolla K, Massari D, Cammaroto A, Colombo A, Cadringher P, Carlesso E, Benti R, Casati R, Zito F, Gattinoni L. Lung inhomogeneities, inflation and [18F]2-fluoro-2-deoxy-D-glucose uptake rate in acute respiratory distress syndrome. Eur Respir J 2015; 47:233-42. [DOI: 10.1183/13993003.00885-2015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/05/2015] [Indexed: 01/17/2023]
Abstract
The aim of the study was to determine the size and location of homogeneous inflamed/noninflamed and inhomogeneous inflamed/noninflamed lung compartments and their association with acute respiratory distress syndrome (ARDS) severity.In total, 20 ARDS patients underwent 5 and 45 cmH2O computed tomography (CT) scans to measure lung recruitability. [18F]2-fluoro-2-deoxy-d-glucose ([18F]FDG) uptake and lung inhomogeneities were quantified with a positron emission tomography-CT scan at 10 cmH2O. We defined four compartments with normal/abnormal [18F]FDG uptake and lung homogeneity.The homogeneous compartment with normal [18F]FDG uptake was primarily composed of well-inflated tissue (80±16%), double-sized in nondependent lung (32±27% versus 16±17%, p<0.0001) and decreased in size from mild, moderate to severe ARDS (33±14%, 26±20% and 5±9% of the total lung volume, respectively, p=0.05). The homogeneous compartment with high [18F]FDG uptake was similarly distributed between the dependent and nondependent lung. The inhomogeneous compartment with normal [18F]FDG uptake represented 4% of the lung volume. The inhomogeneous compartment with high [18F]FDG uptake was preferentially located in the dependent lung (21±10% versus 12±10%, p<0.0001), mostly at the open/closed interfaces and related to recruitability (r2=0.53, p<0.001).The homogeneous lung compartment with normal inflation and [18F]FDG uptake decreases with ARDS severity, while the inhomogeneous poorly/not inflated compartment increases. Most of the lung inhomogeneities are inflamed. A minor fraction of healthy tissue remains in severe ARDS.
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Abstract
Thoracic imaging is widely used to detect lower respiratory tract infections, identify their complications, and aid in differentiating infectious from noninfectious thoracic disease. Less commonly, the combination of imaging findings and a clinical setting can favor infection with a specific organism. This confluence can occur in cases of bronchiectatic nontuberculous mycobacterial infections in immune-competent hosts, invasive fungal disease among neutropenic patients, Pneumocystis jiroveci pneumonia in patients with AIDS, and in cytomegalovirus infections in patients with recent hematopoietic cell transplantation. These specific diagnoses often depend on computed tomography scanning rather than chest radiography alone.
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Abstract
Chest radiography serves a crucial role in imaging of the critically ill. It is essential in ensuring the proper positioning of support and monitoring equipment, and in evaluating for potential complications of this equipment. The radiograph is useful in diagnosing and evaluating the progression of atelectasis, aspiration, pulmonary edema, pneumonia, and pleural fluid collections. Computed tomography can be useful when the clinical and radiologic presentations are discrepant, the patient is not responding to therapy, or in further defining the pattern and distribution of a radiographic abnormality.
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Affiliation(s)
- Matthew R Bentz
- Department of Radiology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L340, Portland, OR 97239, USA.
| | - Steven L Primack
- Division of Pulmonary Medicine, Department of Radiology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L340, Portland, OR 97239, USA
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Clinical and biological heterogeneity in acute respiratory distress syndrome: direct versus indirect lung injury. Clin Chest Med 2014; 35:639-53. [PMID: 25453415 DOI: 10.1016/j.ccm.2014.08.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The acute respiratory distress syndrome (ARDS) is a heterogeneous group of illnesses affecting the pulmonary parenchyma with acute onset bilateral inflammatory pulmonary infiltrates with associated hypoxemia. ARDS occurs after 2 major types of pulmonary injury: direct lung injury affecting the lung epithelium or indirect lung injury disrupting the vascular endothelium. Greater understanding of the differences between direct and indirect lung injury may refine the classification of patients with ARDS and lead to development of new therapeutics targeted at specific subpopulations of patients with ARDS.
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Akira M, Suganuma N. Acute and subacute chemical-induced lung injuries: HRCT findings. Eur J Radiol 2014; 83:1461-9. [PMID: 24853247 DOI: 10.1016/j.ejrad.2014.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/08/2014] [Accepted: 04/19/2014] [Indexed: 11/16/2022]
Abstract
Lung injury caused by chemicals includes bronchitis, bronchiolitis, chemical pneumonitis, pulmonary edema, acute respiratory distress syndrome, organizing pneumonia, hypersensitivity pneumonitis, acute eosinophilic pneumonia, and sarcoid-like granulomatous lung disease. Each chemical induces variable pathophysiology and the situation resembles to the drug induced lung disease. The HRCT features are variable and nonspecific, however HRCT may be useful in the evaluation of the lung injuries and so we should know about HRCT features of lung parenchymal abnormalities caused by chemicals.
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Affiliation(s)
- Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai City, Osaka 591-8555, Japan.
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Difference in pulmonary permeability between indirect and direct acute respiratory distress syndrome assessed by the transpulmonary thermodilution technique: a prospective, observational, multi-institutional study. J Intensive Care 2014; 2:24. [PMID: 25520836 PMCID: PMC4267584 DOI: 10.1186/2052-0492-2-24] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/06/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is characterized by the increased pulmonary permeability secondary to diffuse alveolar inflammation and injuries of several origins. Especially, the distinction between a direct (pulmonary injury) and an indirect (extrapulmonary injury) lung injury etiology is gaining more attention as a means of better comprehending the pathophysiology of ARDS. However, there are few reports regarding the quantitative methods distinguishing the degree of pulmonary permeability between ARDS patients due to pulmonary injury and extrapulmonary injury. METHODS A prospective, observational, multi-institutional study was performed in 23 intensive care units of academic tertiary referral hospitals throughout Japan. During a 2-year period, all consecutive ARDS-diagnosed adult patients requiring mechanical ventilation were collected in which three experts retrospectively determined the pathophysiological mechanisms leading to ARDS. Patients were classified into two groups: patients with ARDS triggered by extrapulmonary injury (ARDSexp) and those caused by pulmonary injury (ARDSp). The degree of pulmonary permeability using the transpulmonary thermodilution technique was obtained during the first three intensive care unit (ICU) days. RESULTS In total, 173 patients were assessed including 56 ARDSexp patients and 117 ARDSp patients. Although the Sequential Organ Failure Assessment (SOFA) score was significantly higher in the ARDSexp group than in the ARDSp group, measurements of the pulmonary vascular permeability index (PVPI) were significantly elevated in the ARDSp group on all days: at day 0 (2.9 ± 1.3 of ARDSexp vs. 3.3 ± 1.3 of ARDSp, p = .008), at day 1 (2.8 ± 1.5 of ARDSexp vs. 3.2 ± 1.2 of ARDSp, p = .01), at day 2 (2.4 ± 1.0 of ARDSexp vs. 2.9 ± 1.3 of ARDSp, p = .01). There were no significant differences in mortality at 28 days, mechanical ventilation days, and hospital length of stay between the two groups. CONCLUSIONS The results of this study suggest the existence of several differences in the increased degree of pulmonary permeability between patients with ARDSexp and ARDSp. TRIAL REGISTRATION This report is a sub-group analysis of the study registered with UMIN-CTR (IDUMIN000003627).
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Acute respiratory distress syndrome induction by pulmonary ischemia-reperfusion injury in large animal models. J Surg Res 2014; 189:274-84. [PMID: 24768138 DOI: 10.1016/j.jss.2014.02.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/17/2014] [Accepted: 02/20/2014] [Indexed: 01/14/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a common critical pulmonary complication after esophagectomy and other thoracic surgeries (e.g., lung transplantation, pulmonary thromboendarterectomy). Direct pulmonary ischemia-reperfusion injury (PIRI) is known to play the main role in induction of ARDS in these cases. Large animal models are an appropriate choice for ARDS as well as PIRI study because of their physiological and anatomic similarities to the human body. With regard to large animal models, we reviewed different methods of inducing in situ direct PIRI and the commonly applied methods for diagnosing and monitoring ARDS or PIRI in an experimental research setting.
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Fioretto JR, Carvalho WB. Temporal evolution of acute respiratory distress syndrome definitions. J Pediatr (Rio J) 2013; 89:523-30. [PMID: 24035871 DOI: 10.1016/j.jped.2013.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/14/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE to review the evolution of acute respiratory distress syndrome (ARDS) definitions and present the current definition for the syndrome. DATA SOURCE a literature review and selection of the most relevant articles on ARDS definitions was performed using the MEDLINE®/PubMed® Resource Guide database (last ten years), in addition to including the most important articles (classic articles) that described the disease evolution. DATA SYNTHESIS the review included the following subjects: introduction; importance of definition; description of the first diagnostic criterion and subsequently used definitions, such as acute lung injury score; definition by the American-European Consensus Conference, and its limitations; description of the definition by Delphi, and its problems; accuracy of the aforementioned definitions; description of most recent definition (the Berlin definition), and its limitations; and practical importance of the new definition. CONCLUSIONS ARDS is a serious disease that remains an ongoing diagnostic and therapeutic challenge. The evolution of definitions used to describe the disease shows that studies are needed to validate the current definition, especially in pediatrics, where the data are very scarce.
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Affiliation(s)
- José R Fioretto
- Pediatrics Department, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil; Sociedade Paulista de Terapia Intensiva, São Paulo, SP, Brazil.
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Temporal evolution of acute respiratory distress syndrome definitions. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Michiue T, Ishikawa T, Oritani S, Kamikodai Y, Tsuda K, Okazaki S, Maeda H. Forensic pathological evaluation of postmortem pulmonary CT high-density areas in serial autopsy cases of sudden cardiac death. Forensic Sci Int 2013; 232:199-205. [DOI: 10.1016/j.forsciint.2013.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 04/22/2013] [Accepted: 07/28/2013] [Indexed: 10/26/2022]
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Factors associated within 28 days in-hospital mortality of patients with acute respiratory distress syndrome. BIOMED RESEARCH INTERNATIONAL 2013; 2013:564547. [PMID: 23878811 PMCID: PMC3708401 DOI: 10.1155/2013/564547] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 12/01/2022]
Abstract
Objective. To determine the factors leading to in-hospital mortality within 28 days in hospitalized patients with ARDS. It was a prospective observational cohort study conducted in Intensive Care Unit of Aga Khan University Hospital Karachi from March to August 2011. Methodology. Data was collected from patients admitted in the intensive care unit on the basis of inclusion and exclusion criteria. The patients were followed daily for 28 days to record any in-hospital complications and the outcome of patients. Results. Total of 46 patients were included during this period out of which 56% (26) were males and 43% (20) were females. Mean age was 44 ± 19 years. There were 11 (23.9%) patients with age >65 and 35 (76%) had age <65 years. There were 21 (45.6%) patients with pulmonary ARDS and 25 (54.3%) had extrapulmonary ARDS. APACHE II score of >20 was present in 23 (50%) patients while the rest had score of <20. Regarding in-hospital complications, 23 (50%) patients developed sepsis, 31 (67.4%) had multiorgan failure, 14 (30%) had refractory shock, and 15 (32.6%) developed refractory hypoxemia. Out of 46 patients, 26 (56.5%) died within 28 days. On univariate analysis, high APACHE score, multiorgan failure, refractory shock, and refractory hypoxemia were main causes of death.
Conclusion. ARDS is a syndrome of high mortality with mortality rate of 56.5% in this study. High APACHE, sepsis, multiorgan failure, refractory shock, and refractory hypoxemia are the leading causes of death in our patients.
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Prospective and management: acute nonimmunologic inhalation injuries. J Occup Environ Med 2013; 55:853-5. [PMID: 23787576 DOI: 10.1097/jom.0b013e318229a6a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.
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Michiue T, Sakurai T, Ishikawa T, Oritani S, Maeda H. Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death. Forensic Sci Int 2012; 220:232-8. [DOI: 10.1016/j.forsciint.2012.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/27/2011] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
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Dakin J, Jones AT, Hansell DM, Hoffman EA, Evans TW. Changes in lung composition and regional perfusion and tissue distribution in patients with ARDS. Respirology 2012; 16:1265-72. [PMID: 21883676 DOI: 10.1111/j.1440-1843.2011.02048.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE ARDS is characterized by bilateral pulmonary infiltrates and refractory hypoxemia attributed to V/Q mismatch. We used dynamic CT to characterize changes in lung composition, regional perfusion and tissue distribution in patients with ARDS in comparison with healthy subjects. METHODS The Fick principle was applied to serial attenuation measurements constructed from sequential CT images acquired during the passage of a bolus of iodinated contrast medium in healthy subjects (n=3) and patients with ARDS (n=11). Perfusion was calculated by the Mullani-Gould method and mapped throughout both lungs. Gradients of perfusion and tissue density against vertical height were constructed. RESULTS In comparison with normal individuals, the tissue component of lungs from patients with ARDS was significantly increased (P<0.05). Blood fraction was unchanged. There was a discernable gradient in tissue density from non dependent to dependent regions in the patients with ARDS that was significantly different from controls. The proportion of perfusion applied to consolidated areas (i.e. shunt) correlated significantly (P<0.05) with the severity of hypoxaemia. CONCLUSIONS In patients with ARDS there are changes in both lung composition and the distribution of tissue and perfusion that may account in part for the physiological changes that define the syndrome.
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Affiliation(s)
- Jonathan Dakin
- Imperial College Unit of Critical Care, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
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Plasma C-reactive protein levels are associated with mortality in elderly with acute lung injury. J Crit Care 2011; 27:524.e1-6. [PMID: 22176804 DOI: 10.1016/j.jcrc.2011.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/13/2011] [Accepted: 10/14/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE The plasma C-reactive protein (CRP) level is considered to be a predictor of severity in both hospital- and community-acquired pneumonias, whereas recent reports have shown that higher CRP levels lead to better outcomes in patients with acute lung injury (ALI). To explain this discrepancy, we evaluated the relationship among plasma CRP levels, etiology, affectors of CRP production, and mortality in patients with ALI. MATERIALS AND METHODS This was a case-control study of 76 consecutive patients with ALI. The plasma CRP levels had been measured in all of the patients within 1 hour of visiting an emergency department. The associations between the plasma CRP levels and 60-day mortality were analyzed after adjusting for the causes of ALI, disease severity, the patients' age, use of corticosteroids, and presence of hepatic failure. RESULTS The CRP levels and patients' ages were strongly related to the mortality (adjusted hazard ratio, 1.005 [P = .007] and 1.059 [P = .011], respectively), whereas the etiology of ALI did not affect the mortality (adjusted hazard ratio, 0.789 [P = .530]) in the Cox proportional hazard models. CONCLUSIONS The plasma CRP level may be a predictor of mortality in elderly patients with ALI.
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Wilcox ME, Herridge MS. Lung function and quality of life in survivors of the acute respiratory distress syndrome (ARDS). Presse Med 2011; 40:e595-603. [PMID: 22078086 DOI: 10.1016/j.lpm.2011.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Recent studies have begun to describe the long-term outcomes of acute respiratory distress syndrome (ARDS) survivors. These patients experience a number of physical, mental and psychological morbidities that significantly impair their health-related quality of life (HRQL). The trajectory of pulmonary recovery in survivors of ARDS, as it relates to lung function, structure and health-related quality of life (HRQL), is predictable and often persists years after hospital discharge. True pulmonary parenchymal morbidity is uncommon and when present, persistent restrictive disease is likely related to diaphragmatic weakness with a mild reduction in diffusion capacity (DLCO). Future research should focus on identifying patients at risk for long-term functional limitations and the design of rehabilitation interventions tailored to individual patient needs.
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Affiliation(s)
- M Elizabeth Wilcox
- University of Toronto, Toronto Western Hospital, Division of Pulmonary and Critical Care Medicine, Toronto, Ontario, Canada.
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Stefanidis K, Dimopoulos S, Tripodaki ES, Vitzilaios K, Politis P, Piperopoulos P, Nanas S. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Crit Care 2011; 15:R185. [PMID: 21816054 PMCID: PMC3387628 DOI: 10.1186/cc10338] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/28/2011] [Accepted: 08/04/2011] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Bedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS). METHODS Ten patients (mean ± standard deviation (SD): age 64 ± 7 years, Acute Physiology and Chronic Health Evaluation II (APACHE II) score 21 ± 4) with early ARDS on mechanical ventilation were included in the study. Transthoracic sonography was performed in all patients to depict the nonaerated area in the dependent lung regions at different PEEP settings of 5, 10 and 15 cm H2O. Lung sonographic assessment of the nonaerated lung area and arterial blood gas analysis were performed simultaneously at the end of each period. A control group of five early ARDS patients matched for APACHE II score was also included in the study. RESULTS The nonaerated areas in the dependent lung regions were significantly reduced during PEEP increases from 5 to 10 to 15 cm H2O (27 ± 31 cm2 to 20 ± 24 cm2 to 11 ± 12 cm2, respectively; P < 0.01). These changes were associated with a significant increase in arterial oxygen partial pressure (74 ± 15 mmHg to 90 ± 19 mmHg to 102 ± 26 mmHg; P < 0.001, respectively). No significant changes were observed in the nonaerated areas in the dependent lung regions in the control group. CONCLUSIONS In this study, we show that transthoracic lung sonography can detect the nonaerated lung area changes during a PEEP trial of patients with early ARDS. Thus, transthoracic lung sonography might be considered as a useful clinical tool in the management of ARDS patients.
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Affiliation(s)
| | - Stavros Dimopoulos
- 1st Critical Care Medicine Department, Evaggelismos Hospital, NKUA, Ipsilantou 45-47, 10676, Athens, Greece
| | - Elli-Sophia Tripodaki
- 1st Critical Care Medicine Department, Evaggelismos Hospital, NKUA, Ipsilantou 45-47, 10676, Athens, Greece
| | | | - Panagiotis Politis
- 1st Critical Care Medicine Department, Evaggelismos Hospital, NKUA, Ipsilantou 45-47, 10676, Athens, Greece
| | | | - Serafim Nanas
- 1st Critical Care Medicine Department, Evaggelismos Hospital, NKUA, Ipsilantou 45-47, 10676, Athens, Greece
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Hasegawa M, Sakai F. 1. Approach to Diagnosis, 2) Radiological Findings of ALI/ARDS. ACTA ACUST UNITED AC 2011; 100:1545-51. [DOI: 10.2169/naika.100.1545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mizue Hasegawa
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
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CT predictors of mortality in pathology confirmed ARDS. Eur Radiol 2010; 21:730-7. [DOI: 10.1007/s00330-010-1979-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 08/11/2010] [Accepted: 09/07/2010] [Indexed: 01/28/2023]
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Brauner M, Romdhane HB, Brillet PY, Freynet O, Dion G, Valeyre D. Imagerie des pneumopathies infiltrantes diffuses. Presse Med 2010; 39:73-84. [DOI: 10.1016/j.lpm.2009.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/14/2009] [Indexed: 11/30/2022] Open
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Varelmann D, Muders T, Zinserling J, Guenther U, Magnusson A, Hedenstierna G, Putensen C, Wrigge H. Cardiorespiratory effects of spontaneous breathing in two different models of experimental lung injury: a randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:R135. [PMID: 18980696 PMCID: PMC2646345 DOI: 10.1186/cc7108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 10/03/2008] [Accepted: 11/04/2008] [Indexed: 12/20/2022]
Abstract
Introduction Acute lung injury (ALI) can result from various insults to the pulmonary tissue. Experimental and clinical data suggest that spontaneous breathing (SB) during pressure-controlled ventilation (PCV) in ALI results in better lung aeration and improved oxygenation. Our objective was to evaluate whether the addition of SB has different effects in two different models of ALI. Methods Forty-four pigs were randomly assigned to ALI resulting either from hydrochloric acid aspiration (HCl-ALI) or from increased intra-abdominal pressure plus intravenous oleic acid injections (OA-ALI) and were ventilated in PCV mode either with SB (PCV + SB) or without SB (PCV – SB). Cardiorespiratory variables were measured at baseline after induction of ALI and after 4 hours of treatment (PCV + SB or PCV – SB). Finally, density distributions and end-expiratory lung volume (EELV) were assessed by thoracic spiral computed tomography. Results PCV + SB improved arterial partial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FiO2) by a reduction in intrapulmonary shunt fraction in HCl-ALI from 27% ± 6% to 23% ± 13% and in OA-ALI from 33% ± 19% to 26% ± 18%, whereas during PCV – SB PaO2/FiO2 deteriorated and shunt fraction increased in the HCl group from 28% ± 8% to 37% ± 17% and in the OA group from 32% ± 12% to 47% ± 17% (P < 0.05 for interaction time and treatment, but not ALI type). PCV + SB also resulted in higher EELV (HCl-ALI: 606 ± 171 mL, OA-ALI: 439 ± 90 mL) as compared with PCV – SB (HCl-ALI: 372 ± 130 mL, OA-ALI: 192 ± 51 mL, with P < 0.05 for interaction of time, treatment, and ALI type). Conclusions SB improves oxygenation, reduces shunt fraction, and increases EELV in both models of ALI.
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Affiliation(s)
- Dirk Varelmann
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany.
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Abstract
OBJECTIVE Acute respiratory distress syndrome is a common disorder associated with significant mortality and morbidity. The aim of this article is to critically evaluate the definition of acute respiratory distress syndrome and examine the impact the definition has on clinical practice and research. DATA SOURCES Articles from a MEDLINE search (1950 to August 2007) using the Medical Subject Heading respiratory distress syndrome, adult, diagnosis, limited to the English language and human subjects, their relevant bibliographies, and personal collections, were reviewed. DATA SYNTHESIS The definition of acute respiratory distress syndrome is important to researchers, clinicians, and administrators alike. It has evolved significantly over the last 40 years, culminating in the American-European Consensus Conference definition, which was published in 1994. Although the American-European Consensus Conference definition is widely used, it has some important limitations that may impact on the conduct of clinical research, on resource allocation, and ultimately on the bedside management of such patients. These limitations stem partially from the fact that as defined, acute respiratory distress syndrome is a heterogeneous entity and also involve the reliability and validity of the criteria used in the definition. This article critically evaluates the American-European Consensus Conference definition and its limitations. Importantly, it highlights how these limitations may contribute to clinical trials that have failed to detect a potential true treatment effect. Finally, recommendations are made that could be considered in future definition modifications with an emphasis on the significance of accurately identifying the target population in future trials and subsequently in clinical care. CONCLUSION How acute respiratory distress syndrome is defined has a significant impact on the results of randomized, controlled trials and epidemiologic studies. Changes to the current American-European Consensus Conference definition are likely to have an important role in advancing the understanding and management of acute respiratory distress syndrome.
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Abstract
Chest radiography serves a crucial role in imaging of the critically ill. Its uses include diagnosis and monitoring of commonly encountered pulmonary parenchymal and pleural space abnormalities. It is also important in evaluating monitoring and support devices and associated complications. CT, another useful imaging modality in select patients, can better characterize pulmonary parenchymal and pleural space disease.
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Affiliation(s)
- Joshua R Hill
- Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L340, Portland, OR 97239, USA.
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