Acute Respiratory Distress Syndrome
This review describes the management of mechanical ventilation in patients with acute respiratory distress syndrome, including in those with coronavirus disease 2019. Low tidal volume ventilation with a moderate to high positive end-expiratory pressure remains the foundation of an evidence-based approach. We consider strategies for setting positive end-expiratory pressure levels, the use of recruitment maneuvers, and the potential role of driving pressure. Rescue therapies including prone positioning and extracorporeal membrane oxygenation are also discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 26, 2021 Category: Intensive Care Authors: Melissa H. Coleman, J. Matthew Aldrich Source Type: research
Long-Term Outcomes in Acute Respiratory Distress Syndrome
Survivors of acute respiratory distress syndrome (ARDS) experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function, and mental health are common and may last for years. The current coronavirus disease 2019 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. Evaluation of the ARDS survivor should be comprehensive, and common domains of impairment that have emerged from long-term outcomes research over the past 2 decades should be systematically evaluated. (Source: C...
Source: Critical Care Clinics - May 26, 2021 Category: Intensive Care Authors: Jessica A. Palakshappa, Jennifer T.W. Krall, Lanazha T. Belfield, D. Clark Files Source Type: research
Acute Kidney Injury and Acute Respiratory Distress Syndrome
The most consistent signal for mortality in acute respiratory distress syndrome (ARDS) is multi-organ failure, specifically when it involves the kidneys. Acute kidney injury (AKI) complicates approximately a third of all ARDS cases, and the combination of the two drastically worsens prognosis. Recent advances in ARDS supportive care have led to improved outcomes, however, much less is known on how to prevent and support patients with AKI and ARDS together. Understanding the dynamic relationship between the kidneys and lungs is crucial for the practicing intensivist in order to prevent injury. In this review, we summarize k...
Source: Critical Care Clinics - May 26, 2021 Category: Intensive Care Authors: Bryan D. Park, Sarah G. Faubel Source Type: research
Acute Respiratory Distress Syndrome: Ventilator Management and Rescue Therapies
This review describes the management of mechanical ventilation in patients with acute respiratory distress syndrome, including in those with COVID-19. Low tidal volume ventilation with moderate to high positive end expiratory pressure (PEEP) remains the foundation of an evidence-based approach. We consider strategies for setting PEEP levels, the use of recruitment maneuvers, and the potential role of driving pressure. Rescue therapies including prone positioning and extracorporeal membrane oxygenation are also discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 26, 2021 Category: Intensive Care Authors: Melissa H. Coleman, J. Matthew Aldrich Source Type: research
Long-Term Outcomes in Acute Respiratory Distress Syndrome: Epidemiology, Mechanisms, and Patient Evaluation
Survivors of ARDS experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function and mental health are common and may last for years. The current COVID-19 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. The evaluation of the ARDS survivor should be comprehensive and systematically evaluate common domains of impairment that have emerged from long-term outcomes research over the past two decades. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 26, 2021 Category: Intensive Care Authors: Jessica A. Palakshappa, Jennifer T.W. Krall, Lanazha T. Belfield, D. Clark Files Source Type: research
COVID-19 –Associated Acute Respiratory Distress Syndrome
Reports examining lung histopathology in coronavirus disease 2019 (COVID-19) infection provide an essential body of information for clinicians and investigators. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) –induced lung injury is complex, involving the airways, alveoli, and pulmonary vessels. Although no anatomic marker is specific, the signature histologic lesion is diffuse alveolar damage (DAD). The biological and molecular mechanisms that drive this pattern of injury are unknown, and the relation ship of SARS-CoV-2-induced DAD to physiologic alterations and clinical outcomes in COVID-19–associated a...
Source: Critical Care Clinics - May 25, 2021 Category: Intensive Care Authors: Elizabeth A. Middleton, Guy A. Zimmerman Source Type: research
Pathophysiology of the Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome that manifests secondary to numerous etiologic insults, and consequently it is associated with a multitude of pathophysiological abnormalities. Despite more than 50 years of experimental studies, translation of these benchside discoveries into effective biological therapies has been elusive. In this review, some of the key advances made in our knowledge of the pathophysiology of ARDS, based on histopathology, imaging, protein, and transcriptomic biomarkers, a re presented. Finally, the role of such human studies in understanding the pathophys...
Source: Critical Care Clinics - May 25, 2021 Category: Intensive Care Authors: Pratik Sinha, Lieuwe D. Bos Source Type: research
COVID-19-Associated Acute Respiratory Distress Syndrome: Lessons from Tissues and Cells
Reports examining lung histopathology in COVID-19 infection provide an essential body of information for clinicians and investigators. SARS-CoV-2-induced lung injury is complex, involving the airways, alveoli, and pulmonary vessels. Although no anatomic marker is specific the signature histologic lesion is diffuse alveolar damage (DAD). The biologic and molecular mechanisms that drive this pattern of injury are unknown, and the relationship of SARS-CoV-2-induced DAD to physiologic alterations and clinical outcomes in COVID-19-associated acute respiratory distress syndrome is undefined. Additional histologic patterns that m...
Source: Critical Care Clinics - May 25, 2021 Category: Intensive Care Authors: Elizabeth A. Middleton, Guy A. Zimmerman Source Type: research
Pathophysiology of The Acute Respiratory Distress Syndrome: Insights from Clinical Studies
Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome that manifests secondary to numerous aetiological insults and consequently it is associated with a multitude of pathophysiological abnormalities. Despite over 50 years of experimental studies, translation of these benchside discoveries into effective biological therapies has been elusive. Recent advances in high throughput biological sampling, imaging and advances in data analytics has allowed studying ARDS in human subjects based on pragmatic studies. In this review, we present some of the key advances made in our knowledge of the pathophysiol...
Source: Critical Care Clinics - May 25, 2021 Category: Intensive Care Authors: Pratik Sinha, Lieuwe D. Bos Source Type: research
Poisons and Patients
Critical care providers frequently care for patients who are poisoned under a variety of circumstances and develop a wide range of clinical syndromes. Poisonings may be intentional (eg, suicide, homicide) or unintentional (eg, recreational abuse, medication error). They may involve over-the-counter medications, prescribed outpatient drugs, inpatient drug regimens, illicit substances, or environmental exposures. In the United States, deaths from overdoses reached 70,630 in 2019.1 Exposures with more serious outcomes (moderate, major, or death) increased 4.61% per year since 2000. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 5, 2021 Category: Intensive Care Authors: Janice L. Zimmerman Tags: Preface Source Type: research
Defining Acute Kidney Injury
Acute kidney injury (AKI) is a syndrome of impaired kidney function associated with reduced survival and increased morbidity. International consensus criteria were developed based on changes in serum creatinine and urine output. Based on these definitions, epidemiologic studies have shown strong associations with clinical outcomes including death and dialysis. However, numerous limitations exist for creatinine and urine volume as markers of AKI and novel biomarkers have been developed to detect cellular stress or damage. Persistent AKI and acute kidney disease are relatively new concepts that explore the idea of AKI as a c...
Source: Critical Care Clinics - March 20, 2021 Category: Intensive Care Authors: Siddharth Verma, John A. Kellum Source Type: research
Neonatal Acute Kidney Injury
The study of neonatal acute kidney injury (AKI) has transitioned from small, single-center studies to the development of a large, multicenter cohort. The scope of research has expanded from assessment of incidence and mortality to analysis of more specific risk factors, novel urinary biomarkers, interplay between AKI and other organ systems, impact of fluid overload, and quality improvement efforts. The intensification has occurred through collaboration between the neonatology and nephrology communities. This review discusses 2 case scenarios to illustrate the clinical presentation of neonatal AKI, important risk factors, ...
Source: Critical Care Clinics - March 20, 2021 Category: Intensive Care Authors: Keegan J. Kavanaugh, Jennifer G. Jetton, Alison L. Kent Source Type: research
Biomarkers in Acute Kidney Injury
Biomarkers have become a pillar of precision medicine in acute kidney injury (AKI). Traditional markers for diagnosis of AKI are insensitive and insufficient to provide comprehensive information for prognostication. Several emerging biomarkers have shown promising results in large-scale clinical studies. These novel markers likely will be beneficial for personalized AKI prevention and treatment. (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 20, 2021 Category: Intensive Care Authors: Win Kulvichit, John A. Kellum, Nattachai Srisawat Source Type: research
Acute Kidney Injury
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 20, 2021 Category: Intensive Care Authors: Dana Y. Fuhrman, John A. Kellum Source Type: research
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ELSEVIER (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 20, 2021 Category: Intensive Care Source Type: research
