Do Newer Monitors of Exhaled Gases, Mechanics, and Esophageal Pressure Add Value?

Owens, Robert L.; Stigler, William S.; Hess, Dean

doi:10.1016/j.ccm.2008.02.001

Cited by 12 publications

(11 citation statements)

References 79 publications

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“…The study demonstrated a very weak association between acute physiology score, myoinositol, and total glutathione (r s ϭ 0.53, q ϭ 0.25, P ϭ 0.05 and r s ϭ 0.56, q ϭ 0.25, P ϭ 0.04, respectively), yet suggested they may be used for determination of disease severity. Given the research evidence of the impact of mechanical ventilation on metabolites (31,48) and the fact that the majority of patients with ARDS have some form of respiratory support, the use of healthy nonventilated controls is a potentially important confounder in the Stringer et al (63) study. Stringer and colleagues later performed a follow-up serum 1 H-NMR study in 2014 comparing 14 patients with ARDS and 33 unventilated patients with sepsis (61).…”

Section: L528mentioning

confidence: 99%

Evolution of ARDS biomarkers: Will metabolomics be the answer?

Metwaly

Côté

Donnelly

et al. 2018

American Journal of Physiology-Lung Cellular and Molecular Phys

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To date, there is no clinically agreed-upon diagnostic test for acute respiratory distress syndrome (ARDS): the condition is still diagnosed on the basis of a constellation of clinical findings, laboratory tests, and radiological images. Development of ARDS biomarkers has been in a state of continuous flux during the past four decades. To address ARDS heterogeneity, several studies have recently focused on subphenotyping the disease on the basis of observable clinical characteristics and associated blood biomarkers. However, the strong correlation between identified biomarkers and ARDS subphenotypes has yet to establish etiology; hence, there is a need for the adoption of other methodologies for studying ARDS. In this review, we will shed light on ARDS metabolomics research in the literature and discuss advances and major obstacles encountered in ARDS metabolomics research. Generally, the ARDS metabolomics studies focused on identification of differentiating metabolites for diagnosing ARDS, but they were performed to different standards in terms of sample size, selection of control cohort, type of specimens collected, and measuring technique utilized. Virtually none of these studies have been properly validated to identify true metabolomics biomarkers of ARDS. Though in their infancy, metabolomics studies exhibit promise to unfold the biological processes underlying ARDS and, in our opinion, have great potential for pushing forward our present understanding of ARDS.

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Section: L528mentioning

confidence: 99%

Evolution of ARDS biomarkers: Will metabolomics be the answer?

Metwaly

Côté

Donnelly

et al. 2018

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…35,36 Baseline determination is made of end-tidal N 2 (F ETN 2 ). It is assumed that oxygen consumption and carbon dioxide production remain constant throughout the measurement.…”

Section: End-expiratory Lung Volumementioning

confidence: 99%

“…36,48 The slope of the P-V curve is C RS . The most common methods used to measure pressure-volume curves are the use of a super syringe, inflation with a constant slow flow (Ͻ 10 L/min), and P plat at various inflation volumes.…”

Section: Pressure-volume Curvesmentioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the RESPIRATORY CARE • NOVEMBER 2014 VOL 59 NO 11 1773 setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressuretime curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.

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“…Methods are now available to measure functional residual capacity at the bedside in patients with ARDS. 113,114 However, it is difficult to know whether an increase in lung volume with an increase in PEEP is due to alveolar recruitment or over-distention.…”

Section: Approaches To Setting Peepmentioning

confidence: 99%

Approaches to Conventional Mechanical Ventilation of the Patient With Acute Respiratory Distress Syndrome

Hess

2011

Respir Care

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To minimize ventilator-induced lung injury, attention should be directed toward avoidance of alveolar over-distention and cyclical opening and closure of alveoli. The most impressive study of mechanical ventilation to date is the Acute Respiratory Distress Syndrome (ARDS) Network study of higher versus lower tidal volume (V T ), which reported a reduction in mortality from 39.8% to 31.0% with 6 mL/kg ideal body weight rather than 12 mL/kg ideal body weight (number-neededto-treat of 12 patients). To achieve optimal lung protection, the lowest plateau pressure and V T possible should be selected. What is most important is limitation of V T and alveolar distending pressure, regardless of the mode set on the ventilator. Accumulating observational evidence suggests that V T should be limited in all mechanically ventilated patients-even those who do not have ALI/ARDS. Evidence does not support the use of pressure controlled inverse-ratio ventilation. Although zero PEEP is probably injurious, an area of considerable controversy is the optimal setting of PEEP. Available evidence does not support the use of higher PEEP, compared to lower PEEP, in unselected patients with acute lung injury (ALI)/ARDS. However, results of a metaanalysis using individual patients from 3 randomized controlled trials suggest that higher PEEP should be used for ARDS, whereas lower PEEP may be more appropriate in patients with ALI. PEEP should be set to maximize alveolar recruitment while avoiding over-distention. Many approaches for setting PEEP have been described, but evidence is lacking that any one approach is superior to any other. In most, if not all, cases of ALI/ARDS, conventional ventilation strategies can be used effectively to provide lung-protective ventilation strategies.

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Do Newer Monitors of Exhaled Gases, Mechanics, and Esophageal Pressure Add Value?

Cited by 12 publications

References 79 publications

Evolution of ARDS biomarkers: Will metabolomics be the answer?

Evolution of ARDS biomarkers: Will metabolomics be the answer?

Respiratory Mechanics in Mechanically Ventilated Patients

Approaches to Conventional Mechanical Ventilation of the Patient With Acute Respiratory Distress Syndrome

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