Incidence of ARDS in an Adult Population of Northeast Ohio

Arroliga, Alejandro C.; Ghamra, Ziad; Trepichio, Alejandro Perez; Trepichio, Patricia Perez; Komara, John J.; Smith, Andre; Wiedemann, Herbert

doi:10.1378/chest.121.6.1972

Cited by 52 publications

(42 citation statements)

References 15 publications

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“…Though ARDS is reasonably uncommon, with an incidence estimated at cases per million population per year, it is associated with a very high mortality (40% or greater). [1][2][3][4][5][6][7][8][9] Many of the deaths occur in young or middle-aged patients. In survivors, ARDS causes derangement of lung function for 2 years or more after hospital discharge, 10,11 as well as marked reductions in quality of life (QoL).…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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BackgroundPatients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.ObjectivesTo determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.DesignA parallel, randomised, unblinded clinical trial.SettingUK intensive care units.ParticipantsMechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.InterventionsTreatment arm HFOV using a Novalung R100®ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.Control arm Conventional mechanical ventilation using the devices available in the participating centres.Main outcome measuresThe primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.ResultsOne hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) −6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £78,260.ConclusionsThe use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.Trial registrationCurrent Controlled Trials ISRCTN10416500.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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“…1,2 Despite considerable recent advances in the understanding of the mechanism underlying ARDS pathogenesis, supportive therapies remain the mainstay of treatment of this disease. 3,4 Because of the high mortality rate and its substantial impact on public health, novel therapeutic approaches for ARDS are badly needed.…”

Section: Introductionmentioning

confidence: 99%

α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

D'Almeida¹,

Oliveira²,

Souza³

et al. 2017

IJN

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Acute respiratory distress syndrome (ARDS) is a severe clinical condition of respiratory failure due to an intense inflammatory response with different etiologies. Despite all efforts, therapy remains limited, and ARDS is still associated with high mortality and morbidity. Plants can provide a vast source of active natural products for the discovery of new drugs. α-bisabolol (α-bis), a constituent of the essential oil from chamomile, has elicited pharmacological interest. However, the molecule has some limitations to its biological application. This study was conducted to develop a drug delivery system using lipid-core nanocapsules (LNCs) to improve the anti-inflammatory effects of orally administered α-bis. α-bis-loaded LNCs (α-bis-LNCs) were prepared by interfacial deposition of poly(ε-caprolactone) and orally administered in a mouse model of ARDS triggered by an intranasal administration of lipopolysaccharide (LPS). We found that α-bis-LNCs (30, 50, and 100 mg kg −1 ) significantly reduced airway hyperreactivity (AHR), neutrophil infiltration, myeloperoxidase activity, chemokine levels (KC and MIP-2), and tissue lung injury 18 hours after the LPS challenge. By contrast, free α-bis failed to modify AHR and neutrophil accumulation in the bronchoalveolar lavage effluent and lung parenchyma and inhibited elevation in the myeloperoxidase and MIP-2 levels only at the highest dose. Furthermore, only α-bis-LNCs reduced LPS-induced changes in mitogen-activated protein kinase signaling, as observed by a significant reduction in phosphorylation levels of ERK1/2, JNK, and p38 proteins. Taken together, our results clearly show that by using LNCs, α-bis was able to decrease LPS-induced inflammation. These findings may be explained by the robust increase of α-bis concentration in the lung tissue that was achieved by the LNCs. Altogether, these results indicate that α-bis-LNCs should further be investigated as a potential alternative for the treatment of ARDS.

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“…ARDS hastalarına %19 NİMV, %30 İMV, %48'ine ise hem NİMV hem de İMV uygulandı. NİMV yapılan hastalarda medyan PEEP 9 [5][6][7][8][9][10] cmH20 , İMV yapılan hastalarda ise medyan PEEP 14 [10][11][12][13][14][15][16][17][18][19][20] cmH20 olarak uygulandı. Hastaların %41'inde permisif hiperkapniye izin verildi.…”

Section: Gereç Ve Yöntemlerunclassified

“…The median age was 46 and 61% of patients were male. Upon admission, the APACHE II and Glasgow coma scores were 23 [17][18][19][20][21][22][23][24][25][26][27][28] and 15 [11][12][13][14][15], respectively. The most common underlying disease was hematological malignancy (57%).…”

mentioning

confidence: 99%

Epidemiological Features of Patients with Acute Respiratory Distress Syndrome and Factors Determining Mortality in These Patients in a Medical Intensive Care Unit in Turkey

Türkoğlu¹,

Aygencel²,

Sencar³

2013

Yoğun Bakim Derg

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Aim: Acute respiratory distress syndrome (ARDS) is an acute hypoxemic respiratory failure refractory to oxygen therapy. The incidence of ARDS is not high, but its management is very difficult for the intensivist and the mortality rate is high. In this study, the general characteristics of patients with ARDS in a medical intensive care unit (ICU) in a university hospital were evaluated. The mortality rate in these patients was determined and factors related to mortality were assessed. Material and Methods: Patients who had ARDS upon admission or developed ARDS after admission between April 2007 to August 2010 in our medical ICU were included in the study. The prospective data of ARDS patients were studied retrospectively. Demographic characteristics, reasons for ARDS, treatment modalities, mortality rate and factors determining mortality were evaluated. Results: One thousand one hundred and twenty-five (1125) patients were admitted to our medical ICU during the study period. Ninety (8%) patients had ARDS upon admission or developed ARDS after admission in this period. These ARDS patients were accepted as the study group. The median age was 46 and 61% of patients were male. Upon admission, the APACHE II and Glasgow coma scores were 23 [17][18][19][20][21][22][23][24][25][26][27][28] and 15 [11][12][13][14][15], respectively. The most common underlying disease was hematological malignancy (57%). Sixty-two percent (62%) of patients were immunocompromised. The most common etiologies of ARDS were pneumonia (58%) and sepsis (21%). The ratio of partial oxygen pressure to inspired oxygen fraction (PaO2/FiO2) was 113 mmHg. Nineteen percent (19%) of ARDS patients received non-invasive mechanical ventilation (NIMV), 30% received invasive mechanical ventilation (IMV), and 48% received both NIMV and IMV. ICU and hospital stay were 8 [4-14] and 22 days, respectively. ICU and hospital mortality were 66% (59) and 70% (63), respectively. Performing NIMV and admission from the emergency room (ER) were found to be independent risk factors associated with lower mortality, whereas the development of immunosuppression and sepsis in the ICU were independent risk factors associated with higher mortality. Conclusion: The ICU mortality rate was 66% in our ARDS patients. We also found that immunosuppression and sepsis that developed in the ICU increased the mortality rate, while performing NIMV and admission from the ER reduced the mortality rate in our ARDS patients. (Yoğun Bakım Derg 2012; 3: 19-22

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Incidence of ARDS in an Adult Population of Northeast Ohio

Cited by 52 publications

References 15 publications

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

Epidemiological Features of Patients with Acute Respiratory Distress Syndrome and Factors Determining Mortality in These Patients in a Medical Intensive Care Unit in Turkey

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Incidence of ARDS in an Adult Population of Northeast Ohio

Cited by 52 publications

References 15 publications

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

&alpha;-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice

Epidemiological Features of Patients with Acute Respiratory Distress Syndrome and Factors Determining Mortality in These Patients in a Medical Intensive Care Unit in Turkey

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Product

Resources

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α-bisabolol-loaded lipid-core nanocapsules reduce lipopolysaccharide-induced pulmonary inflammation in mice