Management of Acute Respiratory Distress Syndrome and Refractory Hypoxemia. A Multicenter Observational Study

Duan, Erick; Adhikari, Neill K. J.; D’Aragon, Frédérick; Cook, Deborah J.; Mehta, Sangeeta; Alhazzani, Waleed; Goligher, Ewan C.; Charbonney, Emmanuel; Arabi, Yaseen M.; Karachi, Tim; Turgeon, Alexis F.; Hand, Lori; Zhou, Qi; Austin, Peggy; Friedrich, Jan O.; Lamontagne, François; Lauzier, François; Patel, Rakesh; Muscedere, John; Hall, Richard; Aslanian, Pierre; Piraino, Thomas; Albert, Martin; Bagshaw, Sean M.; Jacka, Mike; Wood, Gordon; Henderson, William R.; Dorscheid, Delbert R.; Ferguson, Niall D.; Meade, Maureen O.

doi:10.1513/annalsats.201612-1042oc

Cited by 72 publications

(74 citation statements)

References 28 publications

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“…The mainstay of treatment for respiratory distress and refractory hypoxia is intubation and ventilation. Adjunct supportive care treatments that may improve survival include: high levels of PEEP, prone position and neuromuscular blockades . However, for similarly ill patients in respiratory distress despite these measures, we recommend transfer to a facility with ECMO capabilities.…”

Section: Discussionmentioning

confidence: 99%

Case report of massive hemoptysis in pregnancy requiring veno‐venous extracorporeal membrane oxygenation

Stiff

Harrison

Palatnik

2019

J of Obstet and Gynaecol

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Hemoptysis in pregnancy is rare and can be life-threatening. This case describes management of hemoptysis in pregnancy requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient presented with massive hemoptysis in respiratory failure at 26 weeks gestation. VV-ECMO was utilized for maternal stability due to severe hypoxia from lung parenchymal damage. An extensive work-up for hemoptysis returned negative except for an elevated Bordetella pertussis IgG antibody. The patient was delivered via cesarean section with a complicated post-partum course. She and the infant were discharged in stable condition after long hospital stays. Prior publications describing VV-ECMO use in pregnancy are limited to treatment of respiratory infections such as influenza or pneumonia. This case is the first in the literature to describe VV-ECMO utilization for hemoptysis in pregnancy, specifically, and demonstrates its significant benefit in cases of respiratory failure due to hemoptysis.

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Section: Discussionmentioning

confidence: 99%

Case report of massive hemoptysis in pregnancy requiring veno‐venous extracorporeal membrane oxygenation

Stiff

Harrison

Palatnik

2019

J of Obstet and Gynaecol

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“…17 Lastly, institutions participating in this pilot study had previously undertaken observational research with a waiver of research consent. 18,19…”

Section: Ethicsmentioning

confidence: 99%

Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors

D’Aragon

Cook

Dhanani

et al. 2018

Can J Anesth/J Can Anesth

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“…Persistent hypoxemia is a typical symptom of ARDS. Ventilations are always needed to correct hypoxemia [3,4] To avoid or reduce pulmonary morbidity, the low tidal volume ventilation is often applied [5,6]. The ventilation strategy will certainly result in hypercapnia, which is called "permissive hypercapnia" [7,8].…”

Section: Introductionmentioning

confidence: 99%

Hypercapnia promotes microglial pyroptosis via inhibiting mitophagy: implication in neuroinflammation in hypoxemic adult rats

Ding

Liu

et al. 2019

Preprint

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Background: Hypoxemia is a typical symptom of acute respiratory distress syndrome (ARDS). Ventilations are always needed for correcting hypoxemia. To avoid pulmonary morbidity, low tidal volume ventilation is often applied. The ventilation strategy will certainly result in hypercapnia. Our previous study found that hypercapnia could induce IL-1β overproduction in hypoxia-activated microglia. However, the underlying mechanism has remained unclear. This study aimed to explore whether hypercapnia would promote microglial pyroptosis via inhibiting mitophagy in adult rats with hypoxemia. Methods: Cerebral oxygen extraction ratio (CERO2), partial pressure of brain tissue oxygen (PbtO2), and reactive oxygen species (ROS) production in brain tissue in a rat model of hypercapnia/hypoxemia were evaluated. Along with this, the oxygen consumption rate (OCR) and ROS production of BV-2 microglial cells were evaluated after 15% CO2/0.2% O2 treatment. Mitophagy was observed using transmission electron microscopy (TEM). The protein expression level of LC3-II/I, p62, caspase-1, gasdermin D-N domains (GSDMD-N), IL-1β and IL-18 in microglial cells were detected before and after application of a ROS scavenger in vivo and in vitro. Results: PbtO2 level was elevated by hypercapnia in the hypoxemic rats in the first 1.5 h, but it was significantly decreased 2 h after ventilation. This was further evident by the increased levels of CERO2 at 3 h after ventilation. Besides, a high concentration of CO2 treatment could increase the levels of OCR in hypoxic BV-2 microglial cells in vitro. Expression levels of LC3-II were reduced, while those of p62 were increased by hypercapnia in the hypoxic hippocampus and BV-2 microglia. Autophagosomes could be seen in hypoxia treated microglial cells under TEM, while those were rarely observed in hypercapnia + hypoxia treated microglia. Hypercapnia markedly increased the production of ROS and the expression of caspase-1, GSDMD-N, IL-1β, and IL-18 in hypoxia-activated microglia both in vivo and in vitro. Pharmacological scavenging ROS inhibited microglial pyroptosis and expression of IL-1β and IL-18.Conclusion: Hypercapnia-induced mitophagy inhibition may promote pyroptosis and enhance IL-1β and IL-18 release in hypoxia-activated microglia.

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Management of Acute Respiratory Distress Syndrome and Refractory Hypoxemia. A Multicenter Observational Study

Cited by 72 publications

References 28 publications

Case report of massive hemoptysis in pregnancy requiring veno‐venous extracorporeal membrane oxygenation

Case report of massive hemoptysis in pregnancy requiring veno‐venous extracorporeal membrane oxygenation

Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors

Hypercapnia promotes microglial pyroptosis via inhibiting mitophagy: implication in neuroinflammation in hypoxemic adult rats

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