Therapies for Refractory Hypoxemia in Acute Respiratory Distress Syndrome

Pipeling, Matthew R.; Fan, Eddy

doi:10.1001/jama.2010.1752

Cited by 116 publications

(70 citation statements)

References 58 publications

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“…The degree of hypoxemia is a predictor of mortality in these patients, and even though recent attempts to improve oxygenation such as with high-frequency reducedvolume ventilation have reduced hypoxemia, overall mortality rates remain high (45). Since our findings suggest that hypoxia activates an endogenous HIF2α-dependent barrier-protective pathway in the pulmonary endothelium, it may be of value to harness this endogenous endothelial barrier-protective mechanism in ARDS patients.…”

Section: Methodsmentioning

confidence: 67%

HIF2α signaling inhibits adherens junctional disruption in acute lung injury

Gong¹,

Rehman²,

Tang³

et al. 2015

J. Clin. Invest.

115

132

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Section: Methodsmentioning

confidence: 67%

HIF2α signaling inhibits adherens junctional disruption in acute lung injury

Gong¹,

Rehman²,

Tang³

et al. 2015

J. Clin. Invest.

115

132

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“…Lungprotective ventilation strategies seek to prevent ventilatorassociated lung injury by using low tidal volume (V T ) to avoid overdistention, and PEEP to prevent repetitive alveolar collapse and reopening. [2][3][4] SEE THE RELATED EDITORIAL ON PAGE 1552…”

Section: Introductionmentioning

confidence: 99%

Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study

et al. 2013

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BACKGROUND: Low-tidal-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of PEEP is intended to keep the alveoli open. No method of adjusting the optimal PEEP has shown to be superior or to improve clinical outcomes. We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at the highest compliance on oxygenation, multiple-organ-dysfunction, and survival in subjects with ARDS. METHODS: Subjects with ARDS ventilated with low tidal volumes and limitation of airway pressure to 30 cm H 2 O were randomized to either a compliance-guided PEEP group or an F IO 2 -guided group. RESULTS: Of the 159 patients with ARDS admitted during the study period, 70 met the inclusion criteria. Subjects in the compliance-guided group showed nonsignificant improvements in P aO 2 /F IO 2 during the first 14 days, and in 28-day mortality (20.6% vs. 38.9%, P ‫؍‬ .12). Multipleorgan-dysfunction-free days (median 6 vs 20.5 d, P ‫؍‬ .02), respiratory-failure-free days (median 7.5 vs 14.5 d, P ‫؍‬ .03), and hemodynamic-failure-free days (median 16 vs 22 d, P ‫؍‬ .04) at 28 days were significantly lower in subjects with compliance-guided setting of PEEP. CONCLUSIONS: In ARDS subjects, protective mechanical ventilation with PEEP application according to the highest compliance was associated with less organ dysfunction and a strong nonsignificant trend toward lower mortality. ClinicalTrials.gov Number NCT01119872.

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“…Previous studies have shown the benefit of venovenous ECMO (vv-ECMO) support for this indication. [7,8] In 2009, the conventional ventilatory support versus ECMO for severe adult respiratory failure (CESAR) study has demonstrated an important survival benefit with use of ECMO for patients with severe ARDS. [9] To the best of our knowledge, no study has yet performed to investigate the effectiveness of vv-ECMO support for patients with ARDS in Turkey.…”

mentioning

confidence: 99%

Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: our single-center experience

Yüksel¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, akut solunum sıkıntısı sendromunun tedavisinde venovenöz ekstrakorporeal membran oksijenasyonuna ilişkin beş yıllık deneyimimiz sunuldu.Ça lış ma pla nı: Kasım 2010 -Kasım 2015 tarihleri arasında konvansiyonel tedaviye dirençli akut solunum sıkıntısı sendromlu 33 hastaya (24 erkek, 9 kadın; ort. yaş 48.6±14.7 yıl; dağılım 19-76 yıl) venovenöz ekstrakorporeal membran oksijenasyonu desteği uygulandı. Venovenöz ekstrakorporeal membran oksijenasyonu desteğinin genel endikasyonu, konvansiyonel tedavinin optimizasyonuna rağmen, refrakter hipoksi, hiperkapni ve solunumsal asidoz idi. Hastaların detaylı klinik verileri retrospektif olarak incelendi. Bul gu lar:Kanülasyon 24 hastada (%73) femoral-femoral venlerden, dokuz hastada (%27) juguler-femoral venlerden gerçekleştirildi. Ortalama venovenöz ekstrakorporeal membran oksijenasyon desteği 17 (dağılım, 1-52) gün idi. En sık görülen komplikasyon, altı hastada (%18) minör kanama idi. On sekiz hasta (%54.5) başarılı bir şekilde venovenöz ekstrakorporeal membran oksijenasyonu desteğinden ayrıldı. Bu hastaların 13'ü (%39.4) sağkaldı ve hastaneden taburcu edildi.So nuç: Venovenöz ekstrakorporeal membran oksijenasyonu, şiddetli akut solunum sıkıntısı sendromlu hastalarda hayat kurtarıcı bir tedavi yöntemi olabilir. Sonuçların iyileşmesi, deneyimlerin artması ve venovenöz ekstrakorporeal membran oksijenasyonunun tedavisine yönelik standart bir protokolün oluşturulması ile sağlanabilir.Anah tar söz cük ler: Akut solunum sıkıntısı sendromu; hayat kurtarıcı modalite; venovenöz ekstrakorporeal membran oksijenasyonu. ABSTRACTBackground:In this study, we present our five-year experience with venovenous extracorporeal membrane oxygenation for the treatment of acute respiratory distress syndrome.

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Therapies for Refractory Hypoxemia in Acute Respiratory Distress Syndrome

Cited by 116 publications

References 58 publications

HIF2α signaling inhibits adherens junctional disruption in acute lung injury

HIF2α signaling inhibits adherens junctional disruption in acute lung injury

Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study

Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: our single-center experience

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