Toward the prevention of acute lung injury: Protocol-guided limitation of large tidal volume ventilation and inappropriate transfusion*

Yılmaz, Murat; Keegan, Mark T.; İşçimen, Remzi; Afessa, Bekele; Buck, Curtis F; Hubmayr, Rolf D.; Gajic, Ognjen

doi:10.1097/01.ccm.0000269037.66955.f0

Cited by 155 publications

(113 citation statements)

References 32 publications

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“…26,28 Indeed, a quality-improvement intervention aimed at decreasing ventilator tidal volume and liberal transfusion decreased harmful exposures and was associated with a reduced incidence of ARDS in mechanically ventilated patients without ALI at the outset. 29 Our study found that patients with community-acquired ARDS were more likely to be medical patients (85%) with pneumonia (59%), whereas those who developed ARDS after hospital admission were more likely to be surgery patients (54%). TenHoor et al found a proportional mortality ratio (death from ALI vs other causes) of 11.8 (95% CI 3.8 -36.0) with ICD-9 code E870-879.9, "surgical or medical misadventures" such as accidental perforation during medical or surgical care, foreign objects left in body, failure of sterile precautions during a procedure, failure in dosage, contamination of blood or other fluids, and related iatrogenic exposures.…”

Section: Discussionmentioning

confidence: 77%

Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Shari

Kojičić

et al. 2011

Respir Care

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Section: Discussionmentioning

confidence: 77%

Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Shari

Kojičić

et al. 2011

Respir Care

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“…2,5,6 Thus, accurate identification of populations at risk for acute organ dysfunction is crucial to improve understanding of the mechanisms involved in the risk and to develop novel therapies for these patients.…”

Section: Case Definitionmentioning

confidence: 99%

“…Clinical and epidemiological studies [6][7][8][9] have indicated that respiratory dysfunction is less likely in patients who have both sepsis and diabetes mellitus than in patients who have sepsis but no diabetes. Possible explanations for this difference include the effects of hyperglycemia on the inflammatory response, metabolic abnormalities in diabetes, and interactions of agents used to treat diabetes mellitus.…”

mentioning

confidence: 99%

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Yang

Salam

Ong

et al. 2011

American Journal of Critical Care

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Background Sepsis is a common complication in patients with diabetes mellitus. In a Western population, risk of respiratory dysfunction was lower in diabetic patients with sepsis. Objective To compare organ dysfunction, particularly respiratory dysfunction, between sepsis patients with and without diabetes mellitus in an Asian population. Method Hospital discharge data were collected for the period 2004 through 2008. Patients with sepsis, diabetes mellitus, and organ dysfunction were identified by using the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification codes. Results Of the 383 238 patients hospitalized during the 5 years, 2943 of the 9221 who had sepsis also had diabetes (31.9%).The most common organ dysfunctions in patients with sepsis were renal (31.5%), cardiovascular (19.2%), and respiratory (10.9%). Among patients with sepsis, respiratory dysfunction was less likely in patients with diabetes (9.4%) than in those without (11.6%; P = .002), but renal dysfunction was more likely in patients with diabetes (46.5%) than in those without (24.4%; P < .001). However, only 27.6% of patients with diabetes had a respiratory source of sepsis compared with 33.4% in patients without diabetes (P < .001). Among patients with sepsis, diabetes mellitus was a significant and independent predictor of respiratory dysfunction (odds ratio, 0.80; 95% confidence interval, 0.66–0.98) after adjustments for age, sex, ethnicity, admission to intensive care, number of comorbid conditions, and other infection sources. Conclusion Among an Asian population, respiratory dysfunction in patients with sepsis is less likely to develop in those with diabetes than in those without diabetes.

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“…In our practice we have found that a multidisciplinary educational initiative combined with electronic surveillance for injurious tidal volumes and automated provider alerts can limit patients' exposure to unsafe ventilation and have been associated with lower mortality. 21 Transfusion-related ALI, which is the leading cause of death after blood-product administration, is defined as ALI occurring within 6 hours of blood-product transfusion, in the absence of other risk factors (eg, sepsis, aspiration, or lung contusion). If other risk factors are present when ALI develops within 6 hours, the term "possible transfusionrelated ALI" is employed.…”

Section: Ali As a Preventable Complication Of Critical Illnessmentioning

confidence: 99%

Acute Lung Injury: Prevention May Be the Best Medicine

et al. 2011

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Acute lung injury affects a subset of hospitalized patients but is not universal. This syndrome can substantially delay ventilator liberation, prolong intensive care unit (ICU) stay, and increase mortality. As with many critical illness syndromes, the available treatment options are limited in number and impact. Once a patient develops lung injury, the best known strategy is supportive care. Observational studies have identified potential risk factors and have suggested that the use and timing of certain critical care interventions may influence the likelihood of developing lung injury. These findings suggest that a well designed screening tool and the systematic application of best practices in critical care may limit the risk of lung injury. An effective prediction score may also facilitate enrollment in pharmacopreventive trials. Development of such tools is accelerated by multicenter collaboration.

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Toward the prevention of acute lung injury: Protocol-guided limitation of large tidal volume ventilation and inappropriate transfusion*

Abstract: Interdisciplinary intervention effectively decreased large tidal volumes and unnecessary transfusion in mechanically ventilated patients and was associated with a decreased frequency of new acute lung injury.

Cited by 155 publications

References 32 publications

Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Acute Lung Injury: Prevention May Be the Best Medicine

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