What's Next After ARDS: Long-Term Outcomes

Chiumello, Davide; Coppola, Silvia; Froio, Sara; Gotti, Miriam

doi:10.4187/respcare.04644

Cited by 86 publications

(62 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Acute respiratory distress syndrome (ARDS) is a devastating lung condition. Currently, it is the leading cause of death and disability in critically ill patients, with a mortality rate that ranges between 26% and 50% 1–3. ARDS is an inflammatory state; characterised by infiltration of mixed inflammatory cells, diffuse destruction of the alveolar–capillary barrier, severe oedema, consequent hypoxaemia and increase in lung density 4 5.…”

Section: Introductionmentioning

confidence: 99%

Cell therapy for ARDS: efficacy of endobronchial versus intravenous administration and biodistribution of MAPCs in a large animal model

et al. 2019

View full text Add to dashboard Cite

IntroductionBone marrow-derived multipotent adult progenitor cells (MAPCs) are adult allogeneic adherent stem cells currently investigated clinically for use in acute respiratory distress syndrome (ARDS). To date, there is no agreement on which is the best method for stem cells delivery in ARDS. Here, we compared the efficacy of two different methods of administration and biodistribution of MAPC for the treatment of ARDS in a sheep model.MethodsMAPC were labelled with [18F] fluoro-29-deoxy-D-glucose and delivered by endobronchial (EB) or intravenous route 1 hour after lipopolysaccharide infusion in sheep mechanically ventilated. PET/CT images were acquired to determine the biodistribution and retention of the cells at 1 and 5 hours of administration.ResultsThe distribution and retention of the MAPC was dependent on the method of cell administration. By EB route, PET images showed that MAPC remained at the site of administration and no changes were observed after 5 hours, whereas with intravenous route, the cells had broad biodistribution to different organs, being the lung the main organ of retention at 1 and 5 hours. MAPC demonstrated an equal effect on arterial oxygenation recovery by either route of administration.ConclusionThe EB or intravenous routes of administration of MAPC are both effective for the treatment of ARDS in an acute sheep model, and the effect of MAPC therapy is not dependent of parenchymal integration or systemic biodistribution.

show abstract

Section: Introductionmentioning

confidence: 99%

Cell therapy for ARDS: efficacy of endobronchial versus intravenous administration and biodistribution of MAPCs in a large animal model

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The strategic focus of ARDS research, however, has shifted toward identifying patients at a high risk of developing or dying from ARDS. In this regard, the concept of individualized therapeutic approaches for ARDS patients is promising and might contribute to the improvement in ARDS outcomes [ 23 , 26 ]. Reliable biomarkers might be both useful for (1) the identification of patients at risk for developing ARDS and (2) for monitoring treatment progress on the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…When exceeding this threshold, mortality risk more than tripled in our ARDS population. When considering the high mortality risk being inherent to ARDS, a more than tripled risk of death is of considerable impact [ 25 , 26 ]. Interestingly, in the present study, NRBCs were not only independent predictors of mortality but also had high discriminatory power with respect to pulmonary gas exchange and organ failure.…”

Section: Discussionmentioning

confidence: 99%

Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study

Menk¹,

Giebelhäuser²,

Vorderwülbecke³

et al. 2018

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundNucleated red blood cells (NRBCs) in critically ill patients are associated with increased mortality and poor outcome. The aim of the present study was to evaluate the predictive value of NRBCs in patients with acute respiratory distress syndrome (ARDS).MethodsThis observational study was conducted at an ARDS referral center and included patients from 2007 to 2014. Daily NRBC counts were assessed and the predictive validity of NRBCs on mortality was statistically evaluated. A cutoff for prediction of mortality based on NRBCs was evaluated using ROC analysis and specified according to Youden’s method. Multivariate nonparametric analysis for longitudinal data was applied to prove for differences between groups over the whole time course. Independent predictors of mortality were identified with multiple logistic and Cox’ regression analyses. Kaplan–Meier estimations visualized the survival; the corresponding curves were tested for differences with the log-rank test.ResultsA total of 404 critically ill ARDS patients were analyzed. NRBCs were found in 75.5% of the patients, which was associated with longer length of ICU stay [22 (11; 39) vs. 14 (7; 26) days; p < 0.05] and higher mortality rates (50.8 vs. 27.3%; p < 0.001). Logistic regression analysis with mortality as response showed NRBC positivity per se to be an independent risk factor for mortality in ARDS with a doubled risk for ICU death (OR 2.03; 95% CI 1.16–3.55; p < 0.05). Also, NRBC value at ICU admission was found to be an independent risk factor for mortality (OR 3.25; 95% CI 1.09–9.73, p = 0.035). A cutoff level of 220 NRBC/µl was associated with a more than tripled risk of ICU death (OR 3.2; 95% CI 1.93–5.35; p < 0.0001). ARDS patients below this threshold level had a significant survival advantage (median survival 85 days vs. 29 days; log rank p < 0.001). Presence of a severe ARDS was identified as independent risk factor for the occurrence of NRBCs > 220/µl (OR 1.81; 95% CI 1.1–2.97; p < 0.05).ConclusionsNRBCs may predict mortality in ARDS with high prognostic power. The presence of NRBCs in the blood might be regarded as a marker of disease severity indicating a higher risk of ICU death.

show abstract

“…Approximately 25% of mechanically ventilated intensive care unit (ICU) patients have ARDS [ 3 ] and, despite advances in supportive care, ICU mortality rates are still 35–40% and increase with the severity of hypoxemia. Many patients with ARDS also have persistent morbidity after discharge [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

et al. 2017

View full text Add to dashboard Cite

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30–45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS.

show abstract

What's Next After ARDS: Long-Term Outcomes

Cited by 86 publications

References 60 publications

Cell therapy for ARDS: efficacy of endobronchial versus intravenous administration and biodistribution of MAPCs in a large animal model

Cell therapy for ARDS: efficacy of endobronchial versus intravenous administration and biodistribution of MAPCs in a large animal model

Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Contact Info

Product

Resources

About