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ARDS Clinical


Presentation

  • A non-cardiogenic pulmonary edema is present, and mechanical ventilation is usually required. 1 ARDS patients may present with competing fluid management goals – fluid resuscitation for perfusion vs. fluid restriction for lung function 2 .[cheetah-medical.com]
  • Patients with acute respiratory distress syndrome (ARDS) typically present with a large intrapulmonary shunt, which makes even high F IO 2 ineffective in improving P aO 2 .[rc.rcjournal.com]
  • Resources How to Improve Measures Changes Improvement Stories Tools Publications IHI White Papers Case Studies Audio and Video Presentations Posterboards Other Websites The ARDS Clinical Network was established in 1994 to hasten the development of effective[ihi.org]
  • *Need objective assessment (ex.Echocardiography) to exclude hydrostatic oedema if no risk factor present.†Mild 200 300mmHg, Moderate 100 200mmHg, Severe 100mmHg [Fig 1].[en.wikibooks.org]
  • The aim of the present ... Molecular Epidemiology of ARDS BACKGROUND The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality around the world. In the United States alone there are 150,000 cases per year.[centerwatch.com]
Hypoxemia
  • Patients were eligible if they were admitted to the medical ICU and fulfilled the Berlin definition of ARDS with hypoxemia criteria using either the standard PF threshold (PF ratio 300) or a previously published SF threshold (SF ratio 315).[ncbi.nlm.nih.gov]
  • Treprostinil Sodium Inhalation for Patients At High Risk for ARDS ARDS is defined by acute hypoxemia, respiratory failure and the presence of bilateral lung infiltrates.[centerwatch.com]
  • […] at the same time, provision of adequate Oxygenation and Ventilation.The generally accepted ventilatory parameters are a tidal volume (Vt) of 4-6ml/kg of Ideal body weight, a Plateau pressure (Pplat) Restrictive Fluid therapy Therapies for refractory hypoxemia[en.wikibooks.org]
  • Abstract In some patients, acute respiratory distress syndrome (ARDS) leads to life-threatening refractory hypoxemia developing.[ncbi.nlm.nih.gov]
  • This effect ensures constant admixture of deoxygenated blood into the pulmonary vein and hence arterial hypoxemia.[msdmanuals.com]
Rigor
  • “These studies are two more examples of why it is so important to test all potential leads for new therapies in rigorously designed clinical studies in order to give caregivers what they need to make well informed decisions,” Kiley says.[healthitanalytics.com]
  • A rigorous curriculum including didactic and experiential learning in critical care, statistics, and advanced epidemiology will round out the applicant's training, preparing him to be an independent and collaborative faculty investigator and critical[grantome.com]
  • Enrolled subjects of RCTs are rigorously selected, and the generalization of the results from a RCT might be deceptive if applied to the entire population.[atm.amegroups.com]
Cyanotic Congenital Heart Disease
  • Two-dimensional echocardiography and simultaneous pre- and postductal ABGs showed no evidence of cyanotic congenital heart disease or extrapulmonary right-to-left mix.[nature.com]
Dyspnea
  • Findings include dyspnea and tachypnea. Diagnosis is by ABGs and chest x-ray. Treatment usually requires mechanical ventilation.[msdmanuals.com]
  • With the onset of lung injury, patients initially note dyspnea with exertion. This rapidly progresses to severe dyspnea at rest, tachypnea, anxiety, agitation, and the need for increasingly high concentrations of inspired oxygen.[emedicine.medscape.com]
  • , a new definition was recommended by the American-European Consensus Conference Committee [3] [13] which recognized the variability in severity of pulmonary injury. [41] The definition required the following criteria be met: acute onset, persistent dyspnea[en.wikipedia.org]
  • Ashbaugh et al. reported the presence of a specific clinical presentation seen in 12 adult patients and characterized by severe dyspnea and tachypnea, cyanosis not responsive to oxygen therapy, loss of lung compliance and presence of diffuse alveolar[atm.amegroups.com]
Tachypnea
  • Findings include dyspnea and tachypnea. Diagnosis is by ABGs and chest x-ray. Treatment usually requires mechanical ventilation.[msdmanuals.com]
  • This rapidly progresses to severe dyspnea at rest, tachypnea, anxiety, agitation, and the need for increasingly high concentrations of inspired oxygen.[emedicine.medscape.com]
  • Ashbaugh et al. reported the presence of a specific clinical presentation seen in 12 adult patients and characterized by severe dyspnea and tachypnea, cyanosis not responsive to oxygen therapy, loss of lung compliance and presence of diffuse alveolar[atm.amegroups.com]
Tachycardia
  • In Phase III, the 5.0 mg dose will be used unless there is evidence that this dose has an unacceptable safety profile or dose reductions for tachycardia occur in a large fraction of patients. In that case, a lower dose of 2.5 mg will be used.[ncbi.nlm.nih.gov]
  • Signs include confusion or alteration of consciousness, cyanosis, tachypnea, tachycardia, and diaphoresis. Cardiac arrhythmia and coma can result.[msdmanuals.com]
  • Physical Examination Physical findings often are nonspecific and include tachypnea, tachycardia, and the need for a high fraction of inspired oxygen (FiO 2 ) to maintain oxygen saturation. The patient may be febrile or hypothermic.[emedicine.medscape.com]
  • Recruitment will be terminated if one or more of the following signs of clinical deterioration are observed: heart rate 150 or 2 30 s; acute atrial fibrilation, atrial flutter or ventricular tachycardia.[trialsjournal.biomedcentral.com]

Treatment

  • METHODS: The STem cells for ARDS Treatment (START) trial was a multicentre, open-label, dose-escalation, phase 1 clinical trial.[ncbi.nlm.nih.gov]
  • One approach to clinical trials in ARDS has been to target prevention and early treatment rather than treatment of established ARDS.[healthmanagement.org]
  • Liu KD, Wilson JG, Zhuo h, Caballero L, McMillan ML, et al. (2014) Design and implementation of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of human mesenchymal stem/stromal cells for the treatment of moderate-severe acute respiratory[scitcentral.com]
  • The indication for these systems must be evaluated on a case-by-case basis and be considered as a salvage treatment or complementary treatment option.[archbronconeumol.org]
  • Treatment [ edit ] The core principles of treatment are: Recognition of patients at risk Currently there appears to be a lack of diagnostic modalities to identify individuals at risk of developing ARDS.[en.wikibooks.org]

Prognosis

  • In conclusion, higher serum sCD74 levels may reflect more severe lung injury and may be used to help physicians determine prognosis of acute respiratory distress syndrome (ARDS).[ncbi.nlm.nih.gov]
  • Effect of the spectral features on the accuracy of prognosis.[journals.plos.org]
  • Experimental modalities Prognosis [ edit ] The syndrome has a high mortality between 20 and 50%. [5] The mortality rate with ARDS varies widely based on disease severity, the patient's age, and the presence of other underlying medical conditions.[en.wikibooks.org]
  • Early treatment could improve the prognosis of select ARDS patients, and in complications from thoracic surgery and lung transplantation.[archbronconeumol.org]
  • Persistence of neutrophils and high cytokine levels in bronchoalveolar lavage fluid predict a poor prognosis.[msdmanuals.com]

Etiology

  • Martínez-Salazar,Alberto Tobón-Castaño Infectio. 2014; 18(3): 120 4 Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India Tarun George,Stalin Viswanathan,Ali Hasan Faiz Karnam,Georgi Abraham Critical Care Research and Practice.[jpgmonline.com]
  • Prognosis is highly variable and depends on a variety of factors, including etiology of respiratory failure, severity of disease, age, and chronic health status.[msdmanuals.com]
  • ARDSp and ARDSexp are two different features of ARDS, not just in terms of etiology, but also regarding the characteristics of the lung lesions.[atm.amegroups.com]
  • Influence of direct and indirect etiology on acute outcome and 6-month functional recovery in acute respiratory distress syndrome. Crit Care Med. 2001; 29 :562–6. [ PubMed ] [ Google Scholar ] 37.[ncbi.nlm.nih.gov]

Epidemiology

  • To investigate the epidemiology of adult respiratory distress syndrome (ARDS) and the evolution of the inflammatory process in patients with acute lung injury.[clinicaltrials.gov]
  • A rigorous curriculum including didactic and experiential learning in critical care, statistics, and advanced epidemiology will round out the applicant's training, preparing him to be an independent and collaborative faculty investigator and critical[grantome.com]
  • Molecular Epidemiology of ARDS BACKGROUND The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality around the world. In the United States alone there are 150,000 cases per year.[centerwatch.com]
  • Chattopadhyay Transactions of the Royal Society of Tropical Medicine and Hygiene. 2014; 6 The International Epidemiology of Acute Respiratory Distress Syndrome Majid Afshar,Giora Netzer Critical Care Medicine. 2014; 42(3): 739 7 Human adult bone marrow-derived[jpgmonline.com]
  • Epidemiology ARDS incidence—an underestimated syndrome Since the beginning of the recognition of ARDS as defined entity, several studies tried to provide essential information about ARDS epidemiology.[atm.amegroups.com]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Direct (pulmonary) and indirect (extrapulmonary) ARDS are distinct syndromes with important pathophysiologic differences.[ncbi.nlm.nih.gov]
  • Diffuse Alveolar Damage (DAD) Leukocyte-mediated pulmonary inflammation is a key pathophysiological mechanism involved in ARDS. [2] This is presumed to cause Diffuse Alveolar Damage (DAD) [Fig 2].On histologic examination, DAD is present in 40-60% of[en.wikibooks.org]
  • Novel therapeutic approaches for clinical trials in patients with ARDS that are currently being tested include cell-based therapy and combination therapies that target more than one aspect of pathophysiology.[healthmanagement.org]
  • The purpose of this article is to present an approach to VILI pathophysiology focused on the effects of volutrauma that lead to lung injury and the 'mechanotransduction' mechanism.[ncbi.nlm.nih.gov]
  • The lungs and other organs were pathologically investigated what is the pathophysiological findings of clinical ARDS. Elastica stain, Al-PAS stain and immunohistochemistry for type I and IV collagen, α smooth muscle actin and Ki-67 were used.[erj.ersjournals.com]

Prevention

  • Preventative strategies Preventative strategies could include limiting of Blood component transfusion (risk of Transfusion related lung injury), early recognition and treatment of Sepsis, implementation of strategies to prevent 'Ventilator-associated[en.wikibooks.org]
  • June 02, 2014 - Providers may be encouraged to prescribe more statins for the care of hypertension in vulnerable populations, but the widely-used class of drugs has no significant positive effects for patients looking to prevent flare-ups of chronic obstructive[healthitanalytics.com]
  • One approach to clinical trials in ARDS has been to target prevention and early treatment rather than treatment of established ARDS.[healthmanagement.org]
  • “For the relationship that we found between influenza season and ARDS after cardiac surgery to be of clinical value, research is needed to determine whether perioperative strategies aimed at preventing, detecting, or treating subclinical influenza might[clinicaladvisor.com]
  • Crit Care Med 42:31–39. doi:10.1097/CCM.0b013e318298a6db Determann RM, Royakkers A, Wolthuis EK et al (2010) Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized[icmjournal.esicm.org]

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