The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform
Guy A Zimmerman - One of the best experts on this subject based on the ideXlab platform.
-
the acute respiratory Distress Syndrome
Journal of Clinical Investigation, 2012Co-Authors: Michael A. Matthay, Lorraine B Ware, Guy A ZimmermanAbstract:The acute respiratory Distress Syndrome is a common, devastating clinical Syndrome of acute lung injury that affects both medical and surgical patients. Since the last review of this Syndrome appeared in the Journal, 1 more uniform definitions have been devised and important advances have occurred in the understanding of the epidemiology, natural history, and pathogenesis of the disease, leading to the design and testing of new treatment strategies. This article provides an overview of the definitions, clinical features, and epidemiology of the acute respiratory Distress Syndrome and discusses advances in the areas of pathogenesis, resolution, and treatment. Historical Perspective and Definitions . . .
Pr Rocco - One of the best experts on this subject based on the ideXlab platform.
-
Pulmonary and extrapulmonary acute respiratory Distress Syndrome: myth or reality?
Current Opinion in Critical Care, 2008Co-Authors: Pr Rocco, Paolo PelosiAbstract:Current Opinion in Critical Care 2008, 14:50–55 Purpose of review The pathogenesis of acute respiratory Distress Syndrome has been explained by the presence of a direct (pulmonary) or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of acute respiratory Distress Syndrome may differ according to the type of the insult. This article presents a brief overview of the differences between pulmonary and extrapulmonary acute respiratory Distress Syndrome, and discusses the interactions between lung functional, morphological aspects, and response to different therapies, both in experimental models and in patients with acute respiratory Distress Syndrome. Recent findings Many researchers recognize that experimental pulmonary and extrapulmonary acute respiratory Distress Syndrome are not identical when considering morpho-functional aspects, the response to positive end-expiratory pressure and recruitment manoeuvre, prone position and other adjunctive therapies. Contradictory results have been reported in different clinical studies, however, which may be attributed to the difficulty of classifying acute respiratory Distress Syndrome in one or the other category, and being confident of the onset, the phase and the severity of acute respiratory Distress Syndrome in all patients. Summary Heterogeneous acute respiratory Distress Syndrome patients are still considered to suffer from one Syndrome, and are treated in the same way. Understanding the range of different pathways that lead to pulmonary dysfunction makes it possible to better target clinical treatment.
-
Corticosteroids in acute respiratory Distress Syndrome.
Brazilian Journal of Medical and Biological Research, 2005Co-Authors: A.b.s. Fernandes, Walter Araújo Zin, Pr RoccoAbstract:Improving the course and outcome of patients with acute respiratory Distress Syndrome presents a challenge. By understanding the immune status of a patient, physicians can consider manipulating proinflammatory systems more rationally. In this context, corticosteroids could be a therapeutic tool in the armamentarium against acute respiratory Distress Syndrome. Corticosteroid therapy has been studied in three situations: prevention in high-risk patients, early treatment with high-dose, short-course therapy, and prolonged therapy in unresolving cases. There are differences between the corticosteroid trials of the past and recent trials: today, treatment starts 2-10 days after disease onset in patients that failed to improve; in the past, the corticosteroid doses employed were 5-140 times higher than those used now. Additionally, in the past treatment consisted of administering one to four doses every 6 h (methylprednisolone, 30 mg/kg) versus prolonging treatment as long as necessary in the new trials (2 mg kg-1 day-1 every 6 h). The variable response to corticosteroid treatment could be attributed to the heterogeneous biochemical and molecular mechanisms activated in response to different initial insults. Numerous factors need to be taken into account when corticosteroids are used to treat acute respiratory Distress Syndrome: the specificity of inhibition, the duration and degree of inhibition, and the timing of inhibition. The major continuing problem is when to administer corticosteroids and how to monitor their use. The inflammatory mechanisms are continuous and cyclic, sometimes causing deterioration or improvement of lung function. This article reviews the mechanisms of action of corticosteroids and the results of experimental and clinical studies regarding the use of corticosteroids in acute respiratory Distress Syndrome.
-
Pulmonary and extrapulmonary acute respiratory Distress Syndrome: are they different?
Current Opinion in Critical Care, 2005Co-Authors: Pr Rocco, Walter Araújo ZinAbstract:Purpose of reviewAcute respiratory Distress Syndrome has been considered a morphologic and functional expression of lung injury caused by a variety of insults. Two distinct forms of acute respiratory Distress Syndrome/acute lung injury are described, because there are differences between pulmonary a
Kevin C. Wilson - One of the best experts on this subject based on the ideXlab platform.
-
Acute respiratory Distress Syndrome: Epidemiology; pathophysiology; pathology; and etiology
2010Co-Authors: Polly E. Parsons, Kevin C. WilsonAbstract:The epidemiology, pathophysiology, pathologic stages, and etiologies of ARDS will be reviewed here. Other issues related to ARDS are discussed separately. (See "Acute respiratory Distress Syndrome: Definition; clinical features; and diagnosis" and "Acute respiratory Distress Syndrome: Prognosis" and "Mechanical ventilation in acute respiratory Distress Syndrome" and "Supportive care and oxygenation in acute respiratory Distress Syndrome" and "Novel therapies for the acute respiratory Distress Syndrome".) DEFINITIONS — Acute lung injury (ALI) and acute respiratory Distress Syndrome (ARDS) are both defined by the acute onset of bilateral infiltrates consistent with pulmonary edema, but without evidence of elevated left atrial pressure. The pulmonary capillary wedge pressure is ≤18 mmHg if measured. The degree of hypoxemia differentiates ALI and ARDS. Patients with ALI have a ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) of 201 to 300 mmHg. In contrast, patients with ARDS have worse hypoxemia, with a PaO2/FiO2 of ≤200 mmHg. The amount of positive end-expiratory pressure (PEEP) is not accounted for when determining whether a patient has ALI or ARDS. The definitions of ALI and ARDS are discussed in more detail elsewhere. (See "Acute respiratory Distress Syndrome: Definition; clinical features; and diagnosis", section on 'Definitions'.) EPIDEMIOLOGY — The incidence of acute lung injury (ALI) and acute respiratory Distress Syndrome (ARDS) were determined in a multicenter, population-based, prospective cohort study in the United States [2]. The studied followed 1113 patients with ALI or ARDS for 15 months beginning in 1999 or 2000:
-
Acute respiratory Distress Syndrome: Definition; clinical features; and diagnosis
2010Co-Authors: John Hansen-flaschen, Polly E. Parsons, Mark D. Siegel, Kevin C. WilsonAbstract:INTRODUCTION — A distinct type of hypoxemic respiratory failure characterized by acute abnormality of both lungs was first recognized during the 1960s. Military clinicians working in surgical hospitals in Vietnam called it shock lung, while civilian clinicians referred to it as adult respiratory Distress Syndrome [1]. Subsequent recognition that individuals of any age could be afflicted led to the current term, acute respiratory Distress Syndrome (ARDS).
Robinder G Khemani - One of the best experts on this subject based on the ideXlab platform.
-
Alveolar Dead Space Fraction Discriminates Mortality in Pediatric Acute Respiratory Distress Syndrome.
Pediatric Critical Care Medicine, 2016Co-Authors: Nadir Yehya, Anoopindar K Bhalla, Neal J Thomas, Robinder G KhemaniAbstract:Physiologic dead space is associated with mortality in acute respiratory Distress Syndrome, but its measurement is cumbersome. Alveolar dead space fraction relies on the difference between arterial and end-tidal carbon dioxide (alveolar dead space fraction = (PaCO2 - PetCO2) / PaCO2). We aimed to assess the relationship between alveolar dead space fraction and mortality in a cohort of children meeting criteria for acute respiratory Distress Syndrome (both the Berlin 2012 and the American-European Consensus Conference 1994 acute lung injury) and pediatric acute respiratory Distress Syndrome (as defined by the Pediatric Acute Lung Injury Consensus Conference in 2015).Secondary analysis of a prospective, observational cohort.Tertiary care, university affiliated PICU.Invasively ventilated children with pediatric acute respiratory Distress Syndrome.None.Of the 283 children with pediatric acute respiratory Distress Syndrome, 266 had available PetCO2. Alveolar dead space fraction was lower in survivors (median 0.13; interquartile range, 0.06-0.23) than nonsurvivors (0.31; 0.19-0.42; p < 0.001) at pediatric acute respiratory Distress Syndrome onset, but not 24 hours after (survivors 0.12 [0.06-0.18], nonsurvivors 0.14 [0.06-0.25], p = 0.430). Alveolar dead space fraction at pediatric acute respiratory Distress Syndrome onset discriminated mortality with an area under receiver operating characteristic curve of 0.76 (95% CI, 0.66-0.85; p < 0.001), better than either initial oxygenation index or PaO2/FIO2. In multivariate analysis, alveolar dead space fraction at pediatric acute respiratory Distress Syndrome onset was independently associated with mortality, after adjustment for severity of illness, immunocompromised status, and organ failures.Alveolar dead space fraction at pediatric acute respiratory Distress Syndrome onset discriminates mortality and is independently associated with nonsurvival. Alveolar dead space fraction represents a single, useful, readily obtained clinical biomarker reflective of pulmonary and nonpulmonary variables associated with mortality.
-
Pediatric Acute Respiratory Distress Syndrome: Definition, Incidence, and Epidemiology
Pediatric Critical Care Medicine, 2015Co-Authors: Robinder G Khemani, Lincoln S. Smith, Jerry J. Zimmerman, Simon EricksonAbstract:Although there are similarities in the pathophysiology of acute respiratory Distress Syndrome in adults and children, pediatric-specific practice patterns, comorbidities, and differences in outcome necessitate a pediatric-specific definition. We sought to create such a definition. A subgroup of pediatric acute respiratory Distress Syndrome investigators who drafted a pediatric-specific definition of acute respiratory Distress Syndrome based on consensus opinion and supported by detailed literature review tested elements of the definition with patient data from previously published investigations. International PICUs. Children enrolled in published investigations of pediatric acute respiratory Distress Syndrome. None. Several aspects of the proposed pediatric acute respiratory Distress Syndrome definition align with the Berlin Definition of acute respiratory Distress Syndrome in adults: timing of acute respiratory Distress Syndrome after a known risk factor, the potential for acute respiratory Distress Syndrome to coexist with left ventricular dysfunction, and the importance of identifying a group of patients at risk to develop acute respiratory Distress Syndrome. There are insufficient data to support any specific age for "adult" acute respiratory Distress Syndrome compared with "pediatric" acute respiratory Distress Syndrome. However, children with perinatal-related respiratory failure should be excluded from the definition of pediatric acute respiratory Distress Syndrome. Larger departures from the Berlin Definition surround 1) simplification of chest imaging criteria to eliminate bilateral infiltrates; 2) use of pulse oximetry-based criteria when PaO2 is unavailable; 3) inclusion of oxygenation index and oxygen saturation index instead of PaO2/FIO2 ratio with a minimum positive end-expiratory pressure level for invasively ventilated patients; 4) and specific inclusion of children with preexisting chronic lung disease or cyanotic congenital heart disease. This pediatric-specific definition for acute respiratory Distress Syndrome builds on the adult-based Berlin Definition, but has been modified to account for differences between adults and children with acute respiratory Distress Syndrome. We propose using this definition for future investigations and clinical care of children with pediatric acute respiratory Distress Syndrome and encourage external validation with the hope for continued iterative refinement of the definition.
Michael A. Matthay - One of the best experts on this subject based on the ideXlab platform.
-
Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome.
Critical Care Medicine, 2015Co-Authors: Carolyn S. Calfee, Kirsten N. Kangelaris, Edward D. Siew, David R. Janz, Gordon R. Bernard, Addison K. May, Peyton Jacob, Christopher Havel, Michael A. Matthay, Neal L. BenowitzAbstract:The association between cigarette smoke exposure and the acute respiratory Distress Syndrome in patients with the most common acute respiratory Distress Syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-confirmed cigarette smoking and acute respiratory Distress Syndrome in a diverse cohort.Prospective cohort.Tertiary care center.Four hundred twenty-six critically ill patients with acute respiratory Distress Syndrome risk factors (excluding trauma and transfusion): None.We obtained smoking histories and measured urine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (a biomarker of cigarette smoke exposure) on urine samples obtained at the time of study enrollment. The association between cigarette smoke exposure and acute respiratory Distress Syndrome differed based on acute respiratory Distress Syndrome risk factor (p < 0.02 for interaction). In patients with nonpulmonary sepsis as the primary acute respiratory Distress Syndrome risk factor (n = 212), 39% of those with acute respiratory Distress Syndrome were current smokers by history compared with 22% of those without acute respiratory Distress Syndrome (odds ratio, 2.28; 95% CI, 1.24-4.19; p = 0.008). Likewise, cigarette smoke exposure as measured by urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol was significantly associated with acute respiratory Distress Syndrome in this group. The increased risk of acute respiratory Distress Syndrome in nonpulmonary sepsis was restricted to patients with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels consistent with active smoking and was robust to adjustment for other acute respiratory Distress Syndrome predictors. Cigarette smoke exposure as measured by history or 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol was not associated with acute respiratory Distress Syndrome in patients with other risk factors (e.g., pneumonia and aspiration).Cigarette smoking measured both by history and biomarker is associated with an increased risk of acute respiratory Distress Syndrome in patients with nonpulmonary sepsis. This finding has important implications for tobacco product regulation and for understanding the pathogenesis of acute respiratory Distress Syndrome.
-
the acute respiratory Distress Syndrome
Journal of Clinical Investigation, 2012Co-Authors: Michael A. Matthay, Lorraine B Ware, Guy A ZimmermanAbstract:The acute respiratory Distress Syndrome is a common, devastating clinical Syndrome of acute lung injury that affects both medical and surgical patients. Since the last review of this Syndrome appeared in the Journal, 1 more uniform definitions have been devised and important advances have occurred in the understanding of the epidemiology, natural history, and pathogenesis of the disease, leading to the design and testing of new treatment strategies. This article provides an overview of the definitions, clinical features, and epidemiology of the acute respiratory Distress Syndrome and discusses advances in the areas of pathogenesis, resolution, and treatment. Historical Perspective and Definitions . . .
