scholarly journals Association of Sedation, Coma, and In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Acute Respiratory Distress Syndrome

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Karuna Wongtangman ◽  
Peter Santer ◽  
Luca J. Wachtendorf ◽  
Omid Azimaraghi ◽  
Elias Baedorf Kassis ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Sarina K. Sahetya ◽  
◽  
Christopher Mallow ◽  
Jonathan E. Sevransky ◽  
Greg S. Martin ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Airway Pressures ◽  
Ventilated Patients

Abstract Background Higher inspiratory airway pressures are associated with worse outcomes in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). This relationship, however, has not been well investigated in patients without ARDS. We hypothesized that higher driving pressures (ΔP) and plateau pressures (Pplat) are associated with worse patient-centered outcomes in mechanically ventilated patients without ARDS as well as those with ARDS. Methods Using data collected during a prospective, observational cohort study of 6179 critically ill participants enrolled in 59 ICUs across the USA, we used multivariable logistic regression to determine whether ΔP and Pplat at enrollment were associated with hospital mortality among 1132 mechanically ventilated participants. We stratified analyses by ARDS status. Results Participants without ARDS (n = 822) had lower average severity of illness scores and lower hospital mortality (27.3% vs. 38.7%; p <  0.001) than those with ARDS (n = 310). Average Pplat (20.6 vs. 23.9 cm H2O; p <  0.001), ΔP (14.3 vs. 16.0 cm H2O; p <  0.001), and positive end-expiratory pressure (6.3 vs. 7.9 cm H2O; p <  0.001) were lower in participants without ARDS, whereas average tidal volumes (7.2 vs. 6.8 mL/kg PBW; p <  0.001) were higher. Among those without ARDS, higher ΔP (adjusted OR = 1.36 per 7 cm H2O, 95% CI 1.14–1.62) and Pplat (adjusted OR = 1.42 per 8 cm H2O, 95% CI 1.17–1.73) were associated with higher mortality. We found similar relationships with mortality among those participants with ARDS. Conclusions Higher ΔP and Pplat are associated with increased mortality for participants without ARDS. ΔP may be a viable target for lung-protective ventilation in all mechanically ventilated patients.

Acute respiratory distress syndrome (ARDS)

2021 ◽  
pp. 137-144
Author(s):  
Terry Robinson ◽  
Jane Scullion
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Nursing Care ◽  
Distress Syndrome ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Berlin Definition ◽  
General Management ◽  
Ventilated Patients

The incidence of describing acute respiratory distress syndrome (ARDS) is approximately 23% in mechanically ventilated patients. The diagnosis of ARDS varies widely; studies report a variation in the population diagnosed with ARDS, from 10 to 86 cases per 100,000. Complications of mechanical ventilation are common and include ventilator-associated pneumonia (VAP), barotrauma from excessive airway pressures, and volutrauma from excessive tidal volumes which may both worsen ARDS. Pneumothorax occurs in some patients, necessitating the placement of chest drains. This chapter starts with describing ARDS and the Berlin Definition, and its incidence. It also covers aetiology and physiology, then goes on to its treatment and general management. This includes respiratory support, position changes, and other treatments. Situation-dependent prognoses are outlined. Specific nursing care is also described.

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