Extracorporeal CO2 Removal – A Way to Achieve Ultraprotective Mechanical Ventilation and Lung Support: The Missing Piece of Multiple Organ Support Therapy

2010 ◽  
pp. 174-184 ◽  
Author(s):  
Silvia Gramaticopolo ◽  
Alexandra Chronopoulos ◽  
Pasquale Piccinni ◽  
Federico Nalesso ◽  
Alessandra Brendolan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Multiple Organ ◽  
Organ Support

Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

2021 ◽  
pp. 1-10
Author(s):  
Guglielmo Consales ◽  
Lucia Zamidei ◽  
Franco Turani ◽  
Diego Atzeni ◽  
Paolo Isoni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Kidney Injury ◽  
Protective Ventilation ◽  
Retrospective Observational Study ◽  
Organ Support ◽  
Chronic Obstructive

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO<sub>2</sub> with very low extracorporeal blood flows (&#x3c;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO<sub>2</sub>R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO<sub>2</sub>R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO<sub>2</sub> clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO<sub>2</sub>R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

scholarly journals Coronavirus Disease 2019 in a Hemodialysis Patient

2020 ◽  
Vol 49 (6) ◽  
pp. 761-764 ◽  
Author(s):  
Hai Yuan ◽  
E. Guo ◽  
Zhao Gao ◽  
Fengqi Hu ◽  
Li Lu
Keyword(s):  
Mechanical Ventilation ◽  
Polymerase Chain Reaction ◽  
Hemodialysis Patient ◽  
Multiple Organ ◽  
Lung Imaging ◽  
Maintenance Hemodialysis ◽  
Multiple Organ Dysfunction ◽  
Chain Reaction ◽  
Pharyngeal Swab ◽  
Polymerase Chain

There has been a global outbreak of the coronavirus disease 2019 (COVID-19) since December 2019. Here, we describe the case of a 49-year-old male undergoing maintenance hemodialysis (HD) who got infected with COVID-19 and our experience in performing HD for him. The patient’s symptoms and lung imaging changes were atypical. However, his lymphocyte range decreased upon admission and the polymerase chain reaction of the pharyngeal swab for the ­COVID-19 nucleic acid was positive. The patient developed respiratory failure and required mechanical ventilation 8 days after admission. In the end, he died from multiple organ dysfunction syndrome. The difficulties in diagnosis, infection control, and treatment of COVID-19 in maintenance HD patients are discussed in this report.

scholarly journals COVID-19 and Multiorgan Dysfunction Syndrome

2021 ◽  
Author(s):  
Jitendra D. Lakhani ◽  
Sajni Kapadia ◽  
Rohit Choradiya ◽  
Roop Preet Gill ◽  
Som J. Lakhani
Keyword(s):  
Organ Failure ◽  
Kidney Injury ◽  
Glycemic Variability ◽  
Multiple Organ ◽  
Organ Support ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Treatment Support ◽  
Laboratory Investigations ◽  
Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

scholarly journals Elevated Pancreatic Enzymes in ICU Patients With COVID-19 in Wuhan, China: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Peili Ding ◽  
Bin Song ◽  
Xuelin Liu ◽  
Xing Fang ◽  
Hongliu Cai ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pancreatic Enzyme ◽  
Kidney Injury ◽  
Pancreatic Injury ◽  
Multiple Organ ◽  
Pancreatic Enzymes ◽  
Warning Sign ◽  
Logistic Analysis ◽  
Normal Enzyme ◽  
Enzyme Elevation

Background: Pancreatic enzyme elevation has been reported in patients with COVID-19 during the pandemic. However, with the shortage of medical resources and information, several challenges are faced in the examination and treatment of this condition in COVID-19 patients. There is little information on whether such condition is caused by pancreatic injury, and if this is a warning sign of life threatening complications like multiple organ failure in patients. The objective of this study is to explore the relationship between elevated pancreatic enzymes and the underlying risk factors during the management of COVID-19 patients.Method: A total of 55 COVID-19 patients admitted to the intensive care unit (ICU) of Wuhan Jinyintan hospital from January 1 to March 30, 2020 were enrolled in this study. All participants underwent transabdominal ultrasound imaging to assess their pancreas.Results: Out of the 55 patients, three patients had pancreatitis, 29 (52.7%) with elevated pancreatic enzymes, and 23 (41.8%) without. The most common symptoms of patients with COVID-19 were fever and cough. There was no statistical difference in most baseline characteristics except myalgia on admission. Compared with those having normal enzyme levels, patients with elevated pancreatic enzymes had higher rates of mortality (79.3 vs. 52.2%; P = 0.038), and lower rates of discharge (20.7 vs. 47.8%; P = 0.038). Patients with elevated enzymes had higher incidence of mechanical ventilation (P = 0.004) and kidney injury (P = 0.042) than patients without elevated pancreatic enzymes. The results of multivariable logistic analysis showed that the odds ratio were 10.202 (P = 0.002) for mechanical ventilation and 7.673 (P = 0.014) for kidney injury with the elevated enzymes vs. the normal conditions.Conclusions: The findings show that the incidences of pancreatic enzymes elevation are not low in critical COVID-19 patients and only a few of them progressed to acute pancreatitis (AP). Increased pancreatic enzymes levels is associated with poor prognosis in COVID-19 patients. In addition, the kidney injury and oxygenation degradation are associated with the pancreatic enzymes elevation in COVID-19 patients.

Multiple organ support in an ageing population

2019 ◽  
pp. 133-144
Author(s):  
Matt Oliver ◽  
Dave Murray
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Multiple Organ ◽  
Care Staff ◽  
Organ Support ◽  
Ageing Population ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on multiorgan support in the ageing population. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

Human Adipose Tissue-Derived Stromal Cells Attenuate the Multiple Organ Injuries Induced by Sepsis and Mechanical Ventilation in Mice

Inflammation ◽  
2018 ◽  
Vol 42 (2) ◽  
pp. 485-495 ◽  
Author(s):  
Shuya Mei ◽  
Shuang Wang ◽  
Shuqing Jin ◽  
Xiang Zhao ◽  
Zhenzhen Shao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Adipose Tissue ◽  
Stromal Cells ◽  
Human Adipose Tissue ◽  
Multiple Organ

Airway Inflammation Induced by Mechanical Ventilation Through Multiscale Modeling

2012 ◽  
Author(s):  
Ramana M. Pidaparti ◽  
Kevin R. Ward
Keyword(s):  
Mechanical Ventilation ◽  
Multiscale Modeling ◽  
Inflammatory Responses ◽  
Healing Process ◽  
Multiple Organ ◽  
The Body ◽  
Multiple Organ Dysfunction ◽  
Over Expression ◽  
Biomechanical Forces ◽  
External Stimuli

Inflammation has been recognized as a major integral component for most of the acute and chronic diseases. Inflammation can be initiated within the body as an innate process or by external factors such as infections and trauma. Inflammation is a complex and dynamic process, and involves nonlinearity and stochasticity. Without the inflammation, the harmful stimuli cannot be removed and the healing process cannot occur. However, an over-expression or under-expression of inflammatory responses can lead to severe consequences, such as Multiple Organ Dysfunction Syndrome (MODS), which is characterized by sequential organ failure. Acute lung injury (ALI) is typically one of the first manifestation of MODS. It can be triggered by external stimuli such as pathogens or from inflammatory mediators produced from various other processes ranging from other damaged organs or to blood transfusions to even the biomechanical forces of mechanical ventilation itself.

Critical Care Medicine

2012 ◽  
Author(s):  
Otis B. Rickman
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Distress Syndrome ◽  
Life Support ◽  
Venous Access ◽  
Critical Care Medicine ◽  
Organ Support ◽  
Disease States ◽  
Cardiopulmonary Monitoring

Critical care medicine is a multidisciplinary branch of medicine encompassing the provision of organ support to patients who are severely ill. All areas of medicine may have relevance for critically ill patients; however, this review focuses only on aspects of cardiopulmonary monitoring, life support, technologic interventions, and disease states typically managed in the intensive care unit (ICU). Airway management, venous access, respiratory failure, mechanical ventilation, acute respiratory distress syndrome, shock, and sepsis are reviewed.

Sign in / Sign up

Export Citation Format

Share Document