Maximal recruitment strategy guided by thoracic CT scan in severe acute respiratory distress syndrome patients: a case series report

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

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Clinical case of nebulized surfactant therapy for severe COVID-19-associated pneumonia at the 2nd stage of rehabilitation treatment

Medical Council ◽

10.21518/2079-701x-2021-16-78-84 ◽

2021 ◽

pp. 78-84

Author(s):

I. Yu. Stulikova ◽

A. V. Tsvetkova ◽

E. S. Koneva ◽

T. V. Shapovalenko

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Clinical Signs ◽

Medical Rehabilitation ◽

Surfactant Therapy ◽

Rehabilitation Treatment ◽

Atmospheric Air ◽

Thoracic Ct

The development of an effective and safe drug for the treatment of patients with COVID-19 is currently an urgent task for the global medical community. Given that lung damage remains the predominant syndrome in COVID-19, and the development of acute respiratory distress syndrome (ARDS) is the most common reason for transfer to intensive care unit and connection to artificial lung ventilation, it seems promising to study the effectiveness and safety of surfactant therapy, successfully proven in practice in the treatment of adult and preterm infants ARDS. Despite the fact that most studies are devoted to the use of this method in patients in the acute stage, we present a case from our own practice of Surfactant-BL inhalation in a patient with COVID-19-associated pneumonia at the 2nd stage of rehabilitation treatment. Clinical signs of respiratory failure (RR 22 per minute, Sa O2 86% on atmospheric air, 95% on insufflation of humidified oxygen 7 L/min), high percentage of lung tissue damage according to thoracic CT (55% – CT3) on admission to the Medical Rehabilitation Unit, as well as a score of 6 on the NEWS2 scale served as a basis for the patient to receive Surfactant-BL inhalation for the indication «prevention of the development of acute respiratory distress syndrome» in a dosage of 75 mg twice a day for 5 days. Positive dynamics of clinical data at the end of the course of inhalations (decrease of RR to 16 per minute, increase of Sa O2 to 90% on atmospheric air and to 95% on insufflation of humidified oxygen 5 l/min, improvement of auscultatory picture), as well as the control thoracic CT scan, which showed a decrease of lung parenchyma damage to 45.2% (CT-2), indicated the effectiveness and safety of this method in the complex rehabilitation of COVID-19 patient, being a basis for further investigation of this issue

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Faculty Opinions recommendation of How large is the lung recruitability in early acute respiratory distress syndrome: a prospective case series of patients monitored by computed tomography.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13489068.14866196 ◽

2012 ◽

Author(s):

Marcelo Gama de Abreu

Keyword(s):

Computed Tomography ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Case Series ◽

Prospective Case Series

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Pneumothorax in COVID-19 Acute Respiratory Distress Syndrome: Case Series

Cureus ◽

10.7759/cureus.11749 ◽

2020 ◽

Author(s):

Kelvin Wong ◽

Dae Hyeon Kim ◽

Annamaria Iakovou ◽

Sameer Khanijo ◽

Adey Tsegaye ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Case Series

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Hiệu quả của phương pháp oxy hóa qua màng ngoài cơ thể (ECMO) trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân Covid

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2022.75.14 ◽

2022 ◽

Author(s):

Tuan Anh Truong

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Case Series ◽

Patient Reports ◽

Initial Application ◽

October 17

TÓM TẮT Sự bùng phát của hội chứng viêm đường hô hấp cấp do coronavirus 2 (SARS-CoV-2) nhanh chóng trở thành đại dịch trên toàn thế giới với hơn 40 triệu người mắc và hơn 1 triệu người chết tính đến ngày 17 tháng 10 năm 2020. Nhiều bệnh nhân COVID-19 được báo cáo cho thấy rằng có thể dẫn đến suy hô hấp cấp cần chăm sóc đặc biệt (ICU) và thiết bị hỗ trợ thở và bệnh cảnh có thể nhanh chóng tiến triển thành chứng suy hô hấp cấp (ARDS) với thiếu oxy ở mức độ nặng và gây ra tử vong dù đã có sự hỗ trợ của thiết bị hỗ trợ thở, cả 2 khả năng này thậm chí có thể cùng xảy ra. Các tổ chức quốc tế và các chuyên gia trong lĩnh vực này khuyến nghị sử dụng ECMO cho những bệnh nhân ARDS bị bệnh nặng có COVID-19. Tuy nhiên, tỷ lệ sống sót là rất thấp trong những trường hợp được sử dụng ECMO với COVID-19 trong đợt đầu tiên. Nghiên cứu của chúng tôi nhằm đánh giá kết quả bước đầu ứng dụng kỹ thuật ECMO trong hỗ trợ điều trị hội chứng suy hô hấp cấp nguy kịch trên bệnh nhân COVID-19 tại trung tâm hồi sức bệnh viện Trung ương Huế. ABSTRACT EFFECTIVENESS OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN THE TREATMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS WITH COVID-19 The outbreak of acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) quickly developed into a worldwide pandemic with more than 40 million people infected and more than 1 million dead as of October 17, 2020. Numerous patient reports COVID-19 can lead to acute respiratory failure requiring intensive care (ICU) and ventilators, and it can rapidly evolve into a certificate of acute respiratory failure (ARDS) with red oxygen in the heavy and death, despite the protective ventilator, even both. International organizations and experts in the field recommend ECMO for critically ill ARDS patients with COVID-19. However, survival is very low in the ECMO - corrected case series with COVID-19 during the first COVID-19 wave. Our study aimed to evaluate the results of the initial application of transmembrane oxygenation (ECMO) technique in the support of critical acute respiratory distress syndrome on COVID-19 patients at the hospital resuscitation center of Hue central hospital. Keywords: ECMO, ARDS, COVID-19.

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