scholarly journals High fluid volume removal with continuous renal replacement therapy as a therapeutic option for early posttraumatic acute respiratory distress syndrome

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P477
Author(s):  
L Sorrentino ◽  
F De Sanctis ◽  
M Mercieri ◽  
L Bucci ◽  
A Pochini ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Therapeutic Option ◽  
Fluid Volume ◽  
High Fluid

scholarly journals Lung Ultrasound Score Assessing the Pulmonary Edema in Pediatric Acute Respiratory Distress Syndrome Received Continuous Hemofiltration Therapy: A Prospective Observational Study

2020 ◽  
Author(s):  
Fei Wang ◽  
Chunxia Wang ◽  
Jingyi Shi ◽  
Yijun Shan ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Continuous Renal Replacement Therapy ◽  
Pulmonary Edema ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Ultrasound Score

Abstract Background: Lung ultrasound score is a potential method for determining pulmonary edema in acute respiratory distress syndrome. Continuous renal replacement therapy has become the preferred modality to manage fluid overload during acute respiratory distress syndrome. The aim of this study was to evaluate the value of lung ultrasound score on assessing the effects of continuous renal replacement therapy on pulmonary edema and pulmonary function in pediatric acute respiratory distress syndrome. Methods: We conducted a prospective study in children with moderate to severe acute respiratory distress syndrome in a tertiary university pediatric intensive care unit from January 2016 to December 2018. Lung ultrasound score was measured within 2 hours identified acute respiratory distress syndrome as the value of 1st，and the following three days as the 2nd, 3rd, and 4th.Results: A total of 70 patients with acute respiratory distress syndrome were enrolled in this study. Thirty-seven patients received continuous renal replacement therapy (CRRT group) and thirty-three patients treated by conventional therapy (Non-CRRT group). The 1st lung ultrasound score in CRRT group were significantly higher than Non-CRRT group (P < 0.05), but the lung ultrasound score decreased gradually following the continuous renal replacement therapy (P < 0.001). Lung ultrasound score was significantly correlated with PaO2/FiO2, dynamic lung compliance, and oxygen index based on 1st to 4th values (all P<0.001). Lung ultrasound score decreased from 22 (18 - 25) to 15 (13 - 18) and PaO2/FiO2 promoted from 106.00 (96.00 - 121.50) mmHg to 160.00 (142.50 - 173.00) mmHg after continuous renal replacement therapy for four days (both P < 0.001).Conclusions: Lung ultrasound score is closely correlated with PaO2/FiO2, oxygen index and dynamic lung compliance in pediatric acute respiratory distress syndrome. The improvement of pulmonary edema in patient with acute respiratory distress syndrome received continuous renal replacement therapy can be assessed by the lung ultrasound score.Trial registration: CCTR, ChiCTR-ONC-16009698. Registered 1 November 2016, prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=16535&htm=4. This study adheres to CONSORT guidelines.

scholarly journals Use of hemoadsorption in sepsis-associated ECMO-dependent severe ARDS: A case series

2019 ◽  
Vol 21 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Klaus Kogelmann ◽  
Morten Scheller ◽  
Matthias Drüner ◽  
Dominik Jarczak
Keyword(s):  
Septic Shock ◽  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Continuous Renal Replacement Therapy ◽  
Distress Syndrome ◽  
Case Series ◽  
Membrane Oxygenation

Introduction Acute respiratory distress syndrome in the context of severe sepsis and septic shock represents a serious clinical disorder. A recent case series in patients with septic shock and renal failure receiving hemoadsorption treatment showed rapid hemodynamic stabilization and increased survival, particularly in pneumonia patients and in those where therapy was started early. We hypothesized that patients suffering from pneumonia and refractory acute respiratory distress syndrome to the extent that they required extracorporeal membrane oxygenation support could possibly demonstrate the most pronounced benefit from the treatment. Methods We assessed the association of hemoadsorption treatment with hemodynamics, ventilation, and outcome variables in a set of patients with septic shock, acute respiratory distress syndrome, need for veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy. Results Key observations include a significant stabilization in hemodynamics as evidenced by a marked decrease in catecholamine need, which was paralleled by a clear reduction in hyperlactatemia. Respiratory variables improved significantly. In addition, severity of illness and overall organ dysfunction showed a considerable decrease during the course of treatment. Observed mortality was approximately half as predicted by APACHE II. Treatment with CytoSorb was safe and well tolerated with no device-related adverse events. Discussion This is the first case series reporting on outcome variables associated to CytoSorb therapy in critically ill patients with septic shock, acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy. Based on our observations in this small case series, CytoSorb might represent a potentially promising therapy option for patients with refractory extracorporeal membrane oxygenation-dependent acute respiratory distress syndrome in the context of septic shock.

scholarly journals Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome

2021 ◽  
Vol 10 (9) ◽  
pp. 1837
Author(s):  
Ko-Wei Chang ◽  
Shaw-Woei Leu ◽  
Shih-Wei Lin ◽  
Shinn-Jye Liang ◽  
Kuang-Yao Yang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Pneumonia Severity Index ◽  
P Value ◽  
Significant Difference ◽  
Influenza Pneumonia

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.

scholarly journals Prolonged Intermittent Renal Replacement Therapy for Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome

2020 ◽  
pp. 1-9
Author(s):  
Juan C. Ramirez-Sandoval ◽  
Jorge E. Gaytan-Arocha ◽  
Pedro Xolalpa-Chávez ◽  
Juan M. Mejia-Vilet ◽  
Mauricio Arvizu-Hernandez ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Replacement Therapy ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Intradialytic Hypotension ◽  
Intermittent Renal Replacement Therapy

<b><i>Introduction:</i></b> Patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 frequently develop severe acute kidney injury (AKI). Although continuous renal replacement therapy is the standard of care for critically ill patients, prolonged intermittent renal replacement therapy (PIRRT) may be a feasible option. We aimed to describe the tolerability and security of PIRRT treatments in COVID-19 patients with ARDS who required mechanical ventilation and developed severe AKI. <b><i>Methods:</i></b> We prospectively analyzed patients who underwent PIRRT treatments at a COVID-19 reference hospital in Mexico City. Intradialytic hypotension was defined as a systolic blood pressure decrease of ≥20 mm Hg or an increase of 100% in vasopressor dose. <b><i>Results:</i></b> We identified 136 AKI cases (60.7%) in 224 patients admitted to the intensive care unit. Among them, 21 (15%) underwent PIRRT (130 sessions) due to stage 3 AKI. The median age of the cohort was 49 (range 36–73) years, 17 (81%) were male, 7 (33%) had diabetes, and the median time between symptoms onset and PIRRT initiation was 12 (interquartile range [IQR] 7–14) days. The median of PIRRT procedures for each patient was 5 (IQR 4–9) sessions. In 108 (83%) PIRRT sessions, the total ultrafiltration goal was achieved. In 84 (65%) PIRRT procedures, there was a median increase in norepinephrine dose of +0.031 mcg/kg/min during PIRRT (IQR 0.00 to +0.07). Intradialytic hypotensive events occurred in 56 (43%) procedures. Fifteen (12%) PIRRT treatments were discontinued due to severe hypotension. Vasopressor treatment at PIRRT session onset (OR 6.2, 95% CI 1.4–28.0, <i>p</i>: 0.02) and a pre-PIRRT lactate ≥3.0 mmol/L (OR 4.63, 95% CI 1.3–12.8, <i>p</i>: 0.003) were independently and significantly associated with the risk of hypotension during PIRRT. During follow-up, 11 patients (52%) recovered from AKI and respiratory failure and 9 (43%) died. Several adaptations to our PIRRT protocol during the COVID-19 outbreak are presented. <b><i>Conclusions:</i></b> PIRRT was feasible in the majority of COVID-19 patients with ARDS and severe AKI, despite frequent transitory intradialytic hypotensive episodes. PIRRT may represent an acceptable alternative of renal replacement therapy during the COVID-19 outbreak.

scholarly journals Characteristics and outcomes of acute respiratory distress syndrome related to COVID-19 in Belgian and French intensive care units according to antiviral strategies: the COVADIS multicentre observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
David Grimaldi ◽  
◽  
Nadia Aissaoui ◽  
Gauthier Blonz ◽  
Giuseppe Carbutti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Renal Replacement Therapy ◽  
Observational Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Antiviral Treatment ◽  
Standard Of Care ◽  
Increased Risk

Abstract Background Limited data are available regarding antiviral therapy efficacy in most severe patients under mechanical ventilation for Covid-19-related acute respiratory distress syndrome (ARDS). Methods Comparison of antiviral strategies (none, hydroxychloroquine (OHQ), lopinavir/ritonavir (L/R), others (combination or remdesivir) in an observational multicentre cohort of patients with moderate-to-severe Covid-19 ARDS. The primary endpoint was the number of day 28 ventilator-free days (VFD). Patients who died before d28 were considered as having 0 VFD. The variable was dichotomized into “patients still ventilated or dead at day 28” versus “patients weaned and alive at day 28”. Results We analyzed 415 patients (85 treated with standard of care (SOC), 57 with L/R, 220 with OHQ, and 53 others). The median number of d28-VFD was 0 (IQR 0–13) and differed between groups (P = 0.03), SOC patients having the highest d28-VFD. After adjustment for age, sex, Charlson Comorbidity Index, PaO2/FiO2 ratio and plateau pressure and accounting for center effect with a generalized linear mixed model, none of the antiviral strategies increased the chance of being alive and weaned from MV at day 28 compared to the SOC strategy (OR 0.48 CI95% (0.18–1.25); OR 0.96 (0.47–2.02) and OR 1.43 (0.53–4.04) for L/R, OHQ and other treatments, respectively). Acute kidney injury during ICU stay was frequent (55%); its incidence was higher in patients receiving lopinavir (66 vs 53%, P = 0.03). After adjustment for age, sex, BMI, chronic hypertension and chronic renal disease, the use of L/R was associated with an increased risk of renal replacement therapy (RRT). (OR 2.52 CI95% 1.16–5.59). Conclusion In this multicentre observational study of moderate-to-severe Covid-19 ARDS patients, we did not observe any benefit among patients treated with OHQ or L/R compared with SOC. The use of L/R treatment was associated with an increased need for RRT. Take home message Neither hydroxychloroquine nor lopinavir/ritonavir as COVID-19 antiviral treatment is associated with higher ventilator-free days at day 28 when compared with standard of care (no antiviral treatment) in ICU patients under invasive mechanical ventilation. Lopinavir/ritonavir is associated with an increased risk of renal replacement therapy requirement. Tweet COVID-19: Insights from ARDS cohort: no signal of efficacy of any antiviral drugs. Lopinavir/ritonavir may be associated with need for RRT

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