Temperature-Dependent Fluid Viscosity

C, Soler JA, Díaz-Lamas AM, González-Higueras E, Nogales L, Ambrós A, Carriedo D, Hernández M, Martínez D, Blanco J, Belda J, Parrilla D, Suárez- Sipmann F, Tarancón C, Mora-Ordoñez JM, Blanch L, Pérez-Méndez L, Fernández RL, Kacmarek RM; Spanish Initiative for Epidemiology, Stratification and Therapies for ARDS (SIESTA) Investigators Network. A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung- protective ventilation. Crit Care Med. 2017;45(5):843-50.

C, Soler JA, Díaz-Lamas AM, González-Higueras E, Nogales L, Ambrós A, Carriedo D, Hernández M, Martínez D, Blanco J, Belda J, Parrilla D, Suárez- Sipmann F, Tarancón C, Mora-Ordoñez JM, Blanch L, Pérez-Méndez L, Fernández RL, Kacmarek RM; Spanish Initiative for Epidemiology, Stratification and Therapies for ARDS (SIESTA) Investigators Network. A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung- protective ventilation. Crit Care Med. 2017;45(5):843-50.

Material and Methods: This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and program- mation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis.

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate.[1] Many thera- peutic trials have been attempted to improve this situation with little success. Since the pandemic H1N1 period in 2009, extra- corporeal oxygenation (ECMO) therapy has become one of the common rescue treatments for severe ARDS.[2] With the use of advanced rescue therapies, such as ECMO support, lung transplantation (LTPL) has been attempted an alternative therapeu- tic approach for severe ARDS. LTPL could also represent a potential approach to consider in cases of refractory hypoxemia.[1] There are limited data on the use of LTPL as a therapeutic option in cases of severe ARDS but we here report a case of inlu- enza pneumonia-induced ARDS that was successfully treated in this way.

The recent report on “risk factors for acute respiratory distress syndrome (ARDS) development in patients with type A influenza (H1N1)” is an interesting report [1]. It was concluded that “diabetes, late initiation of antiviral therapy and some laboratory tests are risk factors for ARDS development [1].” Indeed, the ARDS is a serious fatal complication of H1N1 infection and high rate of this complication is reported in many developing countries with poor medical resource [2, 3]. To find the risk factor can be useful, however, there are many considerations. The use of retrospective analysis might have the problem of data record and this can affect the final result (for example, one might not know whether he or she has diabetes mellitus or not if there is no previous blood test). Focusing on laboratory investigation, it can be informative. Some new laboratory investigations such as procalcitonin might be useful in managing H1N1 infected patients [4]. Finally, it should be noted that the rapid clinical change in H1N1 infected patients can be expected, hence, closed follow-up is required for all cases with or without risk factors.

Improving the course and outcome of patients with acute respira- tory distress syndrome presents a challenge. By understanding the immune status of a patient, physicians can consider manipulat- ing proinflammatory systems more rationally. In this context, corti- costeroids 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 pro- longed therapy in unresolving cases. There are differences be- tween 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

3. It is unclear whether early application of partial ventilatory support modalities decreases the duration of mechanical ventilation. One RCT including 30 patients [12] demonstrated a clinically and statistically significant reduction in time on a ventilator (1562 in APRV/BIPAP group versus 2162 days in PCV group, p,0.05) (LOE 1b). The other RCT [11], involving 58 patients, found no difference in VFDs between APRV/BIPAP (13.461.7) compared to SIMV+PS (12.261.5, p = 0.83) (LOE 1b), however no comparison to controlled ventilation was made. An observational study of 165 ARDS patients demonstrated that APRV/BIPAP increased the duration of ventilation when compared to A/C (14 versus 10 days, p = 0.04) [16] (LOE 2b); that said, important between-group differences included a greater number of surgical and trauma patients in the APRV/BIPAP group, fewer admissions for primary respiratory disease, a lower comorbidity index and lower APACHE II scores. Table 1. Modified Oxford Centre for Evidence-Based Medicine Levels of Evidence (8).

principles, evidence collected in laboratory experiments, and randomized clinical or observational studies involving actual patients that were available in the literature, current MV recommendations indicate that ventilatory support should be performed at a tidal volume (Vt) of 6mL/Kg predicted body weight, with a delta between plateau pressure and positive end-expiratory pressure (PEEP) not greater than 15cmH 2 O, and end-expiratory pressure levels sufficient to avoid airway and alveolar collapse and ensure adequate gas exchange. Other recommendations include positioning the patient to guarantee adequate and harmless ventilation (such as prone positioning in cases of severe acute respiratory distress syndrome - ARDS) and the use of advanced support techniques (such as extracorporeal carbon dioxide (CO 2 ) removal) in cases of refractory ARDS. The development of increasingly more sophisticated ventilators allow for fine adjustment of sensitivity and include several trigger mechanisms, different inspiratory flow speeds, acceleration, mechanisms for ending inspiratory time, and monitoring options, which enable adjustment of the patient-ventilator synchrony and MV as a function of the patient’s disease. In this regard, the possibility of providing differential ventilatory support for restrictive and obstructive conditions stands out.

Acute respiratory distress syndrome (ARDS), also known as respiratory distress syndrome, adult respiratory distress syndrome, or shock lung, is a fatal pulmonary parenchymal disorder as sequelae of respiratory infection, trauma, or stress triggered by pulmonary cytokine release, impaired endotheli- al barriers and surfactant deiciency resulting in luid accumu- lation in the distal airspaces, ibrotic changes and eventually impaired gas exchange. The ARDS that develops early after cardiopulmonary bypass (CPB) is known as postperfusion or post-pump syndrome, which remains a signiicant clinical problem on those patients receiving heart operations under CPB [1] . In the early years, postperfusion lung syndrome was

Rationale: The pandemic influenza A (H1N1) virus emerged in 2009 and spread globally. This virus infection can induce acute respiratory distress syndrome (ARDS) in some patients. Diffuse alveolar damage (DAD), which is the histological surrogate for ARDS, has a multifactorial etiology. Therefore, it is possible that the immunopathology differs among the various presentations of DAD. Objectives: To compare the lung immunopathology of viral (influenza A(H1N1)pdm09) to non-viral, extrapulmonary etiologies in autopsy cases with DAD. Methods: The lung tissue of 44 patients, was divided into 3 groups: the H1N1 group (n=15) characterized by DAD due to influenza A(H1N1)pdm09 infection; the ARDS group (n=13), characterized by patients with exudative DAD due to non-pulmonary causes; and the control group (n=16), consisting of patients with non-pulmonary causes of death. Measurements and main results: Immunohistochemistry and image analysis were used to quantify, in the lung parenchyma and small airways, several immune cell markers. There was higher expression of CD4+ and CD8+ T lymphocytes, CD83+ dendritic cells, granzyme A+ and natural killer+ cell density in the lung parenchyma of the H1N1 group (p<0,05). In the small airways, there was a lower cell density of tryptase+ mast cells and dendritic+ cells and an increase of IL-17 in both DAD groups, with an increased number of granzyme A in H1N1 group (p<0,05). Conclusion: DAD due to viral A(H1N1)pdm09 is associated with a cytotoxic inflammatory phenotype that is different from non-viral causes of DAD, with partially divergent responses in the parenchyma relative to the small airways.

of ARDS (Acute Respiratory Distress Syndrome); 12 the presence of shock; 13 sepsis; the severity of the disease (according to APACHE II [Acute Physiology and Chronic Health Evaluation] score) 14 and organ dysfunction (defined as a SOFA score . 2 points in the organ systems that were evaluated, which included the cardiovascular, respiratory, neurological, hematological, renal and hepatic systems). 15 The daily incidence of ARDS, shock, infection, organ dysfunction, and tracheostomy and the length of time on MV was recorded prospectively. The evaluation outcomes were the evolution to chronic critical illness and the mortality in the ICU or in the hospital.

The potential use of surfactant preparations in other diseases such as Acute Lung Injury (ALI) and its severe form Acute Respiratory Distress Syndrome (ARDS) demands the evaluation of its immunomodulatory properties. ALI or ARDS is a life-threatening condition that is character- ized by increased inflammatory cytokine levels and cell infiltration into the lungs, non-cardiogenic pulmonary edema, and diffuse alveolar dam- age that culminates in respiratory failure [7,8]. Neutrophils play a key role in the immune defense against invading microbes. These cells can readily move to the inflammatory sites by chemotaxis, phagocytize the microbes and release reactive oxygen metabolites or enzymes for bacterial death [9]. Staphylococcus aureus (S. aureus) remains a major cause of human infections, and the arising of highly virulent, drug- resistant strains has made treatment more difficult [10]. It is also known to be one of the pathogens responsible for sepsis-induced ALI/ ARDS [11].

Acute respiratory distress syndrome (ARDS), described by Ashbaugh et al. in 1967, 24 is the most severe clinical form and the final aspect of acute pulmonary lesions. The disease, initially viewed as simply a surfactant abnormality, similar to neonatal respiratory failure, is nowadays characterized by the inflammatory process which leads to the rupture of the alveolar-capillary barrier and development of interstitial and alveolar edema, reduced pulmonary compliance, and V/Q imbalance (intrapulmonary shunt) and hypoxemia refractory to oxygen therapy. 25 Furthermore, there is an increase in PVR produced by a complex combination of the primary pulmonary lesion resulting from the inflammatory response to pulmonary aggression, and the complications of treatment, primarily pulmonary lesions induced by mechanical ventilation (MV). Furthermore, pulmonary hypertension puts an additional load on the right ventricle limiting cardiac output. 25

Despite advances in the understanding of ARDS pathogenesis, it still results in signiicant mortality. he alveolar recruitment maneuver and prone position seem signiicantly contributive for ARDS patients’ treat- ment, aiming oxygenation improvement and refrac- tory hypoxemia complications minimization, and lung complacency reduction. However there are few papers in the literature evaluating these maneuvers in acute respiratory distress syndrome treatment. As those are mostly experimental, more investigation on this subject is granted, and evidences of its clinical usefulness.

P25 Polyamine uptake in the malaria parasite, Plasmodium falciparum, is dependent on the parasite’s membrane potential. J Niemand, L Birkholtz, A I Louw, K Kirk[r]

showed deinite beneits in the survival of severe acute respiratory distress syndrome (ARDS) patients. In these two patients the hemodynamic and procedural risks of prone positioning were deemed lower than severe hypoxic respiratory failure. As prone position ventilation has been a standard of care in our center for many years, and all personel is trained to manage prone position ventilation (PPV), routine risks are minimal. (7,8) Accordingly, both

HFV and ECMO in children and adolescents with ARDS was carried out. Medline, Lilacs and Embase databases were searched for the following terms: adult respiratory distress syndrome, ARDS, acute respiratory distress syndrome, respiratory distress syndrome, extracorporeal membrane oxygenation, ECMO, high-frequency ventilation, high-frequency jet ventilation and high-frequency oscillatory ventilation. Search was conducted for controlled and randomized clinical trials, cohort studies and a series of cases which compared HFV with conventional mechanic ventilation (CMV), ECMO with CMV, or HFV preceding the use of ECMO.

Extracorporeal membrane oxygenation (ECMO) has been increasingly used to support patients with refractory hypoxemia. To provide adequate blood low for oxygenation, the cannulation site and cannula size must be carefully selected. In acute respiratory distress syndrome (ARDS) patients, the venovenous mode is preferred, in which the femoro-jugular and right internal jugular (with double lumen cannulas) cannulation strategy is the most commonly used. (1) Anticoagulation is usually required during the

Introduction: Acute respiratory distress syndrome (ARDS) has a high incidence and mortality between critical ill patients. The mechanical ventilation is the most important support for these patients with ARDS. However, until now there is an important debate about how is the best ventilatory strategy to use, because the mechanical ventilation if not well set can cause lung injury and increase mortality. The use of high tidal volume is one of the most important mechanics of ventilation induced lung injury and there is evidence in the literature that using low tidal volume is a protective ventilation with better survival. Objective: To explore if high frequency positive pressure ventilation (HFPPV) delivered by a conventional ventilator (Servo-300) is able to allow further tidal volume reductions and to stabilize PaCO 2 in a severe acute respiratory distress

7. Caltabeloti F, Monsel A, Arbelot C, Brisson H, Lu Q, Gu WJ, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care. 2014;18(3):R91.