Articles: respiratory-distress-syndrome.
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Auscultation for an extended period of time using a wearable stethoscope enables objective computerized analysis and longitudinal assessment of lung sounds. However, this auscultation method differs from bedside auscultation in that clinicians are not present to optimize the quality of auscultation. No prior studies have compared these two auscultation methods. ⋯ Extending the duration of auscultation using a wearable stethoscope in a noisy clinical environment showed comparable performance to standard of care intermittent auscultation in identifying patients who have wheezes.
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Journal of critical care · Oct 2022
Observational StudySerum linezolid concentrations are reduced in critically ill patients with pulmonary infections: A prospective observational study.
The concentration-time profile of linezolid varies considerably in critically ill patients. Question of interest is, if the site of infection influences linezolid serum concentrations. ⋯ Linezolid serum concentrations are reduced in patients with pulmonary infections. Future studies should investigate if other linezolid thresholds are needed in those patients due to linezolid pooling in patients´ lung.
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Am. J. Respir. Crit. Care Med. · Oct 2022
Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and ARDS.
Rationale: The leading cause of death in coronavirus disease 2019 (COVID-19) is severe pneumonia, with many patients developing acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD). Whether DAD in fatal COVID-19 is distinct from other causes of DAD remains unknown. Objective: To compare lung parenchymal and vascular alterations between patients with fatal COVID-19 pneumonia and other DAD-causing etiologies using a multidimensional approach. ⋯ Alveolar-septal congestion was associated with a significantly shorter time to death from symptom onset (P = 0.03), length of hospital stay (P = 0.02), and increased ventilatory ratio [an estimate for pulmonary dead space fraction (Vd); p = 0.043] in all cases of ARDS. Conclusions: Severe COVID-19 pneumonia is characterized by significant vasculopathy and aberrant alveolar-septal congestion. Our findings also highlight the role that vascular alterations may play in Vd and clinical outcomes in ARDS in general.
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Journal of critical care · Oct 2022
Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study.
To identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories. ⋯ Hypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity-reflected by the PEEP level required.