Articles: respiratory-distress-syndrome.
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Multicenter Study
Neonatal lung ultrasound and surfactant administration: a pragmatic, multicenter study.
Previous research shows that a lung ultrasound score (LUS) can anticipate CPAP failure in neonatal respiratory distress syndrome. ⋯ LUS is a reliable criterion to administer the first surfactant dose regardless of GA. Its association with oxygen saturation to Fio2 ratio significantly improves the prediction power for surfactant need.
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Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Whereas the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events (AEs) related to prone positioning in ARDS and, secondarily, to collect strategies and recommendations to mitigate these AEs. ⋯ We identified > 40 AEs reported in prone positioning ARDS studies, including additional AEs not yet reported by previous systematic reviews. The pooled AE proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate AEs could promote future consensus-based recommendations.
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Mechanical ventilation is a potentially life-saving therapy for patients with acute lung injury, but the ventilator itself may cause lung injury. Ventilator-induced lung injury (VILI) is sometimes an unfortunate consequence of mechanical ventilation. It is not clear however how best to minimize VILI through adjustment of various parameters including tidal volume, plateau pressure, driving pressure, and positive end expiratory pressure (PEEP). ⋯ There is currently interest in quantifying how static and dynamic parameters contribute to VILI. One concept that has emerged is the consideration of the amount of energy transferred from the ventilator to the respiratory system per unit time, which can be quantified as mechanical power. This review article reports on recent literature in this emerging field and future roles for mechanical power assessments in prospective studies.
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Objectives: In the context of COVID-19 pandemic, the aim of this manuscript is to provide a standard of care of patients with ARDS for non-emergency medicine trained physicians who are not customary with mechanical ventilation. Methods: We conducted a systematic review of the literature to investigate the best practice recommendations regarding the mechanical ventilation of patients with ARDS. ⋯ This focus is particularly addressed to physicians who are not experienced in the invasive respiratory management of ARDS patients. Nevertheless, it remains fundamental to acknowledge that new insights concerning this quickly spreading illness become available on a regular base.
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As of February 2, 2021, the USA has 26,431,799 reported COVID-19 cases with 446,744 deaths. A high mortality rate (15%-40%) was reported among hospitalized patients with COVID-19 during the first wave of the pandemic. However, data regarding variation in COVID-19-related mortality and severity of illness among hospitalized patients with COVID-19 are heterogeneous. ⋯ In-hospital mortality during the second wave was lower (5.9%) compared with the first wave (15.5%). At the last follow-up date, 86.1% were discharged alive from the hospital, 5.9% died and 7.9% were still in the hospital. Multivariate logistic regression showed higher odds of mortality were associated with higher age and elevated lactate dehydrogenase peak.