29 research outputs found
Declining Mortality in Patients With Acute Respiratory Distress Syndrome : an Analysis of the Acute Respiratory Distress Syndrome Network Trials
No full textOBJECTIVES: There has been multiple advances in the management of acute respiratory distress syndrome, but the temporal trends in acute respiratory distress syndrome-related mortality are not well known. This study aimed to investigate the trends in mortality in acute respiratory distress syndrome patients over time and to explore the roles of daily fluid balance and ventilation variables in those patients. DESIGN: Secondary analysis of randomized controlled trials conducted by the Acute Respiratory Distress Syndrome Network from 1996 to 2013. SETTING: Multicenter study involving Acute Respiratory Distress Syndrome Network trials. PATIENTS: Patients with acute respiratory distress syndrome.None. MEASURES AND MAIN RESULTS: Individual patient data from 5,159 acute respiratory distress syndrome patients (excluding the Late Steroid Rescue Study trial) were enrolled in this study. The crude mortality rate decreased from 35.4% (95% CI, 29.9-40.8%) in 1996 to 28.3% (95% CI, 22.0-34.7%) in 2013. By adjusting for the baseline Acute Physiology and Chronic Health Evaluation III, age, ICU type, and admission resource, patients enrolled from 2005 to 2010 (odds ratio, 0.61; 95% CI, 0.50-0.74) and those enrolled after 2010 (odds ratio, 0.73; 95% CI, 0.58-0.92) were associated with lower risk of death as compared to those enrolled before 2000. The effect of year on mortality decline disappeared after adjustment for daily fluid balance, positive end-expiratory pressure, tidal volume, and plateau pressure. There were significant trends of declines in daily fluid balance, tidal volume, and plateau pressure and an increase in positive end-expiratory pressure over the 17 years. CONCLUSIONS: Our study shows an improvement in the acute respiratory distress syndrome-related mortality rate in the critically ill patients enrolled in the Acute Respiratory Distress Syndrome Network trials. The effect was probably mediated via decreased tidal volume, plateau pressure, and daily fluid balance and increased positive end-expiratory pressure
Personalized medicine for ARDS : the 2035 research agenda
No full textIn the last 20 years, survival among patients with acute respiratory distress syndrome (ARDS) has increased substantially with advances in lung-protective ventilation and resuscitation. Building on this success, personalizing mechanical ventilation to patient-specific physiology for enhanced lung protection will be a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. Further understanding of the heterogeneous biology, from molecular to mechanical, underlying early ARDS pathogenesis is essential to inform therapeutic discovery and tailor treatment and prevention strategies to the individual patient. The ARDSne(x)t research agenda for the next 20 years calls for bringing personalized medicine to ARDS, asking simultaneously both whether a treatment affords clinically meaningful benefit and for whom. This expanded scope necessitates standard acquisition of highly granular biological, physiological, and clinical data across studies to identify biologically distinct subgroups that may respond differently to a given intervention. Clinical trials will need to consider enrichment strategies and incorporate long-term functional outcomes. Tremendous investment in research infrastructure and global collaboration will be vital to fulfilling this agenda
Meiobenthos provides a food resource for young cyprinids
No full textSpieth H, Möller T, Ptatscheck C, Kazemi-Dinan A, Traunspurger W. Meiobenthos provides a food resource for young cyprinids. Journal of Fish Biology. 2011;78(1):138-149.Young individuals of the bottom-biting (i.e. sediment-ingesting) common carp Cyprinus carpio and gudgeon Gobio gobio consumed significant amounts of nematodes in laboratory experiments, whereas the selective-feeding roach Rutilus rutilus did not. In mesocosm enclosure experiments in the field, C. carpio strongly decreased the nematode abundance within 4 days, whereas the bottom-biting bream Abramis brama did not affect the abundance until after 14 days. In controlled experiments with a known number of prey, C. carpio but not A. brama significantly reduced the number of nematodes, and G. gobio reduced the nematode abundance dependent on the size of the fish, with smaller fish causing a greater reduction. Cyprinus carpio consumed the nematodes and did not just mechanically kill them in the sediment, as shown by dissection of the fish intestine. Morphometric analysis of the branchial baskets indicated that the mesh width of C. carpio, but not of A. brama, is suitable for consuming meiobenthos. The results indicate that the meiobenthos is a food resource for certain bottom-feeding freshwater fishes. (C) 2010 The Author
Prone positioning for acute respiratory distress syndrome in adults
No full textHafner S, Lepper PM, Muellenbach RM, et al. Bauchlagerung beim akuten Lungenversagen des Erwachsenen. Update zu den physiologischen Effekten, den Indikationen und der Durchführung. Die Anaesthesiologie. 2024;73(8):556–568.The prone position is an immediately available and easily implemented procedure that was introduced more than 50 years ago as a method for improvement of gas exchange in patients with acute respiratory distress syndrome (ARDS). In the meantime, a survival advantage could also be shown in patients with severe ARDS, which led to the recommendation of the prone position for treatment of severe ARDS by expert consensus and specialist society guidelines. The continuing coronavirus disease 2019 (COVID-19) pandemic moved the prone position to the forefront of medicine, including the widespread implementation of the prone position for awake, spontaneously breathing nonintubated patients with acute hypoxemic respiratory insufficiency. The survival advantage is possible due to a reduction of the ventilator-associated lung damage. In this article, the physiological effects, data on clinical results, practical considerations and open questions with respect to the prone position are discussed. © 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature
Correction for Mesquita et al., Genome of Rhodnius prolixus, an insect vector of Chagas disease, reveals unique adaptations to hematophagy and parasite infection
No full textCorrection for “Genome of Rhodnius prolixus , an insect vector of Chagas disease, reveals unique adaptations to hematophagy and parasite infection,” by Rafael D. Mesquita, Raquel J. Vionette-Amaral, Carl Lowenberger, Rolando Rivera-Pomar, Fernando A. Monteiro, Patrick Minx, John Spieth, A. Bernardo Carvalho, Francisco Panzera, Daniel Lawson, André Q. Torres, Jose M. C. Ribeiro, Marcos H. F. Sorgine, Robert M. Waterhouse, Michael J. Montague, Fernando Abad-Franch, Michele Alves-Bezerra, [et al.]...
The authors note that Angela B. Lange should be added to the author list between Leonardo B. Koerich and José Manuel Latorre-Estivalis, and Ian Orchard should be added to the au-thor list between Sheila Ons and Lucia Pagola. Angela B. Lange and Ian Orchard should be credited with supplying sequencing samples and conducting gene annotation and supplementarymaterial writing. The corrected author line, affiliation line, and author contributions appear below. The online version has been corrected
Open lung approach vs acute respiratory distress syndrome network ventilation in experimental acute lung injury
No full textAbstract
BACKGROUND:
Setting and strategies of mechanical ventilation with positive end-expiratory pressure (PEEP) in acute lung injury (ALI) remains controversial. This study compares the effects between lung-protective mechanical ventilation according to the Acute Respiratory Distress Syndrome Network recommendations (ARDSnet) and the open lung approach (OLA) on pulmonary function and inflammatory response.
METHODS:
Eighteen juvenile pigs were anaesthetized, mechanically ventilated, and instrumented. ALI was induced by surfactant washout. Animals were randomly assigned to mechanical ventilation according to the ARDSnet protocol or the OLA (n=9 per group). Gas exchange, haemodynamics, pulmonary blood flow (PBF) distribution, and respiratory mechanics were measured at intervals and the lungs were removed after 6 h of mechanical ventilation for further analysis.
RESULTS:
PEEP and mean airway pressure were higher in the OLA than in the ARDSnet group [15 cmH(2)O, range 14-18 cmH(2)O, compared with 12 cmH(2)O; 20.5 (sd 2.3) compared with 18 (1.4) cmH(2)O by the end of the experiment, respectively], and OLA was associated with improved oxygenation compared with the ARDSnet group after 6 h. OLA showed more alveolar overdistension, especially in gravitationally non-dependent regions, while the ARDSnet group was associated with more intra-alveolar haemorrhage. Inflammatory mediators and markers of lung parenchymal stress did not differ significantly between groups. The PBF shifted from ventral to dorsal during OLA compared with ARDSnet protocol [-0.02 (-0.09 to -0.01) compared with -0.08 (-0.12 to -0.06), dorsal-ventral gradients after 6 h, respectively].
CONCLUSIONS:
According to the OLA, mechanical ventilation improved oxygenation and redistributed pulmonary perfusion when compared with the ARDSnet protocol, without differences in lung inflammatory response
Will all ARDS patients be receiving mechanical ventilation in 2035? No
No full textInternational audienc
Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial
No full textGeneral anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation. The PROtective VARiable ventilation trial ('PROVAR') is a single center, randomized controlled trial enrolling 50 patients who are planning for open abdominal surgery expected to last longer than 3 hours. PROVAR compares conventional (non-variable) lung protective ventilation (CV) with variable lung protective ventilation (VV) regarding pulmonary function and inflammatory response. The primary endpoint of the study is the forced vital capacity on the first postoperative day. Secondary endpoints include further lung function tests, plasma cytokine levels, spatial distribution of ventilation assessed by means of electrical impedance tomography and postoperative pulmonary complications. We hypothesize that VV improves lung function and reduces systemic inflammatory response compared to CV in patients receiving mechanical ventilation during general anesthesia for open abdominal surgery longer than 3 hours. PROVAR is the first randomized controlled trial aiming at intra- and postoperative effects of VV on lung function. This study may help to define the role of VV during general anesthesia requiring mechanical ventilation. Clinicaltrials.gov NCT01683578 (registered on September 3 3012
The Gentlemen's Game: Essays on Golf
No full textThesis advisor: Susan Roberts"The Gentlemen's Game: Essays on Golf" is a collection of seven nonfiction pieces about a historically wealthy pastime. Drawing from his personal experience as a player, caddie, and fan, the author seeks to portray golf’s most compelling stories as well as its many problems. Subjects include stars such as Tiger Woods and Jordan Spieth, as well as lesser-known pros like Mark Baldwin, who travels the country in pursuit of the PGA Tour. The thesis also explores golf’s issues with environmentalism and inclusivity, which have followed the sport for decades. This collection of essays is a testament to the value of the game, despite its reputation for tedium and elitism.Thesis (BA) — Boston College, 2022.Submitted to: Boston College. College of Arts and Sciences.Discipline: Departmental Honors.Discipline: English
