C24. ARDS: BASIC SCIENCE TO THE BEDSIDE最新文献

{"title":"Mechanical Ventilation of Lung Injury with an Automatic Resuscitator: Randomized Controlled Experimental Study Using an ARDS Model","authors":"M. Sousa, B. Katira, V. Hsing, D. Engelberts, M. Post, P. Dorian, L. Brochard","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3806","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3806","url":null,"abstract":"","PeriodicalId":275484,"journal":{"name":"C24. ARDS: BASIC SCIENCE TO THE BEDSIDE","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114497706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-Level Availability of Prone Positioning, 2019 vs 2021","authors":"X. Audhya, N. Bosch, J. Stevens, A. Walkey, A. Law","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3822","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3822","url":null,"abstract":"Rationale. Prone positioning (PP) of patients with moderate-severe acute respiratory distress syndrome (ARDS) is an evidence-based and guideline-recommended practice, but our 2019 survey found that fewer than half of Massachusetts ICUs could routinely offer PP. As studies have described rapid adoption of evidence- and nonevidence- based practices alike during COVID-19, we re-surveyed Massachusetts ICUs in 2021 to determine if institutional-level adoption of PP among intubated patients had changed during the COVID-19 pandemic;we additionally ascertained adoption of awake PP. Methods. In follow-up to our 2019 survey, we surveyed intensive care units (ICUs) at all acute-care hospitals in Massachusetts, June-October 2021. The survey asked: “Does your ICU have the ability to prone intubated patients?” (“Yes, routinely,” “Case-by-case,” or “No”). Follow-up questions inquired if ICUs had protocols/guidelines on intubated PP, trained nurses in intubated PP, and whether awake PP had been adopted. We collected descriptive hospital data (number of ICU and hospital beds, nonprofit status, teaching status, case-mix index) and tested for associations with chi-square tests. Results. Of the 57 acute care hospitals in Massachusetts with ICUs, 47 responded to the survey (82% response;compared to 54/60 [90%] in 2019;three hospitals surveyed in 2019 had closed ICUs in 2021). The number of hospitals able to routinely perform PP in intubated patients increased from 24 (44%) to 39 (83%);hospitals able to perform PP among intubated patients on a case-by-case basis or not at all decreased from 15 (28%) to 5 (11%) and 15 (28%) to 3 (6%), respectively (p<0.001) (Figure 1). ICUs with a protocol/guideline for intubated PP increased from 27 (50%) to 43 (92%) (p< 0.001);ICUs that had trained some or all nurses in intubated PP increased from 34 (63%) to 45 (96%) (p<0.001). In contrast to 2019, in 2021 there were no associations between availability of intubated PP and hospital/ICU bed number, teaching status, nonprofit status, or case-mix index. In 2021, 43 (92%) of Massachusetts ICUs had adopted awake PP, 19 of whom had not adopted routine PP of intubated patients in 2019, and 4 of whom had not adopted intubated PP in 2021. Conclusions. There was a significant increase in the proportion of Massachusetts ICUs that had adopted evidence-based, guideline-recommended PP in intubated patients by 2021. At the same time, almost all ICUs also adopted non-evidence-based PP in awake patients. Our results illustrate that factors other than available evidence play a large role in practice adoption.","PeriodicalId":275484,"journal":{"name":"C24. ARDS: BASIC SCIENCE TO THE BEDSIDE","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129364490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex as a Biologic Variable in the Skeletal Muscle Wasting Response to Acute Lung Injury in Mice","authors":"L. Belfield, Jennifer T W Krall, W. Hiatt, C. Liu, L. Purcell, S. Carter, K. Gibbs, D. Files","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3820","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3820","url":null,"abstract":"","PeriodicalId":275484,"journal":{"name":"C24. ARDS: BASIC SCIENCE TO THE BEDSIDE","volume":" November","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120826364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolomic Biomarkers Measured at Patient Discharge Predict Long-Term Physical Function in Survivors of Acute Respiratory Failure","authors":"T. Shaw, K. Grant, S. Gandotra, E. Hartsell, G. Daly, L. Purcell, M. Hamo, M. Gillespie, D. Files, P. E. Morris, R. J. Langley","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3814","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3814","url":null,"abstract":"RATIONALE: Long-term quality of life is a significant concern for survivors of sepsis and acute respiratory failure (ARF). Financial burdens await as many patients never return to work. Notably, the duration of the ICU stay significantly correlates with the severity of physical impairment and up to 25% of skeletal muscle is lost within one week in the ICU. The recent pandemic due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) is likely to exacerbate these issues. We have previously reported that metabolites related to mitochondrial bioenergetics status can predict acute patient outcomes. Here, we propose that these same metabolomic and mitochondrial biomarkers of mortality also predict physical function in survivors. METHODS: To test this hypothesis, we performed a retrospective analysis of metabolomic changes in ARF survivors using ultrahigh performance liquid chromatography mass spectrometry. Six months after ICU admission, physical function was determined by the short physical performance battery (SPPB), an objective physical function measurement assessing gait speed, balance and lower extremity strength. A total of 70 consecutively enrolled patients were selected, of which 35 had good physical function (SPPB ≥ 7) and 35 had poor physical function (SPPB ≤6). The patients were matched for age, race and sex. Metabolomic analysis of patient's serum was measured at ICU admittance (n=70), 5d-post admittance (n=20) and discharge (n=20). RESULTS: More than 1250 named compounds were identified. There were only 19 metabolites that were significantly different at admittance (ANOVA;p < 0.05), of which seven were bile acids. However at discharge, despite less patient samples tested, 151 metabolites were significantly different (ANOVA;p < 0.05). Specifically, we found that 10 lysophospholipids, eight bile acids, three TCA cycle metabolites, eight kynurenine-related metabolites and nine urea cycle metabolites were significantly different. Many of these pathways have previously been shown to be altered in nonsurvivors of sepsis and ARF. CONCLUSIONS: Findings suggest that bioenergetic abnormalities arising during the acute phase of recovery may be persistent and predict longer-term decrements of physical function in survivors of ARF. Larger retrospective and prospective studies are needed to confirm these preliminary findings;however, predicting poor physical function in survivors as well as identifying the affected metabolic pathways may lead to improved therapies and long-term patient outcomes.","PeriodicalId":275484,"journal":{"name":"C24. ARDS: BASIC SCIENCE TO THE BEDSIDE","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126651893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}