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Diagnosis and Management of Acute Respiratory Distress Syndrome in the ICU

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (1 February 2022) | Viewed by 19431

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Special Issue Editor

Dr. Michele Umbrello

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Guest Editor

SC Rianimazione e Anestesia of ASST Ovest Milanese, Ospedale Nuovo di Legnano, Milano, Italy
Interests: respiratory physiology; lung imaging; diaphragm function; artificial nutrition and metabolism; muscle ultrasound
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Current medical practice is moving toward precision medicine. Advances in our understanding of the pathophysiology of ARDS have enabled the identification of clinical subphenotypes, the development of tailored therapies, and a more accurate prediction of prognosis.

First described over 50 years ago, ARDS still is one of the main causes of ICU admission and mortality. Ever since the first reports, ARDS was identified as a heterogeneous syndrome, associated with variable mechanical and gas exchange disturbances. This clinical and biological heterogeneity contributes substantially to the complex management of the syndrome. Although the standard treatment remains mechanical ventilation support, several adjuvant or rescue therapies have been proposed over the years. Moreover, recent investigations have highlighted how ARDS can be split into subphenotypes depending on the etiology of the lung injury, the physiological alterations and the inflammatory response, which might respond differently to interventions. In patients with ARDS, a holistic and individualized framework of respiratory and hemodynamic support should be provided, aiming to ensure adequate gas exchange while mitigating the risk of ventilator-induced lung injury and patient self-inflicted lung injury, depending on the clinical context. Spontaneous breathing can be either beneficial or deleterious, depending on the strength of spontaneous activity and severity of lung injury. A tailored strategy of lung recruitment and protective mechanical ventilation should be promoted, informed by bedside physiology and supported by recently published data.

This Special Issue aims to improve the clinician’s approach to diagnosis, management, and the prediction of prognosis for patients with ARDS.

Dr. Michele Umbrello
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

ARDS
Lung protective ventilation
Lung recruitment
Prone positioning
Inhaled vasodilators
Neuromuscular blocking agents
Corticosteroids
ECMO

Published Papers (3 papers)

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Review

23 pages, 1095 KiB

Open AccessReview

Neurally Adjusted Ventilatory Assist in Acute Respiratory Failure—A Narrative Review

by Michele Umbrello, Edoardo Antonucci and Stefano Muttini

J. Clin. Med. 2022, 11(7), 1863; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071863 - 28 Mar 2022

Cited by 8 | Viewed by 5249

Abstract

Maintaining spontaneous breathing has both potentially beneficial and deleterious consequences in patients with acute respiratory failure, depending on the balance that can be obtained between the protecting and damaging effects on the lungs and the diaphragm. Neurally adjusted ventilatory assist (NAVA) is an assist mode, which supplies the respiratory system with a pressure proportional to the integral of the electrical activity of the diaphragm. This proportional mode of ventilation has the theoretical potential to deliver lung- and respiratory-muscle-protective ventilation by preserving the physiologic defense mechanisms against both lung overdistention and ventilator overassistance, as well as reducing the incidence of diaphragm disuse atrophy while maintaining patient–ventilator synchrony. This narrative review presents an overview of NAVA technology, its basic principles, the different methods to set the assist level and the findings of experimental and clinical studies which focused on lung and diaphragm protection, machine–patient interaction and preservation of breathing pattern variability. A summary of the findings of the available clinical trials which investigate the use of NAVA in acute respiratory failure will also be presented and discussed. Full article

(This article belongs to the Special Issue Diagnosis and Management of Acute Respiratory Distress Syndrome in the ICU)

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12 pages, 974 KiB

Open AccessReview

Evidence-Based Mechanical Ventilatory Strategies in ARDS

by Adnan Liaqat, Matthew Mason, Brian J. Foster, Sagar Kulkarni, Aisha Barlas, Awais M. Farooq, Pooja Patak, Hamza Liaqat, Rafaela G. Basso, Mohammed S. Zaman and Dhaval Pau

J. Clin. Med. 2022, 11(2), 319; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020319 - 10 Jan 2022

Cited by 12 | Viewed by 9876

Abstract

Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO₂ (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS. Full article

(This article belongs to the Special Issue Diagnosis and Management of Acute Respiratory Distress Syndrome in the ICU)

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13 pages, 626 KiB

Open AccessReview

Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review

by Mi-Kyoung Jun, Jeong-Kui Ku, Il-hyung Kim, Sang-Yoon Park, Jinson Hong, Jae-Young Kim and Jeong-Keun Lee

J. Clin. Med. 2021, 10(16), 3681; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163681 - 19 Aug 2021

Cited by 8 | Viewed by 3620

Abstract

This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords “Hospital dentistry” OR “Oral care” OR “Intensive care unit” OR “Hospital inpatient” OR “Hospitalization” OR “Emergency service” AND “Oral health” OR “Oral hygiene” OR “Dental plaque” was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed. Full article

(This article belongs to the Special Issue Diagnosis and Management of Acute Respiratory Distress Syndrome in the ICU)

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