Interest of a therapeutic optimization strategy in severe ARDS.
Identifieur interne : 000634 ( Main/Exploration ); précédent : 000633; suivant : 000635Interest of a therapeutic optimization strategy in severe ARDS.
Auteurs : N. Guinard [France] ; S. Beloucif ; C. Gatecel ; J. Mateo ; D. PayenSource :
- Chest [ 0012-3692 ] ; 1997.
Descripteurs français
- KwdFr :
- Adolescent (MeSH), Adulte (MeSH), Adulte d'âge moyen (MeSH), Almitrine (usage thérapeutique), Analyse de variance (MeSH), Analyse multifactorielle (MeSH), Diurétiques (usage thérapeutique), Drainage (MeSH), Femelle (MeSH), Humains (MeSH), Hémofiltration (MeSH), Mâle (MeSH), Planification des soins du patient (MeSH), Posture (MeSH), Pronostic (MeSH), Rapport ventilation-perfusion (MeSH), Syndrome de détresse respiratoire de l'adulte (mortalité), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation artificielle (MeSH), Épanchement pleural (MeSH), Études prospectives (MeSH).
- MESH :
- mortalité : Syndrome de détresse respiratoire de l'adulte.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- usage thérapeutique : Almitrine, Diurétiques.
- Adolescent, Adulte, Adulte d'âge moyen, Analyse de variance, Analyse multifactorielle, Drainage, Femelle, Humains, Hémofiltration, Mâle, Planification des soins du patient, Posture, Pronostic, Rapport ventilation-perfusion, Ventilation artificielle, Épanchement pleural, Études prospectives.
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Almitrine (therapeutic use), Analysis of Variance (MeSH), Diuretics (therapeutic use), Drainage (MeSH), Female (MeSH), Hemofiltration (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Multivariate Analysis (MeSH), Patient Care Planning (MeSH), Pleural Effusion (MeSH), Posture (MeSH), Prognosis (MeSH), Prospective Studies (MeSH), Respiration, Artificial (MeSH), Respiratory Distress Syndrome, Adult (mortality), Respiratory Distress Syndrome, Adult (therapy), Ventilation-Perfusion Ratio (MeSH).
- MESH :
- chemical , therapeutic use : Almitrine, Diuretics.
- mortality : Respiratory Distress Syndrome, Adult.
- therapy : Respiratory Distress Syndrome, Adult.
- Adolescent, Adult, Analysis of Variance, Drainage, Female, Hemofiltration, Humans, Male, Middle Aged, Multivariate Analysis, Patient Care Planning, Pleural Effusion, Posture, Prognosis, Prospective Studies, Respiration, Artificial, Ventilation-Perfusion Ratio.
Abstract
STUDY OBJECTIVE
Evaluate the interest of the response to a therapeutic optimization as a predictor of prognosis in ARDS.
DESIGN
Prospective study.
SETTING
ICU of a University Hospital.
PATIENTS
Thirty-six consecutive patients with severe ARDS addressed for extracorporeal carbon dioxide removal (ECCO2R).
INTERVENTIONS
We studied the response during the first 2 days after arrival to the therapeutic optimization strategy consisting in a combination of the following: (1) decrease in extravascular lung water (diuretics or hemofiltration); (2) selection of the best ventilatory mode; (3) permissive hypercarbia; and (4) correction of hypoxemia by alveolar recruitment, additional continuous oxygen insufflation, body position changes (prone position), inhaled nitric oxide, enhancement of hypoxic pulmonary vasoconstriction with almitrine, and drainage of pleural or mediastinal effusions. In patients remaining severely hypoxemic despite these modalities, ECCO2R was then proposed.
MEASUREMENTS AND RESULTS
Thirty-six patients were addressed after 8.3+/-5.5 days of mechanical ventilation. On arrival, mean simplified acute physiologic score was 46.8+/-14.2, multiple system organ failure score was 1.8+/-1.6, Murray score was 3.4+/-0.4, PaO2 was 75.3+/-31.3 (fraction of inspired oxygen [FIO2]=1) for a positive end-expiratory pressure level of 12.3+/-3.4 cm H2O. Nineteen of 36 patients improved their gas exchange within 2 days and their mortality was 21%. The seventeen remaining patients did not improve PaO2/FIO2; PaCO2 and airway pressures remained high and their mortality was 88%. This different response to therapeutic optimization appeared using stepwise logistic regression as the most predictive factor for mortality (p<0.05).
CONCLUSIONS
In patients with severe ARDS, the response to an early performed therapeutic optimization used to improve hypoxemia appeared to be a highly discriminant factor distinguishing deceased from surviving patients.
DOI: 10.1378/chest.111.4.1000
PubMed: 9106581
Affiliations:
Links toward previous steps (curation, corpus...)
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Beloucif</name></author><author><name sortKey="Gatecel, C" sort="Gatecel, C" uniqKey="Gatecel C" first="C" last="Gatecel">C. Gatecel</name></author><author><name sortKey="Mateo, J" sort="Mateo, J" uniqKey="Mateo J" first="J" last="Mateo">J. Mateo</name></author><author><name sortKey="Payen, D" sort="Payen, D" uniqKey="Payen D" first="D" last="Payen">D. 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Guinard</name><affiliation wicri:level="3"><nlm:affiliation>Department of Anesthesiology and Critical Care Medicine, Hôpital Universitaire Lariboisière, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Anesthesiology and Critical Care Medicine, Hôpital Universitaire Lariboisière, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Beloucif, S" sort="Beloucif, S" uniqKey="Beloucif S" first="S" last="Beloucif">S. Beloucif</name></author><author><name sortKey="Gatecel, C" sort="Gatecel, C" uniqKey="Gatecel C" first="C" last="Gatecel">C. Gatecel</name></author><author><name sortKey="Mateo, J" sort="Mateo, J" uniqKey="Mateo J" first="J" last="Mateo">J. Mateo</name></author><author><name sortKey="Payen, D" sort="Payen, D" uniqKey="Payen D" first="D" last="Payen">D. Payen</name></author></analytic><series><title level="j">Chest</title><idno type="ISSN">0012-3692</idno><imprint><date when="1997" type="published">1997</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Almitrine (therapeutic use)</term><term>Analysis of Variance (MeSH)</term><term>Diuretics (therapeutic use)</term><term>Drainage (MeSH)</term><term>Female (MeSH)</term><term>Hemofiltration (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Multivariate Analysis (MeSH)</term><term>Patient Care Planning (MeSH)</term><term>Pleural Effusion (MeSH)</term><term>Posture (MeSH)</term><term>Prognosis (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Respiration, Artificial (MeSH)</term><term>Respiratory Distress Syndrome, Adult (mortality)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term><term>Ventilation-Perfusion Ratio (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Almitrine (usage thérapeutique)</term><term>Analyse de variance (MeSH)</term><term>Analyse multifactorielle (MeSH)</term><term>Diurétiques (usage thérapeutique)</term><term>Drainage (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Hémofiltration (MeSH)</term><term>Mâle (MeSH)</term><term>Planification des soins du patient (MeSH)</term><term>Posture (MeSH)</term><term>Pronostic (MeSH)</term><term>Rapport ventilation-perfusion (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (mortalité)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation artificielle (MeSH)</term><term>Épanchement pleural (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Almitrine</term><term>Diuretics</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Almitrine</term><term>Diurétiques</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Analysis of Variance</term><term>Drainage</term><term>Female</term><term>Hemofiltration</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Patient Care Planning</term><term>Pleural Effusion</term><term>Posture</term><term>Prognosis</term><term>Prospective Studies</term><term>Respiration, Artificial</term><term>Ventilation-Perfusion Ratio</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de variance</term><term>Analyse multifactorielle</term><term>Drainage</term><term>Femelle</term><term>Humains</term><term>Hémofiltration</term><term>Mâle</term><term>Planification des soins du patient</term><term>Posture</term><term>Pronostic</term><term>Rapport ventilation-perfusion</term><term>Ventilation artificielle</term><term>Épanchement pleural</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>STUDY OBJECTIVE</b></p><p>Evaluate the interest of the response to a therapeutic optimization as a predictor of prognosis in ARDS.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>Prospective study.</p></div><div type="abstract" xml:lang="en"><p><b>SETTING</b></p><p>ICU of a University Hospital.</p></div><div type="abstract" xml:lang="en"><p><b>PATIENTS</b></p><p>Thirty-six consecutive patients with severe ARDS addressed for extracorporeal carbon dioxide removal (ECCO2R).</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>We studied the response during the first 2 days after arrival to the therapeutic optimization strategy consisting in a combination of the following: (1) decrease in extravascular lung water (diuretics or hemofiltration); (2) selection of the best ventilatory mode; (3) permissive hypercarbia; and (4) correction of hypoxemia by alveolar recruitment, additional continuous oxygen insufflation, body position changes (prone position), inhaled nitric oxide, enhancement of hypoxic pulmonary vasoconstriction with almitrine, and drainage of pleural or mediastinal effusions. In patients remaining severely hypoxemic despite these modalities, ECCO2R was then proposed.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND RESULTS</b></p><p>Thirty-six patients were addressed after 8.3+/-5.5 days of mechanical ventilation. On arrival, mean simplified acute physiologic score was 46.8+/-14.2, multiple system organ failure score was 1.8+/-1.6, Murray score was 3.4+/-0.4, PaO2 was 75.3+/-31.3 (fraction of inspired oxygen [FIO2]=1) for a positive end-expiratory pressure level of 12.3+/-3.4 cm H2O. Nineteen of 36 patients improved their gas exchange within 2 days and their mortality was 21%. The seventeen remaining patients did not improve PaO2/FIO2; PaCO2 and airway pressures remained high and their mortality was 88%. This different response to therapeutic optimization appeared using stepwise logistic regression as the most predictive factor for mortality (p<0.05).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In patients with severe ARDS, the response to an early performed therapeutic optimization used to improve hypoxemia appeared to be a highly discriminant factor distinguishing deceased from surviving patients.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">9106581</PMID><DateCompleted><Year>1997</Year><Month>05</Month><Day>02</Day></DateCompleted><DateRevised><Year>2019</Year><Month>05</Month><Day>14</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0012-3692</ISSN><JournalIssue CitedMedium="Print"><Volume>111</Volume><Issue>4</Issue><PubDate><Year>1997</Year><Month>Apr</Month></PubDate></JournalIssue><Title>Chest</Title></Journal><ArticleTitle>Interest of a therapeutic optimization strategy in severe ARDS.</ArticleTitle><Pagination><MedlinePgn>1000-7</MedlinePgn></Pagination><Abstract><AbstractText Label="STUDY OBJECTIVE" NlmCategory="OBJECTIVE">Evaluate the interest of the response to a therapeutic optimization as a predictor of prognosis in ARDS.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">Prospective study.</AbstractText><AbstractText Label="SETTING" NlmCategory="METHODS">ICU of a University Hospital.</AbstractText><AbstractText Label="PATIENTS" NlmCategory="METHODS">Thirty-six consecutive patients with severe ARDS addressed for extracorporeal carbon dioxide removal (ECCO2R).</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">We studied the response during the first 2 days after arrival to the therapeutic optimization strategy consisting in a combination of the following: (1) decrease in extravascular lung water (diuretics or hemofiltration); (2) selection of the best ventilatory mode; (3) permissive hypercarbia; and (4) correction of hypoxemia by alveolar recruitment, additional continuous oxygen insufflation, body position changes (prone position), inhaled nitric oxide, enhancement of hypoxic pulmonary vasoconstriction with almitrine, and drainage of pleural or mediastinal effusions. In patients remaining severely hypoxemic despite these modalities, ECCO2R was then proposed.</AbstractText><AbstractText Label="MEASUREMENTS AND RESULTS" NlmCategory="RESULTS">Thirty-six patients were addressed after 8.3+/-5.5 days of mechanical ventilation. On arrival, mean simplified acute physiologic score was 46.8+/-14.2, multiple system organ failure score was 1.8+/-1.6, Murray score was 3.4+/-0.4, PaO2 was 75.3+/-31.3 (fraction of inspired oxygen [FIO2]=1) for a positive end-expiratory pressure level of 12.3+/-3.4 cm H2O. Nineteen of 36 patients improved their gas exchange within 2 days and their mortality was 21%. The seventeen remaining patients did not improve PaO2/FIO2; PaCO2 and airway pressures remained high and their mortality was 88%. This different response to therapeutic optimization appeared using stepwise logistic regression as the most predictive factor for mortality (p<0.05).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">In patients with severe ARDS, the response to an early performed therapeutic optimization used to improve hypoxemia appeared to be a highly discriminant factor distinguishing deceased from surviving patients.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Guinard</LastName><ForeName>N</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Critical Care Medicine, Hôpital Universitaire Lariboisière, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Beloucif</LastName><ForeName>S</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Gatecel</LastName><ForeName>C</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Mateo</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Payen</LastName><ForeName>D</ForeName><Initials>D</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Chest</MedlineTA><NlmUniqueID>0231335</NlmUniqueID><ISSNLinking>0012-3692</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D004232">Diuretics</NameOfSubstance></Chemical><Chemical><RegistryNumber>9A1222NBG4</RegistryNumber><NameOfSubstance UI="D015765">Almitrine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Chest. 1997 Apr;111(4):845-6</RefSource><PMID Version="1">9106557</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015765" MajorTopicYN="N">Almitrine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000704" MajorTopicYN="N">Analysis of Variance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004232" MajorTopicYN="N">Diuretics</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004322" MajorTopicYN="N">Drainage</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006440" MajorTopicYN="N">Hemofiltration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010347" MajorTopicYN="N">Patient Care Planning</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010996" MajorTopicYN="N">Pleural Effusion</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011187" MajorTopicYN="N">Posture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014692" MajorTopicYN="N">Ventilation-Perfusion Ratio</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1997</Year><Month>4</Month><Day>1</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1997</Year><Month>4</Month><Day>1</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1997</Year><Month>4</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">9106581</ArticleId><ArticleId IdType="pii">S0012-3692(15)46863-1</ArticleId><ArticleId IdType="doi">10.1378/chest.111.4.1000</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><noCountry><name sortKey="Beloucif, S" sort="Beloucif, S" uniqKey="Beloucif S" first="S" last="Beloucif">S. Beloucif</name><name sortKey="Gatecel, C" sort="Gatecel, C" uniqKey="Gatecel C" first="C" last="Gatecel">C. Gatecel</name><name sortKey="Mateo, J" sort="Mateo, J" uniqKey="Mateo J" first="J" last="Mateo">J. Mateo</name><name sortKey="Payen, D" sort="Payen, D" uniqKey="Payen D" first="D" last="Payen">D. Payen</name></noCountry><country name="France"><region name="Île-de-France"><name sortKey="Guinard, N" sort="Guinard, N" uniqKey="Guinard N" first="N" last="Guinard">N. Guinard</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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