Putting lungs under less stress

June 05, 2018

The numbers are grim: Of the 200,000 Americans diagnosed with Acute Respiratory Distress Syndrome (ARDS) each year, 30 to 50 percent will die. But, clinical researchers at the University of Missouri School of Medicine's division of Pulmonary, Critical Care and Environmental Medicine identified a less-invasive treatment option for patients with severely impaired lung function.

"Treating patients with ARDS has been historically difficult," said Hariharan Regunath, MD, an assistant professor of clinical medicine at the MU School of Medicine and medical director of the Progressive Care Unit at University Hospital. "These patients tend to be already very sick, and the nature of current interventions means a grueling recovery and possibly being transported to a far-away facility for specialized care. However, what we observed is that it's possible in some cases to significantly decrease the amount of air used by the ventilators used in this process, thereby mitigating further lung injury, which in turn might improve outcomes and access to care."

In a study that included 15 patients, Regunath and his team were able to use lower pressure volumes of ventilation than what is standard - 6 mL per kilogram of the patient's ideal weight - to in some cases as low as 2 mL per kilogram. The researchers referred to this option as "ultra-protective mechanical ventilation," as it creates less risk for typical lung injuries such as hyperinflation and barotrauma.

Regunath noted that this is significant because patients did not require extracorporeal carbon dioxide removal, or ECCO2R, which removes the CO2 produced by the human body using a device commonly called ECMO (extracorporeal membrane oxygenation). Gas exchange is important, as the patient's blood can become acidic if excess carbon dioxide is allowed to build up. However, many referral facilities in the United States and worldwide do not have the ECMO equipment or the expertise for ECCO2R in-house, and often those patients who would most benefit from this type of treatment are too sick for transporting to far-away hospitals with established expertise.

The patients Regunath and his team observed showed only slightly elevated carbon dioxide levels despite not using ECCO2R, and the mortality rate for these patients did not increase.

"The results of this preliminary study highlight two important points," Regunath said. "One, smaller hospitals and referral hospitals in rural areas caring for sick ARDS patients might be able to continue to treat patients closer to their homes rather than transporting them to far away hospitals for ECCO2R. Two, patients who already are struggling to recover from severe illnesses such as ARDS might not have to undergo invasive treatments such as ECCO2R, which carry the potential to make them even sicker from device-related complications. Ultimately, it's important to take an individualized approach to patient care for ARDS."

In addition to Regunath, other researchers in the study included Mohammed Alnijoumi, MD; Troy Whitacre, RRT; and Jonathan Collins, MD.

The study authors declared no potential conflicts of interest with respect to research, authorship and/or publication of this article and received no financial support for the research. The study, "Ultra-protective Mechanical Ventilation without Extra-corporeal Carbon Dioxide Removal for Acute Respiratory Distress Syndrome," was recently published in the Journal of the Intensive Care Society.
-end-


University of Missouri-Columbia

Related Critical Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

New strategies suggested for critical heart care in the ICU
Critically ill heart patients are at increased risk of complications that are potentially preventable and associated with death, longer hospital stays and higher costs.

Capital funding of health care in Canada is critical, yet declined in last 20 years
Capital funding of health care, used to build new hospitals, redesign or upgrade existing facilities and invest in new technologies, has declined in Canada over the last 20 years, according to an analysis in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.191126.

Mortality of mechanically ventilated COVID-19 patients is lower than previously reported reveals study in Critical Care Medicine
An online first study published in Critical Care Medicine indicates the actual mortality rate of adults with critical illness from COVID-19 is less than what was previously reported.

COVID-19 critical care bed modelling study: potential shortage in Canada
A national modelling paper predicting the number of available ICU beds across Canada during the COVID-19 pandemic suggests that self-isolation will likely not be enough to keep demand from exceeding supply.

Covid-19 tool allows health leaders to plan for critical care surge
The challenges of COVID-19 will require hospital leaders, practitioners and regional officials to adopt drastic measures that challenge the standard way of providing care.

Critical care surgery team develops blueprint for essential operations during COVID-19
To help guide hospital surgery departments through this crisis, the acute surgery division at Atrium Health's Carolinas Medical Center in Charlotte, N.C., has developed a tiered plan for marshaling limited resources.

Study: Critical care improvements may differ depending on hospital's patient population
A new study led by researchers at Beth Israel Deaconess Medical Center reveals that while critical care outcomes in ICUs steadily improved over a decade at hospitals with few minority patients, ICUs with a more diverse patient population did not progress comparably.

Study finds disparity in critical care deaths between non-minority and minority hospitals
While deaths steadily declined over a decade in intensive care units at hospitals with few minority patients, in ICUs with large numbers of minority patients, there was less improvement, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Hospital critical care resuscitation unit improves patients' chances of survival
Patients with acutely life-threatening health conditions who were treated in the innovative Critical Care Resuscitation Unit (CCRU) received faster treatment and had better health outcomes, including a 36 percent lower risk of dying than those who were transferred from a hospital's emergency department then evaluated and treated in a traditional intensive care unit, according to a recent study in the Journal of Emergency Medicine conducted by researchers at the University of Maryland School of Medicine.

Read More: Critical Care News and Critical Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.