#ards — Public Fediverse posts
Live and recent posts from across the Fediverse tagged #ards, aggregated by home.social.
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Mhm ob cash wirklich gegen #ards hilft?🤔
https://en.m.wikipedia.org/wiki/Acute_respiratory_distress_syndrome
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But yes, it's #BusinessAsUsual because #Crapitalism requires people to #ConsumeConsumeConsume!
Canadian teen with #BirdFlu was on #LifeSupport, new report reveals
The hospitalized teen was also given three #antiviral treatments, underscoring how severe #H5N1 infection can be
By Nicole Karlis, January 6, 2025
"In November, a teenager in British Columbia was infected and hospitalized with bird flu, caused by the H5N1 virus. While most cases have been mild, commonly characterized by #conjunctivitis and respiratory symptoms, this previously healthy Canadian teen was hospitalized from the virus in critical condition. Their symptoms started with double conjunctivitis, also known as pink eye, and turned into a fever and coughing. A few days later the teenager was admitted to intensive care after developing acute respiratory distress syndrome [#ARDS].
"'This was a healthy teenager prior to this, so no underlying conditions,' said British Columbia’s health officer, Bonnie Henry, at a news conference at the time. 'It just reminds us that in young people this is a virus that can progress and cause quite severe illness.'
"Now, a recent report brings to light more details about the teenager’s case. In the report, published in the New England Journal of Medicine (NEJM), researchers explain that the 13-year-old girl spent weeks fighting for her life after contracting a severe H5N1 infection from an unknown source. In finding her diagnosis, researchers say that she initially tested positive for influenza A, but not the seasonal subtype. Further testing suggested she had a high viral load of a novel influenza A infection, which researchers discovered to be the H5N1 avian flu.
"The next day doctors started her on oseltamivir, also known under the brand name Tamiflu. However, her respiratory functions declined rapidly causing her to be intubated. She was also placed on extracorporeal membrane oxygenation (ECMO), a machine that is a form of life support for people with life-threatening illnesses. In addition to the ECMO machine, the teenager received a plasma exchange and two more antiviral medication treatments — amantadine and baloxavir.
"In an accompanying editorial, experts noted while mutations were detected in her case, it’s 'unclear whether these #mutations were present in the infecting virus or emerged during the course of the patient’s illness.'
"In other words, it’s unclear if the virus #mutated to be more severe in humans.
"'The mutations evident in the Canadian case highlight the urgent need for vigilant surveillance of emerging mutations and assessment of the threat of human-to-human transmission,' the editorial stated, adding that vaccine development and therapeutics are also needed — perhaps to treat more severe illness. 'The Canadian case showed higher viral loads in the lower airway and very prolonged shedding, despite therapy, which highlights the potential need for longer therapy.'
"Researchers concluded their editorial with an acknowledgment that 'many questions remain.' For example, the severity of cases is likely to depend on host immunity, the route of exposure, or other changes in the virus.
"Currently, the CDC says that the risk to most Americans remains low.
"'We do have candidate vaccines and antivirals available to try to mitigate severe influenza in the case of wider spread,' the report stated. 'That said, a balance between enhanced vigilance and ‘business as usual’ is needed."
https://www.salon.com/2025/01/06/new-report-on-severe-case-of-canadian-teen-with-bird-flu/
#HPAI #BirdFluMutations #Flu -
CW: H5N1 / bird flu / ARDS
"Canadian teen in critical condition with suspected bird flu; source of exposure is unknown
The teen has been receiving care at BC Children’s Hospital in Vancouver since Friday, the same day an initial test came back positive for H5 influenza. Government testing confirmed that the strain is H5N1. The young person’s first symptoms, which began a week before they were hospitalized, were conjunctivitis or red eyes, fever and cough, said Dr. Bonnie Henry, an epidemiologist who is the provincial health officer for British Columbia. The illness has progressed to acute respiratory distress syndrome, or ARDS. People with ARDS typically need help breathing with machines such as a ventilator, but officials did not offer specifics on the teen’s treatment except to say they’re receiving antiviral medications. This is the first known human case of bird flu acquired in Canada. The country had one case in 2014, which was travel-related, Henry said. It is still unknown how the teen caught this strain of flu, which has been circulating widely in wild birds, poultry and some mammals, including cattle in North America since 2022."
Source: CNN, shared by Adam Tooze https://adamtooze.substack.com/
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Neue Studie im #JTH von @uniklinikum_Wue zeigt, dass #ECMO bei #ARDS zu Veränderungen in #Thrombozyten führt. Der #GPV-Rezeptor auf den #Blutplättchen wurde als mögliches Ziel zur Vermeidung von Blutungen identifiziert.
https://nachrichten.idw-online.de/2024/06/18/veraenderte-thrombozyten-unter-ecmo-erhoehen-sterberisiko-neue-ansaetze-zur-blutungspraevention -
🫁 Pleural pressure & airway closure during mechanical ventilation? Some physiological considerations at the bedside...
🔓 https://rdcu.be/dKXPr
In reply to
🔓 https://rdcu.be/dKXPzDiscussion refers to editorial on esophageal pressure monitoring in #ARDS
🔓 https://rdcu.be/dKXPM -
Developing AKI & after #ARDS? Individual patient-data analysis
🔍> 5K patients enrolled in 10 multicenter RCTs conducted over 20 years,
🫘incidence of AKI stable over time, overall 43.7% (from 38.8% in ARMA, to 55.8% in ROSE)
🫘 37.1% recovered rapidly from AKI; lower recovery rate in recent trials
🪦 90-day excess in mortality attributable to AKI 15.4% (decreasing from ARMA to FACTT then stable over time: AKI remains significant contributing factor to mortality.
🖇️ http://bit.ly/3XiMqfq -
Finding optimal tidal volume in #ARDS
🫁 is ΔP indicator of unsafe VT & does it directly impact on outcome?
🫁 what factors can influence CRS + interplay between VT & ΔP?
We should continue using protective mechanical ventilation but, rather than fixed cut-of (6 ml/kg PBW) it may be more advantageous individualize VT considering multifactorial contribution of ∆P, CRS, ECW, PEEP + regional lung mechanics.
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dHUzd -
#ARDS guidelines, ESICM vs ATS??
🌊 Both reached similar conclusions. emphasizing challenges in issuing blanket recommendations that apply to all patients + importance of individualising patient care.
🔓 https://rdcu.be/dHb9X
🚇 Mind gap! Underscores need for collaboration/dialogue between scientific societies to develop synergistic clinical (living) guidelines.
🔓 https://rdcu.be/dHcav
🫁 Guidelines can be useful in certain situations, but should not replace reasoning!
🔓 https://rdcu.be/dHb8e -
⏱️ #ARDS? first 24 h should be time stamped:
1️⃣ 🔍 first 3h of non-invasive/invasive respiratory support: rule in diagnosis
2️⃣ ⚖️ first 12h: decide to continue NIV or institute IMV
3️⃣ 🫁 first 6h: implement low Vt strategies & optimization based on Pplat & DP
4️⃣ 🫁 first 12h: Initiate/optimize PEEP
5️⃣ 🛌 first 12-24h: prone eligible pts
6️⃣ 🩸 first 3-6h: #ECLS in patients meeting EOLIA criteria, depending on severity + response to previous interventions + risk/benefit profile
🔓 https://rdcu.be/dGXCI -
Prone positioning on #ECMO for severe #ARDS??
🚦PRO: Performed in experienced/highly specialized centers, PP feasible/safe promising option
🔓 https://rdcu.be/dGIMf
🚦CON: according to PRONECMO trial results, PP during #ECLS did not yield significant benefits vs supine position.
🔓 https://rdcu.be/dGILB
🚦NOT SURE: How to reconcile the results of high-quality, negative RCT with preexisting favorable observational data?
🔓 https://rdcu.be/dGINm
All free to read #FOAMcc #FOAMecmo on @ICM -
🧠 🫁 Mitigating/managing cerebral complications of #ARDS?? Clinical decision making must integrate neuromonitoring-guided evaluation & selection of lung protective interventions with consideration of individual patient cerebral physiology. Individualized approach could prevent additional brain injury, improving neurological outcomes in survivors, potentially impact on post-intensive care syndrome outcomes.
Free to read #FOAMcc on @ICM
🔓 https://bit.ly/4djO8mh -
Safe ventilation in #ARDS?? Elusive... justifying use of #ECLS. Challenge is to treat lung disease effectively while mitigating injury risks. Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dGq5pIn reply to
🔓 https://rdcu.be/dGq6nAll refers to editorial on VILI
🔓https://rdcu.be/dGq6G -
Prone positioning?? Used since 70s to improve oxygenation in patients with #ARDS. Beyond oxygenation benefits, it plays crucial role in preventing VILI + in preserving/improving
hemodynamics, leading to reduced mortality in selected patients. Here concise overview:
🫁 main pathophysiological findings
🫁 supporting evidence & practical considerations for use
🫁 awake proning in non-intubated patients
Free to read #FOAMcc on Intensive Care Medicine
🔓 https://rdcu.be/dFIdO -
Lung ultrasound in #ARDS
🖥️ LUS examination in ARDS
🖥️ diagnosis
🖥️ management
LUS essential for diagnosing & managing ARDS due bedside accessibility/availability across different resource settings, aiding in diagnosis & monitoring of ARDS progression + treatment response, while also offering potential for subphenotyping. #POCUS #echofirst
🎥 PS check supplementary videos!!
🖇️ https://bit.ly/49VMTXw -
Optimizing PEEP in #ARDS, physiological evidence, bedside strategies & clinical applications:
❓ why do we apply PEEP?
🫁 definition of lung recruitability
🔍 what does the evidence say about PEEP setting?
🫁 practical & pragmatic approach
⚙️ advanced methods
No one among available options for tailoring PEEP proved to be superior to others... so clinical practice is highly variable; integration into clinical settings may be challenging.
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dDFbN -
One-year outcomes in #ARDS survivors: need for closer & more prolonged follow-up, particularly in those recovering from #COVID19! Results of follow-up 1 year after #ICU discharge of prospective multicentre 🇫🇷 study assessing symptoms of anxiety, depression, post-traumatic stress disorder:
🔍 mental health symptoms & psychological burden confirmed
🔍 swifter ⬇️ of PTSD symptoms + smaller variation in Mental Component Score if bacterial pneumonia or influenza vs #COVID19
🔓 https://rdcu.be/dC4JD -
DoN'T miss March issue of Intensive Care Medicine
🩸managing major haemorrhage in #ICU
🧫 infections in immunocompromised patients
🫁 #ECMO in #ARDS & 🫀cardiogenic shock
🧠 traumatic brain injury
🌱 environmental sustainability
📷 Imaging in ICM & more...
most free to read 🔓 #FOAMcc (just follow links in our #SoMe posts)
🖇️ bit.ly/ICMMar2024 -
Electrical impedance tomography-guided personalized PEEP titration in #ARDS, systematic review & meta-analysis:
🔍 13 studies (January 2012-May 2023) included, involving > 600 patients
🫁 EIT effective in guiding mechanical ventilation setting in patients with ARDS
🫁 real-time lung function assessment facilitated by EIT allows for personalized PEEP, resulting in enhanced lung compliance + reduced MP/DP
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dB6Fr -
Bedside strategies to personalise approach minimizing patient-self-induced & ventilator-induced lung injury (so risk of lung injury progression) in #ARDS patients
🫁 safer use of noninvasive respiratory support
🫁 safer use of controlled mechanical ventilation: tidal volume and driving pressure, prone position, PEEP & recruitability, transpulmonary pressure and end‑inspiratory lung stress
🫁 safer use of assisted modes & spontaneous breathing
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dBK1u -
#ECLS for #ARDS, systematic review & meta-analysis focused on long-term patients' outcomes:
📖 1 RCT + 31 observational studies included; lack of high-quality data: limited overall quality of evidence
⚠️ major sequelae common: 49% of survivors returning to work, 23% need home assistance
⚖️ #ECMO vs conventional mechanical ventilation? no significant difference in HRQoL, cognitive function, mental health, functional status, respiratory symptoms #FOAMcc #FOAMecmo on @ICM
🔓https://rdcu.be/dw7XC -
Happy Burns night 🏴
Enjoying a wee vintage 2021 bottle of Ards' Bushmills whiskey stout, 8.4% ABV and keeping the cockles warm. Slàinte Mhath.Here's a bottle and an honest friend!
What wad ye wish for mair, man?
Wha kens, before his life may end,
What his share may be o' care, man? -
Some super interesting results from stem cells for ARDS (used for their immunomodulatory properties) - tentatively positive and associated with IL-6/8 levels and mortality https://link.springer.com/epdf/10.1007/s00134-023-07262-x?sharing_token=fOIlXvejepBeYppSvNtH_ve4RwlQNchNByi7wbcMAY4ECWYGj8zKs7pOxs8vYlQ1gvaTP6H7qSmAr4ywGoklpLPEOEonqL_uo5CE_swueV1F4J4JCMRldGGe20uXGZqVu27yY6Z3RWY19uJd6PEul4tqX1XT6Pg_v9J45GsdMWw= #ards #icm #ccm
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Racial & ethnic minority participants in #ARDS randomized controlled clinical trials from North America (2000-2019)
📊 representation did not change significantly over time
📊 of > 5K participants with ARDS, 30.4% were Black, Hispanic or Other (including Asian, American Indian, Alaskan Native, Native Hawaiian, other Pacific Islander)
📊 in the 5 most recent trials no statistically significant differences in mortality between racial/ethnic groups, even after adjustment
🖇️ https://rdcu.be/drupM -
Decidual stromal cells in severe #COVID19 related #ARDS: in this pilot study from 🇨🇦, treating critically ill patients on mechanical ventilation with placenta-derived DSC appeared feasible & safe. In DSC-group, trend to increased survival to #ICU discharge, with no significant difference in #ICU stay; significantly higher survival to hospital discharge.
Free to read #FOAMcc on @ICM
🖇️ https://rdcu.be/drgkR -
🧪 Genetic profile & blood-based biomarkers involved in #ARDS? This study highlights that adding 4 blood genes & 5 immune cell proportions significantly enhanced the precision of acute respiratory distress syndrome risk prediction. These findings present a promising prediction model with potential clinical utility for risk assessment, early detection, and potential guidance of intervention strategies in the management of ARDS.
Free to read #FOAMcc on @ICM 🔓 https://rdcu.be/dqoxX -
Vaping related lung injury is more common with cannibinoid replacement/low dose/THC products - vitamin E acetate causes surfactant to crystallise causing derecruitment. Presents like viral pneumonitis - bilateral opacities, high CRP but low PCT, high temp (quite a few gastro symptoms in some case series too!). Diagnosis of exclusion. #pulmcrit #icu #MedMastodon #criticalcare #icm #intensivecare #ARDS
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ESICM guidelines on acute respiratory distress syndrome, from definition & phenotyping to respiratory support strategies:
🫁 #ARDS definition
🫁 phenotyping
🫁 high‑flow nasal oxygen #HFNO
🫁 CPAP/NIV
🫁 low tidal volume ventilation
🫁 PEEP & recruitment maneuvers
🫁 prone positioning
🫁 neuromuscular blocking agents
🫁 extracorporeal life support #ECMO #ECLS #ECCO2r
Open access #FOAMcc on @yourICM
🖇️ https://bit.ly/43J1OCe -
Some insights on the association of PEEP, CVP, or inflammation with worsening of renal function in (covid) ARDS.
Single center data from a bad time. Proud of the team for persevering. I think it tells us some interesting things.
https://www.accjournal.org/journal/view.php?doi=10.4266/acc.2022.01494
