C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO最新文献

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Transvenous Diaphragm Neurostimulation Reduces Mechanical Power in a Ventilated Preclinical Moderate-ARDS Model 经静脉膈神经刺激降低临床前中度急性呼吸窘迫综合征通气模型的机械功率

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4907

E. Rohrs, T. Bassi, M. Nicholas, J. Wittmann, M. Ornowska, K. Fernandez, S. Reynolds

引用次数: 2

Immunosuppression May Modify Performance of Biomarker-Based ARDS Phenotype Classifiers 免疫抑制可能改变基于生物标志物的ARDS表型分类器的性能

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4898

H. Giannini, C. Cosgriff, T. Miano, A. Weisman, C. Ittner, B. J. Anderson, T. Jones, T. Dunn, R. Agyekum, M. Shashaty, C. Calfee, P. Sinha, J. Reilly, N. Meyer

引用次数: 0

Plasma Metabolic Profiles of Hyperinflammatory and Hypoinflammatory ARDS May Implicate Glycolytic Shift 高炎性和低炎性ARDS的血浆代谢谱可能与糖酵解移位有关

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5787

N. Alipanah-Lechner, E. Mick, L. Neyton, A. Willmore, A. Leligdowicz, A. Jauregui, H. Zhuo, C. Hendrickson, A. Gomez, P. Sinha, K. Kangelaris, K. Liu, M. Matthay, A. Rogers, C. Calfee

引用次数: 0

WWOX Demonstrates Ancestry-Specific Genetic Associations with ARDS Risk in Sepsis WWOX证实与败血症患者急性呼吸窘迫综合征风险的遗传特异性关联

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5785

T. Jones, R. Feng, J. Reilly, B. J. Anderson, H. Giannini, T. Dunn, R. Agyekum, C. Cosgriff, A. Turner, C.C. Ittner, A. Weisman, T. Miano, M. Shashaty, N. Meyer

引用次数: 0

Reversible Sepsis Induced Diaphragm Dysfunction in Mechanically Ventilated Patients 机械通气患者可逆性败血症诱发膈肌功能障碍

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4902

M. Dres, M. Lecronier, B. Jung, N. Molinari, J. Pinot, S. Jaber, T. Similowski, A. Demoule

引用次数: 0

A Two-Hit Model of Sepsis Plus Hyperoxia Causes Lung Permeability and Inflammation 脓毒症加高氧导致肺通透性和炎症的双重打击模型

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4900

J. Bastarache, K. Smith, J. Jesse, N. Putz, J. Meegan, A. Bogart, K. Schaaf, S. Ghosh, C. Shaver, L. Ware

引用次数: 0

Electrical Impedance Tomography Displays Ventilation and Perfusion Mismatch with Pronation in an Animal Model of Late-Stage Lung Injury 电阻抗断层扫描显示晚期肺损伤动物模型的通气和灌注不匹配

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4908

K. Martin, Y. Xin, A. Lenart, M. Petrov, J. Shen, K. Rozenberg, S. Humayun, L. Staelin, T. Kim, U. Sidhu, P. Shah, S. Bathula, K. Reutlinger, M. Staley, P. Delvecchio, J. Barakat, S. Sarfaraz-Khan, C. Morais, R. Rizi, L. Berra, M. Cereda

引用次数: 0

Trends in Patients at Risk for Prolonged Mechanical Ventilation, 2011-2019 2011-2019年有延长机械通气风险的患者趋势

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4904

A. Law, W. Tian, Y. Song, J. Stevens, A. Walkey

Rationale Patients receiving what has been termed “prolonged acute mechanical ventilation” (PAMV, i.e. mechanical ventilation [MV] >96 hours) consume a disproportionate share of hospital and post-acute resources, and a third progress to prolonged mechanical ventilation (MV>14-21 days). Prior estimates (based on 2000-2008 annual growth rates) projected that the incidence of PAMV in 2020 could overwhelm healthcare systems. However, actual trends in incidence and outcomes of PAMV in the last decade, especially just preceding the COVID-19 pandemic, are unclear. Methods Using Medicare Provider Analysis and Review and Master Beneficiary Summary Files from the Center for Medicare and Medicaid Services, we conducted a retrospective cohort study of Medicare fee-for-service beneficiaries >65 years hospitalized between January 1, 2011- December 31, 2019 with admission to an intensive care unit (ICU) who received PAMV (MV>96 hours [ICD-9 96.72 or ICD-10 5A1955Z procedure codes]). We determined annual rates of PAMV out of total MV (ICD-9 96.7, 96.71, 96.72;ICD10 5A1935Z, 5A1945Z, 5A1955Z) and used US Census Bureau population estimates of adults >65 years to derive annual populationstandardized rates of PAMV. Among patients receiving PAMV, we determined annual rates of tracheostomies, median hospital and ICU length of stay, discharge destination, and 90-day and 1-year mortality. We tested for significant trends with Cochrane- Armitage (binary), Cochran-Mantel-Haenszel (categorical) and Jonckheere-Terpstra (continuous outcomes) tests. Results From 2011-2019, a total of 646,677 patients met inclusion criteria. Population-standardized incidence of PAMV decreased from 189 per 100,000 adults >65 years to 112 per 100,000 adults (78,504 to 60,625 individuals, p<0.001), concurrent with a decrease in the total MV population (210,791 to 189,414) and decrease in proportion of PAMV/MV (37% to 32%) (Figure 1). Tracheostomy rates among patients receiving PAMV declined from 21% to 17.5% (p<0.001). Median ICU and hospital length of stay declined from 13 to 12 days (p<0.001) and 16 to 15 days (p<0.001), respectively. Discharge to long-term acute care hospitals was stable at ∼17%;discharge to skilled nursing facilities decreased from 22% to 20% and discharge to hospice increased from 7% to 10% (p<0.001). 90-day mortality increased slightly (61.2% to 62.3% [p=0.01]);1-year mortality remained stable (∼72% [p=0.19]). Conclusions Contrary to prior estimates, the incidence of PAMV declined from 2011-2019. Furthermore, tracheostomy placement and skilled nursing facility use declined with a concurrent increase in hospice use, trends that may reflect improved alignment with patient goals of care. The impact of COVID-19 on incidence of PAMV is unclear. (Figure Presented).

理由:接受所谓“延长急性机械通气”(PAMV，即机械通气[MV] >96小时)的患者消耗了不成比例的医院和急性后资源，第三阶段进展为延长机械通气(MV>14-21天)。先前的估计(基于2000-2008年的年增长率)预测，2020年PAMV的发病率可能会使医疗保健系统不堪重负。然而，在过去十年中，特别是在COVID-19大流行之前，PAMV的发病率和结局的实际趋势尚不清楚。方法利用医疗保险提供者分析与回顾以及医疗保险和医疗补助服务中心的总受益人摘要文件，我们对2011年1月1日至2019年12月31日期间入住重症监护病房(ICU)接受PAMV (MV>96小时[ICD-9 96.72或ICD-10 5A1955Z程序代码])的65岁以上医疗保险按服务收费受益人进行了回顾性队列研究。我们确定了PAMV在总MV中的年率(ICD-9 96.7, 96.71, 96.72; icd - 10 5A1935Z, 5A1945Z, 5A1955Z)，并使用美国人口普查局65岁以上成年人的人口估计值得出PAMV的年人口标准化率。在接受PAMV治疗的患者中，我们确定了气管切开术的年发生率、住院和ICU住院时间的中位数、出院目的地、90天和1年死亡率。我们用Cochrane- Armitage(二元)、Cochrane- mantel - haenszel(分类)和Jonckheere-Terpstra(连续结果)检验了显著趋势。结果2011-2019年，共有646677例患者符合纳入标准。人群标准化的PAMV发病率从189 / 100,000 >65岁成人下降到112 / 100,000(78,504至60,625人，p<0.001)，同时MV总人群减少(210,791至189,414人)，PAMV/MV比例下降(37%至32%)(图1)。接受PAMV患者的气管切开术率从21%下降到17.5% (p<0.001)。ICU和住院时间中位数分别从13天降至12天(p<0.001)和16天降至15天(p<0.001)。长期急症护理医院的出院率稳定在17%左右;熟练护理机构的出院率从22%下降到20%，临终关怀医院的出院率从7%上升到10% (p<0.001)。90天死亡率略有上升(61.2% ~ 62.3% [p=0.01]);1年死亡率保持稳定(~ 72% [p=0.19])。与先前的估计相反，2011-2019年PAMV的发病率有所下降。此外，气管切开术的位置和熟练护理设施的使用随着临终关怀使用的增加而下降，趋势可能反映了与患者护理目标的改进一致性。COVID-19对PAMV发病率的影响尚不清楚。(图)。

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引用次数: 0

Dynamic Interaction Between Positive End Expiratory Pressure and Pronation Therapy Among Progressive Stages of Lung Injury Using Electrical Impedance Tomography in a Pig Model of Acute Respiratory Distress Syndrome 在猪急性呼吸窘迫综合征模型中使用电阻抗断层扫描观察肺损伤进展阶段呼气末正压和旋前治疗的动态相互作用

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4901

K. Martin, Y. Xin, A. Lenart, M. Petrov, J. Shen, K. Rozenberg, L. Staelin, T. Kim, U. Sidhu, P. Shah, S. Bathula, K. Reutlinger, M. Staley, P. Delvecchio, J. Barakat, S. Sarfaraz-Khan, C. Morais, R. Rizi, L. Berra, M. Cereda

引用次数: 0

Thoracic Fluid Content (TFC) Changes Predict Dynamic Fluid Responsiveness in Septic Shock Patients: Secondary Analysis of Fluid Responsiveness Evaluation in Sepsis Hypotension and Shock (FRESH) 胸腔液体含量(TFC)变化预测脓毒症休克患者的动态液体反应性:脓毒症低血压和休克的液体反应性评价的二次分析

C104. CHANGE IS HAPPENING AT A RAPID RATE: ARDS AND MECHANICAL VENTILATION, GO

Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4905

I. Douglas, J. Sahatjian, L. Hayward, D. Hansell, FRESH Investigators

引用次数: 0

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