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Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome
(Springer Science and Business Media LLC, 2025-05-31)
Alexis Lambour
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Yoann Zerbib
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Pablo Mercado
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Loay Kontar
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Bertrand De Cagny
1
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Machine learning-based identification of efficient and restrictive physiological subphenotypes in acute respiratory distress syndrome
(Springer Science and Business Media LLC, 2025-03-01)
Gabriela Meza-Fuentes
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DELGADO BECERRA, OROZIMBA IRIS
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Mario Barbé
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Ignacio Sánchez
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RETAMAL LUCERO, MAURICIO ANTONIO
Acute respiratory distress syndrome (ARDS) is a severe condition with high morbidity and mortality, characterized by significant clinical heterogeneity. This heterogeneity complicates treatment selection and patient inclusion in clinical trials. Therefore, the objective of this study is to identify physiological subphenotypes of ARDS using machine learning, and to determine ventilatory variables that can effectively discriminate between these subphenotypes in a bedside setting with high performance, highlighting potential utility for future clinical stratification approaches.</jats:p> Methodology A retrospective cohort study was conducted using data from our ICU, covering admissions from 2017 to 2021. The study included 224 patients over 18 years of age diagnosed with ARDS according to the Berlin criteria and undergoing invasive mechanical ventilation (IMV). Data on physiological and ventilatory variables were collected during the first 24 h IMV. We applied machine learning techniques to categorize subphenotypes in ARDS patients. Initially, we employed the unsupervised Gaussian Mixture Classification Model approach to group patients into subphenotypes. Subsequently, we applied supervised models such as XGBoost to perform root cause analysis, evaluate the classification of patients into these subgroups, and measure their performance.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Our models identified two ARDS subphenotypes with significant clinical differences and significant outcomes. Subphenotype Efficient (<jats:italic>n</jats:italic> = 172) was characterized by lower mortality, lower clinical severity and presented a less restrictive pattern with better gas exchange compared to Subphenotype Restrictive (<jats:italic>n</jats:italic> = 52), which showed the opposite. The models demonstrated high performance with an area under the ROC curve of 0.94, sensitivity of 94.2% and specificity of 87.5%, in addition to an F1 score of 0.85. The most influential variables in the discrimination of subphenotypes were distension pressure, respiratory frequency and exhaled carbon dioxide volume.Conclusion This study presents an approach to improve subphenotype categorization in ARDS. The generation of clustering and prediction models by machine learning involving clinical, ventilatory mechanics, and gas exchange variables allowed for more accurate stratification of patients. These findings have the potential to optimize individualized treatment selection and improve clinical outcomes in patients with ARDS.</jats:p> Graphical Abstract
Scopus© Citations 2 5
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Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study
(2012)
Pablo Cruces
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Alejandro Donoso
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Jorge Valenzuela
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Franco Díaz
BackgroundLittle is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. MethodsWe enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (C-dyn) and gas exchange 1, 12, and 24hr after the RM. ResultsWe included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2)kg, median PaO2/FIO2 117 (96-139), and median C-dyn 0.48 (0.41-0.68)ml/cmH(2)O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, C-dyn, and PaO2/FIO2 increased significantly (P<0.01 each), without changes in PaCO2 (P=0.4). A >25% improvement in lung function (C-dyn or PaO2/FIO2) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24hr. The 28-day mortality rate was 16%. ConclusionsSequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143. (c) 2012 Wiley Periodicals, Inc.
3Scopus© Citations 31
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A pilot, randomized, controlled clinical trial of lucinactant, a peptide-containing synthetic surfactant, in infants with acute hypoxemic respiratory failure
(2012)
Neal J. Thomas
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Carlos G. Guardia
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Fernando R. Moya
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Ira M. Cheifetz
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Barry Markovitz
Scopus© Citations 31 12
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Assessing Pulmonary Epithelial Damage in Hantavirus Cardiopulmonary Syndrome: Challenging the Predominant Role of Vascular Endothelium through sRAGE as a Potential Biomarker
(2023)
Gabriela Meza-Fuentes
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LOPEZ HERNANDEZ, RENE RAMON
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RETAMAL LUCERO, MAURICIO ANTONIO
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CORTES SALINAS, LINA JIMENA
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VIAL COX, MARIA CECILIA
Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium’s role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.
1
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Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS
(2011)
Pablo Cruces
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Franco Díaz
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Alonso Puga
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Benjamín Erranz
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Alejandro Donoso
Scopus© Citations 26 1
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Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
(2021)
Joaquin Araos
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Leyla Alegria
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Aline Garcia
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Pablo Cruces
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Dagoberto Soto
Scopus© Citations 11 1
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Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19
(2021)
Pablo Cruces
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Camila Cores
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Daniel Casanova
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Federico Pizarro
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Franco Díaz
2Scopus© Citations 13
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Successful extracorporeal membrane oxygenation therapy in a child with coronavirus 2019 disease-associated ARDS and chemotherapy for Ewing’s sarcoma
(2022)
Carmen Niño-Taravilla
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Yuri Zuleta-Morales
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Hugo Otaola-Arca
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Benigno Montenegro
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Cristian Sotomayor F
<jats:p> Most children and adolescents with SARS-CoV-2 infection show no or mild symptoms, but those with medical histories can be susceptible to more severe forms of disease. There are few reported cases of extracorporeal membrane oxygenation (ECMO) in pediatric patients with coronavirus disease 2019 (COVID-19). We present a previously healthy 13-year-old male diagnosed with metastatic Ewing’s sarcoma at the same time as catastrophic acute respiratory distress syndrome due to COVID-19, who was successfully supported by venovenous-ECMO while he received the corresponding chemotherapy protocol. </jats:p><jats:p> ECMO can be used as salvage therapy in oncology pediatric patients with respiratory failure secondary to COVID-19. In addition, successful chemotherapy can be administered while patients are supported on ECMO. </jats:p>
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Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
(2022)
Rodrigo A. Cornejo
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Jorge Montoya
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Abraham I. J. Gajardo
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GRAF SANTOS, JERÓNIMO
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Leyla Alegría
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.</jats:p> </jats:sec>
Scopus© Citations 17 1

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