Additional file 1: of Effects of lung protective mechanical ventilation associated with permissive respiratory acidosis on regional extra-pulmonary blood flow in experimental ARDS

Individual animal data. Excel file with individual data of all animals (ventilation, gas exchange, cardiovascular, and regional blood flow variables). (XLSX 49 kb

Additional file 1: of Tracheostomy procedures in the intensive care unit: an international survey

Questionnaire proposed to European Society of Intensive Care Medicine (ESICM) members. (PDF 79 kb

Additional file 2: of Tracheostomy procedures in the intensive care unit: an international survey

Response rate divided according to geographical localization. (PDF 71 kb

The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial

<div><p>Objective</p><p>We report on the effect of hemoadsorption therapy to reduce cytokines in septic patients with respiratory failure.</p><p>Methods</p><p>This was a randomized, controlled, open-label, multicenter trial. Mechanically ventilated patients with severe sepsis or septic shock and acute lung injury or acute respiratory distress syndrome were eligible for study inclusion. Patients were randomly assigned to either therapy with CytoSorb hemoperfusion for 6 hours per day for up to 7 consecutive days (treatment), or no hemoperfusion (control). Primary outcome was change in normalized IL-6-serum concentrations during study day 1 and 7.</p><p>Results</p><p>97 of the 100 randomized patients were analyzed. We were not able to detect differences in systemic plasma IL-6 levels between the two groups (n = 75; p = 0.15). Significant IL-6 elimination, averaging between 5 and 18% per blood pass throughout the entire treatment period was recorded. In the unadjusted analysis, 60-day-mortality was significantly higher in the treatment group (44.7%) compared to the control group (26.0%; p = 0.039). The proportion of patients receiving renal replacement therapy at the time of enrollment was higher in the treatment group (31.9%) when compared to the control group (16.3%). After adjustment for patient morbidity and baseline imbalances, no association of hemoperfusion with mortality was found (p = 0.19).</p><p>Conclusions</p><p>In this patient population with predominantly septic shock and multiple organ failure, hemoadsorption removed IL-6 but this did not lead to lower plasma IL-6-levels. We did not detect statistically significant differences in the secondary outcomes multiple organ dysfunction score, ventilation time and time course of oxygenation.</p></div

Data_Sheet_1_Outcomes of patients with acute respiratory failure on veno-venous extracorporeal membrane oxygenation requiring additional circulatory support by veno-venoarterial extracorporeal membrane oxygenation.pdf

ObjectiveVeno-venous (V-V) extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with severe acute respiratory distress syndrome (ARDS). In case of additional cardio-circulatory failure, some experienced centers upgrade the V-V ECMO with an additional arterial return cannula (termed V-VA ECMO). Here we analyzed short- and long-term outcome together with potential predictors of mortality.DesignMulticenter, retrospective analysis between January 2008 and September 2021.SettingThree tertiary care ECMO centers in Germany (Hannover, Bonn) and Switzerland (Zurich).PatientsSeventy-three V-V ECMO patients with ARDS and additional acute cardio-circulatory deterioration required an upgrade to V-VA ECMO were included in this study.Measurements and main resultsFifty-three patients required an upgrade from V-V to V-VA and 20 patients were directly triple cannulated. Median (Interquartile Range) age was 49 (28–57) years and SOFA score was 14 (12–17) at V-VA ECMO upgrade. Vasoactive-inotropic score decreased from 53 (12–123) at V-VA ECMO upgrade to 9 (3–37) after 24 h of V-VA ECMO support. Weaning from V-VA and V-V ECMO was successful in 47 (64%) and 40 (55%) patients, respectively. Duration of ECMO support was 12 (6–22) days and ICU length of stay was 32 (16–46) days. Overall ICU mortality was 48% and hospital mortality 51%. Two additional patients died after hospital discharge while the remaining patients survived up to two years (with six patients being lost to follow-up). The vast majority of patients was free from higher degree persistent organ dysfunction at follow-up. A SOFA score > 14 and higher lactate concentrations at the day of V-VA upgrade were independent predictors of mortality in the multivariate regression analysis.ConclusionIn this analysis, the use of V-VA ECMO in patients with ARDS and concomitant cardiocirculatory failure was associated with a hospital survival of about 50%, and most of these patients survived up to 2 years. A SOFA score > 14 and elevated lactate levels at the day of V-VA upgrade predict unfavorable outcome.</p

CD4-cell-activation for control (grey boxes) and treatment group (white boxes) on different study days.

<p>Values > 1000 are evaluated as 1000, values <1 as 1. The number of patients available are displayed in the header of each panel.</p

Median and interquartile range for Interleukin-6 (IL-6) plasma levels in the treatment and in the control group (n = 75).

<p>Median and interquartile range for Interleukin-6 (IL-6) plasma levels in the treatment and in the control group (n = 75).</p

Median and interquartile ranges of platelets (Panel A), white blood cells (WBC) (Panel B), albumin (Panel C), total protein (Panel D) and body temperature (Panel E) of treatment and control group for study day 1 to 7 before and after the treatment if applicable.

<p>Median and interquartile ranges of platelets (Panel A), white blood cells (WBC) (Panel B), albumin (Panel C), total protein (Panel D) and body temperature (Panel E) of treatment and control group for study day 1 to 7 before and after the treatment if applicable.</p

Time course for log-transformed oxygenation index (Panel A), the ratio of arterial partial pressure of oxygen and inspired fraction of oxygen (P/F ratio) (Panel B) and multiple organ dysfunction score (MODS) (Panel C) in the control group (grey boxes) and in the treatment group (white boxes).

<p>The number of patients available are displayed in the header of each panel.</p

Baseline cytokines measurements in pg/ml of patients with available primary endpoint.

<p>Baseline cytokines measurements in pg/ml of patients with available primary endpoint.</p