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Sample records for acute respiratory distress

  1. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016: ...

  2. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst ... A.M. Editorial team. Related MedlinePlus Health Topics Respiratory Failure Browse the Encyclopedia A.D.A.M., Inc. ...

  3. Acute Respiratory Distress Syndrome.

    Yadam, Suman; Bihler, Eric; Balaan, Marvin

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a serious inflammatory disorder with high mortality. Its main pathologic mechanism seems to result from increased alveolar permeability. Its definition has also changed since first being described according to the Berlin definition, which now classifies ARDS on a severity scale based on PaO2 (partial pressure of oxygen, arterial)/FIO2 (fraction of inspired oxygen) ratio. The cornerstone of therapy was found to be a low tidal volume strategy featuring volumes of 6 to 8 mL per kg of ideal body weight that has been shown to have decreased mortality as proven by the ARDSnet trials. There are other areas of treatment right now that include extracorporeal membrane oxygenation, as well for severe refractory hypoxemia. Other methods that include prone positioning for ventilation have also shown improvements in oxygenation. Positive end-expiratory pressure with lung recruitment maneuvers has also been found to be helpful. Other therapies that include vasodilators and neuromuscular agents are still being explored and need further studies to define their role in ARDS. PMID:26919679

  4. The acute respiratory distress syndrome

    Modrykamien, Ariel M.; Gupta, Pooja

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss t...

  5. Pathobiology of acute respiratory distress syndrome.

    Sapru, Anil; Flori, Heidi; Quasney, Michael W; Dahmer, Mary K

    2015-06-01

    The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance of the air-filled, fluid-free status of the alveoli essential for facilitating gas exchange, maintaining alveolar stability, and defending the lung against inhaled pathogens. The hallmark of pathophysiology in acute respiratory distress syndrome is the loss of the alveolar capillary permeability barrier and the presence of protein-rich edema fluid in the alveoli. This alteration in permeability and accumulation of fluid in the alveoli accompanies damage to the lung epithelium and vascular endothelium along with dysregulated inflammation and inappropriate activity of leukocytes and platelets. In addition, there is uncontrolled activation of coagulation along with suppression of fibrinolysis and loss of surfactant. These pathophysiological changes result in the clinical manifestations of acute respiratory distress syndrome, which include hypoxemia, radiographic opacities, decreased functional residual capacity, increased physiologic deadspace, and decreased lung compliance. Resolution of acute respiratory distress syndrome involves the migration of cells to the site of injury and re-establishment of the epithelium and endothelium with or without the development of fibrosis. Most of the data related to acute respiratory distress syndrome, however, originate from studies in adults or in mature animals with very few studies performed in children or juvenile animals. The lack of studies in children is particularly problematic because the lungs and immune system are still developing during childhood and consequently the pathophysiology of pediatric acute respiratory distress syndrome may differ in significant ways from that seen in acute respiratory distress syndrome in adults. This article describes what is known of the pathophysiologic processes of pediatric acute respiratory distress syndrome as we know it today while also presenting the much

  6. Acute Respiratory Distress Due to Methane Inhalation

    Jo, Jun Yeon; Kwon, Yong Sik; Lee, Jin Wook; Park, Jae Seok; Rho, Byung Hak; Choi, Won-Il

    2013-01-01

    Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest rad...

  7. Surfactant treatment for acute respiratory distress syndrome

    Lopez-Herce, J.; de Lucas, N; Carrillo, A.; Bustinza, A.; Moral, R.

    1999-01-01

    OBJECTIVE—To determine prospectively the efficacy of surfactant in acute respiratory distress syndrome.
STUDY DESIGN—Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO2/FiO2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be effectiv...

  8. Pharmacotherapy of Acute Lung Injury and Acute Respiratory Distress Syndrome

    Raghavendran, Krishnan; Pryhuber, Gloria S.; Chess, Patricia R.; Davidson, Bruce A.; Paul R. Knight; Notter, Robert H.

    2008-01-01

    Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Mortality from ALI/ARDS is substantial, and current therapy primarily emphasizes mechanical ventilation and judicial fluid management plus standard treatment of the initiating insult and any known underlying disease. Current pharmacotherapy for ALI/ARDS is not optimal, a...

  9. Acute respiratory distress in a silversmith

    Jignesh Mukeshkumar Parikh

    2014-01-01

    Full Text Available A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO 2 /FiO 2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS. He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air.

  10. Progress and perspectives in pediatric acute respiratory distress syndrome

    Rotta, Alexandre Tellechea; Piva, Jefferson Pedro; Andreolio, Cinara; de Carvalho, Werther Brunow; Garcia, Pedro Celiny Ramos

    2015-01-01

    Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies. PMID:26331971

  11. Acute respiratory distress syndrome: epidemiology and management approaches

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  12. Surfactant therapy for acute respiratory distress in infants

    Corrado Moretti; Barbàra, Caterina S; Rosanna Grossi; Stefano Luciani; Fabio Midulla; Paola Papoff

    2014-01-01

    Acute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Dat...

  13. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

    Inderpaul Singh Sehgal; Sahajal Dhooria; Digambar Behera; Ritesh Agarwal

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure m...

  14. Acute respiratory distress syndrome in an alpaca cria

    Simpson, Katharine M.; Streeter, Robert N.; Genova, Suzanne G.

    2011-01-01

    A 7-hour-old alpaca was presented for lethargy and depression. The cria responded favorably to initial treatment but developed acute-onset dyspnea 48 hours later. Acute respiratory distress syndrome was diagnosed by thoracic imaging and blood gas analysis. The cria was successfully treated with corticosteroids and discharged from the hospital.

  15. The acute respiratory distress syndrome: from mechanism to translation

    Han, SeungHye; Mallampalli, Rama K.

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a form of severe hypoxemic respiratory failure characterized by inflammatory injury to the alveolar capillary barrier with extravasation of protein-rich edema fluid into the airspace. Although many modalities have been investigated to treat ARDS for the past several decades, supportive therapies still remain the mainstay of treatment. Here, we briefly review the definition, epidemiology and pathophysiology of ARDS. Next, we present emerging as...

  16. Serum biomarkers in Acute Respiratory Distress Syndrome an ailing prognosticator

    Pneumatikos Ioannis

    2005-06-01

    Full Text Available Abstract The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions. New research and novel understanding of the molecular basis of the disease reveals an abundance of exciting new biomarkers who present a promise for use in the everyday clinical practice. The past fifteen years have seen the emergence of numerous clinical applications of several new molecules as biologic markers in the research field relevant to acute respiratory distress syndrome (translational research. The scope of this review is to summarize the current state of knowledge about serum biomarkers in acute lung injury and acute respiratory distress syndrome and their potential value as prognostic tools and present some of the future perspectives and challenges.

  17. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  18. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far.......Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  19. Acute Respiratory Distress Syndrome: Pathophysiology and Therapeutic Options

    Pierrakos, Charalampos; Karanikolas, Menelaos; Scolletta, Sabino; Karamouzos, Vasilios; Velissaris, Dimitrios

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a common entity in critical care. ARDS is associated with many diagnoses, including trauma and sepsis, can lead to multiple organ failure and has high mortality. The present article is a narrative review of the literature on ARDS, including ARDS pathophysiology and therapeutic options currently being evaluated or in use in clinical practice. The literature review covers relevant publications until January 2011. Recent developments in the therapeut...

  20. Scrub Typhus with Sepsis and Acute Respiratory Distress Syndrome

    Kurup, Asok; Issac, Aneesh; Loh, Jin Phang; Lee, Too Bou; Chua, Robert; Bist, Pradeep; Chao, Chien-Chung; Lewis, Michael; Gubler, Duane J.; Ching, Wei Mei; Ooi, Eng Eong; Sukumaran, Bindu

    2013-01-01

    Scrub typhus is a major infectious threat in the Asia-Pacific region. We report an unusual case of scrub typhus in a patient in Singapore who presented with sepsis and acute respiratory distress syndrome but lacked the pathognomonic eschar. The patient recovered after appropriate diagnosis and doxycycline treatment. Rickettsial diseases should be included in the differential diagnosis of febrile illnesses in regions where the diseases are endemic, and absence of eschar should not be the crite...

  1. Extracorporeal life support for acute respiratory distress syndromes

    Don Hayes; Joseph D Tobias; Jasleen Kukreja; Preston, Thomas J.; Yates, Andrew R; Stephen Kirkby; Whitson, Bryan A.

    2013-01-01

    The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygena...

  2. The Current Care for Acute Respiratory Distress Syndrome

    Kawamae, Kaneyuki; Iseki, Ken

    2003-01-01

    The mortality rate of acute respiratory distress syndrome (ARDS) has been still high. A many kinds of strategies for ARDS are being tried in the world. The important factors which influence for pathological-physiology of ARDS during the mechanical ventilation are gravity consolidation, atelectasis, and ventilator induced lung injury (VILI). VILI is caused by shear stress that is induced by the repeated collapse and recruit of alveolus. Alveolar over-distention caused by large tidal volume als...

  3. Surfactant alteration and replacement in acute respiratory distress syndrome

    Walmrath Dieter; Grimminger Friedrich; Markart Philipp; Schmidt Reinhold; Ruppert Clemens; Günther Andreas; Seeger Werner

    2001-01-01

    Abstract The acute respiratory distress syndrome (ARDS) is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactan...

  4. Anti-infectious treatment in acute respiratory distress syndrome

    Gao, Min; Xiao, Zhen-Liang; Fu-xiang LI

    2013-01-01

    Acute respiratory distress syndrome (ARDS) is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP) is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI) is different from hospital acquired infection (HAI) in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, ...

  5. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  6. Extracorporeal life support for acute respiratory distress syndromes

    Don Hayes

    2013-01-01

    Full Text Available The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygenation (ECMO including its failures and successes as well as discussing extracorporeal devices now available or nearly accessible while examining current clinical indications and trends of ECMO in respiratory failure.

  7. Acute respiratory distress syndrome assessment after traumatic brain injury

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  8. Early Treatment of Severe Acute Respiratory Distress Syndrome.

    Przybysz, Thomas M; Heffner, Alan C

    2016-02-01

    Acute respiratory distress syndrome (ARDS) is defined by acute diffuse inflammatory lung injury invoked by a variety of systemic or pulmonary insults. Despite medical progress in management, mortality remains 27% to 45%. Patients with ARDS should be managed with low tidal volume ventilation. Permissive hypercapnea is well tolerated. Conservative fluid strategy can reduce ventilator and hospital days in patients without shock. Prone positioning and neuromuscular blockers reduce mortality in some patients. Early management of ARDS is relevant to emergency medicine. Identifying ARDS patients who should be transferred to an extracorporeal membrane oxygenation center is an important task for emergency providers. PMID:26614238

  9. Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever

    Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

    2011-01-01

    Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated wi...

  10. Anti-infectious treatment in acute respiratory distress syndrome

    Min GAO

    2013-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI is different from hospital acquired infection (HAI in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, atypical pathogens and Klebsiella pneumoniae. However, HAI is mainly caused by Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant Staphylococcus aureus(MRSA, and other drug-resistant bacteria. The drug-resistant bacterial infection not only makes treatment difficult, but also leads to an increase in mechanical ventilation time, length of ICU stay, mortality rate, and medical costs. The present paper has reviewed the relationship between ARDS and infection, therapeutic principles and measures of ARDS related infection, and introduced the optimal strategy of anti-infectious treatment of ARDS.

  11. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair.

    Im, Daniel; Shi, Wei; Driscoll, Barbara

    2016-01-01

    Clinical and basic experimental approaches to pediatric acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within 7 days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9 to 9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation, and surfactant regulation have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long-term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long-term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute, and long-term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis. PMID:27066462

  12. Surfactant alteration and replacement in acute respiratory distress syndrome

    Walmrath Dieter

    2001-10-01

    Full Text Available Abstract The acute respiratory distress syndrome (ARDS is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactant phospholipids and apoproteins into polymerizing fibrin, and damage/inhibition of surfactant compounds by inflammatory mediators. There is now good evidence that these surfactant abnormalities promote alveolar instability and collapse and, consequently, loss of compliance and the profound gas exchange abnormalities seen in ARDS. An acute improvement of gas exchange properties together with a far-reaching restoration of surfactant properties was encountered in recently performed pilot studies. Here we summarize what is known about the kind and severity of surfactant changes occuring in ARDS, the contribution of these changes to lung failure, and the role of surfactant administration for therapy of ARDS.

  13. Surfactant therapy for acute respiratory distress in infants

    Corrado Moretti

    2014-06-01

    Full Text Available Acute respiratory distress syndrome (ARDS remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Data indicate that adoption of a lung protective ventilation with low tidal volumes and of an open-lung ventilation strategy, characterized by sufficient positive end-expiratory pressure (PEEP to avoid atelectasis, provides the greatest likelihood of survival and minimizes lung injury. The relative benefits of strategies such as high frequency oscillatory ventilation (HFOV, inhaled nitric oxide (iNO, recruiting manoeuvres and prone position are also considered. Moreover this article examines exogenous lung surfactant replacement therapy and its efficacy in the treatment of paediatric ARDS. In infants and children with acute lung injury the endogenous surfactant system is not only deficient, as observed in preterm infants, but altered via a variety of other mechanisms like inhibition and dysfunction. All factors contribute to the altered physiology seen in ARDS. The role of exogenous surfactant in lung injury beyond the neonatal period is therefore more complex and its limited efficacy may be related to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution or, simply, an inability of the drug to counteract the underlying pathophysiology of ARDS. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS, however some studies have shown that this therapy can improve oxygenation and decrease mortality in some specific

  14. Role of Ventilation in Cases of Acute Respiratory Distress Syndrome /Acute Lung injury

    Hemant M Shah; Shilpa B Sutariya; Parul M Bhatt; Nishil Shah; Shweta Gamit

    2014-01-01

    Introduction: Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are characterized by refractory hypoxemia that develops secondary to high-permeability pulmonary edema. These syndromes are gaining more attention as a means of better comprehending the pathophysiology of ARDS and possiblyfor modifying ventilatory management. In this context a study was done to compare role of invasive and non-invasive ventilation in cases of ARDS/ALI. Methods: in this study patients of AR...

  15. Lung tissue remodeling in the acute respiratory distress syndrome

    Souza Alba Barros de

    2003-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibropro­liferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient?s prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.

  16. Pulmonary hypertension due to acute respiratory distress syndrome

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  17. Acute respiratory distress syndrome (ARDS): HRCT findings in survivors

    Jung, Jung Im; Park, Seog Hee; Lee, Jae Mun; Song, Jeong Sup; Lee, Kyo Young [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this report is to describe the high-resolution computed tomography (HRCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one year, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hyperoxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.

  18. Fluid in the management of the acute respiratory distress syndrome

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  19. Respiratory Distress

    1976-01-01

    The University of Miami School of Medicine asked the Research Triangle Institute for assistance in improvising the negative pressure technique to relieve respiratory distress in infants. Marshall Space Flight Center and Johnson Space Center engineers adapted this idea to the lower-body negative-pressure system seals used during the Skylab missions. Some 20,000 babies succumb to respiratory distress in the U.S. each year, a condition in which lungs progressively lose their ability to oxygenate blood. Both positive and negative pressure techniques have been used - the first to force air into lungs, the second to keep infant's lungs expanded. Negative pressure around chest helps the baby expand his lungs and maintain proper volume of air. If doctors can keep the infant alive for four days, the missing substance in the lungs will usually form in sufficient quantity to permit normal breathing. The Skylab chamber and its leakproof seals were adapted for medical use.

  20. Acute Respiratory Distress following Intravenous Injection of an Oil-Steroid Solution

    Michael Russell; Aric Storck; Martha Ainslie

    2011-01-01

    Several case reports have described acute lung injury and respiratory distress following the intravascular injection of oil. Although biochemical and mechanical theories explaining the pathological mechanism of pulmonary oil embolism have been proposed, the phenomenon is not completely understood. This report describes a case of acute respiratory distress and hypoxemia involving a 21-year-old bodybuilder who self-administered an injection of anabolic steroids suspended in oil. The ensuing bri...

  1. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute hypoxaemic respiratory failure (AHRF), defined as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), are critical conditions. AHRF results from a number of systemic conditions and is associated with high mortality and morbidity in all ages. Inhaled nitric oxide (INO) has...

  2. Acute Respiratory Distress Syndrome and Outcomes after Near-hanging

    Mansoor, Sahar; Afshar, Majid; Barrett, Matthew; Smith, Gordon S.; Barr, Erik A.; Lissauer, Matthew E.; McCurdy, Michael T.; Murthi, Sarah B.; Netzer, Giora

    2015-01-01

    Purpose Assess the case rate of Acute Respiratory Distress Syndrome (ARDS) after near-hanging, and the secondary outcomes of traumatic and/or anoxic brain injury, and death. Risk factors for the outcomes were assessed. Method Single-center, state-wide retrospective cohort study of consecutive patients admitted between August, 2002, and September, 2011, with a primary diagnosis of non-judicial "hanging injury". Results Of 56 patients, 73% were male. The median age was 31 (IQR: 16–56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR: 3–15); 14% (8/56) had a GCS=3. ARDS developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS [3 (IQR: 3–7) vs. 14 (IQR: 3–15), p=0.0003] and intubation in field or in trauma resuscitation unit [100% (5/5) vs. 16% (8/51), p=0.0003] were associated with ARDS development. Risk factors of death were GCS=3 [100% (3/3) vs. 9% (5/53), p=0.002]; pulselessness upon arrival of emergency medical services [100% (3/3) vs. 4% (2/53), p<0.001]; and abnormal neurologic imaging [50% (1/2) vs. zero, p=0.04]. Conclusions The ARDS case rate after near-hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low. PMID:25596627

  3. Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects

    Carrasco Loza, R; Villamizar Rodríguez, G; Medel Fernández, N

    2015-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically...

  4. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS): the mechanism, present strategies and future perspectives of therapies

    Luh, Shi-Ping; Chiang, Chi-huei

    2006-01-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS), which manifests as non-cardiogenic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/AR...

  5. Mesenchymal stem cells - a promising therapy for Acute Respiratory Distress Syndrome.

    Hayes M; Curley G; Laffey JG.

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) constitutes a spectrum of severe acute respiratory failure in response to a variety of inciting stimuli that is the leading cause of death and disability in the critically ill. Despite decades of research, there are no therapies for ARDS, and management remains supportive. A growing understanding of the complexity of the pathophysiology of ARDS, coupled with advances in stem cell biology, has lead to a renewed interest in the therapeutic potential of...

  6. Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome

    Dushianthan, Ahilanandan; Goss, Victoria; Cusack, Rebecca; Grocott, Michael P. W.; Postle, Anthony D

    2014-01-01

    Background Acute respiratory distress syndrome (ARDS) is a life-threatening critical illness, characterised by qualitative and quantitative surfactant compositional changes associated with premature airway collapse, gas-exchange abnormalities and acute hypoxic respiratory failure. The underlying mechanisms for this dysregulation in surfactant metabolisms are not fully explored. Lack of therapeutic benefits from clinical trials, highlight the importance of detailed in-vivo analysis and charact...

  7. Acute respiratory distress syndrome--two decades later.

    Cunningham, A. J.

    1991-01-01

    Twenty years have now elapsed since Ashbaugh and Petty first described the syndrome of acute respiratory failure associated with a wide spectrum of clinical conditions. During the past two decades, significant advances have emerged in our understanding of the clinical conditions associated with the syndrome and the pathophysiological changes affecting the alveolar-capillary membrane responsible for the characteristic non-cardiogenic pulmonary edema. Recent data have reaffirmed the notion that...

  8. Acute respiratory distress syndrome in an adult patient with a myelodysplastic disorder.

    Pentimone, F; Cini, G; Meola, N; Ferrannini, E

    1983-01-01

    A 58-year-old man was diagnosed to have refractory anaemia with excessive blasts. After 3 1/2 years of relative control on periodic blood transfusions, the patient developed an acute leukaemia. Although the blastic crisis was not extreme (WBC counts less than 100 X 10(9)/l), a severe, intractable respiratory distress syndrome set in and brought the patient to the exitus in a few days. Overt signs of septic shock were absent, as was evidence of any other known cause of adult respiratory distress. Acute pulmonary failure can be the cause of death in leukaemic patients even in the absence of overwhelming sepsis or hyperleucocytosis. PMID:6404107

  9. Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome.

    Rocco, Patricia R M; Pelosi, Paolo; de Abreu, Marcelo Gama

    2010-08-01

    In patients with acute lung injury and acute respiratory distress syndrome, a protective mechanical ventilation strategy characterized by low tidal volumes has been associated with reduced mortality. However, such a strategy may result in alveolar collapse, leading to cyclic opening and closing of atelectatic alveoli and distal airways. Thus, recruitment maneuvers (RMs) have been used to open up collapsed lungs, while adequate positive end-expiratory pressure (PEEP) levels may counteract alveolar derecruitment during low tidal volume ventilation, improving respiratory function and minimizing ventilator-associated lung injury. Nevertheless, considerable uncertainty remains regarding the appropriateness of RMs. The most commonly used RM is conventional sustained inflation, associated with respiratory and cardiovascular side effects, which may be minimized by newly proposed strategies: prolonged or incremental PEEP elevation; pressure-controlled ventilation with fixed PEEP and increased driving pressure; pressure-controlled ventilation applied with escalating PEEP and constant driving pressure; and long and slow increase in pressure. The efficiency of RMs may be affected by different factors, including the nature and extent of lung injury, capability of increasing inspiratory transpulmonary pressures, patient positioning and cardiac preload. Current evidence suggests that RMs can be used before setting PEEP, after ventilator circuit disconnection or as a rescue maneuver to overcome severe hypoxemia; however, their routine use does not seem to be justified at present. The development of new lung recruitment strategies that have fewer hemodynamic and biological effects on the lungs, as well as randomized clinical trials analyzing the impact of RMs on morbidity and mortality of acute lung injury/acute respiratory distress syndrome patients, are warranted. PMID:20658909

  10. [Role of computed tomography in the diagnosis of acute lung injury/acute respiratory distress syndrome].

    Mazzei, Maria Antonietta; Guerrini, Susanna; Cioffi Squitieri, Nevada; Franchi, Federico; Volterrani, Luca; Genovese, Eugenio Annibale; Macarini, Luca

    2012-11-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a complex pulmonary pathology with high mortality rates, manifesting over a wide range of severity. Clinical diagnosis relies on the following 4 criteria stated by the American-European Consensus Conference: acute onset of impaired gas exchange, severe hypoxemia defined as a PaO2 to FiO2 ratio <300 (PaO2 in mmHg), bilateral diffuse infiltration on chest X-ray; pulmonary artery wedge pressure of ≤18 mmHg to rule out cardiogenic causes of pulmonary edema. The aim of this study was to determine the usefulness of CT in the diagnosis and management of this condition. PMID:23096732

  11. ROLE OF SURFACTANT ADMINISTRATION IN PREMATURE INFANTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

    Vamseedhar

    2015-07-01

    Full Text Available BACKGROUND: The significant advancement in the treatment of acute respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancemen t in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. AIM OF THE STUDY : To find the efficacy of surfactant therapy in relation to time of administration. MATERIALS AND METHODS: We analyzed data of 122 preterm babies with Acute respiratory distress syndrome (ARDS hospitalized in the Special Neonatal Care Unit (SNCU of the Pediatric Department, Rajiv Gandhi Institute of Medical Sciences (RIMS, Kadapa, A. P., India. RESU LTS: We investigated the clinical efficacy of surfactant therapy in relation to the time of administration and found that early treatment with surfactant is more effective and resulted in highly significant reduction of mortality rate (p<0.01. CONCLUSION: Surfactant therapy is beneficial in preterm babies with acute respiratory distress syndrome (ARDS. So a reasonable recommendation is to treat the infants with surfactant as soon as the clinical signs of respiratory distress appear.

  12. Interleukin-10 polymorphism in position -1082 and acute respiratory distress syndrome

    Gong, M.N.; Thompson, B T; Williams, P.L.; Zhou, W.; Wang, M. Z.; Pothier, L.; Christiani, D C

    2006-01-01

    The GG genotype of the interleukin (IL)-10 promoter polymorphism in position -1082 (-1082GG) has been associated with increased IL-10 production. The current authors hypothesised that the -1082GG genotype is associated with the development of, and outcomes in, acute respiratory distress syndrome (ARDS).

  13. Acute respiratory distress associated with external jugular vein catheterization in the newborn.

    Bitar, Fadi F; Obeid, Mounir; Dabbous, Ibrahim; Hayek, Paula; Akel, Samir; Mroueh, Salman

    2003-12-01

    We report on the acute onset of respiratory distress secondary to fluid accumulation in the chest within hours of placement of an external jugular venous line in a newborn. External jugular venous catheterization in the newborn is a procedure with potentially serious complications, and should be avoided unless the patient is monitored closely. PMID:14618649

  14. Acute Respiratory Distress Syndrome is a TH17-like and Treg immune disease

    Hu, Wan-Chung

    2013-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a very severe syndrome leading to respiratory failure and subsequent mortality. Sepsis is one of the leading causes of ARDS. Thus, extracellular bacteria play an important role in the pathophysiology of ARDS. Overactivated neutrophils are the major effector cells in ARDS. Thus, extracellular bacteria triggered TH17-like innate immunity with neutrophil activation might accounts for the etiology of ARDS. Here, microarray analysis was employed to des...

  15. ROLE OF SURFACTANT ADMINISTRATION IN PREMATURE INFANTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

    Vamseedhar; Praveen Raju; Rama Mohan

    2015-01-01

    BACKGROUND: The significant advancement in the treatment of acute respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancemen t in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. AIM OF THE STUDY : To find the efficacy of surfactant therapy ...

  16. Azathioprine associated acute respiratory distress syndrome: case report and literature review

    Scherbak D; Wyckoff R; Singarajah C

    2014-01-01

    A 58-year-old Caucasian man treated with azathioprine to prevent rejection of an orthotopic liver transplant, presented to the Carl Hayden VA Medical Center with rapid respiratory decline and appeared septic. He required urgent intubation, mechanical ventilator support and empiric antibiotics. His clinical picture and imaging studies were consistent with acute respiratory distress syndrome; however, extensive infectious work up failed to reveal an offending organism. Review of his current med...

  17. Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome.

    McLean, Barbara

    2015-12-01

    In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. Generally, the right ventricle operates passively to support the ejection of the left ventricular diastolic volume. A loss of right ventricular wall compliance secondary to pulmonary pressures may result in an alteration in the normal pressure-volume relationship, ultimately affecting the stroke volume and cardiac output. Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale. PMID:26567491

  18. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    E.N.G. Vinhaes; Dolhnikoff, M; Saldiva, P. H. N.

    2002-01-01

    Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia). The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD) and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS). The objective of the present study was to perform a quantita...

  19. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study

    Stefanidis, Konstantinos; Dimopoulos, Stavros; Tripodaki, Elli-Sophia; Vitzilaios, Konstantinos; Politis, Panagiotis; Piperopoulos, Ploutarchos; Nanas, Serafim

    2011-01-01

    Introduction Bedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS). Methods Ten patients (mean ± standard deviation (SD): age 64 ± 7 years, Acute Physiology and Chronic Health Evaluation ...

  20. Should Immune-Enhancing Formulations Be Used for Patients With Acute Respiratory Distress Syndrome?

    Roosevelt, Hannah

    2016-08-01

    The potential for regulating immune function in acute respiratory distress syndrome (ARDS) through enteral-administered anti-inflammatory lipids has generated much interest over the past 20 years. Yet recommendations remain inconclusive regarding the utilization of ω-3 fatty acids in patients with ARDS and acute lung injury (ALI). Studies are limited in number, with differing methods, small sample sizes, and conflicting results, making recommendations difficult to interpret. PMID:27339156

  1. The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: experimental evidence from a lung model.

    Nay, M-A; Mankikian, J; Auvet, A; Dequin, P-F; Guillon, A

    2016-02-01

    Flexible bronchoscopy is essential for appropriate care during mechanical ventilation, but can significantly affect mechanical ventilation of the lungs, particularly for patients with acute respiratory distress syndrome. We aimed to describe the consequences of bronchoscopy during lung-protective ventilation in a bench study, and thereby to determine the optimal diameter of the bronchoscope for avoiding disruption of the protective-ventilation strategy during the procedure. Immediately following the insertion of the bronchoscope into the tracheal tube, either minute ventilation decreased significantly, or positive end-expiratory pressure increased substantially, according to the setting of the inspiratory pressure limit. The increase in end-expiratory pressure led to an equivalent increase in the plateau pressure, and lung-protective ventilation was significantly altered during the procedure. We showed that a bronchoscope with an external diameter of 4 mm (or less) would allow safer bronchoscopic interventions in patients with severe acute respiratory distress syndrome. PMID:26559154

  2. Education and support needs during recovery in acute respiratory distress syndrome survivors

    Lee, Christie M; Herridge, Margaret S.; Matte, Andrea; Cameron, Jill I

    2009-01-01

    Introduction There is a limited understanding of the long-term needs of survivors of the acute respiratory distress syndrome (ARDS) as they recover from their episode of critical illness. The Timing it Right (TIR) framework, which emphasizes ARDS survivors' journey from the ICU through to community re-integration, may provide a valuable construct to explore the support needs of ARDS survivors during their recovery. Methods Twenty-five ARDS survivors participated in qualitative interviews exam...

  3. Acute respiratory distress in diabetic ketoacidosis: possible contribution of low colloid osmotic pressure.

    Leonard, R. C.; Asplin, C; McCormick, C. V.; Hockaday, T. D.

    1983-01-01

    The "shock lung" syndrome may occur in diabetic ketoacidosis in association with disseminated intravascular coagulation; occasionally it occurs alone after treatment of the ketoacidosis. Two patients developed pulmonary opacities with clinical features of acute respiratory distress such as are seen in the shock lung syndrome; in both, however, the findings suggested a different mechanism from that occurring in the syndrome. Hypoalbuminaemia was prominent, and it is postulated that a low plasm...

  4. Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome

    Alexey A. Smetkin; Kuzkov, Vsevolod V; Eugeny V. Suborov; Bjertnaes, Lars J; Kirov, Mikhail Y.

    2012-01-01

    Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a ...

  5. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation

    Das(2), Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

    2015-01-01

    Introduction Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patie...

  6. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review

    Koulouras, Vasilios; Papathanakos, Georgios; Papathanasiou, Athanasios; Nakos, Georgios

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first describ...

  7. A comparison between two different alveolar recruitment maneuvers in patients with acute respiratory distress syndrome

    Mahmoud, Khaled M; Ammar, Amany S.

    2011-01-01

    Background: Alveolar recruitment is a physiological process that denotes the reopening of previously gasless lung units exposed to positive pressure ventilation. The current study was aimed to compare two recruitment maneuvers, a high continuous positive airway pressure (CPAP), and an extended sigh in patients with ARDS. Materials and Methods: Forty patients with acute respiratory distress syndrome were randomly divided into two groups, 20 patients each. Group I received a CPAP of 40 cm H2O f...

  8. Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome.

    Gregory, T J; Longmore, W J; Moxley, M A; Whitsett, J A; Reed, C R; Fowler, A. A.; Hudson, L D; Maunder, R. J.; Crim, C.; Hyers, T. M.

    1991-01-01

    Acute Respiratory Distress Syndrome (ARDS) is characterized by lung injury and damage to the alveolar type II cells. This study sought to determine if endogenous surfactant is altered in ARDS. Bronchoalveolar lavage was performed in patients at-risk to develop ARDS (AR, n = 20), with ARDS (A, n = 66) and in normal subjects (N, n = 29). The crude surfactant pellet was analyzed for total phospholipids (PL), individual phospholipids, SP-A, SP-B, and minimum surface tension (STmin). PL was decrea...

  9. Acute respiratory distress syndrome due to pulmonary involvement by neoplastic plasma cells in multiple myeloma

    Marmor, D B; Farber, J. L.; Gottlieb, J E

    2006-01-01

    Pulmonary involvement with multiple myeloma occurs infrequently and may be difficult to distinguish from more common primary lung tumours, metastatic disease, or other pleural and parenchymal abnormalities. A patient who developed acute respiratory distress syndrome (ARDS) was subsequently found to have multiple myeloma with involvement of lung parenchyma by neoplastic plasma cells. Only one other report of ARDS in association with multiple myeloma was found, and there are no previous reports...

  10. Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

    Kao, Kuo-Chin; Hu, Han-Chung; Chang, Chih-Hao; Hung, Chen-Yiu; Chiu, Li-Chung; Li, Shih-Hong; Lin, Shih-Wei; Chuang, Li-Pang; Wang, Chih-Wei; Li, Li-Fu; Chen, Ning-Hung; Yang, Cheng-Ta; Huang, Chung-Chi; Tsai, Ying-Huang

    2015-01-01

    Introduction Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent open lung biopsy. Methods We retrospectively reviewed all ARDS patients who met the Berlin definition and underwent open lung biopsy from January 1999 to January 2014 in a referred med...

  11. [Current approaches to the treatment of severe hypoxic respiratory insufficiency (acute lung injury; acute respiratory distress syndrome)].

    Kluge, S; Müller, T; Pfeifer, M

    2011-02-01

    Lung-protective ventilation with a low tidal volume, plateau pressure 90% and permissive hypercapnia results in reduction of the mortality rate in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The level of the positive end-expiratory pressure (PEEP) must be chosen in relation to oxygen requirement. High frequency oscillatory ventilation and neurally adjusted ventilatory assist are promising methods. However, further studies with firm end-points have to be awaited before a final judgment is possible. Veno-venous extracorporeal membrane oxygenation (ECMO) can ensure life-sustaining gas exchange in patients with severe vitally compromised pulmonary failure, to provide time for lung tissue to heal and reduce ventilatory stress. The latest guidelines for analgesia and sedation in intensive care medicine demand consistent monitoring of the level of sedation and the intensity of pain. The sedation should be interrupted daily, with phases of awakenings and, if possible, spontaneous breathing. Methods of supportive treatment: Positional treatment (prone position) and inhalation of vasodilators can improve ventilation/perfusion mismatch and thus oxygenation. However, administration of surfactant is currently not advised in adult respiratory failure. PMID:21271478

  12. MicroRNA Regulation of Acute Lung Injury and Acute Respiratory Distress Syndrome.

    Rajasekaran, Subbiah; Pattarayan, Dhamotharan; Rajaguru, P; Sudhakar Gandhi, P S; Thimmulappa, Rajesh K

    2016-10-01

    The acute respiratory distress syndrome (ARDS), a severe form of acute lung injury (ALI), is a very common condition associated with critically ill patients, which causes substantial morbidity and mortality worldwide. Despite decades of research, effective therapeutic strategies for clinical ALI/ARDS are not available. In recent years, microRNAs (miRNAs), small non-coding molecules have emerged as a major area of biomedical research as they post-transcriptionally regulate gene expression in diverse biological and pathological processes, including ALI/ARDS. In this context, this present review summarizes a large body of evidence implicating miRNAs and their target molecules in ALI/ARDS originating largely from studies using animal and cell culture model systems of ALI/ARDS. We have also focused on the involvement of miRNAs in macrophage polarization, which play a critical role in regulating the pathogenesis of ALI/ARDS. Finally, the possible future directions that might lead to novel therapeutic strategies for the treatment of ALI/ARDS are also reviewed. J. Cell. Physiol. 231: 2097-2106, 2016. © 2016 Wiley Periodicals, Inc. PMID:26790856

  13. Anesthetic management of parturient with thoracic kyphoscoliosis, malaria and acute respiratory distress syndrome for urgent cesarean section

    Pandey, Ravindra Kr; Batra, Meenu M; Darlong, Vanlal; Garg, Rakesh; Punj, Jyotsna; Kumar, Sri

    2015-01-01

    The management of cesarean section in kyphoscoliotic patient is challenging. The respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients. Presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation. We report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section. PMID:26702219

  14. Acute respiratory distress following the inhalation of an aerosol upholstery cleaner: the importance of reporting from the Emergency Department

    Mistry, Dipak; Meredith, Carolyn

    2009-01-01

    Aerosols are commonplace in the home and in industry as they provide a quick and controlled way of distributing chemicals or perfumes. It is well known that deliberating concentrating and inhaling vapours may result in dizziness, euphoria, blackouts, respiratory distress, cardiac and renal failure. However, in the most part, warnings and guidance on use are sparse. Here, a proven case of acute respiratory distress is presented and a reporting mechanism via the UK National Poisons Information ...

  15. Candidate genes and pathogenesis investigation for sepsis-related acute respiratory distress syndrome based on gene expression profile

    WANG Min; Yan, Jingjun; He, Xingxing; Zhong, Qiang; Zhan, Chengye; Li, Shusheng

    2016-01-01

    Background Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury as well as a major cause of acute respiratory failure. Although researchers have made significant progresses in elucidating the pathophysiology of this complex syndrome over the years, the absence of a universal detail disease mechanism up until now has led to a series of practical problems for a definitive treatment. This study aimed to predict some genes or pathways asso...

  16. Acute respiratory distress syndrome in a woman with heroin and methamphetamine misuse.

    Yeh, P S; Yuan, A; Yu, C J; Kuo, S H; Luh, K T; Yang, P C

    2001-08-01

    Methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in Asia. In Taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea. PMID:11678007

  17. Recent Advances in the Management of the Acute Respiratory Distress Syndrome.

    Hager, David N

    2015-09-01

    Advances in management of the acute respiratory distress syndrome (ARDS) include the use of volume and pressure-limited ventilation and a fluid conservative strategy. Despite the extensive study of positive end expiratory pressure, consensus regarding the best approach to its application is lacking. The use of neuromuscular blocking agents and prone positioning in the setting of refractory hypoxemia is supported by the outcomes of recent studies. Alternate modes of ventilation remain unproven. A focus on ARDS risk factor reduction and the development of tools predicting progression to ARDS have the potential to further reduce its incidence. PMID:26304285

  18. Acute Respiratory Distress following Intravenous Injection of an Oil-Steroid Solution

    Michael Russell

    2011-01-01

    Full Text Available A case of acute respiratory distress and hypoxemia following accidental intravenous injection of an oil-steroid solution in a body builder is presented. Chest roentography at the time of presentation showed diffuse bilateral opacities, and computed tomography revealed predominantly peripheral ground-glass opacifications. The patient’s symptoms gradually improved over 48 h and imaging of the chest was unremarkable one week later. The pathophysiology, diagnosis and treatment of this rare but potentially life-threatening complication of intravenous oil injection are discussed.

  19. The role of heparin-binding protein in acute respiratory distress syndrome

    刘杨

    2014-01-01

    Objective To study the role of heparin-binding protein(HBP)in sepsis-associated acute respiratory distress syndrome(ARDS),and to evaluate the prognostic value of HBP in ARDS.Methods Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin-8 and HBP by ELISA,counted the

  20. Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report.

    Takahashi, Naoki; Shinohara, Tsutomu; Oi, Rie; Ota, Muneyuki; Toriumi, Shinichi; Ogushi, Fumitaka

    2016-05-01

    Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS. PMID:27162691

  1. Secretory leukocyte proteinase inhibitor is preferentially increased in patients with acute respiratory distress syndrome.

    Sallenave, J M; Donnelly, S C; Grant, I S; Robertson, C; Gauldie, J; Haslett, C

    1999-05-01

    Inappropriate release of proteases from inflammatory and stromal cells can lead to destruction of the lung parenchyma. Antiproteinases such as alpha-1-proteinase inhibitor (alpha1-Pi), secretory leukocyte proteinase inhibitor (SLPI) and elastase-specific inhibitor (elafin) control excess production of human neutrophil elastase. In the present study, the concentrations of alpha1-Pi, SLPI and elafin found in bronchoalveolar lavage (BAL) fluid from control subjects, patients at risk of developing acute respiratory distress syndrome (ARDS) and patients with established ARDS were determined. Levels of all three inhibitors were raised in patients compared with normal subjects. SLPI was increased in the group of patients who were at risk of ARDS and went on to develop the condition, compared with the "at-risk" group who did not progress to ARDS (p=0.0083). Alpha1-Pi and elafin levels were similar in these two populations. In patients with established ARDS, both alpha1-Pi and SLPI levels were significantly increased, compared to patients at risk of ARDS who did (p=0.0089) or did not (p=0.0003) progress to ARDS. The finding of increased antiproteinases shortly before the development of acute respiratory distress syndrome provide further evidence for enhanced inflammation prior to clinical disease. PMID:10414400

  2. Effect and mechanism analysis of continuous blood purification on acute respiratory distress syndrome

    Xiao-Hong Xu; Jia-Bin Chen; Yin-Wen Xia

    2016-01-01

    Objective:To analyze the effect and mechanism of continuous blood purification (CBP) on acute respiratory distress syndrome (ARDS) and provide reference for clinical treatment. Methods:80 cases of patients with ARDS in our hospital were analyzed, the clinical indicators and hemodynamic parameters before and after CBP were compared, and ELISA was used to detect expression change of serum interleukin family and ERK signaling pathway protein. 80 cases of healthy subjects during the same period were taken as control group.Results:Compared with before treatment, heart rate, pulmonary artery pressure and pulmonary artery wedge pressure were effectively normalized after CBP, hemodynamic parameters were effectively improved, and compared with control group, there were significant statistical differences (P<0.05); meanwhile, after CBP, interleukins IL2, IL6 and IL10 as well as TGFβlevels significantly decreased, MEK signaling pathway protein Ras, MEK and ERK1/2 expression significantly decreased, and compared with before treatment, there were significant statistical differences (P<0.01,P<0.05).Conclusions:Continuous blood purification may play the role of treating acute respiratory distress syndrome through reducing levels of interleukins and TGFβ as well as inhibiting MEK signaling pathway.

  3. Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome.

    Kim, Seo-Hyun; Park, I-Nae

    2016-07-01

    Antisynthetase syndrome has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with polymyositis and dermatomyositis. It is associated with serum antibody to aminoacyl-transfer RNA synthetases and is characterized by a constellation of manifestations, including fever, myositis, interstitial lung disease, mechanic's hand-like cutaneous involvement, Raynaud phenomenon, and polyarthritis. Lung disease is the presenting feature in 50% of the cases. We report a case of a 60-year-old female with acute respiratory distress syndrome (ARDS), which later proved to be an unexpected and initial manifestation of anti-Jo-1 antibody-positive antisynthetase syndrome. The present case showed resolution of ARDS after treatment with high-dose corticosteroids. Given that steroids are not greatly beneficial in the treatment of ARDS, it is likely that the improvement of the respiratory symptoms in this patient also resulted from the prompt suppression of the inflammatory systemic response by corticosteroids. PMID:27433180

  4. Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children

    ZHU Yan-feng; YU Wen-liang; XIE Min-hui; YAN Chao-ying; LU Zhu-jin; SUN Bo; XU Feng; LU Xiu-lan; WANG Ying; CHEN Jian-li; CHAO Jian-xin; ZHOU Xiao-wen; ZHANG Jian-hui; HUANG Yan-zhi

    2012-01-01

    Background Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS),and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively.This study aimed at prospectively investigating incidence,causes,mortality and its risk factors,and any relationship to initial tidal volume (VT) levels of mechanical ventilation,in children ≤5 years of age with AHRF and ARDS.Methods In 12 consecutive months in 23 pediatric intensive care units (PICU),AHRF and ARDS were identified in those requiring >12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge.ARDS was diagnosed according to the American-European Consensus definitions.The mortality and ventilation free days (VFD) were measured as the primary outcome,and major complications,initial disease severity,and burden were measured as the secondary outcome.Results In 13 491 PICU admissions,there were 439 AHRE,of which 345 (78.6%) developed ARDS,resulting in incidences of 3.3% and 2.6%,and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively.No association was found in VT levels during the first 7 days with mortality,nor for VT at levels <6,6-8,8-10,and >10 ml/kg in the first 3 days with mortality or length of VFD.By binary Logistic regression analyses,higher pediatric risk of mortality score Ⅲ,higher initial oxygenation index,and age <1 year were associated with higher mortality or shorter VFD in AHRF.Conclusions The incidence and mortalities of AHRF and ARDS in children ≤5 years were similar to or lower than the previously reported rates (in age up to 15 years),associated with initial disease severity and other confounders,but causal relationship for the initial VT levels as the independent factor to the major outcome

  5. Interpretation of chest radiographs in both cancer and other critical care patients with acute respiratory distress syndrome

    Sema Yilmaz

    2013-04-01

    Full Text Available Acute respiratory distress syndrome is a clinical, pathophysiological and radiographic pattern that has signs of pulmonary edema occur without elevated pulmonary venous pressures. Clinical presentation and progression of acute respiratory distress syndrome are followed by frequently ordered portable chest X-ray in critically ill patients. We evaluated chest radiographs of ten cancer and other six critical care pediatric patients. The parenchymal imaging of lung in patients with cancer was reported the same as that of other critically ill children despite underlying pathophysiological variations in our investigation. [Cukurova Med J 2013; 38(2.000: 270-273

  6. Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review.

    Fitzgerald, Marianne; Millar, Jonathan; Blackwood, Bronagh; Davies, Andrew; Brett, Stephen J; McAuley, Daniel F; McNamee, James J

    2014-01-01

    Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO₂R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO₂R was used in seven studies, and venovenous ECCO₂R in seven studies. Available evidence suggests no mortality benefit to ECCO₂R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO₂R is a rapidly evolving technology and is an efficacious treatment

  7. Adult respiratory distress syndrome

    Due to improved emergency resuscitation procedures, and with advancing medical technology in the field of critical care, an increasing number of patients survive the acute phase of shock and catastrophic trauma. Patients who previously died of massive sepsis, hypovolemic or hypotensive shock, multiple fractures, aspiration, toxic inhalation, and massive embolism are now surviving long enough to develop previously unsuspected and unrecognized secondary effects. With increasing frequency, clinicians are recognizing the clinical and radiographic manifestations of pathologic changes in the lungs occurring secondary to various types of massive insult. This paper gives a list of diseases that have been shown to precipitate or predispose to diffuse lung damage. Various terms have been used to describe the lung damage and respiratory failure secondary to these conditions. The term adult respiratory distress syndrome (ARDS) is applied to several cases of sudden respiratory failure in patients with previously healthy lungs following various types of trauma or shock. Numerous investigations and experiments have studied the pathologic changes in ARDS, and, while there is still no clear indication of why it develops, there is now some correlation of the sequential pathologic developments with the clinical and radiographic changes

  8. Newborn Respiratory Distress.

    Hermansen, Christian L; Mahajan, Anand

    2015-12-01

    Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn. PMID:26760414

  9. Can differential regional ventilation protect the spared lung in acute respiratory distress syndrome?

    Soni, Kapil Dev; Dash, Devi Prasad; Aggrawal, Richa; Kumar, Narendra; Kumar, Niraj

    2015-08-01

    Acute respiratory distress syndrome (ARDS) is a common clinical problem prevalent in intensive care settings. It can complicate many critical illnesses. The general treatment is mainly supportive. Mechanical ventilation, low tidal volume strategy, and control of plateau pressure form the basis of current management. No specific treatment exists for ARDS. Various interventions have been tested for the lethal condition including steroids, fluid restriction, statins, high-frequency ventilation, nitric oxide, and prone ventilation strategy. However, none has shown improvement apart from prone positioning and low tidal volume ventilation. We report our observation in a patient with ARDS, which may potentially show a new mechanism to protect normal alveoli in ARDS lung and thereby may improve survival. PMID:25770594

  10. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome

    Nuttapol Rittayamai

    2015-03-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS.

  11. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome.

    Rittayamai, Nuttapol; Brochard, Laurent

    2015-03-01

    Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS. PMID:25726563

  12. Acute Respiratory Distress Syndrome: A Rare Complication in Pediatric Diabetic Ketoacidosis.

    Sudhanshu, Siddhnath; Jevalikar, Ganesh; Das, Pravin K; Singh, Pramod K; Bhatia, Eesh; Bhatia, Vijayalakshmi

    2016-05-01

    Cerebral edema (CE) and non cardiogenic pulmonary edema (acute respiratory distress syndrome, ARDS) are life-threatening complications of diabetic ketoacidosis (DKA). In contrast to CE complicating DKA, which is primarily reported in pediatric patients, ARDS is rarely described in this age group. Here, the authors present a child with DKA who developed both cerebral edema and ARDS during the course of her management. It is feasible that severe acidosis, hypotension, azotemia, hypoalbuminemia and the superimposed aggressive intravenous fluid administration were important risk factors for the development of cerebral edema and ARDS in the index patient. The report highlights the importance of early diagnosis and aggressive therapy in the management of ARDS, and summarizes the published literature on this rarely reported complication of pediatric DKA. PMID:26666907

  13. Argument against the Routine Use of Steroids for Pediatric Acute Respiratory Distress Syndrome

    Hartmann, Silvia M.; Hough, Catherine L.

    2016-01-01

    Steroids have a plausible mechanism of action of reducing severity of lung disease in acute respiratory distress syndrome (ARDS) but have failed to show consistent benefits in patient-centered outcomes. Many studies have confounding from the likely presence of ventilator-induced lung injury and steroids may have shown benefit because administration minimized ongoing inflammation incited by injurious ventilator settings. If steroids have benefit, it is likely for specific populations that fall within the heterogeneous diagnosis of ARDS. Those pediatric patients with concurrent active asthma or reactive airway disease of prematurity, in addition to ARDS, are the most common group likely to derive benefit from steroids, but are poorly studied. With the information currently available, it does not appear that the typical adult or pediatric patient with ARDS derives benefit from steroids and steroids should not be given on a routine basis.

  14. Analysis of high risk factors related to acute respiratory distress syndrome following severe thoracoabdominal injuries

    ZHENG Guo-shou; BAI Xiang-jun; ZHAN Cheng-ye

    2007-01-01

    Objective: To investigate the high risk factors related to acute respiratory distress syndrome ( ARDS ) following serious thoracoabdominal injuries.Methods: The clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.Results: The incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries.The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock,dyspnea, abnormal arterial blood gas, hemopneumothorax,pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.Conclusion: There are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of ARDS.

  15. Lung Postmortem Autopsy Revealing Extramedullary Involvement in Multiple Myeloma Causing Acute Respiratory Distress Syndrome

    Aurélie Ravinet

    2014-01-01

    Full Text Available Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14 translocation. Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.

  16. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    Jed Lipes; Francois Lellouche; Azadeh Bojmehrani

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung inj...

  17. Extracorporeal blood therapy in sepsis and acute respiratory distress syndrome: the "purifying dream"

    Xu Xuefeng; Dai Huaping; Jia Chun'e; Wang Chen

    2014-01-01

    Objective To discuss the rationale,hypothesis,modality of extracorporeal blood purification (EBP) techniques for the critically ill animal models or patients,and to summarize the experimental and clinical studies with inconsistent data which explored the EBP's efficacy in the areas of critical care medicine.Data sources Articles referred in this review were collected from the database of PubMed published in English up to June 2014.Study selection We had done a literature search by using the term "(sepsis OR acute lung injury OR acute respiratory distress syndrome) AND (extracorporeal blood purification OR hemofiltration OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton)".Related original or review articles were included and carefully analyzed.Results Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome (ARDS).Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits.Such failure shifts the therapeutic rationale to the nonspecific,broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response.Therefore,EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution.Over the years,multiple extracorporeal techniques for the critically ill animal models or patients have been developed,including hemofiltration (HF),high-volume hemofiltration (HVHF),high-cutoff hemofiltration (HCO-HF),hemo-perfusion or-adsorption (HP/HA),coupled plasma filtration adsorption (CPFA),and plasma exchange (PE).These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients.However,data on their efficacy (especially on the clinical benefits,such as mortality) were inconsistent.Conclusions It is not now to conclude that EBP intervention can purify septic or ARDS

  18. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    Vinhaes E.N.G.

    2002-01-01

    Full Text Available Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia. The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS. The objective of the present study was to perform a quantitative analysis of the histology of carotid bodies collected from patients who died of ARDS. A morphometric study of carotid bodies collected during routine autopsies was carried out on three groups: patients that died of non-respiratory diseases (controls, N = 8, patients that presented COPD and died of its complications or associated diseases (N = 7, and patients that died of ARDS (N = 7. Morphometric measurements of the volume fraction of clusters of chief cells were performed in five fields on each slide at 40X magnification. The numerical proportion of the four main histological cell types (light, dark, progenitor and sustentacular cells was determined analyzing 10 fields on each slide at 400X magnification. The proportion of dark cells was 0.22 in ARDS patients, 0.12 in controls (P<0.001, and 0.08 in the COPD group. The proportion of light cells was 0.33 (ARDS, 0.44 (controls (P<0.001, and 0.36 (COPD. These findings suggest that chronic and acute hypoxia have different effects on the histology of glomic tissue.

  19. Potential therapeutic application of adult stem cells in acute respiratory distress syndrome

    JIANG Jian-xin; LI Li

    2009-01-01

    Acute respiratory distress syndrome (ARDS) remains a poor prognosis in spite of the recent development of new therapeutic strategies. Cell-based therapy with stem cells has been considered as a promising way for the treatment of vital organ damage. Putative endogenous stem cells have been shown to be located within the adult lung in the basal layer of the upper airways, within or near pulmonary neu-roendocrine cell rests, at the bronchoalveolar junction, as well as within the alveolar epithelium. These stem cells are hypothesized to be the source of lung regeneration and repair. But this mechanism seems to be insufficient after lung injury. There is increasing excitement over the last few years with the suggestion that exogenous stem cells may offer new treatment options for ARDS. Exogenous stem cells have the abihty to differentiate and function as both airway and lung parenchymal epithelial cells in both in vitro and in-creasingly in vivo experiments. However, there is great con-troversy concerning the repair effect of adult stem cells in lung injury. This review evaluates the advances in endog-enous respiratory stem cells, and assesses the evidence for the use of stem cells in the repair of lung injury.

  20. Recent insights: mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome

    Horie, Shahd; Laffey, John G.

    2016-01-01

    Acute respiratory distress syndrome (ARDS) causes respiratory failure, which is associated with severe inflammation and lung damage and has a high mortality and for which there is no therapy. Mesenchymal stromal/stem cells (MSCs) are adult multi-progenitor cells that can modulate the immune response and enhance repair of damaged tissue and thus may provide a therapeutic option for ARDS. MSCs demonstrate efficacy in diverse in vivo models of ARDS, decreasing bacterial pneumonia and ischemia-reperfusion-induced injury while enhancing repair following ventilator-induced lung injury. MSCs reduce the pro-inflammatory response to injury while augmenting the host response to bacterial infection. MSCs appear to exert their effects via multiple mechanisms—some are cell interaction dependent whereas others are paracrine dependent resulting from both soluble secreted products and microvesicles/exosomes derived from the cells. Strategies to further enhance the efficacy of MSCs, such as by overexpressing anti-inflammatory or pro-repair molecules, are also being investigated. Encouragingly, early phase clinical trials of MSCs in patients with ARDS are under way, and experience with these cells in trials for other diseases suggests that the cells are well tolerated. Although considerable translational challenges, such as concerns regarding cell manufacture scale-up and issues regarding cell potency and batch variability, must be overcome, MSCs constitute a highly promising potential therapy for ARDS.

  1. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review.

    Koulouras, Vasilios; Papathanakos, Georgios; Papathanasiou, Athanasios; Nakos, Georgios

    2016-05-01

    Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung" - and the "shape matching" -model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort. PMID:27152255

  2. A case of lung cancer associated with acute respiratory distress syndrome after thoracic radiotherapy

    A 73-year-old man presented with dyspnea, cough, fever, appetite loss and stridor due to bronchial stenosis. Fiber-optic bronchoscopy revealed an endobronchial lesion in the right main bronchus and biopsy specimens showed poorly differentiated squamous cell carcinoma. The clinical stage of lung cancer was IIIB (T4N2M0). The patient received 60 Gy in 30 fractions over 43 days to a field including the right hilum and mediastinum. The tumor decreased in size and stenosis of the bronchus disappeared. A week after completion of radiation the patient began to have high grade fever and dyspnea, and progressive hypoxia developed. A chest radiograph showed diffuse bilateral interstitial infiltrates. Despite mechanical ventilation with PEEP and the administration of steroids, he died of respiratory failure three weeks after completion of radiation. Necropsy specimens obtained from the left lung revealed massive deposition of fibrin in the alveolar airspaces associated with hyaline membranes and hyperplasia of type II cells indicating diffuse alveolar damage. The patient had mild pulmonary fibrosis on a CT scan taken before the start of radiotherapy. We conclude that care should be taken if the case has pulmonary fibrosis because radiation therapy can precipitate severe radiation pneumonitis and acute respiratory distress syndrome in such cases. (author)

  3. Recruitment maneuvers in acute respiratory distress syndrome and during general anesthesia.

    Chiumello, Davide; Algieri, Ilaria; Grasso, Salvatore; Terragni, Pierpaolo; Pelosi, Paolo

    2016-02-01

    The use of low tidal volume ventilation and low to moderate positive end-expiratory pressure (PEEP) levels is a widespread strategy to ventilate patients with non-injured lungs during general anesthesia and in intensive care as well with mild to moderate acute respiratory distress syndrome (ARDS). Higher PEEP levels have been recommended in severe ARDS. Due to the presence of alveolar collapse, recruitment maneuvers (RMs) by causing a transient elevation in airway pressure (i.e. transpulmonary pressure) have been suggested to improve lung inflation in non-inflated and poorly-inflated lung regions. Various types of RMs such as sustained inflation at high pressure, intermittent sighs and stepwise increases of PEEP and/or airway plateau inspiratory pressure have been proposed. The use of RMs has been associated with mixed results in terms of physiological and clinical outcomes. The optimal method for RMs has not yet been identified. The use of RMs is not standardized and left to the individual physician based on his/her experience. Based on the same grounds, RMs have been proposed to improve lung aeration during general anesthesia. The aim of this review was to present the clinical evidence supporting the use of RMs in patients with ARDS and during general anesthesia and as well their potential biological effects in experimental models of acute lung injury. PMID:25881732

  4. Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome

    Huh, Jin Won; Jung, Hoon; Choi, Hye Sook; Hong, Sang-Bum; Lim, Chae-Man; Koh, Younsuck

    2009-01-01

    Introduction In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS. Methods Fifty-seven patients with early ARDS were randomly assigned to a group given decremental ...

  5. Enhanced Surfactant Adsorption via Polymer Depletion Forces: A Simple Model for Reversing Surfactant Inhibition in Acute Respiratory Distress Syndrome

    Stenger, Patrick C.; Zasadzinski, Joseph A.

    2006-01-01

    Lung surfactant adsorption to an air-water interface is strongly inhibited by an energy barrier imposed by the competitive adsorption of albumin and other surface-active serum proteins that are present in the lung during acute respiratory distress syndrome. This reduction in surfactant adsorption results in an increased surface tension in the lung and an increase in the work of breathing. The reduction in surfactant adsorption is quantitatively described using a variation of the classical Smo...

  6. KL-6 concentration in pulmonary epithelial lining fluid is a useful prognostic indicator in patients with acute respiratory distress syndrome

    Kondo, Tomohiro; Hattori, Noboru; Ishikawa, Nobuhisa; MURAI, HIROSHI; Haruta, Yoshinori; Hirohashi, Nobuyuki; Tanigawa, Koichi; Kohno, Nobuoki

    2011-01-01

    Background: KL-6 is a mucin-like glycoprotein expressed on the surface of alveolar type II cells. Elevated concentrations of KL-6 in serum and epithelial lining fluid (ELF) in patients with acute respiratory distress syndrome (ARDS) have been previously reported; however, kinetics and prognostic significance of KL-6 have not been extensively studied. This study was conducted to clarify these points in ARDS patients.Methods: Thirty-two patients with ARDS who received mechanical ventilation und...

  7. KL-6 concentration in pulmonary epithelial lining fluid is a useful prognostic indicator in patients with acute respiratory distress syndrome

    Tanigawa Koichi; Hirohashi Nobuyuki; Haruta Yoshinori; Murai Hiroshi; Ishikawa Nobuhisa; Hattori Noboru; Kondo Tomohiro; Kohno Nobuoki

    2011-01-01

    Abstract Background KL-6 is a mucin-like glycoprotein expressed on the surface of alveolar type II cells. Elevated concentrations of KL-6 in serum and epithelial lining fluid (ELF) in patients with acute respiratory distress syndrome (ARDS) have been previously reported; however, kinetics and prognostic significance of KL-6 have not been extensively studied. This study was conducted to clarify these points in ARDS patients. Methods Thirty-two patients with ARDS who received mechanical ventila...

  8. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez; Saurabh Kothari; Dhaval Dave; Manish Pendse; Divya Lala; Smita Patil; Archana Bhate

    2015-01-01

    Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV). The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of a...

  9. A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome

    Files, D. Clark; Sanchez, Michael A; Morris, Peter E

    2015-01-01

    Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underly...

  10. Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model

    Cogo Paola E; Toffolo Gianna; Ori Carlo; Vianello Andrea; Chierici Marco; Gucciardi Antonina; Cobelli Claudio; Baritussio Aldo; Carnielli Virgilio P

    2007-01-01

    Abstract Background In patients with acute respiratory distress syndrome (ARDS), it is well known that only part of the lungs is aerated and surfactant function is impaired, but the extent of lung damage and changes in surfactant turnover remain unclear. The objective of the study was to evaluate surfactant disaturated-phosphatidylcholine turnover in patients with ARDS using stable isotopes. Methods We studied 12 patients with ARDS and 7 subjects with normal lungs. After the tracheal instilla...

  11. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers.

    Herridge, Margaret S; Moss, Marc; Hough, Catherine L; Hopkins, Ramona O; Rice, Todd W; Bienvenu, O Joseph; Azoulay, Elie

    2016-05-01

    Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge. Cognitive impairment in ARDS survivors ranges from 70 to 100 % at hospital discharge, 46 to 80 % at 1 year, and 20 % at 5 years, and mood disorders including depression and post-traumatic stress disorder (PTSD) are also sustained and prevalent. Robust multidisciplinary and longitudinal interventions that improve these outcomes are still uncertain and data in our literature are conflicting. Studies are needed in family members of ARDS survivors to better understand long-term outcomes of the post-ICU family syndrome and to evaluate how it affects patient recovery. PMID:27025938

  12. Increased extravascular lung water reduces the efficacy of alveolar recruitment maneuver in acute respiratory distress syndrome.

    Smetkin, Alexey A; Kuzkov, Vsevolod V; Suborov, Eugeny V; Bjertnaes, Lars J; Kirov, Mikhail Y

    2012-01-01

    Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H(2)O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO(2)/FiO(2) increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective. PMID:22649717

  13. Pressure controlled inverse ratio ventilation in acute respiratory distress syndrome patients.

    Tripathi M

    2002-01-01

    Full Text Available Appropriate ventilatory intervention is life saving in acute respiratory distress syndrome (ARDS. Pressure controlled inverse ratio ventilation (PC-IRV is the likely mode of ventilation benefiting in extreme conditions of ARDS. However, guidelines when to start PC-IRV is not yet well defined. The ventilation-related dilemma, which we faced in two illustrative cases of ARDS are presented. The first patient presenting clinically with ARDS but with high peak airway pressure (PIP and low dynamic lung compliance, PC-IRV helped in reducing PIP, improved haemodynamics and the oxygenation of blood. In second patient with similar clinical presentation of ARDS, where although PIP was high but the dynamic compliance was better, the PC-IRV caused deterioration in PaO2. Here, patient rather did better with high PEEP (15 cm H2O and usual I: E ratio (1:2. It is probable that the dynamic lung compliance (< 20ml/cmH2O, PIP (> 50 cm H2O at conventional I: E ratio (1:2 ventilation (10 ml/kg with hypotension might form the basis to develop a scoring system for guidance to switch over to PC-IRV ventilation. Further randomised prospective controlled clinical trials will then be required to establish indication to start PC-IRV in ARDS.

  14. Distinct Proteasome Subpopulations in the Alveolar Space of Patients with the Acute Respiratory Distress Syndrome

    S. U. Sixt

    2012-01-01

    Full Text Available There is increasing evidence that proteasomes have a biological role in the extracellular alveolar space, but inflammation could change their composition. We tested whether immunoproteasome protein-containing subpopulations are present in the alveolar space of patients with lung inflammation evoking the acute respiratory distress syndrome (ARDS. Bronchoalveolar lavage (BAL supernatants and cell pellet lysate from ARDS patients (n=28 and healthy subjects (n=10 were analyzed for the presence of immunoproteasome proteins (LMP2 and LMP7 and proteasome subtypes by western blot, chromatographic purification, and 2D-dimensional gelelectrophoresis. In all ARDS patients but not in healthy subjects LMP7 and LMP2 were observed in BAL supernatants. Proteasomes purified from pooled ARDS BAL supernatant showed an altered enzyme activity ratio. Chromatography revealed a distinct pattern with 7 proteasome subtype peaks in BAL supernatant of ARDS patients that differed from healthy subjects. Total proteasome concentration in BAL supernatant was increased in ARDS (971 ng/mL ± 1116 versus 59±25; P<0.001, and all fluorogenic substrates were hydrolyzed, albeit to a lesser extent, with inhibition by epoxomicin (P=0.0001. Thus, we identified for the first time immunoproteasome proteins and a distinct proteasomal subtype pattern in the alveolar space of ARDS patients, presumably in response to inflammation.

  15. Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

    Cíntia Lourenço Santos

    2015-04-01

    Full Text Available Supporting patients with acute respiratory distress syndrome (ARDS, using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

  16. Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

    Xianming Zhang

    Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

  17. Acute respiratory distress syndrome in adenovirus type 4 pneumonia: A case report.

    Narra, R; Bono, P; Zoccoli, A; Orlandi, A; Piconi, S; Grasselli, G; Crotti, S; Girello, A; Piralla, A; Baldanti, F; Lunghi, G

    2016-08-01

    Human adenoviruses (HAdVs) cause a wide spectrum of clinical syndromes, depending on species and types, from mild respiratory infections to deadly pneumonia: in particular, severe infections occur in immunocompromised patients. In this report, we describe the case of a 36 years-old woman admitted to our intensive care unit (ICU) with severe respiratory distress syndrome caused by adenovirus pneumonia, that required invasive respiratory support (mechanical ventilation and extracorporeal membrane oxygenation). Molecular assays detected the virus in respiratory and plasma specimen and sequencing procedure identified HAdV type 4. Patient improved after cidofovir administration. Leukopenia and subsequent bacterial infection occurred, but the patient recovered completely and was discharged from the hospital after 54days. PMID:27354307

  18. CAUSES OF RESPIRATORY DISTRESS IN CHILDREN

    M M Karambin

    2008-11-01

    Full Text Available "nThere is a lack of large, prospective epidemiologic studies concerning acute lung injury (ALI and acute respiratory distress syndrome (ARDS in pediatric population. To determine the different causes of respiratory distress in children, we prepared a retrospective study and included the whole 567 children with respiratory distress referred to 17-Shahrivar Hospital, Rasht, Guilan. Using their medical files, data including age, sex, and causes of respiratory distress were collected. SPSS 13.0 (statistical software applied for statistical analysis. Pneumonia, asthma, and croup were the major causes of ARDS in children with a rate of 38.4, 19.04, and 16.5 percent, respectively. It seems that infectious factors are at the top of the list of ARDS causing factors which can be helpful to approach and manage such patients. We suggest vaccinating these at risk groups against common infectious factors such as H. Influenza and RSV which can cause either pneumonia or inducing asthma.

  19. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Wang, Changsong; Wang, Xiaoyang; Chi, Chunjie; Guo, Libo; Guo, Lei; Zhao, Nana; Wang, Weiwei; Pi, Xin; Sun, Bo; Lian, Ailing; Shi, Jinghui; Li, Enyou

    2016-01-01

    To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients. PMID:26955891

  20. Identification of novel single nucleotide polymorphisms associated with acute respiratory distress syndrome by exome-seq.

    Katherine Shortt

    Full Text Available Acute respiratory distress syndrome (ARDS is a lung condition characterized by impaired gas exchange with systemic release of inflammatory mediators, causing pulmonary inflammation, vascular leak and hypoxemia. Existing biomarkers have limited effectiveness as diagnostic and therapeutic targets. To identify disease-associating variants in ARDS patients, whole-exome sequencing was performed on 96 ARDS patients, detecting 1,382,399 SNPs. By comparing these exome data to those of the 1000 Genomes Project, we identified a number of single nucleotide polymorphisms (SNP which are potentially associated with ARDS. 50,190SNPs were found in all case subgroups and controls, of which89 SNPs were associated with susceptibility. We validated three SNPs (rs78142040, rs9605146 and rs3848719 in additional ARDS patients to substantiate their associations with susceptibility, severity and outcome of ARDS. rs78142040 (C>T occurs within a histone mark (intron 6 of the Arylsulfatase D gene. rs9605146 (G>A causes a deleterious coding change (proline to leucine in the XK, Kell blood group complex subunit-related family, member 3 gene. rs3848719 (G>A is a synonymous SNP in the Zinc-Finger/Leucine-Zipper Co-Transducer NIF1 gene. rs78142040, rs9605146, and rs3848719 are associated significantly with susceptibility to ARDS. rs3848719 is associated with APACHE II score quartile. rs78142040 is associated with 60-day mortality in the overall ARDS patient population. Exome-seq is a powerful tool to identify potential new biomarkers for ARDS. We selectively validated three SNPs which have not been previously associated with ARDS and represent potential new genetic biomarkers for ARDS. Additional validation in larger patient populations and further exploration of underlying molecular mechanisms are warranted.

  1. Partial ventilatory support modalities in acute lung injury and acute respiratory distress syndrome-a systematic review.

    Sarah M McMullen

    Full Text Available PURPOSE: The efficacy of partial ventilatory support modes that allow spontaneous breathing in patients with acute lung injury (ALI and acute respiratory distress syndrome (ARDS is unclear. The objective of this scoping review was to assess the effects of partial ventilatory support on mortality, duration of mechanical ventilation, and both hospital and intensive care unit (ICU lengths of stay (LOS for patients with ALI and ARDS; the secondary objective was to describe physiologic effects on hemodynamics, respiratory system and other organ function. METHODS: MEDLINE (1966-2009, Cochrane, and EmBase (1980-2009 databases were searched using common ventilator modes as keywords and reference lists from retrieved manuscripts hand searched for additional studies. Two researchers independently reviewed and graded the studies using a modified Oxford Centre for Evidence-Based Medicine grading system. Studies in adult ALI/ARDS patients were included for primary objectives and pre-clinical studies for supporting evidence. RESULTS: Two randomized controlled trials (RCTs were identified, in addition to six prospective cohort studies, one retrospective cohort study, one case control study, 41 clinical physiologic studies and 28 pre-clinical studies. No study was powered to assess mortality, one RCT showed shorter ICU length of stay, and the other demonstrated more ventilator free days. Beneficial effects of preserved spontaneous breathing were mainly physiological effects demonstrated as improvement of gas exchange, hemodynamics and non-pulmonary organ perfusion and function. CONCLUSIONS: The use of partial ventilatory support modalities is often feasible in patients with ALI/ARDS, and may be associated with short-term physiological benefits without appreciable impact on clinically important outcomes.

  2. Systemic inflammatory response syndrome, acute lung injury and acute respiratory distress syndrome%全身炎症反应综合征、急性肺损伤与急性呼吸窘迫综合征

    钱桂生

    2005-01-01

    @@ 1967年Ashbaugh等首次报道了成人急性呼吸窘迫(acute respiratory distress in adult),为了和新生儿或婴儿呼吸窘迫综合征(infantile respiratory distress syndrome,IRDS)相区别,被命名为成人呼吸窘迫综合征(adult respiratory distress syndrome,ARDS).

  3. Innate Lymphoid Cells are the Predominant Source of Interleukin-17A During the Early Pathogenesis of Acute Respiratory Distress Syndrome

    Muir, Roshell; Osbourn, Megan; Dubois, Alice V.; Doran, Emma; Small, Donna M; Monahan, Avril; O'Kane, Cecilia M.; McAllister, Katherine; Fitzgerald, Denise C; Kissenpfennig, Adrien; McAuley, Daniel F; Ingram, Rebecca J.

    2015-01-01

    Rationale: IL-17A is purported to help drive early pathogenesis in acute respiratory distress syndrome (ARDS) by enhancing neutrophil recruitment. Whilst IL-17A is the archetypal cytokine of T helper (Th)17 cells, it is produced by a number of lymphocytes, the source during ARDS being unknown. Objectives: To identify the cellular source and the role of IL17A in the early phase of lung injuryMethods: Lung injury was induced in WT (C57BL/6) and IL-17 KO mice with aerosolised LPS (100 µg) or Pse...

  4. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez

    2015-12-01

    Full Text Available Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV. The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of antivirals, especially in adult pox, to tackle the complications of disease and get a favourable outcome. [Int J Res Med Sci 2015; 3(12.000: 3924-3927

  5. Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1 virus infection

    Carlos Toufen Jr.

    2011-01-01

    Full Text Available BACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.

  6. Changes in lung parenchyma after acute respiratory distress syndrome (ARDS): assessment with high-resolution computed tomography

    The aim of this study was to evaluate the appearance, extent, and distribution of parenchymal changes in the lung after acute respiratory distress syndrome (ARDS) as a function of disease severity and therapeutic procedures. High-resolution computed tomography (HRCT), clinical examination, and lung function tests were performed in 15 patients, 6-10 months after ARDS. The appearance and extent of parenchymal changes were compared with the severity of ARDS, as well as with clinical and therapeutic data. Lung parenchymal changes resembling those found in the presence of pulmonary fibrosis were observed in 13 of 15 patients (87%). The changes were significantly more frequent and more pronounced in the ventral than in the dorsal portions of the lung (p<0.01). A significant correlation was observed between the extent of lung alterations and the severity of ARDS (p<0.01), and the duration in which patients had received mechanical ventilation either with a peak inspiratory pressure greater than 30 mmHg (p<0.05), or with more than 70% oxygen (p<0.01). Acute respiratory distress syndrome frequently is followed by fibrotic changes in lung parenchyma. The predominantly ventral distribution of these changes indicates that they may be caused by the ventilation regimen and the oxygen therapy rather than by the ARDS. (orig.)

  7. Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

    ZHAO Xiao-gang; WU Jun-song; HE Xiao-di; MA Yue-feng; ZHANG Mao; GAN Jian-xin; XU Shao-wen; JIANG Guan-yu

    2008-01-01

    Background Among the deaths due to trauma,about one half of the patients suffer from road traffic injury(RTI).Most of RTI patients complicate acute respiratory distress syndrome(ARDS)and severe multiple injuries.ARDS is a major contributor to morbidity and mortality in trauma patients.Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients.their relative importance in development of the syndrome are undefined.We hypothesize that not all of the traditionaI risk factors impacting mortality are independently associated with patients strictly identified by traffic injury.This study aimed to sieve distinctive risk factors in our RTI population,meanwhile,we also hypothesize that there may exist significantly different risk factors in these patients.Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit (EICU)admission.Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed.Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive iterns in these severe RTI patients.Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period.The unadjusted odds ratio(OR)and 95% confidence intervals(CI) of mortality were associated with six risk factors out of 23:APACHE Ⅱ score,duration of trauma factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation.The adjusted ORs with 95% CI were denoted with respect to surviving beyond 96 hours EICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 EICU admission(duration of trauma factor,sepsis,duration of mechanical ventilation)and mechanicaI ventilation beyond 7 days EICU admission

  8. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    Manzar Vakili

    2015-01-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2 less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 % in the 24 hours and 4 (1.33% patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937 and sex (P

  9. Fas and Fas Ligand Are Up-Regulated in Pulmonary Edema Fluid and Lung Tissue of Patients with Acute Lung Injury and the Acute Respiratory Distress Syndrome

    Albertine, Kurt H; Soulier, Matthew F.; Wang, Zhengming; Ishizaka, Akitoshi; Hashimoto, Satoru; Zimmerman, Guy A.; Matthay, Michael A; Lorraine B. Ware

    2002-01-01

    Apoptosis mediated by Fas/Fas ligand (FasL) interaction has been implicated in human disease processes, including pulmonary disorders. However, the role of the Fas/FasL system in acute lung injury (ALI) and in the acute respiratory distress syndrome (ARDS) is poorly defined. Accordingly, we investigated both the soluble and cellular expression of the Fas/FasL system in patients with ALI or ARDS. The major findings are summarized as follows. First, the soluble expression of the Fas/FasL system...

  10. Successful use of inhaled nitric oxide to decrease intracranial pressure in a patient with severe traumatic brain injury complicated by acute respiratory distress syndrome: a role for an anti-inflammatory mechanism?

    Medhkour Azedine; Papadimos Thomas J; Yermal Sooraj

    2009-01-01

    Abstract Use of inhaled nitric oxide in humans with traumatic brain injury and acute respiratory distress syndrome has twice previously been reported to be beneficial. Here we report a third case. We propose that INO may decrease the inflammatory response in patients with increased intracranial pressure caused by traumatic brain injury accompanied by acute respiratory distress syndrome thereby contributing to improved outcomes.

  11. Association between insertion/deletion polymorphism in angiotensin-converting enzyme gene and acute lung injury/acute respiratory distress syndrome: a meta-analysis

    Matsuda Akihisa

    2012-08-01

    Full Text Available Abstract Background A previous meta-analysis reported a positive association between an insertion/deletion (I/D polymorphism in the angiotensin-converting enzyme gene (ACE and the risk of acute lung injury (ALI/acute respiratory distress syndrome (ARDS. Here, we updated this meta-analysis and additionally assessed the association of this polymorphism with ALI/ARDS mortality. Methods We searched electronic databases through October 2011 for the terms “angiotensin-converting enzyme gene”, “acute lung injury”, and “acute respiratory distress syndrome,” and reviewed all studies that reported the relationship of the I/D polymorphism in ACE with ALI/ARDS in humans. Seven studies met the inclusion criteria, comprising 532 ALI/ARDS patients, 3032 healthy controls, and 1432 patients without ALI/ARDS. We used three genetic models: the allele, dominant, and recessive models. Results The ACE I/D polymorphism was not associated with susceptibility to ALI/ARDS for any genetic model. However, the ACE I/D polymorphism was associated with the mortality risk of ALI/ARDS in Asian subjects ( Pallele Pdominant = 0.001, Precessive = 0.002. This finding remained significant after correction for multiple comparisons. Conclusions There is a possible association between the ACE I/D polymorphism genotype and the mortality risk of ALI/ARDS in Asians.

  12. Traumatic memories, post-traumatic stress disorder and serum cortisol levels in long-term survivors of the acute respiratory distress syndrome

    Hauer, Daniela; Weis, Florian; Krauseneck, Till; Vogeser, Michael; Schelling, Gustav; Roozendaal, Benno

    2009-01-01

    Survivors of the acute respiratory distress syndrome (ARDS) often report traumatic memories from the intensive care unit (ICU) and display a high incidence of post-traumatic stress disorder (PTSD). As it is known that subjects with PTSD often show sustained reductions in circulating cortisol concent

  13. Scrub Typhus with Acute Respiratory Distress Syndrome (ARDS) and its Management in Intensive Care Unit: A Case Report.

    Sankuratri, Srinivas; Kalagara, Pavani; Samala, Kartika Balaji; Veledandi, Prabhakar Krishna; Atiketi, Srinadh Babu

    2015-05-01

    Scrub typhus is zoonotic disease caused by Orientia tsutsugamushi (O tsutsugamushi). It is transmitted to humans by the bite of trombiculid mite larvae (chiggers). It is a re-emerging infectious disease in India. Clinical manifestations include fever, headache, anorexia, myalgia, eschar, adenopathy and maculopapular rash. Complications of Scrub typhus develop after first week of illness. Complications include meningoencephalitis, jaundice, myocarditis, ARDS and renal failure. Eschar and rash may be unnoticed or absent. Thorough physical examination, identification of eschar/rash throws light in thinking about scrub typhus, treating and preventing further complications. Here, we report a case of scrub typhus with Acute Respiratory Distress Syndrome (ARDS) and its management with non invasive ventilation in the intensive care unit. PMID:26155511

  14. Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature

    Dhooria, Sahajal; Sehgal, Inderpaul Singh; Agrawal, Anshu Kumar; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Behera, Digambar

    2016-01-01

    Background and Aims: This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. Materials and Methods: In this prospective, observational study, consecutive patients with ARDS discharged from the Intensive Care Unit (ICU) underwent evaluation with Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and overnight polysomnography. Patients having one or more of the following characteristics were classified as having abnormal sleep: ESS>10, PSQI>5, FOSQ 10, seven (35%) had global PSQI>5 and one had FOSQ <17.9. Ten (50%) patients had at least one characteristic that suggested abnormal sleep (4 insomnia, 2 central sleep apnea, 1 obstructive sleep apnea, 1 REM-SDB, and 2 with a high PSQI, but no specific sleep abnormality). Conclusions: Sleep disturbances are common in ARDS survivors early after discharge from the ICU. PMID:27390455

  15. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax

    Narula, Deepali; Nangia, Vivek

    2014-01-01

    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. Ho...

  16. Roles of neurally adjusted ventilatory assist in improving gas exchange in a severe acute respiratory distress syndrome patient after weaning from extracorporeal membrane oxygenation: a case report

    Goto, Yuya; Katayama, Shinshu; Shono, Atsuko; Mori, Yosuke; Miyazaki, Yuya; Sato, Yoko; Ozaki, Makoto; Kotani, Toru

    2016-01-01

    Background Patient-ventilator asynchrony is a major cause of difficult weaning from mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is reported useful to improve the synchrony in patients with sustained low lung compliance. However, the role of NAVA has not been fully investigated. Case presentation The patient was a 63-year-old Japanese man with acute respiratory distress syndrome secondary to respiratory infection. He was treated with extracorporeal membrane oxygenation ...

  17. Comparative Study of pressure-control ventilation and volume-control ventilation in treating traumatic acute respiratory distress syndrome

    杨云梅; 黄卫东; 沈美亚; 徐哲荣

    2005-01-01

    Objective: To observe the clinical therapeutic effect and side effect of pressure-control ventilation (PCV) on traumatic acute respiratory distress syndrome (ARDS) compared with volume-control ventilation (VCV).Methods: Forty patients with traumatic ARDS were hospitalized in our department from June 1996 to December 2002. Twenty were treated with PCV (PCV group) and 20 with VCV (VCV group). The changes of the peak inflating pressure and the mean pressure of the airway were observed at the very beginning of the mechanical ventilation and the following 12 and 24 hours, respectively. The transcutaneous saturation of oxygen pressure, the pressure of oxygen in artery, the mean blood pressure, the central venous pressure, the heart rate and the incidence of the pressure injury were also monitored before ventilation and 12 hours after ventilation.Results: The pressure of oxygen in artery, the transcutaneous saturation of oxygen pressure, the heart rate and the respiratory rate in the PCV group were obviously improved after ventilation treatment. The peak inflating pressure, the mean pressure of the airway and the central venous pressure in the PCV group were lower than in the VCV group. The incidence of pressure injury was 0 in the PCV group while 10% in the VCV group. Conclusions: The clinical effect of PCV on traumatic ARDS is better and the incidence rate of pressure injury is lower than that of VCV. PCV has minimal effects on the hemodynamics.

  18. Monitoring extravascular lung water in acute respiratory distress syndrome induced by probable 2009 pandemic influenza A (H1N1) virus: report of two cases

    LI Hong-liang; WANG Zong-yu; YAO Gai-qi; ZHU Xi

    2010-01-01

    @@ During the spring of 2009, a pandemic novel influenza A (H1N1) vims emerged and spread globally. As of January 3, 2009, more than 208 countries and overseas territories or communities have reported laboratory-confirmed cases of pandemic influenza H1N1 2009, including at least 12 799 death cases.1 Critical cases developed severe acute respiratory distress syndrome (ARDS) rapidly, which was refractory to conventional mechanical ventilation and rescue therapies.

  19. NOX1 is responsible for cell death through STAT3 activation in hyperoxia and is associated with the pathogenesis of Acute Respiratory Distress Syndrome

    Carnesecchi, Stephanie; Dunand-Sauthier, Isabelle; Zanetti, Filippo; Singovski, Grigory; Deffert, Christine; Donati, Yves; Cagarelli, Thomas; Pache, Jean-Claude; Krause, Karl-Heinz; Reith, Walter; Barazzone-Argiroffo, Constance

    2014-01-01

    Reactive oxygen species (ROS) contribute to alveolar cell death in Acute Respiratory Distress Syndrome (ARDS) and we previously demonstrated that NOX1-derived ROS contributed to hyperoxia-induced alveolar cell death in mice. The study investigates whether NOX1 expression is modulated in epithelial cells concomitantly to cell death and associated to STAT3 signaling in the exudative phase of ARDS. In addition, the role of STAT3 activation in NOX1-dependent epithelial cell death was confirmed by...

  20. Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced life-threatening hypoxaemia aggravated by hepatopulmonary syndrome

    Monsel, Antoine; Mal, Hervé; Brisson, Hélène; Luo, Rubin; Eyraud, Daniel; Vézinet, Corinne; Do, Chung Hi; Lu, Qin; Vaillant, Jean-Christophe; Hannoun, Laurent; Houssel, Pauline; Durand, François; Rouby, Jean-Jacques

    2011-01-01

    Introduction Combined with massive lung aeration loss resulting from acute respiratory distress syndrome, hepatopulmonary syndrome, a liver-induced vascular lung disorder characterized by diffuse or localized dilated pulmonary capillaries, may induce hypoxaemia and death in patients with end-stage liver disease. Methods The case of such a patient presenting with both disorders and in whom an extracorporeal membrane oxygenation was used is described. Results A 51-year-old man with a five-year ...

  1. Kerbs von Lungren 6 antigen is a marker of alveolar inflammation but not of infection in patients with acute respiratory distress syndrome

    Nathani, Nazim; Perkins, Gavin D; Tunnicliffe, William; Murphy, Nick; Manji, Mav; Thickett, David R.

    2008-01-01

    Background Kerbs von Lungren 6 antigen (KL-6) is expressed on the surface of alveolar type II cells, and elevated plasma and epithelial lining fluid levels of KL-6 have previously been shown to correlate with the severity of disease and survival in acute respiratory distress syndrome (ARDS). The relationship between alveolar inflammation and KL-6 measurements has not been ascertained. We hypothesized that the elevation of KL-6 in ARDS is dependent upon the severity of neutrophilic inflammatio...

  2. Administration of intrapulmonary sodium polyacrylate to induce lung injury for the development of a porcine model of early acute respiratory distress syndrome

    Henderson, William R.; Barnbrook, Julian; Dominelli, Paolo B.; Griesdale, Donald EG; Arndt, Tara; Molgat-Seon, Yannick; Foster, Glen; Ackland, Gareth L; Xu, James; Ayas, Najib T.; Sheel, Andrew W.

    2014-01-01

    Background The loss of alveolar epithelial and endothelial integrity is a central component in acute respiratory distress syndrome (ARDS); however, experimental models investigating the mechanisms of epithelial injury are lacking. The purpose of the present study was to design and develop an experimental porcine model of ARDS by inducing lung injury with intrapulmonary administration of sodium polyacrylate (SPA). Methods The present study was performed at the Centre for Comparative Medicine, ...

  3. Increased Risk of Post-Trauma Stroke after Traumatic Brain Injury-Induced Acute Respiratory Distress Syndrome.

    Chen, Gunng-Shinng; Liao, Kuo-Hsing; Bien, Mauo-Ying; Peng, Giia-Sheun; Wang, Jia-Yi

    2016-07-01

    This study determines whether acute respiratory distress syndrome (ARDS) is an independent risk factor for an increased risk of post-traumatic brain injury (TBI) stroke during 3-month, 1-year, and 5-year follow-ups, respectively, after adjusting for other covariates. Clinical data for the analysis were from the National Health Insurance Database 2000, which covered a total of 2121 TBI patients and 101 patients with a diagnosis of TBI complicated with ARDS (TBI-ARDS) hospitalized between January 1, 2001 and December 31, 2005. Each patient was tracked for 5 years to record stroke occurrences after discharge from the hospital. The prognostic value of TBI-ARDS was evaluated using a multivariate Cox proportional hazard model. The main outcome found that stroke occurred in nearly 40% of patients with TBI-ARDS, and the hazard ratio for post-TBI stroke increased fourfold during the 5-year follow-up period after adjusting for other covariates. The increased risk of hemorrhagic stroke in the ARDS group was considerably higher than in the TBI-only cohort. This is the first study to report that post-traumatic ARDS yielded an approximate fourfold increased risk of stroke in TBI-only patients. We suggest intensive and appropriate medical management and intensive follow-up of TBI-ARDS patients during the beginning of the hospital discharge. PMID:26426583

  4. INTERRELATIONS BETWEEN NEUTRO PHIL ENZYMES AND THEIR INHIBITORS IN PATHOGENESIS OF ACUTE RESPIRATORY DISTRESS SYNDROME ASSOCIATED WITH INFLUENZA PNEUMONIA

    E. V. Prutkina

    2012-01-01

    Full Text Available Abstract. Amounts of several neutrophil enzymes (elastase, myeloperoxidase (MPO, MMP-2 and their local inhibitors, i.e., Clara cell protein (CC16 and HSP-70, have been determined in blood plasma from fifty-two patients with various forms of influenza A/H1N1. Sixteen patients have developed acute respiratory distress syndrome (ARDS. In cases of uncomplicated influenza, elastase and MPO levels were shown to be increased, while MMP-2 levels did not change, along with higher contents of HSP-70 and unchanged CC16 amounts. Upon development of influenza-associated pneumonia, elastase and MPO concentrations became elevated, whereas MMP-2 levels were decreased, along with unchanged amounts of CC16 and HSP-70. In cases of ARDS development, CC16 amounts exhibited a sharp decrease. Meanwhile, contents of other proteins remained at the levels shown for pneumonia patients. It has been shown that increased concentrations of neutrophil elastase and MPO with a relative CC16 deficiency and decreased MMP-2 may represent a mechanism of pneumonia development. Decreased CC16 concentration may serve as a risk predictor of ARDS development.

  5. Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.

    Hong Du

    Full Text Available OBJECTIVES: The aim of this study was to investigate the clinical characteristics and outcomes of critical patients with hemorrhagic fever with renal syndrome (HFRS complicated by acute respiratory distress syndrome (ARDS. MATERIALS AND METHODS: To observe the demographic, epidemiological and clinical characteristics, and to explore the predictive effects for prognosis in laboratory findings, we conducted a detailed retrospective analysis of clinical records for critical patients with HFRS complicated by ARDS, treated at the center for infectious diseases, Tangdu Hospital, between January 2008 and December 2012. RESULTS: A total of 48 critical patients with laboratory confirmed HFRS accompanied by ARDS were enrolled in the study, including 27 survivors and 21 non-survivors, with a fatality rate of 43.75%. Thirty-one individuals (64.6% contracted HFRS between the months of September and December. The non-survivors tended to have lower incidence of overlapping phase (P = 0.025. There were no obvious differences in the needs for mechanical ventilation (MV and renal replacement therapy (RRT, except for the need for vasoactive drugs between the survivors and non-survivors (P = 0.001. The non-survivors were found to have higher frequencies of encephalopathy, refractory shock and multiple organ dysfunction syndrome (MODS, lower incidences of acute renal failure (ARF and secondary hypertension (P<0.05. The non-survivors tended to have lower levels of serum creatinine (Scr (P<0.001 and fibrinogen (Fib (P = 0.003, higher incidences of prolonged prothrombin time (PT (P = 0.006 and activated partial thromboplastin time (APTT (P = 0.020 and higher levels of aspartate aminotransferase (AST (P = 0.015, and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P<0.05. CONCLUSION: The high mortality rate of critical patients with HFRS complicated by ARDS emphasizes the importance of

  6. A specific phospholipase C activity regulates phosphatidylinositol levels in lung surfactant of patients with acute respiratory distress syndrome.

    Spyridakis, Spyros; Leondaritis, George; Nakos, George; Lekka, Marilena E; Galanopoulou, Dia

    2010-03-01

    Lung surfactant (LS) is a lipid-rich material lining the inside of the lungs. It reduces surface tension at the liquid/air interface and thus, it confers protection of the alveoli from collapsing. The surface-active component of LS is dipalmitoyl-phosphatidylcholine, while anionic phospholipids such as phosphatidylinositol (PtdIns) and primarily phosphatidylglycerol are involved in the stabilization of the LS monolayer. The exact role of PtdIns in this system is not well-understood; however, PtdIns levels change dramatically during the acute respiratory distress syndrome (ARDS) evolution. In this report we present evidence of a phosphoinositide-specific phospholipase C (PI-PLC) activity in bronchoalveolar lavage (BAL) fluid, which may regulate PtdIns levels. Characterization of this extracellular activity showed specificity for PtdIns and phosphatidylinositol 4,5-bisphosphate, sharing the typical substrate concentration-, pH-, and calcium-dependencies with mammalian PI-PLCs. Fractionation of BAL fluid showed that PI-PLC did not co-fractionate with large surfactant aggregates, but it was found mainly in the soluble fraction. Importantly, analysis of BAL samples from control subjects and from patients with ARDS showed that the PI-PLC specific activity was decreased by 4-fold in ARDS samples concurrently with the increase in BAL PtdIns levels. Thus, we have identified for the first time an extracellular PI-PLC enzyme activity that may be acutely involved in the regulation of PtdIns levels in LS. PMID:19491339

  7. A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome.

    Files, D Clark; Sanchez, Michael A; Morris, Peter E

    2015-01-01

    Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underlying mechanisms. The early phase occurs temporally with the onset of lung injury, is driven by inflammation and disuse, and is marked predominantly by muscle atrophy from increased protein degradation. The ubiquitin-proteasome, autophagy, and calpain-caspase pathways have all been implicated in early-phase muscle dysfunction. Late-phase muscle weakness persists in many patients despite resolution of lung injury and cessation of ongoing acute inflammation-driven muscle atrophy. The clinical characteristics and mechanisms underlying late-phase muscle dysfunction do not involve the massive protein degradation and atrophy of the early phase and may reflect a failure of the musculoskeletal system to regain homeostatic balance. Owing to these underlying mechanistic differences, therapeutic interventions for treating muscle dysfunction in ARDS may differ during the early and late phases. Here, we review clinical and translational investigations of muscle dysfunction in ARDS, placing them in the conceptual framework of the early and late phases. We hypothesize that this conceptual model will aid in the design of future mechanistic and clinical investigations of the skeletal muscle system in ARDS and other critical illnesses. PMID:26134116

  8. A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome

    Chow John L

    2006-03-01

    Full Text Available Abstract Background Management of acute respiratory distress syndrome (ARDS in the intensive care unit (ICU is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS. The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker? Methods The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Results Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5% – 95% percentiles $42,259 – $83,766, with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. Conclusion ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS.

  9. Incidence of respiratory distress syndrome

    Objective: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies. Subjects and Methods: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study. Results: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births. 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%). Conclusion: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world. (author)

  10. Bayesian inference of the lung alveolar spatial model for the identification of alveolar mechanics associated with acute respiratory distress syndrome

    Christley, Scott; Emr, Bryanna; Ghosh, Auyon; Satalin, Josh; Gatto, Louis; Vodovotz, Yoram; Nieman, Gary F.; An, Gary

    2013-06-01

    Acute respiratory distress syndrome (ARDS) is acute lung failure secondary to severe systemic inflammation, resulting in a derangement of alveolar mechanics (i.e. the dynamic change in alveolar size and shape during tidal ventilation), leading to alveolar instability that can cause further damage to the pulmonary parenchyma. Mechanical ventilation is a mainstay in the treatment of ARDS, but may induce mechano-physical stresses on unstable alveoli, which can paradoxically propagate the cellular and molecular processes exacerbating ARDS pathology. This phenomenon is called ventilator induced lung injury (VILI), and plays a significant role in morbidity and mortality associated with ARDS. In order to identify optimal ventilation strategies to limit VILI and treat ARDS, it is necessary to understand the complex interplay between biological and physical mechanisms of VILI, first at the alveolar level, and then in aggregate at the whole-lung level. Since there is no current consensus about the underlying dynamics of alveolar mechanics, as an initial step we investigate the ventilatory dynamics of an alveolar sac (AS) with the lung alveolar spatial model (LASM), a 3D spatial biomechanical representation of the AS and its interaction with airflow pressure and the surface tension effects of pulmonary surfactant. We use the LASM to identify the mechanical ramifications of alveolar dynamics associated with ARDS. Using graphical processing unit parallel algorithms, we perform Bayesian inference on the model parameters using experimental data from rat lung under control and Tween-induced ARDS conditions. Our results provide two plausible models that recapitulate two fundamental hypotheses about volume change at the alveolar level: (1) increase in alveolar size through isotropic volume change, or (2) minimal change in AS radius with primary expansion of the mouth of the AS, with the implication that the majority of change in lung volume during the respiratory cycle occurs in the

  11. Bayesian inference of the lung alveolar spatial model for the identification of alveolar mechanics associated with acute respiratory distress syndrome

    Acute respiratory distress syndrome (ARDS) is acute lung failure secondary to severe systemic inflammation, resulting in a derangement of alveolar mechanics (i.e. the dynamic change in alveolar size and shape during tidal ventilation), leading to alveolar instability that can cause further damage to the pulmonary parenchyma. Mechanical ventilation is a mainstay in the treatment of ARDS, but may induce mechano-physical stresses on unstable alveoli, which can paradoxically propagate the cellular and molecular processes exacerbating ARDS pathology. This phenomenon is called ventilator induced lung injury (VILI), and plays a significant role in morbidity and mortality associated with ARDS. In order to identify optimal ventilation strategies to limit VILI and treat ARDS, it is necessary to understand the complex interplay between biological and physical mechanisms of VILI, first at the alveolar level, and then in aggregate at the whole-lung level. Since there is no current consensus about the underlying dynamics of alveolar mechanics, as an initial step we investigate the ventilatory dynamics of an alveolar sac (AS) with the lung alveolar spatial model (LASM), a 3D spatial biomechanical representation of the AS and its interaction with airflow pressure and the surface tension effects of pulmonary surfactant. We use the LASM to identify the mechanical ramifications of alveolar dynamics associated with ARDS. Using graphical processing unit parallel algorithms, we perform Bayesian inference on the model parameters using experimental data from rat lung under control and Tween-induced ARDS conditions. Our results provide two plausible models that recapitulate two fundamental hypotheses about volume change at the alveolar level: (1) increase in alveolar size through isotropic volume change, or (2) minimal change in AS radius with primary expansion of the mouth of the AS, with the implication that the majority of change in lung volume during the respiratory cycle occurs in the

  12. PCR use in miliary tuberculosis presenting with acute respiratory distress syndrome

    Riachy, Moussa Albert

    2011-01-01

    A 30-year-old pregnant woman admitted to the hospital for rapidly progressive dyspnoea, non-productive cough and altered general status evolving over 1-month period. Her vital signs showed a low blood pressure 90/60 mm Hg, pulse rate 100 beats/min, respiratory rate 32 breaths/min and oxygen saturation on room air of 88%. Laboratory findings showed haemoglobin 9.7 g/dl, white blood cells 15 000/mm3 (neutrophils 82%), C reactive protein 74 mg/l, alkaline phosphatase 320 U/l, alanine aminotransf...

  13. Case Report: Severe acute respiratory distress by tracheal obstruction due to a congenital thyroid teratoma.

    Colleti Junior, Jose; Tannuri, Uenis; Monti Lora, Felipe; Armelin Benites, Eliana Carla; Koga, Walter; Honda Imamura, Janete; Rute Moutinho, Patricia; Brunow de Carvalho, Werther

    2015-01-01

    Congenital teratoma is a rare condition and is a germ cell tumor composed of elements from one or more of the embryonic germ layers and contain tissues usually foreign to the anatomic site of origin. We report a case of a neck tumor diagnosed during pregnancy, initially thought to be a goiter. After birth the neck mass kept growing until it compressed the trachea and produced respiratory failure. The infant had a difficult tracheal intubation because of the compressing mass. The staff decided to surgically remove the neck mass. After that, the infant became eupneic. The histological analysis showed a mature teratoma with no atypias. PMID:26664704

  14. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

    YANG Yi; LI Yang; LIU Song-qiao; LIU Ling; HUANG Ying-zi; GUO Feng-mei; QIU Hai-bo

    2013-01-01

    Background Intra-abdominal hypertension (IAH) is common in acute respiratory distress syndrome (ARDS) patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure (PEEP).We investigated the effect of PEEP titrated by transpulmonary pressure (Ptp) on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol.Methods ARDS patients admitted to the intensive care unit (ICU) of the Zhongda Hospital were enrolled.Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol.Respiratory mechanics,gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round.IAH was defined as intra-abdominal pressure of 12 mmHg or more.Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled.PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH ((17.3±2.6) cmH2O vs.(6.3±1.6)cmH2O and without IAH ((9.5±2.1) cmH2O vs.(7.8±1.9) cmH2O).Arterial pressure of O2/fraction of inspired oxygen (PaO2/FiO2)was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH ((27.2±4.0) cmHg vs.(20.9± 5.0) cmHg.But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH.In ARDS patients with IAH,static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol.In ARDS patients with IAH,central venous pressure (CVP) was higher during PEEP titrated by Ptp than byARDSnet protocol.Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

  15. Factors Associated with Death Due to 2009 Influenza A (H1N1) Virus Infection and Acute Respiratory Distress Syndrome in Beijing, 2009-2011

    Jin-qian; Zhang; Li-cheng; Zhang; Na; Ren; Ming; Zhang; Li-min; Guo; Xing-wang; Li; Jun; Cheng

    2012-01-01

    Objective Patients with H1N1 virus infection were hospitalized and quarantined, and some of them developed into acute respiratory failure, and were transfered to the medical intensive care unit of Beijing Ditan Hospital, Capital Medical University in Beijing, China. Methods The clinical features and preliminary epidemiologic findings among 30 patients with confirmed H1N1 virus infection who developed into acute respiratory failure for ventilatory support were investigated. Results A total of 30 patients(37.43 ± 18.80 years old) with 2009 influenza A(H1N1) related acute respiratory distress syndrome(ARDS) received treatment with mechanical ventilation, 15 cases of whom were male and 17 cases died of ARDS. Fatal cases were significantly associated with an APACHE Ⅱ score(P = 0.016), but not with PaO 2 /FIO 2(P = 0.912) and chest radiograph(P = 0.333). The most common complication was acute renal failure(n = 9). Five patients received extracorporeal membrane oxygenation(ECMO), 3 of whom died and the others survived. The major causes of death were multiple organ dysfunction syndrome(MODS)(39%), intractable respiratory failure(27%) and sepsis(20%). Conclusions Most patients with respiratory failure due to influenza A(H1N1) virus infection were young, with a high mortality, particularly associated with APACHE Ⅱ score, secondary infection of lung or type 2 diabetes mellitus.

  16. A 16-Year-Old Girl with Acute Onset Respiratory Distress

    Saeed Safari

    2014-03-01

    Full Text Available A 16-year-old girl with an intellectual disability (known case of Down syndrome arrived in the emergency eepartment with complaints of severe breathlessness, bloody salivation (bright red blood or clots, and difficulty in speaking and swallowing of liquids and solids. The patient gradually developed progressive bloody salivation and hoarseness, never had any history of trauma to the head and neck and respiratory problems, and was symptomatic from the previous 48 h. Furthermore, the patient had a positive history of peptic ulcer, chronic consumption of non-steroidal anti-inflammatory drugs, and traveled out of town and drank water from a well in the mentioned period. On admission, the patient had a respiratory rate of 17 per min, pulse rate of 89 per min, blood pressure of 120/80 mmHg, 90% O2 saturation in room air, and 38°C axillary temperature. The only positive finding on physical examination was inspiratory stridor. The auscultation of lung and heart sounds was normal. Digital rectal examination revealed brown feces. Throat examination was not possible owing to lack of patient cooperation. After initial assessment and essential consideration, electrocardiography (ECG and imaging was performed. The ECG showed normal sinus rhythm, and analysis of arterial blood gas revealed the following: pH = 7. 35, Pa-CO2 = 39 mmHg, HCO3 = 24 mEq/L, PaO2 = 89 mmHg, and O2 saturation = 92%. All other laboratory data, including complete blood counts (CBC, urine analysis, hepatic and renal function tests, and coagulation profile were in the normal range.  What is your diagnosis?

  17. Extremes of Interferon-Stimulated Gene Expression Associate with Worse Outcomes in the Acute Respiratory Distress Syndrome.

    Nick, Jerry A; Caceres, Silvia M; Kret, Jennifer E; Poch, Katie R; Strand, Matthew; Faino, Anna V; Nichols, David P; Saavedra, Milene T; Taylor-Cousar, Jennifer L; Geraci, Mark W; Burnham, Ellen L; Fessler, Michael B; Suratt, Benjamin T; Abraham, Edward; Moss, Marc; Malcolm, Kenneth C

    2016-01-01

    Acute Respiratory Distress Syndrome (ARDS) severity may be influenced by heterogeneity of neutrophil activation. Interferon-stimulated genes (ISG) are a broad gene family induced by Type I interferons, often as a response to viral infections, which evokes extensive immunomodulation. We tested the hypothesis that over- or under-expression of immunomodulatory ISG by neutrophils is associated with worse clinical outcomes in patients with ARDS. Genome-wide transcriptional profiles of circulating neutrophils isolated from patients with sepsis-induced ARDS (n = 31) and healthy controls (n = 19) were used to characterize ISG expression. Hierarchical clustering of expression identified 3 distinct subject groups with Low, Mid and High ISG expression. ISG accounting for the greatest variability in expression were identified (MX1, IFIT1, and ISG15) and used to analyze a prospective cohort at the Colorado ARDS Network site. One hundred twenty ARDS patients from four urban hospitals were enrolled within 72 hours of initiation of mechanical ventilation. Circulating neutrophils were isolated from patients and expression of ISG determined by PCR. Samples were stratified by standard deviation from the mean into High (n = 21), Mid, (n = 82) or Low (n = 17) ISG expression. Clinical outcomes were compared between patients with High or Low ISG expression to those with Mid-range expression. At enrollment, there were no differences in age, gender, co-existing medical conditions, or type of physiologic injury between cohorts. After adjusting for age, race, gender and BMI, patients with either High or Low ISG expression had significantly worse clinical outcomes than those in the Mid for number of 28-day ventilator- and ICU-free days (P = 0.0006 and 0.0004), as well as 90-day mortality and 90-day home with unassisted breathing (P = 0.02 and 0.004). These findings suggest extremes of ISG expression by circulating neutrophils from ARDS patients recovered early in the syndrome are associated

  18. The Hemagglutinin Stem-Binding Monoclonal Antibody VIS410 Controls Influenza Virus-Induced Acute Respiratory Distress Syndrome.

    Baranovich, Tatiana; Jones, Jeremy C; Russier, Marion; Vogel, Peter; Szretter, Kristy J; Sloan, Susan E; Seiler, Patrick; Trevejo, Jose M; Webby, Richard J; Govorkova, Elena A

    2016-04-01

    Most cases of severe influenza are associated with pulmonary complications, such as acute respiratory distress syndrome (ARDS), and no antiviral drugs of proven value for treating such complications are currently available. The use of monoclonal antibodies targeting the stem of the influenza virus surface hemagglutinin (HA) is a rapidly developing strategy for the control of viruses of multiple HA subtypes. However, the mechanisms of action of these antibodies are not fully understood, and their ability to mitigate severe complications of influenza has been poorly studied. We evaluated the effect of treatment with VIS410, a human monoclonal antibody targeting the HA stem region, on the development of ARDS in BALB/c mice after infection with influenza A(H7N9) viruses. Prophylactic administration of VIS410 resulted in the complete protection of mice against lethal A(H7N9) virus challenge. A single therapeutic dose of VIS410 given 24 h after virus inoculation resulted in dose-dependent protection of up to 100% of mice inoculated with neuraminidase inhibitor-susceptible or -resistant A(H7N9) viruses. Compared to the outcomes in mock-treated controls, a single administration of VIS410 improved viral clearance from the lungs, reduced virus spread in lungs in a dose-dependent manner, resulting in a lower lung injury score, reduced the extent of the alteration in lung vascular permeability and protein accumulation in bronchoalveolar lavage fluid, and improved lung physiologic function. Thus, antibodies targeting the HA stem can reduce the severity of ARDS and show promise as agents for controlling pulmonary complications in influenza. PMID:26787699

  19. Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model

    Cogo Paola E

    2007-02-01

    Full Text Available Abstract Background In patients with acute respiratory distress syndrome (ARDS, it is well known that only part of the lungs is aerated and surfactant function is impaired, but the extent of lung damage and changes in surfactant turnover remain unclear. The objective of the study was to evaluate surfactant disaturated-phosphatidylcholine turnover in patients with ARDS using stable isotopes. Methods We studied 12 patients with ARDS and 7 subjects with normal lungs. After the tracheal instillation of a trace dose of 13C-dipalmitoyl-phosphatidylcholine, we measured the 13C enrichment over time of palmitate residues of disaturated-phosphatidylcholine isolated from tracheal aspirates. Data were interpreted using a model with two compartments, alveoli and lung tissue, and kinetic parameters were derived assuming that, in controls, alveolar macrophages may degrade between 5 and 50% of disaturated-phosphatidylcholine, the rest being lost from tissue. In ARDS we assumed that 5–100% of disaturated-phosphatidylcholine is degraded in the alveolar space, due to release of hydrolytic enzymes. Some of the kinetic parameters were uniquely determined, while others were identified as lower and upper bounds. Results In ARDS, the alveolar pool of disaturated-phosphatidylcholine was significantly lower than in controls (0.16 ± 0.04 vs. 1.31 ± 0.40 mg/kg, p de novo synthesis of disaturated-phosphatidylcholine were also significantly lower, while mean resident time in lung tissue was significantly higher in ARDS than in controls. Recycling was 16.2 ± 3.5 in ARDS and 31.9 ± 7.3 in controls (p = 0.08. Conclusion In ARDS the alveolar pool of surfactant is reduced and disaturated-phosphatidylcholine turnover is altered.

  20. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez

    2013-08-01

    Full Text Available Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing efforts. Respiratory distress syndrome or complications caused by respiratory distress syndrome are the most important causes of mortality and morbidity in premature infants. This article briefly reviews respiratory distress syndrome and its complications. [Archives Medical Review Journal 2013; 22(4.000: 615-630

  1. PCR use in miliary tuberculosis presenting with acute respiratory distress syndrome.

    Riachy, Moussa Albert

    2011-01-01

    A 30-year-old pregnant woman admitted to the hospital for rapidly progressive dyspnoea, non-productive cough and altered general status evolving over 1-month period. Her vital signs showed a low blood pressure 90/60 mm Hg, pulse rate 100 beats/min, respiratory rate 32 breaths/min and oxygen saturation on room air of 88%. Laboratory findings showed haemoglobin 9.7 g/dl, white blood cells 15 000/mm(3) (neutrophils 82%), C reactive protein 74 mg/l, alkaline phosphatase 320 U/l, alanine aminotransferase 62 IU/l, aspartate aminotransferase 120 IU/l, γ glutamyl transpeptidase 125 U/l; brain natriuretic peptide 25.4 pg/ml, procalcitonine >2, lactate dehydrogenase 1618 U/l. Chest radiographics showed diffuse bilateral micronodular pulmonary infiltrates and CT of the chest confirmed 1-3 mm diffuse bilateral micronodular infiltrates with ground glass opacities. Complete investigation including bronchoalveolar lavage (BAL) for any viral, bacteriologic, acid-fast bacilli and full serum antibodies panel were all negative. DNA amplification for mycobacterium using PCR on the BAL rapidly rectified the diagnosis of tuberculosis. PMID:22694890

  2. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez; Hacer Yapicioglu Yildizdas; Ferda Ozlu

    2013-01-01

    Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing effor...

  3. Terapia com células-tronco na síndrome do desconforto respiratório agudo Stem cell therapy in acute respiratory distress syndrome

    Tatiana Maron-Gutierrez

    2009-03-01

    Full Text Available A síndrome do desconforto respiratório agudo é caracterizada por uma reação inflamatória difusa do parênquima pulmonar, podendo ser induzida por um insulto direto ao epitélio alveolar (síndrome do desconforto respiratório agudo pulmonar ou indireto através do endotélio vascular (síndrome do desconforto respiratório agudo extrapulmonar. Acredita-se que uma terapia eficaz para o tratamento da síndrome do desconforto respiratório agudo deva atenuar a resposta inflamatória e promover adequado reparo da lesão pulmonar. O presente artigo apresenta uma breve revisão acerca do potencial terapêutico das células-tronco na síndrome do desconforto respiratório agudo. Essa revisão bibliográfica baseou-se em uma pesquisa sistemática de artigos experimentais e clínicos sobre terapia celular na síndrome do desconforto respiratório agudo incluídos nas bases de dados MedLine e SciELO nos últimos 10 anos. O transplante de células-tronco promove melhora da lesão inflamatória pulmonar e do conseqüente processo fibrótico, induzindo adequado reparo tecidual. Dentre os mecanismos envolvidos, podemos citar: diferenciação em células do epitélio alveolar e redução na liberação de mediadores inflamatórios e sistêmicos e fatores de crescimento. A terapia com células-tronco derivadas da medula óssea pode vir a ser uma opção eficaz e segura no tratamento da síndrome do desconforto respiratório agudo por acelerar o processo de reparo e atenuar a resposta inflamatória. Entretanto, os mecanismos relacionados à atividade antiinflamatória e antifibrogênica de tais células necessitam ser mais bem elucidados, limitando, assim, o seu uso clínico imediato.Acute respiratory distress syndrome is characterized by an acute pulmonary inflammatory process induced by the presence of a direct (pulmonary insult that affects lung parenchyma, or an indirect (extrapulmonary insult that results from an acute systemic inflammatory response

  4. Endocan Levels in Peripheral Blood Predict Outcomes of Acute Respiratory Distress Syndrome

    Ling Tang

    2014-01-01

    Full Text Available Purpose. To investigate the prognostic significance of endocan, compared with procalcitonin (PCT, C-reactive protein (CRP,white blood cells (WBC, neutrophils (N, and clinical severity scores in patients with ARDS. Methods. A total of 42 patients with ARDS were initially enrolled, and there were 20 nonsurvivors and 22 survivors based on hospital mortality. Plasma levels of biomarkers were measured and the acute physiology and chronic health evaluation II (APACHE II was calculated on day 1 after the patient met the defining criteria of ARDS. Results. Endocan levels significantly correlated with the APACHE II score in the ARDS group (r=0.676, P=0.000, n=42. Of 42 individuals with ARDS, 20 were dead, and endocan was significantly higher in nonsurvivors than in survivors (median (IQR 5.01 (2.98–8.44 versus 3.01 (2.36–4.36 ng/mL, P=0.017. According to the results of the ROC-curve analysis and COX proportional hazards models, endocan can predict mortality of ARDS independently with a hazard ratio of 1.374 (95% CI, 1.150–1.641 and an area of receiver operator characteristic curve (AUROC of 0.715 (P=0.017. Moreover, endocan can predict the multiple-organ dysfunction of ARDS. Conclusion. Endocan is a promising biomarker to predict the disease severity and mortality in patients with ARDS.

  5. Cerebral gas embolism in a case of Influenza A-associated acute respiratory distress syndrome treated with high-frequency oscillatory ventilation

    Christian M Sebat

    2013-01-01

    Full Text Available A 22-year-old obese asthmatic woman with Influenza A (H1N1-associated acute respiratory distress syndrome died from cerebral artery gas emboli with massive cerebral infarction while being treated with High-Frequency Oscillatory Ventilation in the absence of a right to left intracardiac shunt. We review and briefly discuss other causes of systemic gas emboli (SGE. We review proposed mechanisms of SGE, their relation to our case, and how improved understanding of the risk factors may help prevent SGE in positive pressure ventilated patients.

  6. Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome

    Deja, Maria; Denke, Claudia; Weber-Carstens, Steffen; Schröder, Jürgen; Pille, Christian E; Hokema, Frank; Falke, Konrad J; Kaisers, Udo

    2006-01-01

    Introduction We investigated health-related quality of life (HRQoL) and persistent symptoms of post-traumatic stress disorder (PTSD) in long-term survivors of acute respiratory distress syndrome (ARDS). We wished to evaluate the influence of PTSD on HRQoL and to investigate the influence of perceived social support during intensive care unit (ICU) treatment on both PTSD symptoms and HRQoL. Methods In ARDS patients we prospectively measured HRQoL (Medical Outcomes Study 36-Item Short Form; SF-...

  7. Receptor Interacting Protein 3-Mediated Necroptosis Promotes Lipopolysaccharide-Induced Inflammation and Acute Respiratory Distress Syndrome in Mice.

    Linlin Wang

    Full Text Available Necrosis amplifies inflammation and plays important roles in acute respiratory distress syndrome (ARDS. Necroptosis is a newly identified programmed necrosis that is mediated by receptor interacting protein 3 (RIP3. However, the potential involvement and impact of necroptosis in lipopolysaccharide (LPS-induced ARDS remains unknown. We therefore explored the role and mechanism of RIP3-mediated necroptosis in LPS-induced ARDS. Mice were instilled with increasing doses of LPS intratracheally to induce different degrees of ARDS. Lung tissues were harvested for histological and TUNEL staining and western blot for RIP3, p-RIP3, X-linked inhibitor of apoptosis protein (XIAP, mixed lineage kinase domain-like protein (MLKL, total and cleaved caspases-3/8. Then, wild-type and RIP3 knock-out mice were induced ARDS with 30 mg/kg LPS. Pulmonary cellular necrosis was labeled by the propidium Iodide (PI staining. Levels of TNF-a, Interleukin (IL-1β, IL-6, IL-1α, IL-10 and HMGB1, tissue myeloperoxidase (MPO activity, neutrophil counts and total protein concentration were measured. Results showed that in high dose LPS (30mg/kg and 40mg/kg -induced severe ARDS, RIP3 protein was increased significantly, accompanied by increases of p-RIP3 and MLKL, while in low dose LPS (10mg/kg and 20mg/kg -induced mild ARDS, apoptosis was remarkably increased. In LPS-induced severe ARDS, RIP3 knock-out alleviated the hypothermia symptom, increased survival rate and ameliorated the lung tissue injury RIP3 depletion also attenuated LPS-induced increase in IL-1α/β, IL-6 and HMGB1 release, decreased tissue MPO activity, and reduced neutrophil influx and total protein concentration in BALF in severe ARDS. Further, RIP3 depletion reduced the necrotic cells in the lung and decreased the expression of MLKL, but had no impact on cleaved caspase-3 in LPS-induced ARDS. It is concluded that RIP3-mediated necroptosis is a major mechanism of enhanced inflammation and lung tissue injury in

  8. Computed tomographic criteria as expected effect to inhaled nitric oxide in patients with severe acute respiratory distress syndrome

    Purpose: inhaled nitric oxide (iNO) is an effective therapy for severe hypoxemia in most patients with acute respiratory distress syndrome (ARDS). For unknown reason, a subset of ARDS patients does not respond favorably to iNO therapy. We hypothesized that radiological manifestation of lung injury may be related to iNO response. Materials and methods: we retrospectively analyzed data from n = 25 ARDS patients who received iNO, and underwent chest CT within 72 h prior to inhaled treatment. The morphology of coherently pathologic lung tissue was characterized by the length of the borderline between consolidated, infiltrated and atelectatic lung tissue and radiologically normal lung tissue. This quantity was expressed as relative fraction of the visceral pleural circumference and averaged over all CT slices. Furthermore we semiquantitatively determined the total volume of consolidated lung tissue as part of the whole lung. Results: in n = 6 non-responders to iNO (ΔPaO2 10%), we found significantly less coherently consolidated lung tissue evidenced by an increased relative borderline when compared to iNO non-responders (0.09 ± 0.02 vs. 0.1 ± 0.01; P < 0.05). Moreover, there was a moderate and significant correlation between ΔPaO2 induced by iNO and the relative borderline in all patients studied (R = 0.59; P < 0.05). Total fraction of consolidated lung tissue volume was not different between iNO non-responders and responders (60 ± 3% vs. 54 ± 2% n. s.). Conclusion: our data demonstrate that the gross morphological distribution of pathological lung tissue influences iNO response in ARDS. Inhaled NO was most beneficial in injured lungs characterized by many small consolidated areas surrounded by normal lung tissue. The increased borderline between pathologic and normal lung tissue offers additional possibility for iNO to divert blood flow from shunt areas to ventilated lung regions, which consequently improves arterial oxygenation. (orig.)

  9. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

    Hu Sung-Yuan

    2011-03-01

    Full Text Available Abstract Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

  10. Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report

    Chakravorty Indranil

    2008-05-01

    Full Text Available Abstract Introduction Bronchiolitis Obliterans Organising Pneumonia (BOOP may often present initially as a recurrent spontaneous pneumothorax and then develop multi-system complications. Case presentation A 17-year-old boy presented with a pneumothorax, which developed into rapidly progressive Bronchiolitis Obliterans Organising Pneumonia (BOOP. He developed multi-organ dysfunction (including adult respiratory distress syndrome, oliguric renal failure, acute coronary syndrome, cardiac failure and a right atrial thrombus which necessitated prolonged intensive care. Diagnosis was confirmed on open lung biopsy and he responded well to treatment with corticosteroids. Conclusion BOOP is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.

  11. Intercambio gaseoso en el síndrome de dificultad respiratoria aguda Gas exchange in acute respiratory distress syndrome

    G. A. Raimondi

    2003-04-01

    efecto beneficioso de todas estas técnicas en la mejoría del IG en el ARDS, no se ha demostrado efecto beneficioso en la sobrevida.The hypoxemia of acute respiratory distress syndrome (ARDS depends chiefly upon shunt and ventilation-perfusion (V A/Q inequality produced by fluid located in the interstitial space, alveolar collapse and flooding. Variables other than inspired oxygen fraction and the underlying physiological abnormality can influence arterial oxygen partial pressure (PaO2. Changes in cardiac output, hemoglobin concentration, oxygen consumption and alcalosis can cause changes in PaO2 through their influence on mixed venous PO2. Gas exchange (GE in ARDS may be studied using the inert gas elimination technique (MIGET which enables to define the distribution of ventilation and perfusion without necessarily altering the FIO2 differentiating shunt from lung units with low V A/Q ratios and dead space from lung units with high V A/Q ratios. Different ventilatory strategies that increase mean airway pressure (positive end-expiratory pressure, high tidal volumes, inverse inspiratory-expiratory ratio, etc improve PaO2 through increasing lung volume by recruiting new open alveoli and spreading the intra-alveolar fluid over a large surface area. Also prone-position ventilation would result in a marked improvement in GE enhancing dorsal lung ventilation by the effects on the gravitional distribution of pleural pressure and the reduction in the positive pleural pressure that develops in dorsal regions in ARDS. Inhaled nitric oxide (NO has been shown to increase PaO2 in ARDS patients by inducing vasodilation predominantly in ventilated areas redistributing pulmonary blood flow away from nonventilated toward ventilated areas of the lung thus resulting in a shunt reduction. On the same way inhaled prostaglandins (PGI2 or PGE1 causes selective pulmonary vasodilation improving pulmonary GE. Intravenous almitrine, a selective pulmonary vasoconstrictor, has been shown to

  12. X-ray picture of the respiratory distress syndrome (shock lung)

    X-Ray picture of the respiratory distress syndrome (shock lung) in 78 patients exposed to high temperature as a result of gas condensate explosion is analyzed. X-ray and morphologic fundings in these patients are compared to those in 13 similar patients in whom acute respiratory failure developed because of other causes. Morphologic basis of the4 majority of x-ray signs of acute respiratory distress has been investigated. A relationship between respiratory distress syndrome development and changes in the heart size has been revealed, which may serve the prediction criterion

  13. Hereditary mucoepithelial dysplasia and severe respiratory distress

    Mahmoud Halawa

    2015-01-01

    Full Text Available Hereditary mucoepithelial dysplasia (HMD is a rare autosomal dominant disorder characterized by mucoepithelial disruption of the skin, hair and mucous membranes. It results from defective gap junction formation and leads to non-scarring alopecia, mucosal erythema, perineal erythematous intertrigo, involvement of the conjunctival mucosa, and pulmonary disease. We present a case of severe respiratory distress in an initially healthy full term infant born to a mother with HMD. This infant later developed signs and symptoms of HMD. A high index of suspicion for pulmonary infection with atypical organism is essential in infants with a family history of HMD who present with respiratory distress.

  14. Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study

    Chiu Rossa WK

    2005-04-01

    Full Text Available Abstract Background It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele of the angiotensin converting enzyme (ACE gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. Method One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. Results There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. Conclusion The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.

  15. Controvérsias acerca da acidose hipercápnica na síndrome do desconforto respiratório agudo Controversies involving hypercapnic acidosis in acute respiratory distress syndrome

    Liliane Nardelli

    2009-12-01

    Full Text Available A síndrome do desconforto respiratório agudo é caracterizada por uma reação inflamatória difusa do parênquima pulmonar induzida por um insulto direto ao epitélio alveolar (síndrome do desconforto respiratório agudo pulmonar ou indireto por meio do endotélio vascular (síndrome do desconforto respiratório agudo extrapulmonar. A principal estratégia terapêutica da síndrome do desconforto respiratório agudo é o suporte ventilatório. Entretanto, a ventilação mecânica pode agravar a lesão pulmonar. Nesse contexto, uma estratégia ventilatória protetora com baixo volume corrente foi proposta. Tal estratégia reduziu a taxa de mortalidade dos pacientes com síndrome do desconforto respiratório agudo, porém acarretou acidose hipercápnica. O presente artigo apresenta uma revisão da literatura acerca dos efeitos da acidose hipercápnica na síndrome do desconforto respiratório agudo. Para tal, realizou-se uma revisão sistemática da literatura científica conforme critérios já estabelecidos para análise documental incluindo artigos experimentais e clínicos sobre o tema, usando-se como bases de dados MedLine, LILACS, SciElo, PubMed, Cochrane. A acidose hipercápnica é defendida por alguns autores como moduladora do processo inflamatório da síndrome do desconforto respiratório agudo. Entretanto, estudos clínicos e experimentais acerca dos efeitos da acidose hipercápnica têm demonstrado resultados controversos. Logo, é fundamental a realização de mais pesquisas para elucidar o papel da acidose hipercápnica na síndrome do desconforto respiratório agudo.Acute respiratory distress syndrome is characterized by a diffuse inflammatory reaction of lung parenchyma induced by a direct insult to the alveolar epithelium (pulmonary acute respiratory distress syndrome or an indirect lesion through the vascular endothelium (extrapulmonary acute respiratory distress syndrome. The main therapeutic strategy for acute respiratory

  16. Diagnostic value of static and dynamic scintigraphy in diagnosis of acute respiratory distress syndrome in the course of sepsis. Part 1. Lung perfusion scintigraphy

    One of the most important complication of sepsis is acute respiratory distress syndrome (ARDS). Diagnosis of the illness is mainly based on chest radiography and gasometric parameters of the blood. The aim of the study was to estimate the diagnostic usefulness of lung perfusion scintigraphy in early detection of blood flow and gas-exchange abnormalities in patients with ARDS in the course of sepsis. Scintigraphic studies of 12 patients in critical condition were performed, using Hungarian planar gamma camera type MB9200 and human albumin microspheres labelled with 99mTc. Perfusion scans of patients with ARDS demonstrated blurring outlines and abundant diffuse foci of lack of radioactivity in both lungs and quantitative analysis indicated relative increase of Tc99m-MSA accumulation in upper zones of both lungs. Scans of suffering from sepsis were similar to control one. The course of the studies showed that scintigraphic methods could be safely use in patients with sepsis and ARDS and may be helpful in the early diagnosis of ARDS in the septic patients. (author)

  17. ARDS诊断——“柏林标准”的价值与意义%Acute Respiratory Distress Syndrome: Berlin Definition

    杨毅

    2012-01-01

    急性呼吸窘迫综合征(ARDS)病死率高,其早期准确的诊断是有效治疗的前提.然而,当前ARDS诊断标准的准确性备受质疑,临床迫切需要便捷可靠严谨的诊断标准.“柏林标准”从起病时间、氧合指数、肺水肿的来源及胸部影像学表现四个方面对ARDS进行诊断,是既往诊断标准的总结与延伸,其有效性及准确性已被证实,对于临床诊疗和科学研究有重大意义.%Acute respiratory distress syndrome is associated with high mortality. It already be commonly conceded that early identification and diagnosis of ARDS be very crucial to following successful treatment. However, contemporary ARDS criteria have met many challenges and thus an integrated and precise definition was urgently needed for clinical practice. The new Berlin ARDS definition includes 4 key components: timing, oxygenation index, origin of edema, chest imagines, and already be considered as summary and extend of previous standard. The validation and reliability of new definition have been verified and therefore would cast significantly influences on future clinical practices and scientific researches.

  18. Acute Respiratory Distress due to Thymoma in a Patient Treated with TK Inhibitor: A Case Report and Review of the Current Treatment Options

    P. Zarogoulidis

    2011-03-01

    Full Text Available Thymic malignancies are rare intrathoracic tumors that may be aggressive and difficult to treat in advanced stage. Surgery is the cornerstone of the management of thymomas: it is significant for the definite histopathological diagnosis and staging, and in most cases, it constitutes the first step of the treatment strategy. For patients with primary unresectable thymomas, the multimodal treatment schedule nowadays includes neoadjuvant chemotherapy, extensive surgery, adjuvant radiotherapy, and in some cases, adjuvant chemotherapy. A patient with a history of stage III COPD and an undiagnosed thoracic mass was admitted to the intensive care unit with acute respiratory distress. A radiologic evaluation by CT scan revealed a mass of 13 cm in diameter at the mediastinum. Fine needle aspiration was performed and revealed a thymoma. Due to poor performance status, the patient was not able to undergo surgery. He refused to be treated with neither chemotherapy nor radiotherapy, but due to EGFR overexpression, treatment with TK inhibitor was suggested. Fine needle aspiration biopsy is commonly used to identify metastasis to the mediastinum. However, it is less often employed as a primary diagnostic tool for tumors, particularly thymic neoplasms. The use of targeted therapies for the treatment of thymic malignancies has been described in the literature. Over the past years, significant efforts have been made to dissect the molecular pathways involved in the carcinogenesis of these tumors. Insights have been obtained following anecdotal clinical responses to targeted therapies, and large-scale genomic analyses have been conducted.

  19. Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone.

    Ugas, Melissa Brosset; Carroll, Timothy; Kovar, Lacey; Chavez-Bueno, Susana

    2016-01-01

    Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics. PMID:27294165

  20. Functional characterization of polymorphisms in the peptidase inhibitor 3 (elafin) gene and validation of their contribution to risk of acute respiratory distress syndrome.

    Tejera, Paula; O'Mahony, D Shane; Owen, Caroline A; Wei, Yongyue; Wang, Zhaoxi; Gupta, Kushagra; Su, Li; Villar, Jesus; Wurfel, Mark; Christiani, David C

    2014-08-01

    Elafin (peptidase inhibitor 3 [PI3]) and its biologically active precursor, pre-elafin, are neutrophil serine proteinase inhibitors with an important role in preventing excessive tissue injury during inflammatory events. Recently, we reported an association between single-nucleotide polymorphism (SNP) rs2664581 in the PI3 gene, increased risk of acute respiratory distress syndrome (ARDS) and pre-elafin circulating levels. This study aims to validate the legitimacy of this association by using a cohort of patients who met the criteria for systemic inflammatory response syndrome and were at risk of developing ARDS (n = 840). A comprehensive functional study of SNPs in PI3 gene was also performed. Luciferase assays and electrophoretic mobility shift assays were conducted to determine the functional relevance of promoter region variants. The effect of the coding SNP rs2664581 on the neutrophil elastase inhibitory activity and transglutaminase binding properties of pre-elafin was also investigated. The variant allele of rs2664581 (C) was significantly associated with increased ARDS risk, mainly among subjects with sepsis (odds ratio = 1.44; 95% confidence interval = 1.04-1.99; P = 0.0276, adjusted by age, sex, and Acute Physiology and Chronic Health Evaluation III). Pre-elafin recombinant protein carrying the amino acid change associated with rs2664581 (Thr34Pro, mutant protein [MT]) had greater capacity to undergo transglutaminase-mediated cross-linking to immobilized fibronectin than wild-type protein in vitro (P A. Our results confirm the association between SNP rs2664581 and enhanced risk of ARDS, further supporting the role of PI3 in ARDS development. SNPs in the PI3 locus may act synergistically by regulating PI3 gene expression and pre-elafin biological functions. PMID:24617927

  1. Hereditary mucoepithelial dysplasia and severe respiratory distress

    Mahmoud Halawa; Abu-Hasan, Mutasim N; ElMallah, Mai K.

    2015-01-01

    Hereditary mucoepithelial dysplasia (HMD) is a rare autosomal dominant disorder characterized by mucoepithelial disruption of the skin, hair and mucous membranes. It results from defective gap junction formation and leads to non-scarring alopecia, mucosal erythema, perineal erythematous intertrigo, involvement of the conjunctival mucosa, and pulmonary disease. We present a case of severe respiratory distress in an initially healthy full term infant born to a mother with HMD. This infant later...

  2. Resonance frequency in respiratory distress syndrome

    Lee, S.; Milner, A

    2000-01-01

    AIM—To observe how the resonance frequency changes with the course of respiratory distress syndrome (RDS), by examining the effect of changing static compliance on the resonance frequency in premature infants.
METHODS—In 12 ventilated premature infants with RDS (mean gestational age 26.6 weeks, mean birth weight 0.84 kg), resonance frequency and static compliance were determined serially using phase analysis and single breath mechanics technique respectively in the first ...

  3. Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center

    Tanvir Samra

    2011-01-01

    Full Text Available H1N1 subtype of influenza A virus has clinical presentation ranging from mild flu like illness to severe lung injury and acute respiratory distress syndrome (ARDS. The aim of our study was to compare the demographic characteristics, clinical presentation, and mortality of critically ill patients with (H1N1+ and without H1N1 infection (H1N1-. We retrospectively analyzed medical charts of patients admitted in "Swine Flu ICU" with ARDS from August 2009 to May 2010. Real-time reverse transcriptase polymerase chain reaction (RT-PCR assay was used for detection of H1N1 virus in the respiratory specimens. Clinical data from 106 (H1N1 , 45; H1N1+, 61 patients was collected and compared. Mean delay in presentation to our hospital was 5.7 ± 3.1 days and co-morbidities were present in two-fifth of the total admissions. Sequential Organ Failure Assessment (SOFA score of patients with and without H1N1 infection was comparable; 7.8 ± 3.5 and 6.6 ± 3.1 on day 1 and 7.2 ± 4.5 and 6.5 ± 3.1 on day 3, respectively. H1N1+ patients were relatively younger in age (34.2 ± 12.9 years vs. 42.8 ± 18.1, P = 0.005 but presented with significantly lower PaO 2 :FiO 2 ratio (87.3 ± 48.7 vs. 114 ± 51.7 in comparison to those who subsequently tested as H1N1 . The total leucocyte counts were significantly lower in H1N1+ patients during the first four days of illness but incidence of renal failure (P = 0.02 was higher in H1N1+ patients. The mortality in both the groups was high (H1N1+, 77%; H1N1, 68% but comparable. There was a mean delay of 5.7 ± 3.1 days in initiation of antivirals. Patients with H1N1 infection were relatively younger in age and with a significantly higher incidence of refractory hypoxia and acute renal failure. Mortality from ARDS reported in our study in both the groups was high but comparable.

  4. A better recognition of the mechanism of acute respiratory distress syndrome%急性呼吸窘迫综合征发病机制的现代认识

    崔德健

    2002-01-01

    @@ 急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是在多种原发病和诱因作用下发生的严重急性呼吸衰竭,以非心源性肺水肿和顽固性低氧血症为特征;其病理生理基础为全身炎症反应综合征(systemic inflammatory response syndrome,SIRS);其病理基础为急性肺损伤(acute lung injury,ALI).

  5. Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

    Helm, Emma; Babyn, Paul [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Talakoub, Omid; Alirezaie, Javad [Ryerson University, Department of Electrical and Computer Engineering, Toronto, ON (Canada); Grasso, Francesco; Engelberts, Doreen; Kavanagh, Brian P. [Hospital for Sick Children and the University of Toronto, Departments of Anesthesia and Critical Care Medicine and the Program in Pulmonary and Experimental Medicine, Toronto (Canada)

    2009-01-15

    Negative pressure ventilation via an external device ('iron lung') has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV=61%, ventilated lung PPV=47%, p<0.001; atelectatic lung NPV=10%, atelectatic lung PPV 19%, p<0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used. (orig.)

  6. Clinical efficacy and safety of recruitment maneuver in patients with acute respiratory distress syndrome using low tidal volume ventilation: a multicenter randomized controlled clinical trial

    XI Xiu-ming; JIANG Li; ZHU Bo; the RM group

    2010-01-01

    Background The recruitment maneuver (RM) has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome (ARDS) using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units (ICUs) at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups: control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight (PBW) in both groups. RM was performed by continuous positive airway pressure (CPAP) of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two (P=0.007and P=0.001). There were no significant differences between the RM and control group in hospital mortality (41.8% vs.56.4%, P=0.13), 28-day mortality (29.1% vs. 43.6%, P=0.11) and ventilator-free days at day 28 (10.8±10.1 vs. 7.4±10.0,P=0.08). ICU mortality (32.7% vs. 52.7%, P=0.03), the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 (58.2% vs. 36.2%, P=0.02), and nonpulmonary organ failure-free days at day 28 (17.4±11.1vs. 13.0±12.0, P=0.03) favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60

  7. Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

    Tripathi Mukesh

    2009-09-01

    Full Text Available Context: Mechanical ventilation with positive end expiratory pressure (PEEP is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning. Aims: To validate proposed lung infiltration score (LIS based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients. Settings and Design: University hospital ICU. Prospective, observational study of consecutive patients. Materials and Methods: Sixteen adult patients of both genders on mechanical ventilation with PEEP for 24 to < 48 hours. On chest x-ray, 6 segments were identified on each lung. The proposed LIS points (0- normal; 1- patchy infiltrates; 2- white infiltrates matching heart shadow were assigned to each segment. Without changing ventilation parameters, supine, left and right lateral positions at 45° tilt were randomly changed. At the end of 20 minutes of ventilation in each position, we observed arterial oxygen saturation, hemodynamic and arterial blood gases. Later, position change protocol (4 hourly was practiced in ICU, and skin pressure sore grading was noted within a week of ICU stay. Statistical Analysis Used: Nonparametric Bland and Altman correlation analysis, ANOVA and Student t test. Results: Arterial oxygenation (PaO 2 /FiO 2 = 313± 145.6 was significantly (P< 0.01 higher in better lung (lower LIS-down position than supine (PaO 2 /FiO 2 = 199± 70.2 or a better lung-up position (PaO 2 /FiO 2 = 165± 64.8. The positioning-related arterial oxygenation was significant (P< 0.05 at LIS asymmetry ≥3 between two lungs. Conclusions: The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side.

  8. Síndrome de Distrés Respiratorio Agudo: Utilidad de los Corticoides Acute respiratory distress syndrome: Role of steroids

    Célica L. Irrazábal

    2004-06-01

    Full Text Available En Argentina, el síndrome de distrés respiratorio agudo (SDRA representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%. Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15% y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.The acute respiratory distress syndrome (ARDS represents 7.7% of the intensive care population, and is associated with great morbidity and mortality (58%. Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15% and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.

  9. Acute respiratory distress syndrome (ARDS) complicating influenza A/H1N1v infection--a clinical approach.

    Witczak, Agnieszka; Prystupa, Andrzej; Kurys-Denis, Ewa; Borys, Michał; Czuczwar, Mirosław; Niemcewicz, Marcin; Kocik, Janusz; Michalak, Anna; Pietrzak, Aldona; Chodorowska, Grażyna; Krupski, Witold; Mosiewicz, Jerzy; Tomasiewicz, Krzysztof

    2013-01-01

    ARDS is defined as an acute inflammatory syndrome characterized with bilateral parenchymal lung infiltrates on chest radiograph and PaO2/FiO2 ratiofat embolism, surface burn, massive blood transfusion. Influenza A/H1N1 infection seems to be responsible for the development of extremely severe type of ARDS with poor response to routine treatment. Despite great progress in the management of ARDS with novel agents and sophisticated techniques, including antimicrobial drugs, extracorporeal membrane oxygenation, prostaglandins, nitric oxide, prostacyclin, exogenous surfactant administration and activated protein C, supportive treatment based mostly on advanced mechanical ventilation in the intensive care units seems to be the most important for the prognosis. PMID:24364461

  10. Massive low-grade fibromyxoid sarcoma presenting as acute respiratory distress in a 12-year-old girl

    Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue sarcoma that usually presents in young adults as a painless, slow-growing mass. Evans first described LGFMS in 1987 as a spindle-cell sarcoma with bland histological features and paradoxically aggressive behavior. Although young adults are most frequently affected, recent reports describe pediatric cases being increasingly more common. Males and females are affected approximately equally and common locations include the deep soft tissue of the lower extremity, particularly the thigh and trunk. Primary occurrence within the chest cavity is exceedingly rare. Local recurrence and metastasis are not uncommon and present the clinician and radiologist with challenges regarding follow-up recommendations. Review of the literature reveals many cases of slowly progressive symptoms related to a mass effect. We present a healthy 12-year-old African-American girl who interestingly developed acute symptoms of shortness of breath and chest pain while playing with her brother. (orig.)

  11. Massive low-grade fibromyxoid sarcoma presenting as acute respiratory distress in a 12-year-old girl

    Steiner, Michael A.; Giles, Henry W. [University of Mississippi, Department of Diagnostic Radiology, Jackson, MS (United States); Daley, William P. [University of Mississippi, Department of Pathology, Jackson, MS (United States)

    2009-04-15

    Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue sarcoma that usually presents in young adults as a painless, slow-growing mass. Evans first described LGFMS in 1987 as a spindle-cell sarcoma with bland histological features and paradoxically aggressive behavior. Although young adults are most frequently affected, recent reports describe pediatric cases being increasingly more common. Males and females are affected approximately equally and common locations include the deep soft tissue of the lower extremity, particularly the thigh and trunk. Primary occurrence within the chest cavity is exceedingly rare. Local recurrence and metastasis are not uncommon and present the clinician and radiologist with challenges regarding follow-up recommendations. Review of the literature reveals many cases of slowly progressive symptoms related to a mass effect. We present a healthy 12-year-old African-American girl who interestingly developed acute symptoms of shortness of breath and chest pain while playing with her brother. (orig.)

  12. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  13. Physiological relevance and performance of a minimal lung model – an experimental study in healthy and acute respiratory distress syndrome model piglets

    Chiew Yeong

    2012-09-01

    Full Text Available Abstract Background Mechanical ventilation (MV is the primary form of support for acute respiratory distress syndrome (ARDS patients. However, intra- and inter- patient-variability reduce the efficacy of general protocols. Model-based approaches to guide MV can be patient-specific. A physiological relevant minimal model and its patient-specific performance are tested to see if it meets this objective above. Methods Healthy anesthetized piglets weighing 24.0 kg [IQR: 21.0-29.6] underwent a step-wise PEEP increase manoeuvre from 5cmH2O to 20cmH2O. They were ventilated under volume control using Engström Care Station (Datex, General Electric, Finland, with pressure, flow and volume profiles recorded. ARDS was then induced using oleic acid. The data were analyzed with a Minimal Model that identifies patient-specific mean threshold opening and closing pressure (TOP and TCP, and standard deviation (SD of these TOP and TCP distributions. The trial and use of data were approved by the Ethics Committee of the Medical Faculty of the University of Liege, Belgium. Results and discussions 3 of the 9 healthy piglets developed ARDS, and these data sets were included in this study. Model fitting error during inflation and deflation, in healthy or ARDS state is less than 5.0% across all subjects, indicating that the model captures the fundamental lung mechanics during PEEP increase. Mean TOP was 42.4cmH2O [IQR: 38.2-44.6] at PEEP = 5cmH2O and decreased with PEEP to 25.0cmH2O [IQR: 21.5-27.1] at PEEP = 20cmH2O. In contrast, TCP sees a reverse trend, increasing from 10.2cmH2O [IQR: 9.0-10.4] to 19.5cmH2O [IQR: 19.0-19.7]. Mean TOP increased from average 21.2-37.4cmH2O to 30.4-55.2cmH2O between healthy and ARDS subjects, reflecting the higher pressure required to recruit collapsed alveoli. Mean TCP was effectively unchanged. Conclusion The minimal model is capable of capturing physiologically relevant TOP, TCP and SD of both healthy and ARDS lungs. The

  14. The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients.

    Lai, Chih-Cheng; Sung, Mei-I; Liu, Hsiao-Hua; Chen, Chin-Ming; Chiang, Shyh-Ren; Liu, Wei-Lun; Chao, Chien-Ming; Ho, Chung-Han; Weng, Shih-Feng; Hsing, Shu-Chen; Cheng, Kuo-Chen

    2016-04-01

    The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS.This prospective observational study was conducted in a single tertiary medical center in Taiwan and compared the stabilized PaO2/FiO2 ratio (Day 1) following standard ventilator settings and the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0). Patients admitted to intensive care units and in accordance with the Berlin criteria for ARDS were collected between December 1, 2012 and May 31, 2015. Main outcome was 28-day mortality. Arterial blood gas and ventilator setting on Days 0 and 1 were obtained.A total of 238 patients met the Berlin criteria for ARDS were enrolled, and they were classified as mild (n = 50), moderate (n = 125), and severe (n = 63) ARDS, respectively. Twelve (5%) patients who originally were classified as ARDS did not continually meet the Berlin definition, and a total of 134 (56%) patients had the changes regarding the severity of ARDS from Day 0 to Day 1. The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. Moreover, the area under receiver-operating curve for mortality prediction using PaO2/FiO2 on Day 1 was significant higher than that on Day 0 (P = 0.016).PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0. PMID:27057912

  15. Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome

    GUO Feng-mei; DING Jing-jing; SU Xin; XU Hui-ying; SHI Yi

    2008-01-01

    Background It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS).This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume,to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP.Methods Twenty-four patients with ARDS were studied.A lung recruiting maneuver was performed,then each patient was ventilated with PEEP of 8 cmH2O for 4 hours and subsequently with PEEP of 16 cmH2O for 4 hours.At the end of each PEEP level period,gas exchange,hemodynamic data,lung mechanics,stress index "b" of the dynamic pressure-time curve,intrinsic PEEP and recruited volume by PEEP were measured.Results Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH2O were (425±65) ml and 10 patients were non-recruiters.Compared with the PEEP 8 cmH2O period,after the application of the PEEP 16 cmH2O,the PaO2/FiO2 ratio and static lung compliance both remained unchanged in non-recruiters,whereas they increased significantly in recruiters.Changes in PaO2/FiO2 and static lung compliance after PEEP increase were independently associated with the alveolar recruitment.Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP,we found a notable correlation.Conclusions The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters.Improving in PaO2/FiO2,static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application.

  16. Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

    Beretta Chiara

    2009-04-01

    Full Text Available Abstract Introduction Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia. Case presentation We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m2/dose associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level. Conclusions This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our

  17. 儿童急性呼吸窘迫综合征肺复张策略的研究进展%Recruitment maneuvers in pediatric patients with acute respiratory distress syndrome

    谢波

    2014-01-01

    近年来肺复张策略因可打开肺泡,减少肺泡萎陷所致的肺损伤,改善肺顺应性,提高动脉氧分压与氧合指数,减少肺内分流而成为急性呼吸窘迫综合征机械通气治疗手段之一.本文就肺复张在儿童急性呼吸窘迫综合征的应用做一综述.%Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.

  18. Uso de corticosteroide na síndrome do desconforto respiratório agudo em pacientes pediátricos Corticosteroids therapy in pediatric acute respiratory distress syndrome

    Maria Clara de Magalhães Barbosa

    2010-12-01

    mais pesquisas para elucidar a segurança e eficácia da administração de metilprednisolona na lesão pulmonar aguda/síndrome do desconforto respiratório agudo em crianças, bem como estabelecer os melhores parâmetros a serem utilizados no diagnóstico e acompanhamento da doença, na monitorização das complicações da corticoterapia, bem como os desfechos primários mais adequados.The use of corticosteroids in acute lung injury and acute respiratory distress syndrome is one of the most controversial issues in the literature. However, acute lung injury/acute respiratory distress syndrome studies are restricted to adults, despite the widespread use of corticosteroid for hyper-reactive respiratory airway diseases in children. This review aimed to describe experimental and clinical evidence for corticosteroid therapy in acute lung injury/acute respiratory distress syndrome and to point out the risks and benefits of its use in pediatrics. For this purpose, an extensive review of the literature was performed from 1980 to 2010 including both experimental and clinical papers, as well as reviews and meta-analysis, using Medline, Cochrane Central Register of Controlled Trials, Cochrane database of systematic reviews, SciELO, Lilacs and Bireme databases. The search terms were: acute lung injury, acute respiratory distress syndrome, steroids, child, clinical trials, meta-analyses, reviews, and case reports. Most studies showed that the corticosteroids-induced down-regulation of systemic inflammatory response is associated with oxygenation improvement, reduction of multiple organ dysfunctions, mechanical ventilation time, and intensive care units length of stay. Based on the literature, the authors suggest early and prolonged methylprednisolone administration for acute lung injury/acute respiratory distress syndrome, using continuous 1 mg/kg/day infusion to prevent glycemic variability, associated with strict infection surveillance. In addition, they recommend some

  19. Síndrome do desconforto respiratório agudo pulmonar e extrapulmonar: existem diferenças? Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?

    Cristiane S. N. Baez Garcia

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A patogênese da síndrome do desconforto respiratório agudo (SDRA tem sido explicada pela presença de uma agressão direta (SDRA pulmonar e/ou indireta (SDRA extrapulmonar ao parênquima pulmonar. Evidências indicam que a fisiopatologia da doença pode diferir com o tipo de lesão. O objetivo deste estudo foi apresentar breve revisão das diferenças entre a SDRA pulmonar e a SDRA extrapulmonar e discutir as interações entre os aspectos morfofuncionais e a resposta aos diferentes tratamentos. CONTEÚDO: Esta revisão bibliográfica baseou-se em uma pesquisa sistemática de artigos experimentais e clínicos sobre SDRA incluídos nas bases de dados MedLine e SciElo nos últimos 20 anos. Muitos pesquisadores concordam, com base em estudos experimentais, que a SDRA pulmonar e a SDRA extrapulmonar não são idênticas no que diz respeito aos aspectos morfofuncionais, a resposta à pressão positiva ao final da expiração (PEEP, manobra de recrutamento alveolar, posição prona e outras terapias farmacológicas. Entretanto, os estudos clínicos têm descrito resultados contraditórios, os quais podem ser atribuídos à dificuldade de se classificar a SDRA em uma ou outra etiologia, e de se precisar o início, a fase e a gravidade da SDRA nos pacientes. CONCLUSÕES: Pacientes com SDRA de etiologias distintas perduram sendo considerados como pertencendo a uma mesma síndrome e, assim, são tratados da mesma forma. Logo, é fundamental entender as diferenças fisiopatológicas entre a SDRA pulmonar e extrapulmonar para que a terapia seja mais bem direcionada.BACKGROUND AND OBJECTIVES: The pathogenesis of acute respiratory distress syndrome (ARDS has been described by the presence of direct (pulmonary and/or indirect (extrapulmonary insult to the lung parenchyma. Evidence indicates that the pathophysiology of ARDS may differ according to the type of primary insult. This article presents a brief overview of differences

  20. 无创机械通气治疗急性呼吸窘迫综合征的临床观察%Clinical observation of non-invasive mechanical ventilation for acute respiratory distress syndrome

    耿新普

    2012-01-01

    目的 观察无创机械通气治疗急性呼吸窘迫综合征(ARDS)的临床疗效.方法 72例急性呼吸窘迫综合征患者在常规治疗(药物治疗+吸氧)基础上加用无创机械通气,观察患者治疗前后临床症状和动脉血气分析.结果 给予无创机械通气后患者呼吸困难症状明显改善,pH、SaO2、PaO2、PaO2/FiO2等指标上升明显,与治疗前相比差异有统计学意义(P<0.05);呼吸频率、心率、血压、PaCO2,等指标明显下降,与治疗前相比差异有统计学意义(P<0.05).动脉血气PaO2明显上升(P<0.05),PaCO2下降明显(P<0.05).结论 无创机械通气治疗能有效缓解急性呼吸窘迫综合征患者的临床症状,并改善患者的各项血气指标,值得在临床中推广应用.%Objective To investigate the clinical efficacy of the non-invasive mechanical ventilation in acute respiratory distress syndrome. Methods 72 patients with acute respiratory distress syndrome were used non-invasive mechanical ventilation on the basis of the conventional therapy( drug treatment + oxygen ). Before and after treatment, clinical symptoms and arterial blood gas analysis were measured. Results After treatment, the original dificulty breathing symptoms of patients improved, pH,SaO2 ,PaO2 ,PaO2/FiO2 increased significantly, and there were significant differences compared with before treatment P <0. 05 );respiratory rate, heart rate, blood pressure, PaCO2 decreased significantly compared with before treatment with significant differences( P <0. 05 ). Conclusion Non-invasive mechanical ventilation in acute respiratory distress syndrome can quickly relieve the clinical symptoms and improve the blood gas analysis in patients. It is worthy of clinically use.

  1. A phase I study evaluating the pharmacokinetics, safety and tolerability of an antibody-based tissue factor antagonist in subjects with acute lung injury or acute respiratory distress syndrome

    Morris Peter E

    2012-02-01

    Full Text Available Abstract Background The tissue factor (TF-dependent extrinsic pathway has been suggested to be a central mechanism by which the coagulation cascade is locally activated in the lungs of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS and thus represents an attractive target for therapeutic intervention. This study was designed to determine the pharmacokinetic and safety profiles of ALT-836, an anti-TF antibody, in patients with ALI/ARDS. Methods This was a prospective, randomized, placebo-controlled, dose-escalation Phase I clinical trial in adult patients who had suspected or proven infection, were receiving mechanical ventilation and had ALI/ARDS (PaO2/FiO2 ≤ 300 mm. Eighteen patients (6 per cohort were randomized in a 5:1 ratio to receive ALT-836 or placebo, and were treated within 48 hours after meeting screening criteria. Cohorts of patients were administered a single intravenously dose of 0.06, 0.08 or 0.1 mg/kg ALT-836 or placebo. Blood samples were taken for pharmacokinetic and immunogenicity measurements. Safety was assessed by adverse events, vital signs, ECGs, laboratory, coagulation and pulmonary function parameters. Results Pharmacokinetic analysis showed a dose dependent exposure to ALT-836 across the infusion range of 0.06 to 0.1 mg/kg. No anti-ALT-836 antibody response was observed in the study population during the trial. No major bleeding episodes were reported in the ALT-836 treated patients. The most frequent adverse events were anemia, observed in both placebo and ALT-836 treated patients, and ALT-836 dose dependent, self-resolved hematuria, which suggested 0.08 mg/kg as an acceptable dose level of ALT-836 in this patient population. Conclusions Overall, this study showed that ALT-836 could be safely administered to patients with sepsis-induced ALI/ARDS. Trial registration ClinicalTrials.gov: NCT01438853

  2. The adult respiratory distress syndrome bronchogenic pulmonary tuberculosis.

    R. A. Dyer; Potgieter, P D

    1984-01-01

    In three cases of pulmonary tuberculosis associated with the adult respiratory distress syndrome the clinical features, which were similar to those of patients with miliary tuberculosis and adult respiratory distress syndrome, included a history of cough, fever, and dyspnoea on effort, and the physical signs of fever, tachypnoea, pulmonary adventitious sounds, tachycardia, and hepatomegaly. In these cases the radiological features, though suggestive of diffuse pulmonary oedema, were more prom...

  3. Prevalence and etiology of respiratory distress in newborns

    Objective: To determine the prevalence and etiology of respiratory distress in the newborns delivered over the period of one year from 1st January 2008 to 31st Dec 2008. Study Design: A descriptive study Place and Duration of Study: The study was conducted in Armed Forces Hospital Sharurah Kingdom of Saudi Arabia over a period of one year from January 2008 to Dec 2008 Patients and methods: All live newborns delivered at Armed Forces Hospital Sharurah during the study period were included and observed for development of respiratory distress. Results: All newborns (n=659), delivered at this hospital over the period of 12 months, were observed for respiratory distress. The overall prevalence of respiratory distress (RD) was 4.24%. Prevalence was 19.7% in preterm and 2.3% in full term. Transient tachypnea of newborn(TTN) was found to be the commonest 35.7% cause of Respiratory Distress (RD) followed by Hyaline membrane disease (HMD) 25%, meconium aspiration syndrome (MAS) 17.9%, congenital pneumonia 7.1% and other congenital anomalies 14.3%. TTN was found to be common among both term and preterm babies, while hyaline membrane disease was seen among preterm, and meconium aspiration syndrome among term and post term babies. Conclusion: Respiratory distress is a common neonatal problem with significant morbidity and mortality. Majority of cases are due to TTN followed by hyaline membrane disease and meconium aspiration syndrome. (author)

  4. Association of alveolar recruitment maneuvers and prone position in acute respiratory disease syndrome patients.

    Costa, Daniela Caetano; Rocha, Eduardo; Ribeiro, Tatiane Flores

    2009-06-01

    The acute respiratory distress syndrome is the clinical presentation of acute lung injury characterized by diffuse alveolar damage and development of non-cardiogenic pulmonary edema due to increased pulmonary alveolar-capillary membrane permeability. Alveolar recruitment maneuvers and prone position can be used in the treatment of acute respiratory distress syndrome. The objective of this review of literature was to identify possible benefits, indications, complications and care of the associated recruitment maneuvers and prone position for treatment of the acute respiratory distress syndrome. This national and international scientific literature review was developed according to the established criteria for searching the databases MedLine, LILACS, SciElo, PubMed, Cochrane, from 1994 to 2008 in Portuguese and English, with the key words: acute respiratory distress syndrome, alveolar recruitment maneuver and prone position. Despite advances in the understanding of acute respiratory distress syndrome pathophysiology, mortality is still expressive. Alveolar recruitment maneuvers and prone position significantly contribute to treatment of acute respiratory distress syndrome patient aiming to improve oxygenation and minimizing complications of refractory hypoxemia and reduction of pulmonary compliance. However,as there are few studies in literature associating alveolar recruitment maneuvers and prone position for treatment of acute respiratory distress syndrome, additional research and evidences of clinical application are required. PMID:25303351

  5. Intrathoracic cystic hygroma with sudden respiratory distress mimicking pneumonia

    Umesh Goneppanavar

    2012-01-01

    Full Text Available Benign cystic lesions such as cystic hygroma commonly manifest as progressively increasing swelling in the neck with or without compression effects. Rarely, they present with sudden respiratory distress in instances such as infection or haematoma resulting in a sudden increase in the size of the tumour. We present a seven month old child with sudden onset respiratory distress without any obvious neck swelling. The chest X ray findings correlated with the history and were suggestive of right upper lobe pneumonia that leads to a wrong diagnosis of aspiration pneumonia. However, presence of a deviated trachea in the neck raised a suspicion of possible mass. Computed tomogram showed a large cystic mass in the right upper mediastinum with tracheal collapse. We caution intensivists and paediatricians that sudden respiratory distress in infants in the absence of obvious neck swelling does not rule out possibility of intrathoracic tumour.

  6. SMART phones and the acute respiratory patient.

    Gleeson, L

    2012-05-01

    Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2\\/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2\\/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.

  7. Inhaled nitric oxide in acute respiratory distress syndrome with and without septic shock requiring norepinephrine administration: a dose–response study

    Mourgeon, Eric; Puybasset, Louis; Law-Koune, Jean-Dominique; Lu, Qin; Abdennour, Lamine; Gallart, Lluis; Malassine, Patrick; Rao, GS Umamaheswara; Cluzel, Philippe; Bennani, Abdelhai; Coriat, Pierre; Rouby, Jean-Jacques

    1997-01-01

    Background: The aim of this prospective study was to assess whether the presence of septic shock could influence the dose response to inhaled nitric oxide (NO) in NO-responding patients with adult respiratory distress syndrome (ARDS). Results: Eight patients with ARDS and without septic shock (PaO2 = 95 ± 16 mmHg, PEEP = 0, FiO2 = 1.0), and eight patients with ARDS and septic shock (PaO2 = 88 ± 11 mmHg, PEEP = 0, FiO2 = 1.0) receiving exclusively norepinephrine were studied. All responded to 15 ppm inhaled NO with an increase in PaO2 of at least 40 mmHg, at FiO2 1.0 and PEEP 10 cmH2O. Inspiratory intratracheal NO concentrations were recorded continuously using a fast response time chemiluminescence apparatus. Seven inspiratory NO concentrations were randomly administered: 0.15, 0.45, 1.5, 4.5, 15, 45 and 150 ppm. In both groups, NO induced a dose-dependent decrease in mean pulmonary artery pressure (MPAP), pulmonary vascular resistance index (PVRI), and venous admixture (QVA/QT), and a dose-dependent increase in PaO2/FiO2 (P ≤ 0.012). Dose-response of MPAP and PVRI were similar in both groups with a plateau effect at 4.5 ppm. Dose-response of PaO2/FiO2 was influenced by the presence of septic shock. No plateau effect was observed in patients with septic shock and PaO2/FiO2 increased by 173 ± 37% at 150 ppm. In patients without septic shock, an 82 ± 26% increase in PaO2/FiO2 was observed with a plateau effect obtained at 15 ppm. In both groups, dose-response curves demonstrated a marked interindividual variability and in five patients pulmonary vascular effect and improvement in arterial oxygenation were dissociated. Conclusion: For similar NOinduced decreases in MPAP and PVRI in both groups, the increase in arterial oxygenation was more marked in patients with septic shock. PMID:11056694

  8. Surfactant function in neonates with respiratory distress syndrome

    Griese, Matthias; Westerburg, Bettina

    1998-01-01

    The function of pulmonary surfactant of a group of 14 preterm neonates (birth weight 907 +/- 60 g) who suffered from severe respiratory distress syndrome (RDS) and who had received exogenous bovine lipid extracted surfactant on the first day of life was compared to that in a second group of 8 neonates (birth weight 940 +/- 110 g) with mild RDS who had not received surfactant treatment. Mechanical respiratory support from day 2 on was the same in both groups. The minimal surface tension (gamma...

  9. Pyogenic sacroiliitis and adult respiratory distress syndrome: a case report.

    Asavamongkolkul, A; Keerasuntonpong, A; Kuagoolwongse, C

    2007-08-01

    Staphylococcus aureus sacroiliitis is uncommon and may lead to bacteraemia, sepsis, and death if diagnosis and treatment are delayed. Its association with pulmonary symptoms has not been reported. We report a 36-year-old Thai woman who presented with a 4-day history of right buttock pain, aggravated by walking, which came on after having a traditional foot massage. She later developed adult respiratory distress syndrome. She was treated with open drainage, respiratory support, and antibiotics. PMID:17709867

  10. Hearing evaluation of infants with respiratory distress syndrome by TEOAE test

    Mahya Sharifinik

    2015-02-01

    Conclusion: According to results, it seems that the respiratory distress syndrome could affects the cochlear and the function of outer hair cell in it so in infants who suffer respiratory distress syndrome we should use the test battery of hearing.

  11. Respiratory Distress Syndrome in Curacao - Conventional versus surfactant treatment

    Verhagen, AAE; van der Meulen, GN; Wiersma, HE; Keli, SO

    2002-01-01

    The aim of this study was to determine the incidence of Respiratory Distress Syndrome (RDS) and to evaluate the efficacy of surfactant treatment at the Neonatal Intensive Care Unit (NICU) at the St Elisabeth Hospital, Curaqao, Netherlands, Antilles, This was a retrospective cohort study of 86 infant

  12. 压力控制法肺复张在急性呼吸窘迫综合征中的应用%The Use of Pressure-controlled Recruitment Maneuver in Patients with Acute Respiratory Distress Syndrome

    罗婉琳

    2011-01-01

    机械通气是急性呼吸窘迫综合征(ARDS)的主要治疗手段,肺复张手法应用较高压力开放塌陷肺泡,并使用高呼吸末正压防止肺泡塌陷,期望恢复肺泡的同一性,减少呼吸机相关性肺损伤,改善患者预后.但近年的临床试验却得出矛盾的结果,其有效性及安全性及具体实施方法仍无统一意见.现就压力控制法肺复张在ARDS中的有效性、安全性的操作方法予以综述.%Mechanical ventilation is the major treatment for patients with acute respiratory distress syndrome( ARDS) . Recruitment maneuvers that use high tranapulmonary pressure to reopen atelectatic alveoli and employ high end-expiratory pressure to prevent alveolar collapse, with the expectation to reconstruct the alveolar homogeneity ,reduce the ventilation-associated pulmonary injuries, and improve the prognosis of patients. However, the recent clinical studies show controversial results , remaining controversial in the effectiveness , aafety, and protocol. This article reviews the effectiveness and safe practice of pressure-controlled recruitment maneuver.

  13. Umbilical cord blood and neonatal endothelin-1 levels in preterm newborns with and without respiratory distress syndrome

    A.C.W. Benjamin

    2005-09-01

    Full Text Available Increased pulmonary vascular resistance in preterm newborn infants with respiratory distress syndrome is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. We determined umbilical cord blood and neonatal (second sample levels of endothelin-1 in 18 preterm newborns with respiratory distress syndrome who had no clinical or echocardiographic diagnosis of pulmonary hypertension and 22 without respiratory distress syndrome (gestational ages: 31.4 ± 1.6 and 29.3 ± 2.3 weeks, respectively. Umbilical cord blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Median umbilical cord blood endothelin-1 levels were similar in both groups (control: 10.9 and respiratory distress syndrome: 11.4 pg/mL and were significantly higher than in the second sample (control: 1.7 pg/mL and respiratory distress syndrome: 3.5 pg/mL, P < 0.001 for both groups. Median endothelin-1 levels in the second sample were significantly higher in children with respiratory distress syndrome than in control infants (P < 0.001. There were significant positive correlations between second sample endothelin-1 and Score for Neonatal Acute Physiology and Perinatal Extension II (r = 0.36, P = 0.02, and duration of mechanical ventilation (r = 0.64, P = 0.02. A slower decline of endothelin-1 from birth to 40 h of life was observed in newborns with respiratory distress syndrome when compared to controls. A significant correlation between neonatal endothelin-1 levels and some illness-severity signs suggests that endothelin-1 plays a role in the natural course of respiratory distress syndrome in preterm newborns.

  14. Noninvasive ventilation in acute respiratory failure due to H1N1 influenza

    Mohapatra, Prasanta R.; Naveen Dutt; Sushant Khanduri; Baijayantimala Mishra; Janmeja, Ashok K

    2011-01-01

    We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.

  15. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome.

    R.A.M. Fouchier (Ron); P.M. Schneeberger (Peter); F.W. Rozendaal (Frans); J.M. Broekman (Jan); S.A. Kemink (Stiena); V.J. Munster (Vincent); G.F. Rimmelzwaan (Guus); M. Schutten (Martin); G.J.J. van Doornum (Gerard); G. Koch (Guus); A. Bosman (Arnold); M.P.G. Koopmans D.V.M. (Marion); A.D.M.E. Osterhaus (Albert); T. Kuiken (Thijs)

    2004-01-01

    textabstractHighly pathogenic avian influenza A viruses of subtypes H5 and H7 are the causative agents of fowl plague in poultry. Influenza A viruses of subtype H5N1 also caused severe respiratory disease in humans in Hong Kong in 1997 and 2003, including at least seven fatal cases, posing a serious

  16. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    Paolo Ruggeri; Salvatore Calcaterra; Antonio Bottari; Giuseppe Girbino; Vincenzo Fodale

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drow...

  17. The Role of Surfactant in Respiratory Distress Syndrome

    Ma, Christopher Cheng-Hwa; Ma, Sze

    2012-01-01

    The key feature of respiratory distress syndrome (RDS) is the insufficient production of surfactant in the lungs of preterm infants. As a result, researchers have looked into the possibility of surfactant replacement therapy as a means of preventing and treating RDS. We sought to identify the role of surfactant in the prevention and management of RDS, comparing the various types, doses, and modes of administration, and the recent development. A PubMed search was carried out up to March 2012 u...

  18. Genetic risk factors associated with respiratory distress syndrome

    Jo, Heui Seung

    2014-01-01

    Respiratory distress syndrome (RDS) among preterm infants is typically due to a quantitative deficiency of pulmonary surfactant. Aside from the degree of prematurity, diverse environmental and genetic factors can affect the development of RDS. The variance of the risk of RDS in various races/ethnicities or monozygotic/dizygotic twins has suggested genetic influences on this disorder. So far, several specific mutations in genes encoding surfactant-associated molecules have confirmed this. Spec...

  19. Atrial natriuretic factor and postnatal diuresis in respiratory distress syndrome.

    Rozycki, H J; Baumgart, S.

    1991-01-01

    To find out if atrial natriuretic factor plays a part in the control of urine output during the initiation alone or throughout postnatal diuresis in neonates with respiratory distress syndrome, atrial natriuretic factor concentrations and clinical and renal variables were measured prospectively three times during the first three days of life in 13 premature infants. Atrial natriuretic factor concentrations rose significantly between the first and second sample times as did the urine output an...

  20. Influence of inspiration to expiration ratio on cyclic recruitment and derecruitment of atelectasis in a saline lavage model of acute respiratory distress syndrome*

    Boehme, Stefan; Bentley, Alexander H.; Hartmann, Erik K.; Chang, Shi; Erdös, Gabor; Prinzing, Anatol; Hagmann, Michael; Baumgardner, James E; Ullrich, Roman; Markstaller, Klaus; David, Matthias

    2015-01-01

    OBJECTIVE Cyclic recruitment and derecruitment of atelectasis can occur during mechanical ventilation, especially in injured lungs. Experimentally, cyclic recruitment and derecruitment can be quantified by respiration-dependent changes in PaO2 (ΔPaO2), reflecting the varying intrapulmonary shunt fraction within the respiratory cycle. This study investigated the effect of inspiration to expiration ratio upon ΔPaO2 and Horowitz index. DESIGN Prospective randomized study. SETTING...

  1. Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome

    Formenti, Federico; Chen, R.; McPeak, Hanne; Murison, Pamela; Matejovic, M; Hahn, Clive; Farmery, Andrew

    2015-01-01

    Background There is considerable interest in oxygen partial pressure (PO2) monitoring in physiology, and in tracking PO2 changes dynamically when it varies rapidly. For example, arterial PO2 ([Math Processing Error]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Math Processing Error] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Math Processing Error] oscillations could become a useful diagnostic...

  2. Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome

    Formenti, F.; Chen, R.; McPeak, H; Murison, PJ; Matejovic, M; Hahn, CEW; Farmery, AD; Galley, HF

    2015-01-01

    BACKGROUND: There is considerable interest in oxygen partial pressure (Po2) monitoring in physiology, and in tracking Po2 changes dynamically when it varies rapidly. For example, arterial Po2 ([Formula: see text]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Formula: see text] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Formula: see text] oscillations could become a useful diagnostic tool of CA...

  3. The damage of pulmonary microvascular endothelial cell barrier and acute respiratory distress syndrome%肺微血管内皮细胞屏障功能损伤与急性呼吸窘迫综合征

    韩凤

    2015-01-01

    急性呼吸窘迫综合征( ARDS)是急性呼吸衰竭发生的主要原因,其特征是弥漫性的肺泡损伤,伴透明膜形成,肺泡腔高蛋白性水肿、毛细血管损伤和肺泡上皮破裂,它最突出的临床表现为顽固的低氧血症. 尽管在最佳的通气支持和液体平衡的治疗改善后,它仍有很高的死亡率及短、长期的并发症. 因此,对这种综合征的早期识别和治疗性干预措施的早期应用至关重要. 本综述描述了肺微血管内皮细胞( PMVECs )屏障功能损伤与ARDS发生、发展的相互关系.具体来说是描述了ARDS定义、PMVECs的屏障功能,以及在ARDS的发生、发展时PMVECs的通透性改变,异常凋亡、分泌和功能失调,以期深入探讨ARDS可能的病理生理学机制.%The acute respiratory distress syndrome ( ARDS) is a major cause of acute respiratory failure characterized by a diffused alveolar damage , formation of hyaline membranes , protein -rich edema fluid in the alveolar spaces , capillary injury and disruption of the alveolar epithelium , and the most prominent clinical manifestation of ARDS is refractory hypoxemia . Despite improvements in intensive care with optimal ventilation support and fluid balance , its development also leads to high mortality, as well as short -and long -term complications.Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity .In this review article , we describe the mutual relation between the damage of pulmonary microvascular endothelial cell ( PMVECs ) barrier and the occurrence and development of ARDS .Specifically , we describe the Berlin definition of ARDS and barrier function of PMVECs, as well as the permeability changes , the abnormal apoptosis and secretion and the dysfunction of PMVECs in the development of ARDS in order to further discuss its possible pathophysiological mechanism.

  4. The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (Sus scrofa models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

    Rismala Dewi

    2016-04-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW elevation and levels of interleukin-8 (IL-8 and vascular cell adhesion molecule-1 (VCAM-1 have been studied as indicators playing a role in the pathogenesis of ARDS. The aim of the study was to determine the effects of colloid or crystalloid on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.Methods: This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test.Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to the crystalloid group. There was no significant difference in IL-8 and VCAM-1 levels between the two groups.Conclusion: The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI, but not with IL-8 or VCAM-1 levels.

  5. Alternative therapies for respiratory distress syndrome in preterm infants

    Sinha IP

    2011-11-01

    Full Text Available Ian P Sinha1, Sunil K Sinha21Division of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; 2Department of Neonatology, University of Durham and James Cook University Hospital, Middlesbrough, UKAbstract: There is growing interest in the use of noninvasive methods of providing respiratory support to preterm infants, especially those born at the limits of viability. This paper relates to the use of noninvasive forms of respiratory support, which could be used to treat preterm infants with respiratory distress syndrome (RDS. Evidence is reviewed from clinical trials that have evaluated the use of continuous positive airway pressure (CPAP, nasal intermittent positive airway pressure (NIPPV, and high flow nasal cannulae (HFNC.Keywords: CPAP, NIPPV, RDS, preterm

  6. Critical care ultrasonography in acute respiratory failure.

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-01-01

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript. PMID:27524204

  7. Submersion and acute respiratory failure

    Yu-Jang Su

    2014-01-01

    Objectives:To know the relationship between hypothermia, etiology, respiratory failure and prognosis of submersion in environmental emergency medicine.Methods:FromDecember1, 2002 toSeptember30,2007, there were52 hospitalized near- drowning cases in a medical center at northernTaiwan.Retrospective study of52 submersion patients who were hospitalized during the duration was analyzed.Results:The hypothermic groups are more commonly seen in acute respiratory failure after submersion,36%vs.21%,P<0.05.The hypothermic submersion patients who are older in age than normothermic submersion patients(44vs.27 years old,P<0.05).The suicidal submersion patients are older, hypothermic and longer length of stay than accidental submersion patients.Conclusions:Submersion patients who are hypothermic on arrival of emergency department(ED) are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  8. Involvement of Mycoplasma synoviae in Respiratory Distress Cases of Broilers

    S. Ehtisham-ul-Haque*, S. U. Rahman, M. Siddique and A. S. Qureshi1

    2011-04-01

    Full Text Available Mycoplasma synoviae (MS is an important pathogen of poultry worldwide, causing respiratory tract infection and infectious synovitis in chickens and turkeys. The study was designed to detect M. synoviae through serology, culture isolation and polymerase chain reaction (PCR assay to document the involvement of MS infection in respiratory distress cases of broiler birds. The validated PCR assay amplifying the conserved gene region of 16SrRNA gene was applied for the detection of M. synoviae from culture as well as in clinical samples. The results indicated that 04 out of total 17 commercial broiler flocks showing respiratory distress signs were found positive with M. synoviae infection indicating 76.57% sero-positivity as, determined with rapid serum agglutination (RSA test. Out of 85 clinical specimens (collected from sero-positive birds; M. synoviae culture isolation was successfully attained in 36 (42.35% samples. Whereas, PCR test has detected 84 (98.82% positive cases. The prevalence of MS in broiler birds was observed maximum as measured through PCR. It is suggested that the true prevalence of MS may best be reflected by combining RSA and PCR test findings.

  9. A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study.

    Lall, Ranjit; Hamilton, Patrick; Young, Duncan; Hulme, Claire; Hall, Peter; Shah, Sanjoy; MacKenzie, Iain; Tunnicliffe, William; Rowan, Kathy; Cuthbertson, Brian; McCabe, Chris; Lamb, Sallie

    2015-01-01

    BACKGROUND Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage. OBJECTIVES To determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation. DESIGN A parallel, randomised, unblinded clinical trial. SETTING UK intensive care units. PARTICIPANTS Mechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment. INTERVENTIONS Treatment arm HFOV using a Novalung R100(®) ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning. Control arm Conventional mechanical ventilation using the devices available in the participating centres. MAIN OUTCOME MEASURES The primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained. RESULTS One hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) -6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40; p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to

  10. Radiological diagnosis of adult respiratory distress syndrome (ARDS)

    The bedside chest radiograph represents the imaging modality of choice for diagnosis and monitoring of adult respiratory distress syndrome (ARDS). Imaging findings are strongly influenced by means of mechanical ventilation therapy. The chest radiograph is relatively insensitive and not specific for the diagnosis of complications such as pneumonia or interstitial emphysema. Computed tomography (CT) is suitable for quantitative assessment of lung compartments with respect to the underlying pathophysiology and the effects of ventilation therapy (PEEP) could be improved. The role of CT in the clinical routine is still limited due to the high risk to transport patients with ARDS. (author)

  11. Adult respiratory distress syndrome due to mycoplasma pneumonia.

    Shah, D. C.; Muthiah, M. M.

    1996-01-01

    A previously fit 48-year-old man was admitted with an acute respiratory failure due to mycoplasma pneumonia that was confirmed by raised mycoplasma titre on complement fixation test. It was also associated with disseminated intravascular coagulopathy. The patient made a full recovery but required intermittent positive pressure ventilation.

  12. Effect of ulinastatin on acute respiratory distress syndrome:A meta-analysis%乌司他丁治疗急性呼吸窘迫综合征效果的荟萃分析

    2013-01-01

    Objective To assess the effect of ulinastatin on acute respiratory distress syndrome (ARDS). Methods A meta-analysis was performed for the clinical trials on ulinastatin in treatment of ARDS covered in PubMed, Embase, CBMdisk, CNKI and Wanfang Database before May 2012 with the software of ReviewManager4.2 on Cochrane Cooperation Network. The curative effect indexes of ulinastatin included respiratory frequency, PaO2/FiO2, PaCO2 and mortality. Results Meta analysis showed that the mean respiratory frequency and mortality were lower whereas the mean PaCO2 and PaO2/FiO2 were higher in ulinastatin treatment group than in control group 7 days after ulinastatin treatment (WMD=-5.74, P=0.003;RR=0.62, P=0.04;WMD=4.78, P<0.000 01;WMD=59.94, P<0.000 01). Conclusion Ulinastatin can significantly improve the pulmonary ventilation and reduce the mortality of ARDS patients.%  目的系统评价乌司他丁治疗急性呼吸窘迫综合征的效果。方法检索2012年5月以前在PubMed、Embase、CBMdisk、CNKI和万方数据库公开发表的有关乌司他丁治疗急性呼吸窘迫综合征的临床研究并采用Cochrane协作网提供的ReviewManager4.2软件对纳入的研究做Meta分析。疗效判定指标包括呼吸频率、氧合指数、PaCO2以及病死率。结果 Meta分析显示,经过7 d的治疗,乌司他丁治疗组的呼吸频率均数小于对照组(WMD=-5.74,P=0.003),而且前者的PaCO2均数(WMD=4.78,P<0.00001)、氧合指数均数(WMD=59.94,P<0.00001)都高于对照组;此外,乌司他丁治疗组的病死率低于对照组(RR=0.62,P=0.04)。结论乌司他丁在改善肺通气和降低急性呼吸窘迫综合征的病死率方面优势明显。

  13. Ventilação de alta freqüência em crianças e adolescentes com síndrome do desconforto respiratório agudo (impacto sobre o uso de ecmo High-frequency ventilation in children and adolescents with acute respiratory distress syndrome (impact on the use of ecmo

    Lucília Santana Faria

    2007-06-01

    Full Text Available OBJETIVO: Avaliar o efeito da ventilação de alta freqüência (VAF em crianças e adolescentes com síndrome do desconforto respiratório (SDRA por meio de estimativas de sobrevida e tempo de ventilação. Verificar se a VAF reduziu a indicação de oxigenação de membrana extracorpórea (ECMO em crianças e adolescentes com SDRA. MÉTODOS: A técnica empregada foi uma revisão sistemática da literatura médica sobre o uso de VAF e ECMO em crianças e adolescentes com SDRA. O levantamento bibliográfico utilizou os bancos de dados Medline, Lilacs e Embase. Os termos utilizados para pesquisa foram: adult respiratory distress syndrome, ARDS, acute respiratory distress syndrome, respiratory distress syndrome, extracorporeal membrane oxygenation, ECMO, high-frequency ventilation, high-frequency jet ventilation e high-frequency oscillatory ventilation. Foram procurados ensaios clínicos controlados e randomizados, estudos de coorte e série de casos que comparavam VAF com ventilação mecânica convencional (VMC, ECMO com VMC ou VAF precedendo o uso de ECMO. RESULTADOS: Foram identificadas 289 publicações relacionadas a VAF, SDRA e ECMO. Destas, apenas nove atendiam aos critérios de seleção pré-estabelecidos referindo-se a utilização de VAF e/ou ECMO em crianças e adolescentes com SDRA. CONCLUSÃO: Não foi possível confirmar se o uso de VAF melhora a sobrevida de crianças e adolescentes com SDRA. Quanto ao tempo de ventilação, não houve estudo que comprovasse, com significância estatística, a sua redução ou aumento. Não foi possível verificar se VAF diminui ou não a indicação de ECMO em crianças e adolescentes com SDRA.OBJECTIVE: To assess the effect of high-frequency ventilation (HFV in children and adolescents with acute respiratory distress syndrome (ARDS through estimates of survival rate and time of ventilation. To verify whether HFV can reduce the indication for extracorporeal membrane oxygenation (ECMO in children

  14. What Is Acute Respiratory Distress Syndrome?

    ... treated in the intensive care unit (ICU) or critical care unit (CCU) of a hospital. Therapies commonly used ... may be done. (See ATS fact sheet on Tracheostomy). What is an ICU and what can I ...

  15. Clinic analysis of sequential noninvasive-invasve mechanical ventilation in treating acute respiratory distress syndrome%无创-有创序贯通气治疗急性呼吸窘迫综合症的临床分析

    李文元; 王淑华; 丁士芳; 张堃慧

    2014-01-01

    Objective To investigate the treatment efficiency of acute respiratory distress syndrome ,with the application of direct invasive ventilation and forced in-vasive ventilation after the failure of no -invasive positive pressure ventilation.Methods The clinical data of ARDS patients with the application of direct IV and NIPPV-IV were retrospectively analyzed from January 2008 to January 2011.Results direct IV group was 90 patients and NIPPV -IV group was 47 patients,the analysis showed that sexual,age,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores,simple acute physical(SAPⅡ)scores,lung injury scores,the original of ARDS,sepsis severity were no significant between direct IV group and NIPPV -IV group(p>0.05),after the different mechanical ventilation,the number of organ dysfunction,treatment days in ICU and mortality were significant between direct IV group and NIPPV -IV group(p<0.05).Conclusions ARDS patients should be established artificial airway directly for the application of invasive ventilation ,NIPPV should be used with caution in ARDS patients in order to avoid poor prognosis by its failure .%目的:评价无创正压通气失败后被迫有创通气( NIPPV-IV)和直接有创通气( IV)治疗急性呼吸窘迫综合征( ARDS)的疗效和安全性。方法回顾性分析2008年1月至2011年1月综合ICU的ARDS患者的临床资料,分为无创正压通气失败后进行有创通气治疗( NIPPV-IV)组和直接有创通气治疗( IV)组。结果 NIPPV-IV组47例,IV组90例,两组患者之间性别、年龄、APACHEⅡ评分、SOFA评分、SAPⅡ评分、肺损伤评分( Lis)、ARDS来源、脓毒症严重程度无统计学意义(P>0.05),经过治疗后,直接IV组中的器官功能不全数目、ICU住院时间和死亡率低于NIPPV-IV组,差异有统计学意义(P<0.05)。结论 ARDS患者应慎用无创通气治疗,防止无创

  16. Surfactant therapy for maternal blood aspiration: an unusual cause of neonatal respiratory distress syndrome.

    Celik, Istemi Han; Demirel, Gamze; Canpolat, Fuat Emre; Erdeve, Omer; Dilmen, Ugur

    2012-10-01

    Surfactant replacement therapy is the main treatment of neonatal respiratory distress syndrome. However, surfactant therapy has been shown to be effective in the treatment of other diseases causing neonatal respiratory diseases such as pulmonary hemorrhage, meconium aspiration syndrome, pneumonia/sepsis, pulmonary edema or acute lung injury resulting a secondary surfactant deficiency (SSD). Rarely, as like as in the present patient, exogenous blood aspiration such as breast milk or formula aspiration may lead to SSD. Blood in alveolus leads to a significant biochemical and functional disturbance of the surfactant system and inhibits surfactant production. Here, the authors report a preterm infant of 33 wk gestational age with secondary surfactant deficiency due to maternal blood aspiration because of abruptio placentae. She was received two courses of beractant, a natural bovine surfactant, therapy in 24 h. She was extubated on second day and did not require oxygen on 4(th) day. To the authors' knowledge, this is the first reported case of SSD due to maternal blood aspiration treated with surfactant. In conditions such as abruptio placentae, infant should be protected from blood aspiration and if respiratory distress occurs, surfactant inhibition and need for surfactant administration should be considered. PMID:22120615

  17. Evaluation of Serum Levels of N-terminal Pro Brain Natriuretic Peptide and Atrial Natriuretic Peptide in Neonates with Respiratory Distress

    Noor Mohammad Noori; Sima Savadkoohi; Alireza Teimouri; Fatemeh Alizadeh

    2016-01-01

    Background: Acute respiratory distress (ARD) is a critical respiratory failure due to lung injury of neonates leading to the clinical appearance of poor lung compliance. The aimed of the study was to evaluate the diagnostic values in differentiating respiratory from heart diseases with using of N-terminal pro brain natriuretic peptide (NT-pro BNP) and Atrial natriuretic peptide(ANP) in neonates. Material and Methods: Ninety  neonates  randomly collected from those who hospitalized in the neon...

  18. ADULT RESPIRATORY DISTRESS SYNDROME SECONDARY TO END-STAGE LIVER DISEASE—SUCCESSFUL OUTCOME FOLLOWING LIVER TRANSPLANTATION1

    Doyle, Howard R.; Marino, Ignazio R.; Miro, Adelaida; Scott, Victor; Martin, Maureen; Fung, John; Kramer, David; Starzl, Thomas E.

    1993-01-01

    The adult respiratory distress syndrome (ARDS) complicating liver failure carries a 100% mortality. Two cases of ARDS that resolved following liver transplantation have been reported, one associated with acute allograft rejection, and the second due to sepsis. There is, however, a great reluctance to transplant these very-high-risk patients. We report the first series of patients with ARDS secondary to liver failure who successfully underwent OLTX. No patient had sepsis or pneumonia. Posttran...

  19. Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome

    2011-01-01

    Background We aimed to evaluate the effects of chest and motor physiotherapy treatment on hemodynamic variables in preterm newborns with respiratory distress syndrome. Methods We evaluated heart rate (HR), respiratory rate (RR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), temperature and oxygen saturation (SO2%) in 44 newborns with respiratory distress syndrome. We compared all variables between before physiotherapy treatment vs. after the last physiotherapy treatment. N...

  20. Neonatal respiratory distress: recent progress in understanding pathogenesis and treatment outcomes

    So Young Kim

    2010-01-01

    Full Text Available Transient tachypnea of the newborn (TTN, respiratory distress syndrome (RDS, and persistent pulmonary hypertension (PPHN are the three most common disorders that cause respiratory distress after birth. An understanding of the pathophysiology of these disorders and the development of effective therapeutic strategies is required to control these conditions. Here, we review recent papers on the pathogenesis and treatment of neonatal respiratory disease.

  1. 肺源性与肺外源性急性呼吸窘迫综合征呼吸力学的异同及机械通气策略%Respiratory mechanic differences and mechanical ventilation strategy for acute respiratory distress syndrome caused by pulmonary and extrapulmonary Injury

    喻文亮

    2010-01-01

    Acute respiratory distress syndrome(ARDS) can be divided into pulmonary ARDS and extrapulmonary ARDS according to its origin.The prevalent damage in early stages of pulmonary ARDS is intra-alveolar,whereas in extra-pulmonary ARDS it is the interstitial edema.In pulmonary ARDS,lung compliance is worse than in extrapulmonary ARDS,whereas the main abnormality is the decrease in chest Wall compliance.due to abnormally high intra-abdominal pressure.Positive end expiratory pressure,recruitment maneuver and prone position ventilation are more effective in extrapulmonary ARDS,whereas low tidal volume ventilation play equal role in rescuing the two types of ARDS.%急性呼吸窘迫综合征(ARDS)按其病因可分为肺源性ARDS和肺外源性ARDS.肺源性ARDS早期多为肺泡损害,而肺外源性ARDS多为间质性肺水肿.肺源性ARDS患儿肺顺应性降低,而肺外源性ARDS由于腹腔内压增高其胸壁顺应性更低.肺外源性ARDS中应用呼气末正压、肺复张手法及俯卧位通气效果更好,而两者的小潮气量通气效果相似.

  2. 鱼油对ARDS患者预后影响的Meta分析%Effects of fish oil on patients with acute respiratory distress syndrome:a meta-analysis

    李洋; 黄亮; 曹春水; 熊华威; 占钻; 刘勇; 刘坚

    2016-01-01

    Objective To evaluate the contribution of fish oil in patients with acute respiratory distress syndrome (ARDS).Methods The PubMed,Embase,Cochrane Clinical Trials Register, Highwire,CBM,CNKI,WanFang databases and Current Controlled Trial (www.controlled-trials.com), the U.S.National Institute of Health Clinical Trials(www.clinicaltrials.gov)databases were searched.All related data were extracted.Meta-analysis was conducted using the statistical software Review Manager 5 .2 on the basis of strict quality evaluation,the methods recommended by the Cochrane Collaboration. Results Seven randomized controlled studies (n=994) were included in this meta-analysis.Compared with the non-fish oil group,28-day mortality was not decreased in the fish oil group(RR=0.81,95%CI :0.56-1.18,P=0.27),the time of mechanical ventilation was not decreased in the fish oil group(WMD=-2.06,95%CI :-4.81-0.70,P =0.14),ICU stay time was significantly lower in the fish oil group (WMD=-2.47,95%CI :-4.33--0.60,P=0.009).Conclusions For patients with ARDS,fish oil is non-beneficial in improving the survival and decreasing the time of mechanical ventiation,but can reduce ICU stay time.%目的:评价鱼油对 ARDS 患者预后的影响。方法计算机及手工检索 PubMed、Embase、Cochrane图书馆临床随机对照试验资料库、Highwire、中国生物医学文献数据库、中国学术期刊全文数据库(CNKI)、万方数据库,并在互联网检索正在进行的试验:Current Controlled Trial (www.controlled-trials.com)和美国国立卫生研究院临床试验数据库(www.clinicaltrials.gov)。按Cochrane系统评价的方法,选择试验、评价质量,使用 Review Manager 5.2软件进行 Meta 分析。结果共纳入7项随机对照临床试验,包括994例研究对象。与非鱼油添加组相比:鱼油未能降低ARDS患者28 d病死率(RR =0.81,95%CI :0.56~1.18,P =0.27);鱼油未能减少 ARDS 患者28 d机械通气时间(WMD=-2.06,95%CI :-4.81~0.70,P=0.14)

  3. Extracorporeal lung assist strategy on acute respiratory distress syndrome%体外肺支持策略用于急性呼吸窘迫综合征的实验研究

    甘斌; 翁羡吾

    2013-01-01

    目的:评价和比较静脉-静脉体外膜肺氧合(V-V ECMO)与无泵驱动体外肺辅助(PECLA)技术在急性呼吸窘迫综合征(ARDS)动物模型中应用的效果.方法:将28只幼猪随机分为健康对照组(CON组)、常规机械通气组(MV组)、ECMO联合小潮气量通气治疗组(EC组)、pECLA联合小潮气量通气治疗组(PE组)4组,采用油酸诱导法建立ARDS模型后接受不同方案治疗,进行肺功能监测、血气分析、血流动力学和常规生化检查,对不同时间点的监测数据进行分析.结果:与CON组相比,造模后动物肺功能存在显著差异,体外支持治疗对肺功能损伤较轻,EC组血流动力学无显著变化,MV组与PE组随治疗时间的延长,平均动脉压与心排量下降;MV组最终全部死亡.结论:对于传统机械通气辅助呼吸治疗无效的ARDS,体外肺支持(ECLA)策略是安全、有效的治疗手段;若血流动力学稳定,应用PECLA进行辅助则更为简单、易行.%Objective: To evaluate and compare the effect of vein- veinous extracorporeal membrane oxygenation ( V- V ECMO ) and pumpless extracorporeal lung assist( PECLA ) applied on animal modeled as acute respiratory distress syndrome( ARDS ). Methods: 28 piglets were randomly divided into four groups. ARDS model was established with olive acid followed by different treatment. Lung function, blood gas analysis, the hemodynamic, blood cell test and biochemical examination were carried out at different time points. Results: Compared with group CON, the lung function and blood gas analysis of ARDS animal exist significant differences, but group PE and group EC was better than the mechanical ventilation group; Hemodynamic of group EC was steady, but MAP and CO of group MV and group PE was descent. All of group MV was death. Conclusion: To the ARDS failure in traditional mechanical ventilation treatment, EC LA strategy is safe, effective treatment method. If hemodynamic was stable, PECLA would provide more

  4. 胆红素对成人肝移植术后急性呼吸窘迫综合征的影响%The impact of bilirubin for acute respiratory distress syndrome in post-liver transplantation adults

    赵蔚; Victor W.Xia

    2014-01-01

    目的:回顾性分析成人肝移植患者术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的发生和临床危险因素,探讨胆红素对ARDS发病和预后的影响。方法经医学伦理委员会同意,选择2004年1月1日至2011年12月31日的成人(年龄≥18岁)肝移植患者,所有数据来自加州大学洛杉矶分校(UCLA)的移植数据中心。诊断标准采用2011年ARDS柏林新定义,将患者分为ARDS组和非ARDS(No-ARDS)组两组,均采用全身麻醉。分析数据包括一般情况,实验室检查如总胆红素、肌酐、电解质(K+、Na+)及预后情况。数据分析软件采用IBM SPSS 20.0软件。结果1335例肝移植患者中有57例术后出现ARDS,发生率为4.3%;终末期肝病模型(MELD)评分和术前是否已经气管内插管两组之间差异均有统计学意义(均P<0.05)。电解质和肌酐两组间无明显差异(P>0.05)。总胆红素在术前〔(411.01±322.16)μmol/L比(250.17±271.04)μmol/L〕和术后第7天〔(164.84±146.55)μmol/L比(84.13±91.83)μmol/L〕ARDS组明显高于No-ARDS组(均P<0.05);经logistic分析,术前总胆红素≥324.9μmol/L(P=0.013,95%CI=1.164~3.578)和术后第7天总胆红素≥188.1μmol/L(P=0.001,95%CI=1.488~5.331)是ARDS发生的独立危险因素。ARDS组1年病死率明显高于No-ARDS组(6.10%比3.30%,P=0.033)。结论①肝移植术后ARDS发生率为4.3%,是多个因素作用的结果;②胆红素对ARDS的作用与剂量有关,术前总胆红素≥324.9μmol/L、术后第7天总胆红素≥188.1μmol/L是术后ARDS发生的危险因素。%Objective To retrospectively analyze the incidence and risk factors of acute respiratory distress syndrome(ARDS)in post-liver transplant adult patients, and to approach the effect of bilirubin on morbidity and prognosis of ARDS. Methods After winning institutional review board approval

  5. Orbital and Subcutaneous Emphysema Following Enucleation and Respiratory Distress in a Japanese Chin.

    Gornik, Kara R; Pirie, Christopher G; Alario, Anthony F

    2015-01-01

    A 7 yr old, neutered male Japanese chin presented to the Cummings School of Veterinary Medicine at Tufts University (CSVMTU) for evaluation of chronic unilateral orbital swelling that worsened following an episode of respiratory distress. The left eye had been enucleated 5 yr previously. Intermittent mild-to-moderate left orbital swelling had been noted by the owner since the initial surgery. Examination demonstrated a moderate-to-severe, soft, fluctuant swelling involving the left orbit with erythema of the overlying skin. Crepitus was noted over the occipital tuberosity. Computed tomography revealed a large volume of gas involving the left orbit. The gas extended caudally within the subcutaneous tissues to both hemimandibles, dorsal to the cranium, and partially surrounded the cranial neck. The presence of a mucosa-lined, air-filled space with a patent nasolacrimal duct was noted on orbital exploration. The lining was removed and the duct closed. Histopathology confirmed the presence of an epithelial lining. No recurrence of the swelling was observed on examination 8 wk after surgery. This is the first report documenting acute worsening of orbital swelling following an episode of respiratory distress. This case highlights the importance of addressing the nasolacrimal duct while performing an enculeation in a brachycephalic dog. PMID:26535462

  6. Traumatic retropharyngeal emphysema as a cause for severe respiratory distress in a newborn

    Traumatic injury to the pharynx or esophagus in a newborn from intubation or tube suctioning may have various presentations. Difficulty passing a gastric tube or feeding problems may erroneously suggest the diagnosis of esophageal atresia. Associated respiratory distress may be caused by pneumothorax or pleural effusion if the pleural space is entered. We report the case of a full-term newborn presenting with severe respiratory distress caused by a large retropharyngeal air collection resulting from hypopharyngeal perforation from prior intubation and suctioning. Chest abnormality, sufficient to account for the degree of respiratory distress, was not demonstrated. (orig.)

  7. Intravenous naloxone in acute respiratory failure.

    Ayres, J.; J Rees; Lee, T.; Cochrane, G M

    1982-01-01

    A 58-year-old man presented with acute on chronic respiratory failure. In the acute stage of his illness an infusion of the opiate antagonist naloxone caused an improvement in oxygen saturation as measured by ear oximetry from 74% to 85%, while a saline infusion resulted in a return of oxygen saturation to the original value. When he had recovered from the acute episode the same dose of naloxone had no effect on oxygen saturation. These findings suggest that in acute respiratory failure there...

  8. Surfactant in the Treatment of Respiratory Distress Syndrome

    I Fatehi

    1990-07-01

    Full Text Available Respiratory distress syndrome of the newborn infant is still the most common problem in nursery and major cause of neonatal mortality. Surfactant deficiency is a major factor in the pathogenesis of RDS. The induction of pulmonary surfactant with maternally administered steroids plays an important role in reducing the incidence of this disease. Combination of betamethasone plus TRH for the prevention of RDS will prove not only more effective for acceleration of fetal lung maturation, it may also decrease the interval that is required between administration of the hormone and delivery. The most exciting recent advance in management of RDS appears to be administration of exogenous surfactant. Administration of natural bovine surfactant resulted in remarkable improvement in pulmonary status in RDS. Whereas surfactant replacement offers great clinical promise, the ideal preparation and the amount, time, and method of administration remain under study. It thus seems likely that in the future both hormonal enhancement of lung maturation and surfactant therapy may be used in combination to further reduce the morbidity and mortality from RDS

  9. Association between lamellar body count and respiratory distress in neonates

    Assessment of fetal lung maturity by a simple and rapid test has a pivotal role in obstetric managements. Lack of modern laboratory techniques in our country made US investigate whether lamellar body count (Lb) can be applied efficiently in the evaluation of fetal lung maturity. Lamellar body count was assessed in 104 un spun amniotic fluid samples taken from pregnant women admitted at A kbar Aba di Hospital, Tehran, Iran between May 2003 and November 2003 whose fetuses were at risk for respiratory distress syndrome (RDS). Cut-off points for LBC were determined to evaluate the risk of RDS. Standard clinical and radiographic criteria were used to diagnose RDS. An LBC of less than 10,000 was 99.1% specific for lung immaturity (positive predictive value = 99.1%, negative predictive value = 83.5%). The LBCs of greater than 45,000 eliminates RDS (negative predictive value = 98.9%). Lamellar body count is an easy, rapid and cost-effective test to assess fetal lung maturity in high-risk fetuses. Using the cut-off points of 10,000 and 45,000, LBC can serve as the first screening test of fetal lung maturity. (author)

  10. Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome

    Bunt, JEH; Carnielli, VP; Janssen, DJ; Wattimena, JLD; Hop, WC; Sauer, PJ; Zimmermann, LJI

    2000-01-01

    Objective: Treatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabol