WorldWideScience

Sample records for acute respiratory syndrome

  1. Acute respiratory distress syndrome

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000103.htm Acute respiratory distress syndrome To use the sharing features on this page, please enable JavaScript. Acute respiratory distress syndrome (ARDS) is a life-threatening lung ...

  2. Severe acute respiratory syndrome (SARS)

    Science.gov (United States)

    SARS; Respiratory failure - SARS ... Complications may include: Respiratory failure Liver failure Heart failure ... 366. McIntosh K, Perlman S. Coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). ...

  3. ARDS (Acute Respiratory Distress Syndrome)

    Science.gov (United States)

    ... Topics / ARDS ARDS What Is ARDS, or acute respiratory distress syndrome, is a lung condition that leads ... treat ARDS. Other Names Acute lung injury Adult respiratory distress syndrome Increased-permeability pulmonary edema Noncardiac pulmonary ...

  4. Acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Marco Confalonieri

    2017-04-01

    Full Text Available Since its first description, the acute respiratory distress syndrome (ARDS has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care.

  5. Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Carmen Sílvia Valente Barbas

    2012-01-01

    Full Text Available This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA, biomarkers and response to infection therapy allows changes in the initial treatment plans and can help decrease ARDS mortality.

  6. Severe Acute Respiratory Syndrome- SARS

    Indian Academy of Sciences (India)

    Table of contents. Severe Acute Respiratory Syndrome- SARS · PowerPoint Presentation · Slide 3 · Global pattern of SARS epidemic · Slide 5 · SARS – clinical features ... SARS virus · SARS – Koch´Postulates proved. SARS – virus jumps species · How infectious is SARS virus · SARS – Global Distribution- 10th July 2003.

  7. Acute respiratory failure following ovarian hyperstimulation syndrome

    Directory of Open Access Journals (Sweden)

    Antonello Nicolini

    2013-03-01

    Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non

  8. Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome

    OpenAIRE

    Calfee, CS; Matthay, MA; Kangelaris, KN; Siew, ED; Janz, DR; Bernard, GR; May, AK; Jacob, P; Havel, C; Benowitz, NL; Ware, LB

    2015-01-01

    © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-confirmed cigarette smoking and acute respiratory distress syndrome in a diverse cohort. Design: Prospective ...

  9. Chinese herbal medicine for severe acute respiratory syndrome

    DEFF Research Database (Denmark)

    Liu, Jianping; Manheimer, Eric; Shi, Yi

    2004-01-01

    To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

  10. Acute Respiratory Distress Syndrome in Lemierre’s Syndrome

    Directory of Open Access Journals (Sweden)

    Paul N. Hein

    2014-01-01

    Full Text Available Lemierre’s syndrome is an infectious disease defined by the presence of septic thrombophlebitis with associated embolic phenomenon, most commonly to the lungs. Here we present two cases from a single institution of acute respiratory distress syndrome (ARDS developing as a result of Lemierre’s syndrome in previously healthy young adult men. ARDS can occur as a consequence of pulmonary septic emboli and sepsis, both of which are well-described consequences of Lemierre’s syndrome. We describe important diagnostic and management considerations in the care of patients with hypoxemic respiratory failure and Lemierre’s syndrome. Essential components of management include prompt antibiotic therapy, lung-protective ventilation strategies, and supportive care.

  11. Acute Respiratory Distress Syndrome: 30 Years Later?

    Directory of Open Access Journals (Sweden)

    Olivier Lesur

    1999-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS was first described about 30 years ago. Modern definitions and statements have recently been proposed to describe ARDS accurately, but none is perfect. Diffuse alveolar damage is the basic pathological pattern most commonly observed in ARDS, and the term includes permeability edema. The alveolar epithelium of the alveolar-capillary barrier is clearly a key component requiring repair, given its multipotent functional activity. Lung inflammation and neutrophil accumulation are essential markers of disease in ARDS, and a wide variety of pro- and anti-inflammatory cytokines have been described in the alveolar fluid and blood of patients. These molecules still have to prove their value as diagnostic or prognostic biomarkers of ARDS.

  12. Pathogenesis of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    A. M. Golubev

    2012-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a common complication of many diseases. Its polyetiological pattern determines the specific features of lung morphological changes and the clinical course of ARDS. Objective: to analyze the pathogenesis of ARDS in the context of the general pathological processes underlying its development. Material and methods. More than 200 lungs from the people who had died from severe concomitant injury or ARDS-complicated pneumonia were investigated. More than 150 rat experiments simulated various types of lung injury: ventilator-induced lung injury with different ventilation parameters; reperfusion injuries (systemic circulation blockade due to 12-minute vascular fascicle ligation, followed by the recovery of cardiac performance and breathing; microcirculatory disorder (injection of a thromboplastin solution into the jugular vein; blood loss; betaine-pepsin aspiration; and closed chest injury. Different parts of the right and left lungs were histologically examined 1 and 3 hours and 1 and 3 days after initiation of the experiment. Lung pieces were fixed in 10% neutral formalin solution and embedded in paraffin. Histological sections were stained with hematoxylin and eosin and using the van Gieson and Weigert procedures; the Schiff test was used. Results. The influence of aggression factors (trauma, blood loss, aspiration, infection, etc. results in damage to the lung and particularly air-blood barrier structures (endothelium, alveolar epithelium, their basement membrane. In turn the alteration of cellular and extracellular structures is followed by the increased permeability of hemomicrocirculatory bed vessels, leading to the development of non-cardiogenic (interstitial, alveolar pulmonary edema that is a central component in the pathogenesis of ARDS. Conclusion. The diagnosis of the early manifestations of ARDS must account for the nature of an aggression factor, the signs confirming the alteration of the lung

  13. Survival of severe acute respiratory syndrome coronavirus.

    Science.gov (United States)

    Lai, Mary Y Y; Cheng, Peter K C; Lim, Wilina W L

    2005-10-01

    The primary modes of transmission of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) appear to be direct mucus membrane contact with infectious droplets and through exposure to formites. Knowledge of the survival characteristics of the virus is essential for formulating appropriate infection-control measures. Survival of SARS-CoV strain GVU6109 was studied in stool and respiratory specimens. Survival of the virus on different environmental surfaces, including a laboratory request form, an impervious disposable gown, and a cotton nondisposable gown, was investigated. The virucidal effects of sodium hypochlorite, house detergent, and a peroxygen compound (Virkon S; Antec International) on the virus were also studied. SARS-CoV GVU6109 can survive for 4 days in diarrheal stool samples with an alkaline pH, and it can remain infectious in respiratory specimens for >7 days at room temperature. Even at a relatively high concentration (10(4) tissue culture infective doses/mL), the virus could not be recovered after drying of a paper request form, and its infectivity was shown to last longer on the disposable gown than on the cotton gown. All disinfectants tested were shown to be able to reduce the virus load by >3 log within 5 min. Fecal and respiratory samples can remain infectious for a long period of time at room temperature. The risk of infection via contact with droplet-contaminated paper is small. Absorbent material, such as cotton, is preferred to nonabsorptive material for personal protective clothing for routine patient care where risk of large spillage is unlikely. The virus is easily inactivated by commonly used disinfectants.

  14. Acute Respiratory Distress: from syndrome to disease.

    Science.gov (United States)

    Cardinal-Fernández, P; Correger, E; Villanueva, J; Rios, F

    2016-04-01

    The acute respiratory distress syndrome (ARDS) is currently one of the most important critical entities given its high incidence, rate of mortality, long-term sequelae and non-specific pharmacological treatment. The histological hallmark of ARDS is diffuse alveolar damage (DAD). Approximately 50% of ARDS patients present DAD, the rest is made up of a heterogeneous group of histological patterns, many of which correspond to a well-recognized disease. For that reason, if these patterns could be diagnosed, patients could benefit from a treatment. Recently, the effect of DAD in clinical and analytical evolution of ARDS has been demonstrated, so the classical approach to ARDS as an entity defined solely by clinical, radiological and gasometrical variables should be reconsidered. This narrative review aims to examine the need to evolve from the concept of ARDS as a syndrome to ARDS as a specific disease. So we have raised 4 critical questions: a) What is a disease?; b) what is DAD?; c) how is DAD considered according to ARDS definition?, and d) what is the relationship between ARDS and DAD? Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  15. Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome.

    Science.gov (United States)

    Chen, Peng; Zhang, Ying; Li, Long-Yun

    2014-09-01

    Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome and the pathology of acute respiratory insufficiency in the preterm infant, including the current therapy modalities on disposition are presented. Since the therapeutical challenge and primary clinical goal are to normalize ventilation ratio and lung perfusion, when respiratory insufficiency occurs, it is very important to introduce the respiratory support as soon possible, in order to reduce development of pulmonary cyanosis and edema, and intrapulmonary or intracardial shunts. A characteristic respiratory instability that reflects through fluctuations in gas exchange and ventilation is often present in premature infants. Adapting the respiratory support on a continuous basis to the infant's needs is challenging and not always effective. Although a large number of ventilation strategies for the neonate are available, there is a need for additional consensus on management of acute respiratory distress syndrome in pediatric population lately redefined by Berlin definition criteria, in order to efficiently apply various modes of respiratory support in daily pediatrician clinical use.

  16. Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Prabhas Prasun Giri

    2011-01-01

    Full Text Available Drug rash with eosinophilia and systemic symptoms (DRESS syndrome reflects a serious hypersensitivity reaction to drugs, and is characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause DRESS syndrome. We report a case of a 10-year-old girl who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis after taking phenobarbital for seizures, with subsequent development of sepsis, acute respiratory distress syndrome (ARDS and spontaneous air leak syndrome (pnemothorax and pneumomediastinum. She was put on steroids and various antibiotics and was ventilated, but ultimately succumbed to sepsis and pulmonary complications.

  17. Acute respiratory distress syndrome: epidemiology and management approaches

    Directory of Open Access Journals (Sweden)

    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

  18. Acute Interstitial Pneumonia (Hamman-Rich Syndrome as a Cause of Idiopathic Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Jackrapong Bruminhent

    2011-01-01

    Full Text Available Hamman-Rich syndrome, also known as acute interstitial pneumonia, is a rare and fulminant form of idiopathic interstitial lung disease. It should be considered as a cause of idiopathic acute respiratory distress syndrome. Confirmatory diagnosis requires demonstration of diffuse alveolar damage on lung histopathology. The main treatment is supportive care. It is not clear if glucocorticoid therapy is effective in acute interstitial pneumonia. We report the case of a 77-year-old woman without pre-existing lung disease who initially presented with mild upper respiratory tract infection and then progressed to rapid onset of hypoxic respiratory failure similar to acute respiratory distress syndrome with unknown etiology. Despite glucocorticoid therapy, she did not achieve remission and expired after 35 days of hospitalization. The diagnosis of acute interstitial pneumonia was supported by the histopathologic findings on her lung biopsy.

  19. Severe acute respiratory syndrome: Aetiopathogenesis and ...

    African Journals Online (AJOL)

    No Abstract. Keywords: SARS; Adult respiratory distress syndrome; pathology. Annals of Ibadan Postgraduate Medicine Vol. 1 (1) 2003: pp. 9-14. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/aipm.v1i1.39095 · AJOL African ...

  20. Acute Respiratory Distress Syndrome Associated with Tumour Lysis Syndrome in Leukemia

    Directory of Open Access Journals (Sweden)

    Chaim M Bell

    1997-01-01

    Full Text Available Acute tumour lysis syndrome (ATLS developed in two patients with acute myelogenous leukemia soon after they were treated with cytosine arabinoside. The patients also developed respiratory distress requiring intubation. Autopsy and clinical findings demonstrated the presence of acute respiratory distress syndrome (ARDS. An association appears to be present between ARDS and ATLS in this group of patients.

  1. [Gas exchange in acute respiratory distress syndrome].

    Science.gov (United States)

    Raimondi, Guillermo A

    2003-01-01

    The hypoxemia of acute respiratory distress syndrome (ARDS) depends chiefly upon shunt and ventilation-perfusion (VA/Q) inequality produced by fluid located in the interstitial space, alveolar collapse and flooding. Variables other tham 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 VA/Q ratios and dead space from lung units with high VA/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 increase PaO2 by increasing hypoxic pulmonary vasoconstriction. A synergistic effect was found between inhaled NO and almitrine

  2. Prone position in patients with acute respiratory distress syndrome

    Science.gov (United States)

    Setten, Mariano; Plotnikow, Gustavo Adrián; Accoce, Matías

    2016-01-01

    Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position. This method, first recommended to improve oxygenation in 1974, can be easily implemented in any intensive care unit with trained personnel. Prone position has extremely robust bibliographic support. Various randomized clinical studies have demonstrated the effect of prone decubitus on the oxygenation of patients with acute respiratory distress syndrome measured in terms of the PaO2/FiO2 ratio, including its effects on increasing patient survival. The members of the Respiratory Therapists Committee of the Sociedad Argentina de Terapia Intensiva performed a narrative review with the objective of discovering the available evidence related to the implementation of prone position, changes produced in the respiratory system due to the application of this maneuver, and its impact on mortality. Finally, guidelines are suggested for decision-making. PMID:27925054

  3. Clipboard: Severe acute respiratory syndrome (SARS): an old virus ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Biosciences; Volume 28; Issue 4. Clipboard: Severe acute respiratory syndrome (SARS): an old virus jumping into a new host or a new creation? M S Shaila. Volume 28 Issue 4 June 2003 pp 359-360. Fulltext. Click here to view fulltext PDF. Permanent link:

  4. Human Metapneumovirus Infection and Acute Respiratory Distress Syndrome During Pregnancy.

    Science.gov (United States)

    Fuchs, Alina; McLaren, Rodney; Saunders, Paul; Karakash, Scarlett; Minkoff, Howard

    2017-09-01

    Human metapneumovirus has recently been recognized as an important cause of severe respiratory viral infections and of viral infections in patients admitted to intensive care units. Little is known about the course of this infection in pregnancy. A late-preterm primigravid woman was admitted to the intensive care unit for acute respiratory distress syndrome and subsequently diagnosed with human metapneumovirus. Because of worsening maternal respiratory status, she was intubated and a primary cesarean delivery was performed. The patient's respiratory status continued to decline postpartum, and she ultimately required extracorporeal membrane oxygenation. She was treated supportively until her respiratory status improved, at which time she was extubated and weaned off extracorporeal membrane oxygenation and subsequently discharged home. Human metapneumovirus can lead to severe respiratory illness during pregnancy.

  5. Message concerning Severe Acute Respiratory Syndrome ("SARS")

    CERN Multimedia

    2003-01-01

    IMPORTANT REMINDER If you have just come back from one of the regions identified by the WHO as being infected with SARS, it is essential to monitor your state of health for ten days after your return. The syndrome manifests itself in the rapid onset of a high fever combined with respiratory problems (coughing, breathlessness, breathing difficulty). Should these signs appear, you must contact the CERN Medical Service as quickly as possible on number 73802 or 73186 during normal working hours, and the fire brigade at all other times on number 74444, indicating that you have just returned from one of the WHO-identified areas with recent local transmission.China: Beijing, Hong Kong (Special Administrative Region), Guangdong Province, Inner Mongolia, Shanxi Province, Tianjin ProvinceTaiwan:TaipeiMoreover, until further notice the CERN Management requests that all trips to these various regions of the world be reduced to a strict minimum and then only with the consent of the Division Leader concerned. Anyone comin...

  6. Interleukin-17A Is Associated With Alveolar Inflammation and Poor Outcomes in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Mikacenic, Carmen; Hansen, Elizabeth E; Radella, Frank; Gharib, Sina A; Stapleton, Renee D; Wurfel, Mark M

    2016-03-01

    Interleukin-17A is a proinflammatory cytokine known to play a role in host defense and pathologic inflammation in murine models of lung injury. The relationship between interleukin-17A and inflammation in human lung injury is unknown. Our primary objective was to determine whether interleukin-17A levels are associated with alveolar measures of inflammation and injury in patients with acute respiratory distress syndrome. Our secondary objective was to test whether interleukin-17A levels are associated with acute respiratory distress syndrome-related outcomes. Observational study. Six North American medical centers. We studied two groups of patients with acute respiratory distress syndrome: 1) patients previously enrolled in a placebo-controlled clinical trial of omega-3 fatty acids performed at five North American medical centers (n = 86, acute respiratory distress syndrome 1), and 2) patients with systemic inflammatory response syndrome admitted to an ICU who developed acute respiratory distress syndrome (n = 140, acute respiratory distress syndrome 2). In acute respiratory distress syndrome 1, we used paired serum and bronchoalveolar lavage fluid samples obtained within 48 hours of acute respiratory distress syndrome onset, whereas in acute respiratory distress syndrome 2, we used plasma obtained within the first 24 hours of ICU admission. None. We measured circulating interleukin-17A in acute respiratory distress syndrome 1 and acute respiratory distress syndrome 2. We also measured interleukin-17A, neutrophil counts, and total protein in bronchoalveolar lavage fluid from acute respiratory distress syndrome 1. We found that bronchoalveolar lavage interleukin-17A was strongly associated with higher bronchoalveolar lavage percent neutrophils (p syndrome1. In both acute respiratory distress syndrome 1 and acute respiratory distress syndrome 2, elevated interleukin-17A was associated with higher Sequential Organ Failure Assessment scores (p syndrome.

  7. Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

    Directory of Open Access Journals (Sweden)

    Ming-Ju Tsai

    2011-03-01

    Full Text Available Strongyloidiasis is endemic in tropic and subtropic areas, but is currently seldom encountered in developed area like Taiwan. We present an elder man with acute respiratory distress syndrome complicating Strongyloides stercoralis hyperinfection. There was no significant clue initially for diagnosing this patient as having S. stercoralis hyperinfection. Neither peripheral eosinophilia nor significant hemoptysis was noted. Bronchoscopy played a critical role to define the unexpected cause of his progressive pulmonary infiltrates. The correct diagnosis was soon made by recognition of the worm in bronchioloalveolar lavage cytology, and specific treatment was initiated promptly. For a septic patient with progressive pulmonary infiltrates, bronchoscopic studies including cytology may be necessary for defining the cause. Hyperinfection strongyloidiasis should be considered as a cause of acute respiratory distress syndrome in immunocompromised patient, especially with the presence of chronic gastrointestinal symptoms.

  8. Severe acute respiratory syndrome and its lesions in digestive system

    Institute of Scientific and Technical Information of China (English)

    Jian-Zhong Zhang

    2003-01-01

    Severe acute respiratory syndrome (SARS) is an infectious atypical pneumonia that has recently been recognized in the patients in 32 countries and regions. This brief review summarizes some of the initial etiologic findings,pathological description, and its lesions of digestive system caused by SARS virus. It is an attempt to draw gastroenterologists and hepatologists' attention to this fatal illness, especially when it manifests itself initially as digestive symptoms.

  9. The acute respiratory distress syndrome network controversy: lessons and legacy.

    Science.gov (United States)

    Silverman, Henry J

    2004-12-01

    Several of the Acute Respiratory Disease Syndrome Network clinical trials embrace a clinical trial design that evaluates contrasting strategies, one or both of which represents only a segment of standard practices. Such a trial design has engendered ethical controversy regarding the value of such trials and their ability to protect human subjects. During the past year, commentators have continued to reflect on the significance of such trials. Several authors have reflected on the ethical significance of the standard of care in clinical trial design and have offered a framework for determining control group selection in critical care trials. Other authors have written on methodologic issues and approaches to determine whether control groups are reflective of standard practices. Surveys have been performed to determine the impact and hence the relevancy of the Acute Respiratory Disease Syndrome Network tidal volume trial on clinical practice. The controversy related to and the impact of the Acute Respiratory Disease Syndrome Network clinical trial design on clinical practice offer an opportunity to explore the trade-offs between explanatory and pragmatic types of clinical trials. Such discussions will lead to a clearer understanding of the value of both types of clinical trials and the optimal ethical conduct of such trials.

  10. A review of pulmonary coagulopathy in acute lung injury, acute respiratory distress syndrome and pneumonia

    NARCIS (Netherlands)

    Nieuwenhuizen, Laurens; de Groot, Philip G.; Grutters, Jan C.; Biesma, Douwe H.

    Enhanced bronchoalveolar coagulation is a hallmark of many acute inflammatory lung diseases such as acute lung injury, acute respiratory distress syndrome and pneumonia. Intervention with natural anticoagulants in these diseases has therefore become a topic of interest. Recently, new data on the

  11. Embelia ribes ameliorates lipopolysaccharide-induced acute respiratory distress syndrome.

    Science.gov (United States)

    Shirole, R L; Shirole, N L; Saraf, M N

    2015-06-20

    Embelia ribes Burm. f. (Fam. Myrsinaceae) locally known as Vidanga have been used for treating tumors, ascites, bronchitis, jaundice, diseases of the heart and brain in traditional Indian medicine. However, no scientific studies providing new insights in its pharmacological properties with respect to acute respiratory distress syndrome have been investigated. The present investigation aimed to elucidate the effectiveness of Embelin isolated from Embelia ribes seeds on attenuation of LPS-induced acute respiratory distress syndrome in murine models. Embelin (5, 10 and 20 mg/kg/day, i.p.) and Roflumilast (1 mg/kg/day, p.o.) were administered for four days and prior to LPS in rats (i.t.). Four hour after LPS challenge animals were anesthesized and bronchoalveolar lavage was done with ice-cold phosphate buffer. Assessment of BAL fluid was done for albumin, total protein, total cell and neutrophil count, TNF-α levels, nitrosoative stress. Superior lobe of right lung was used for histopathologic evaluation. Inferior lobe of right lung was used to obtain lung edema. Left lung was used for myeloperoxidase estimation. Arterial blood was collected immediately and analyzed for pH, pO2 and pCO2 were estimated. Pretreatment with embelin (5, 10 and 20 mg/kg, i.p.) decreased lung edema, mononucleated cellular infiltration, nitrate/nitrite, total protein, albumin concentrations, TNF-α in the bronchoalveolar lavage fluid and myeloperoxidase activity in lung homogenate. Embelin markedly prevented pO2 down-regulation and pCO2 augmentation. Additionally, it attenuated lung histopathological changes in acute respiratory distress syndrome model. The study demonstrates the effectiveness of Embelia ribes Burm. f. (Fam. Myrsinaceae) seeds in acute respiratory distress syndrome possibly related to its anti-inflammatory and protective effect against LPS induced airway inflammation by reducing nitrosative stress, reducing physiological parameters of blood gas change, TNF-α and mononucleated

  12. Clinical utility of the neutrophil elastase inhibitor sivelestat for the treatment of acute respiratory distress syndrome

    National Research Council Canada - National Science Library

    Aikawa, Naoki; Kawasaki, Yasushi

    2014-01-01

    .... Sivelestat is a neutrophil elastase inhibitor approved in Japan and the Republic of Korea for acute lung injury, including acute respiratory distress syndrome in patients with systemic inflammatory response syndrome...

  13. Early Upregulation of Acute Respiratory Distress Syndrome-Associated Cytokines Promotes Lethal Disease in an Aged-Mouse Model of Severe Acute Respiratory Syndrome Coronavirus Infection

    OpenAIRE

    Rockx, Barry; Baas, Tracey; Zornetzer, Gregory; Haagmans, Bart; Sheahan, Timothy; Frieman, Matthew; Dyer, Matthew; Teal, Thomas; Proll, Sean; Brand, Judith; Baric, Ralph; Katze, Michael

    2009-01-01

    textabstractSeveral respiratory viruses, including influenza virus and severe acute respiratory syndrome coronavirus (SARS-CoV), produce more severe disease in the elderly, yet the molecular mechanisms governing age-related susceptibility remain poorly studied. Advanced age was significantly associated with increased SARS-related deaths, primarily due to the onset of early- and late-stage acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. Infection of aged, but not young, mice...

  14. Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands : A survey

    NARCIS (Netherlands)

    Wind, Jan; Versteegt, Jens; Twisk, Jos; van der Werf, Tjip S.; Bindels, Alexander J. G. H.; Spijkstra, Jan-Jaap; Girbes, Armand R. J.; Groeneveld, A. B. Johan

    2007-01-01

    Background: The characteristics, incidence and risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) may depend on definitions and geography. Methods: A prospective, 3-day point-prevalence study was performed by a survey of all intensive care units (ICU) in the

  15. Acute respiratory tract infections: a potential trigger for the acute coronary syndrome

    NARCIS (Netherlands)

    Harskamp, Ralf E.; van Ginkel, Margreet W.

    2008-01-01

    Clinical studies suggest that acute respiratory tract infection (ARTI) may be a risk factor for the acute coronary syndrome (ACS). ARTI is associated with an increased risk for ACS up to 2 weeks prior to a cardiac event. The mechanism that may underlie this association is unclear. Infections are

  16. Mechanical ventilation in the acute respiratory distress syndrome.

    Science.gov (United States)

    Epelbaum, Oleg; Aronow, Wilbert S

    2017-08-01

    The management of the acute respiratory distress syndrome (ARDS) patient is fundamental to the field of intensive care medicine, and it presents unique challenges owing to the specialized mechanical ventilation techniques that such patients require. ARDS is a highly lethal disease, and there is compelling evidence that mechanical ventilation itself, if applied in an injurious fashion, can be a contributor to ARDS mortality. Therefore, it is imperative for any clinician central to the care of ARDS patients to understand the fundamental framework that underpins the approach to mechanical ventilation in this special scenario. The current review summarizes the major components of the mechanical ventilation strategy as it applies to ARDS.

  17. Transmission Dynamics and Control of Severe Acute Respiratory Syndrome

    Science.gov (United States)

    Lipsitch, Marc; Cohen, Ted; Cooper, Ben; Robins, James M.; Ma, Stefan; James, Lyn; Gopalakrishna, Gowri; Chew, Suok Kai; Tan, Chorh Chuan; Samore, Matthew H.; Fisman, David; Murray, Megan

    2003-06-01

    Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and epidemic curves from other settings, we estimated the reproductive number for SARS in the absence of interventions and in the presence of control efforts. We estimate that a single infectious case of SARS will infect about three secondary cases in a population that has not yet instituted control measures. Public-health efforts to reduce transmission are expected to have a substantial impact on reducing the size of the epidemic.

  18. Respiratory system mechanics in acute respiratory distress syndrome.

    Science.gov (United States)

    Kallet, Richard H; Katz, Jeffrey A

    2003-09-01

    Respiratory mechanics research is important to the advancement of ARDS management. Twenty-eight years ago, research on the effects of PEEP and VT indicated that the lungs of ARDS patients did not behave in a manner consistent with homogenously distributed lung injury. Both Suter and colleagues] and Katz and colleagues reported that oxygenation continued to improve as PEEP increased (suggesting lung recruitment), even though static Crs decreased and dead-space ventilation increased (suggesting concurrent lung overdistension). This research strongly suggested that without VT reduction, the favorable effects of PEEP on lung recruitment are offset by lung overdistension at end-inspiration. The implications of these studies were not fully appreciated at that time, in part because the concept of ventilator-associated lung injury was in its nascent state. Ten years later. Gattinoni and colleagues compared measurements of static pressure-volume curves with FRC and CT scans of the chest in ARDS. They found that although PEEP recruits collapsed (primarily dorsal) lung segments, it simultaneously causes overdistension of non-dependent, inflated lung regions. Furthermore, the specific compliance of the aerated, residually healthy lung tissue is essentially normal. The main implication of these findings is that traditional mechanical ventilation practice was injecting excessive volumes of gas into functionally small lungs. Therefore, the emblematic low static Crs measured in ARDS reflects not only surface tension phenomena and recruitment of collapsed airspaces but also overdistension of the remaining healthy lung. The studies reviewed in this article support the concept that lung injury in ARDS is heterogeneously distributed, with resulting disparate mechanical stresses, and indicate the additional complexity from alterations in chest wall mechanics. Most of these studies, however, were published before lung-protective ventilation. Therefore, further studies are needed to

  19. [Acute respiratory distress syndrome: a review of the Berlin definition].

    Science.gov (United States)

    de Luis Cabezón, N; Sánchez Castro, I; Bengoetxea Uriarte, U X; Rodrigo Casanova, M P; García Peña, J M; Aguilera Celorrio, L

    2014-01-01

    Acute Respiratory Distress Syndrome (ARDS) is due to many causes. The absence of a universal definition up until now has led to a series of practical problems for a definitive diagnosis. The incidences of ARDS and Acute Lung Injury (ALI) vary widely in the current literature. The American-European Consensus Conference definition has been applied since its publication in 1994 and has helped to improve knowledge about ARDS. However, 18 years later, in 2011, the European Intensive Medicine Society, requested a team of international experts to meet in Berlin to review the ARDS definition. The purpose of the Berlin definition is not to use it as a prognostic tool, but to improve coherence between research and clinical practice. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference.

    Science.gov (United States)

    Khemani, Robinder G; Smith, Lincoln S; Zimmerman, Jerry J; Erickson, Simon

    2015-06-01

    Although there are similarities in the pathophysiology of acute respiratory distress syndrome in adults and children, pediatric-specific practice patterns, comorbidities, and differences in outcome necessitate a pediatric-specific definition. We sought to create such a definition. A subgroup of pediatric acute respiratory distress syndrome investigators who drafted a pediatric-specific definition of acute respiratory distress syndrome based on consensus opinion and supported by detailed literature review tested elements of the definition with patient data from previously published investigations. International PICUs. Children enrolled in published investigations of pediatric acute respiratory distress syndrome. None. Several aspects of the proposed pediatric acute respiratory distress syndrome definition align with the Berlin Definition of acute respiratory distress syndrome in adults: timing of acute respiratory distress syndrome after a known risk factor, the potential for acute respiratory distress syndrome to coexist with left ventricular dysfunction, and the importance of identifying a group of patients at risk to develop acute respiratory distress syndrome. There are insufficient data to support any specific age for "adult" acute respiratory distress syndrome compared with "pediatric" acute respiratory distress syndrome. However, children with perinatal-related respiratory failure should be excluded from the definition of pediatric acute respiratory distress syndrome. Larger departures from the Berlin Definition surround 1) simplification of chest imaging criteria to eliminate bilateral infiltrates; 2) use of pulse oximetry-based criteria when PaO2 is unavailable; 3) inclusion of oxygenation index and oxygen saturation index instead of PaO2/FIO2 ratio with a minimum positive end-expiratory pressure level for invasively ventilated patients; 4) and specific inclusion of children with preexisting chronic lung disease or cyanotic congenital heart disease. This

  1. Acute respiratory distress syndrome, metabolic acidosis, and respiratory acidosis associated with citalopram overdose

    Directory of Open Access Journals (Sweden)

    Hawa Edriss

    2013-11-01

    Full Text Available We report a 53-year-old man who ingested 2400 mg of citalopram and presented to the emergency department three hours post-ingestion with altered mental status, somnolence, and a blood pressure of 67/45 mmHg. He failed to respond to three boluses of normal saline (1000 ml each and required vasopressors. The patient developed serotonin syndrome with hyper-reflexia, rigidity, and ankle myoclonus. He had a tonic-clonic seizure in the ER requiring intravenous lorazepam and phenytoin. An ECG showed QT prolongation. Chest x-ray on presentation was normal. Within 32 hours the patient developed acute respiratory distress, hypoxemia, a wide A-a gradient, PaO2/FiO2< 200, and chest x-ray changes compatible with acute respiratory distress syndrome (ARDS. He had normal central venous pressures, normal cardiac biomarkers, normal systolic and diastolic functions on echocardiography, and no acute ST/T wave changes. His ABG showed a metabolic acidosis and a respiratory acidosis. The patient required intubation and ventilation. Citalopram has been associated with seizures and ECG abnormalities after overdoses. The respiratory complications and metabolic acidosis have been reported only a few times in the literature.  We are reporting the second case of ARDS and the fifth case of metabolic acidosis due to citalopram overdose and suggest that the metabolic acidemia is explained by propionic acid. The respiratory acidosis seen in this patient has not been reported previously.

  2. Risk Factors for Mortality and Outcomes in Pediatric Acute Lung Injury/Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Panico, Flávia F; Troster, Eduardo J; Oliveira, Cindy S; Faria, Aline; Lucena, Michelle; João, Paulo R D; Saad, Everardo D; Foronda, Flávia A K; Delgado, Artur F; de Carvalho, Werther Brunow

    2015-09-01

    Children admitted to PICUs often present with or develop respiratory failure that requires mechanical ventilation. We prospectively identified children admitted to three general PICUs, with the goal of identifying risk factors for mortality. Prospective multicenter observational study. Three general PICUs, two in São Paulo and one in Curitiba, Brazil. Children aged between 1 month and 15 years, consecutively admitted between August 2008 and July 2010, with acute lung injury or acute respiratory distress syndrome that developed at least 12 hours after invasive or noninvasive mechanical ventilation. None. We used logistic regression models to explore the relationship between death and independent variables. Of 3,046 patients admitted to the three PICUs, 1,658 patients underwent mechanical ventilation, and 84 fulfilled the acute lung injury/acute respiratory distress syndrome inclusion criteria and were analyzed. Nearly 60% were boys, and the median age was 31 months. Pressure control/assist control was the initial mode of mechanical ventilation in 86% of cases, and the median durations of mechanical ventilation and PICU stay were 12 and 15 days, respectively. None of the eight patients with acute lung injury died, whereas 33 of 76 of the remaining patients with acute respiratory distress syndrome died, for an overall mortality rate of 39.3% (95% CI, 28.8-50.6%). In different multivariate logistic regression model, the number of organ dysfunctions at admission, peak inspiratory pressure, airway pressure gradient on day 1, and the mean airway pressure gradient over the first 7 days of mechanical ventilation were significantly associated with mortality. Mortality is high in pediatric acute lung injury/acute respiratory distress syndrome. Mechanical ventilation-associated risk factors for death among such patients are potential targets for intervention.

  3. History of mechanical ventilation may affect respiratory mechanics evolution in acute respiratory distress syndrome.

    Science.gov (United States)

    Koutsoukou, Antonia; Perraki, Helen; Orfanos, Stylianos E; Koulouris, Nikolaos G; Tromaropoulos, Andreas; Sotiropoulou, Christina; Roussos, Charis

    2009-12-01

    The aim of this study was to investigate the effect of mechanical ventilation (MV) before acute respiratory distress syndrome (ARDS) on subsequent evolution of respiratory mechanics and blood gases in protectively ventilated patients with ARDS. Nineteen patients with ARDS were stratified into 2 groups according to ARDS onset relative to the onset of MV: In group A (n = 11), MV was applied at the onset of ARDS; in group B (n = 8), MV had been initiated before ARDS. Respiratory mechanics and arterial blood gas were assessed in early (ventilated patients with ARDS, late alteration of respiratory mechanics occurs more commonly in patients who have been ventilated before ARDS onset, suggesting that the history of MV affects the subsequent progress of ARDS even when using protective ventilation.

  4. Potential Application of Viral Empty Capsids for the Treatment of Acute Lung Injury/Acute Respiratory Distress Syndrome

    Science.gov (United States)

    2016-07-01

    Acute Respiratory Distress Syndrome PRINCIPAL INVESTIGATOR: Prof. Ariella Oppenheim CONTRACTING ORGANIZATION: Hebrew University of Jerusalem...Lung / 5a. CONTRACT NUMBER Injury/Acute Respiratory Distress Syndrome 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Prof. Ariella...Particles (VLPs), may attenuate ARDS, increasing survival and recovery from this severe clinical condition. The hypothesis was successfully

  5. Is Overall Mortality the Right Composite Endpoint in Clinical Trials of Acute Respiratory Distress Syndrome?

    Science.gov (United States)

    Villar, Jesús; Martínez, Domingo; Mosteiro, Fernando; Ambrós, Alfonso; Añón, José M; Ferrando, Carlos; Soler, Juan A; Montiel, Raquel; Vidal, Anxela; Conesa-Cayuela, Luís A; Blanco, Jesús; Arrojo, Regina; Solano, Rosario; Capilla, Lucía; Del Campo, Rafael; Civantos, Belén; Fernández, María Mar; Aldecoa, César; Parra, Laura; Gutiérrez, Andrea; Martínez-Jiménez, Chanel; González-Martín, Jesús M; Fernández, Rosa L; Kacmarek, Robert M

    2018-02-07

    Overall mortality in patients with acute respiratory distress syndrome is a composite endpoint because it includes death from multiple causes. In most acute respiratory distress syndrome trials, it is unknown whether reported deaths are due to acute respiratory distress syndrome or the underlying disease, unrelated to the specific intervention tested. We investigated the causes of death after contracting acute respiratory distress syndrome in a large cohort. A secondary analysis from three prospective, multicenter, observational studies. A network of multidisciplinary ICUs. We studied 778 patients with moderate-to-severe acute respiratory distress syndrome treated with lung-protective ventilation. None. We examined death in the ICU from individual causes. Overall ICU mortality was 38.8% (95% CI, 35.4-42.3). Causes of acute respiratory distress syndrome modified the risk of death. Twenty-three percent of deaths occurred from refractory hypoxemia due to nonresolving acute respiratory distress syndrome. Most patients died from causes unrelated to acute respiratory distress syndrome: 48.7% of nonsurvivors died from multisystem organ failure, and cancer or brain injury was involved in 37.1% of deaths. When quantifying the true burden of acute respiratory distress syndrome outcome, we identified 506 patients (65.0%) with one or more exclusion criteria for enrollment into current interventional trials. Overall ICU mortality of the "trial cohort" (21.3%) was markedly lower than the parent cohort (relative risk, 0.55; 95% CI, 0.43-0.70; p respiratory distress syndrome patients are not directly related to lung damage but to extrapulmonary multisystem organ failure. It would be challenging to prove that specific lung-directed therapies have an effect on overall survival.

  6. Anti-infectious treatment in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    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.

  7. Prolonged Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Wen-Je Ko

    2006-01-01

    Full Text Available When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS have failed, extracorporeal membrane oxygenation (ECMO can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

  8. Early upregulation of acute respiratory distress syndrome-associated cytokines promotes lethal disease in an aged-mouse model of severe acute respiratory syndrome coronavirus infection

    NARCIS (Netherlands)

    B. Rockx (Barry); T. Baas (Tracey); G.A. Zornetzer (Gregory); B.L. Haagmans (Bart); T. Sheahan (Timothy); M. Frieman (Matthew); M.D. Dyer (Matthew); T.H. Teal (Thomas); S. Proll (Sean); J.M.A. van den Brand (Judith); R. Baric (Ralph); M.G. Katze (Michael)

    2009-01-01

    textabstractSeveral respiratory viruses, including influenza virus and severe acute respiratory syndrome coronavirus (SARS-CoV), produce more severe disease in the elderly, yet the molecular mechanisms governing age-related susceptibility remain poorly studied. Advanced age was significantly

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

    DEFF Research Database (Denmark)

    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...

  10. Extracorporeal support for patients with acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Simon J. Finney

    2014-09-01

    Full Text Available Extracorporeal membrane oxygen (ECMO has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure study and excellent outcomes in patients who suffered severe influenza A (H1N1/09 infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1 the types of extracorporeal support available; 2 the rationale for its use; 3 the relationship with lung protective ventilation; and 4 the current evidence for its use.

  11. The Recent Severe Acute Respiratory Syndrome (SARS) Epidemic ...

    African Journals Online (AJOL)

    It is a syndrome characterized by fever, cough, sore throat , shortness of breath and malaise which may deteriorate very rapidly to respiratory failure and death. The symptoms of SARS are quite similar to those of common cold, malaria and respiratory tract infections all of which are common in our environment. SARS, being ...

  12. Severe acute respiratory syndrome (SARS): the pharmacist's role.

    Science.gov (United States)

    Chin, Thomas W F; Chant, Clarence; Tanzini, Rosemary; Wells, Janice

    2004-06-01

    After two outbreaks of severe acute respiratory syndrome (SARS) occurred in Toronto, Ontario, Canada, from March-June 2003, we reviewed the unexpected role and responsibilities of pharmacists during these two crises, and present strategies for better crisis preparedness. Pharmacists were actively involved in battling the SARS crises. After conducting extensive literature searches and evaluations, pharmacists prepared administration and dosing guidelines for the two investigational drugs, ribavirin and interferon alfacon-1, that were being used to treat the syndrome. They provided direct patient care under modified conditions. They revised drug distribution procedures and developed new ones to meet more stringent infection-control standards. Collaborative teamwork with key stakeholders was important in accomplishing tasks in an efficient and timely manner. Regular communication with health care staff took place internally and externally. Education and updated information for pharmacists was crucial. Pharmacists can play a vital role during crises in the areas of drug distribution, drug information, and direct patient care. Collaborative teamwork and close communication are keys to success. Pharmacists must be proactive and take a leadership role in assuming pharmacy-related responsibilities. By evaluating what worked and what didn't, pharmacists can develop procedures for future crises requiring pharmacy support.

  13. Surfactant alteration and replacement in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    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.

  14. Diagnosis of Acute Respiratory Distress Syndrome in Nosocomial Pneumonia

    Directory of Open Access Journals (Sweden)

    A. N. Kuzovlev

    2009-01-01

    Full Text Available Objective: to define the informative value of the parameters of gas exchange, lung volumetry, and central hemodynamics in the diagnosis of acute respiratory distress syndrome (ARDS in nosocomial pneumonia (NP. Subjects and methods. The study included 38 patients with cancer and severe injury who were divided into 3 groups in accordance with the diagnostic criteria of ARDS and NP: 1 patients with ARDS + NP; 2 those with NP; 3 those with non-ARDS, non-PN. ARDS was diagnosed in 2 steps. At Step 1, the investigators took into account risk factors for ARDS and used the lung injury scale developed by J. Murray et al. and the ARDS diagnostic criteria defined by the American-European Consensus Conference on ARDS. At Step 2, after obtaining the data of lung volume-try (1—2 hours after Step 1, they assessed the compliance of the above criteria for ARDS with those developed by the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, and redistributed the patients between the groups. The stage of ARDS was determined in accordance with the classification of the above Institute. All the patients underwent a comprehensive examination the key element of which was to estimate gas exchange parameters and to monitor lung volumetry and central hemodynamics by the transpulmonary thermodilution methods, by using a Pulsion PiCCO Plus monitor (Pulsion Medical Systems, Germany. The findings were statistically analyzed using a Statistica 7.0 package (arithmetic mean, error of the mean, _ Student’s test, Newman-Keuls test, correlation analysis. The difference was considered to be significant if p-value was Results. The patients with ARDS + NP were observed to have a significantly lower oxygenation index (10 ml/kg and Murray scale scores (>2 than those in patients with NP without ARDS. The reference values of the pulmonary vascular permeability index due to its inadequate informative value call for further investigation. The

  15. Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews

    OpenAIRE

    Dalmedico, Michel Marcos; Salas, Dafne; Oliveira, Andrey Maciel de; Baran, Fátima Denise Padilha; Meardi, Jéssica Tereza; Santos, Michelle Caroline

    2017-01-01

    Abstract OBJECTIVE To identify and integrate the available scientific evidence related to the use of the prone position in patients with acute respiratory distress syndrome for the reduction of the outcome variable of mortality compared to the dorsal decubitus position. METHOD Overview of systematic reviews or meta-analyzes of randomized clinical trials. It included studies that evaluated the use of prone positioning in patients with acute respiratory distress syndrome published between 201...

  16. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU

    Science.gov (United States)

    Ingelse, Sarah A.; Wösten-van Asperen, Roelie M.; Lemson, Joris; Daams, Joost G.; Bem, Reinout A.; van Woensel, Job B.

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar–capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes. PMID:27047904

  17. Pediatric acute respiratory distress syndrome: fluid management in the PICU

    Directory of Open Access Journals (Sweden)

    Sarah A Ingelse

    2016-03-01

    Full Text Available The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS. Patients with ARDS have widespread damage of the alveolar capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Young-Jae Cho

    2016-05-01

    Full Text Available There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS. We generate strong (1 and weak (2 grade of recommendations based on high (A, moderate (B and low (C grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A and prone position if it is not contraindicated (1B to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B and inhaled nitric oxide (1A as a standard treatment. We also suggest high positive end-expiratory pressure (2B, extracorporeal membrane oxygenation as a rescue therapy (2C, and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B. The application of recruitment maneuver may reduce mortality (2B, however, the use of systemic steroids cannot reduce mortality (2B. In mechanically ventilated patients, we recommend light sedation (1B and low tidal volume even without ARDS (1B and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B. Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A. In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

  1. Pulmonary hypertension due to acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    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.

  2. Lung tissue remodeling in the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    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.

  3. Acute Respiratory Distress Syndrome Associated With Rabies: A Case Report

    Directory of Open Access Journals (Sweden)

    Yung-Hsiang Hsu

    2006-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is the first potentially lethal complication in rabies virus infection, although its occurrence is rare. We report on a fatal case of rabies virus infection in a 45-year-old woman from Hu-Nan Province, China. The neurologic signs of limb numbness and water phobia occurred from 61 days after the dog bite; the clinical course was progressive, with the most severe clinical manifestations being fever, encephalitis, and ARDS. The woman expired 12 days after admission to the hospital. An autopsy proved rabies encephalitis, mainly involving the medulla oblongata, the thalamus, part of the pons, the cerebellum, and the hippocampus. The lung pathologic examination revealed the organizing phase of ARDS with diffuse alveolar damage, hyaline membrane formation, type II alveolar cell hyperplasia accompanied by proliferation of fibroblasts and infiltration of mononuclear cells into the interstitial space. Immunohistochemistry stain and reverse transcription-polymerase chain reaction for rabies virus failed to demonstrate the organism in the lung tissue. Strong expression of inducible nitric oxide synthase (iNOS was detected in the alveolar macrophages. An immunologic mechanism with iNOS expression in the absence of direct invasion of the organism may participate in the pathogenesis of ARDS associated with rabies.

  4. Definition and epidemiology of acute respiratory distress syndrome.

    Science.gov (United States)

    Rezoagli, Emanuele; Fumagalli, Roberto; Bellani, Giacomo

    2017-07-01

    Fifty years ago, Ashbaugh and colleagues defined for the first time the acute respiratory distress syndrome (ARDS), one among the most challenging clinical condition of the critical care medicine. The scientific community worked over the years to generate a unified definition of ARDS, which saw its revisited version in the Berlin definition, in 2014. Epidemiologic information about ARDS is limited in the era of the new Berlin definition, and wide differences are reported among countries all over the world. Despite decades of study in the field of lung injury, ARDS is still so far under-recognized, with 2 out of 5 cases missed by clinicians. Furthermore, although advances of ventilator strategies in the management of ARDS associated with outcome improvements-such as protective mechanical ventilation, lower driving pressure, higher PEEP levels and prone positioning-ARDS appears to be undertreated and mortality remains elevated up to 40%. In this review, we cover the history that led to the current worldwide accepted Berlin definition of ARDS and we summarize the recent data regarding ARDS epidemiology.

  5. Lung volume assessment in acute respiratory distress syndrome.

    Science.gov (United States)

    Chen, Lu; Brochard, Laurent

    2015-06-01

    Measurements of lung volumes allow evaluating the pathophysiogical severity of acute respiratory distress syndrome (ARDS) in terms of the degree of reduction in aerated lung volume, calculating strain, quantifying recruitment and/or hyperinflation, and gas volume distribution. We summarize the current techniques for lung volume assessment selected according to their possible usage in the ICU and discuss the recent findings obtained with implementation of these techniques in patients with ARDS. Computed tomography technique remains irreplaceable in terms of quantitative aeration of different lung regions, but the commonly used cut-offs for classification may be questioned with recent findings on nonpathological lungs. Monitoring end expiratory lung volume using nitrogen washout technique enhanced our understanding on lung volume change during positioning, pleural effusion drainage, intra-abdominal hypertension, and recruitment maneuver. Recent studies supported that tidal volume could not surrogate tidal strain, which needs measurement of functional residual capacity and which is correlated with pro-inflammatory lung response. Although lung volume measurements are still limited to research area of ARDS, recent progress in technology provides clinicians more opportunities to evaluate lung volumes noninvasively at the bedside and may facilitate individualization of ventilator settings based on the specific physiological understandings of a given patient.

  6. Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Chen, Lu; Chen, Guang-Qiang; Shore, Kevin; Shklar, Orest; Martins, Concetta; Devenyi, Brian; Lindsay, Paul; McPhail, Heather; Lanys, Ashley; Soliman, Ibrahim; Tuma, Mazin; Kim, Michael; Porretta, Kerri; Greco, Pamela; Every, Hilary; Hayes, Chris; Baker, Andrew; Friedrich, Jan O; Brochard, Laurent

    2017-04-04

    Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test. The respiratory mechanics assessment constituted a set of bedside measurements to determine passive lung and chest wall mechanics, response to positive end-expiratory pressure, and alveolar derecruitment. It was obtained early after ARDS diagnosis. The results were provided to the clinical team to be used at their own discretion. We compared ventilator settings and physiological variables before and after the test. The physiological endpoints were oxygenation index, dead space, and plateau and driving pressures. Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by switching pressure-targeted mode to volume-targeted mode. Following changes, the oxygenation index, airway plateau, and driving pressures were significantly improved, whereas the dead-space fraction remained unchanged. The oxygenation index continued to improve in the next 48 h. Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. The present study involves data from our ongoing registry for respiratory mechanics (ClinicalTrials.gov identifier: NCT02623192 . Registered 30 July 2015).

  7. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Wilson, Bryan; Typpo, Katri

    2016-01-01

    Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement, and maintenance of EN. Strategies to improve early initiation and advancement and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both, over and underfeeding, prolong duration of mechanical ventilation in children and worsen other organ function such that precise calorie goals are needed. The gut is thought to act as a “motor” of organ dysfunction, and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review, we examine the current evidence regarding dose, route, and timing of nutrition

  8. Severe acute respiratory syndrome coronavirus persistence in Vero cells.

    Science.gov (United States)

    Palacios, Gustavo; Jabado, Omar; Renwick, Neil; Briese, Thomas; Lipkin, W Ian

    2005-03-20

    Several coronaviruses establish persistent infections in vitro and in vivo, however it is unknown whether persistence is a feature of the severe acute respiratory syndrome coronavirus (SARS-CoV) life cycle. This study was conducted to investigate viral persistence. We inoculated confluent monolayers of Vero cells with SARS-CoV at a multiplicity of infection of 0.1 TCID50 and passaged the remaining cells every 4 to 8 days for a total of 11 passages. Virus was titrated at each passage by limited dilution assay and nucleocapsid antigen was detected by Western blot and immunofluoresence assays. The presence of viral particles in passage 11 cells was assessed by electron microscopy. Changes in viral genomic sequences during persistent infection were examined by DNA sequencing. Cytopathic effect was extensive after initial inoculation but diminished with serial passages. Infectious virus was detected after each passage and viral growth curves were identical for parental virus stock and virus obtained from passage 11 cells. Nucleocapsid antigen was detected in the majority of cells after initial inoculation but in only 10%-40% of cells at passages 2-11. Electron microscopy confirmed the presence of viral particles in passage 11 cells. Sequence analysis at passage 11 revealed fixed mutations in the spike (S) gene and ORFs 7a-8b but not in the nucleocapsid (N) gene. SARS-CoV can establish a persistent infection in vitro. The mechanism for viral persistence is consistent with the formation of a carrier culture whereby a limited number of cells are infected with each round of virus replication and release. Persistence is associated with selected mutations in the SARS-CoV genome. This model may provide insight into SARS-related lung pathology and mechanisms by which humans and animals can serve as reservoirs for infection.

  9. The severe acute respiratory syndrome coronavirus in tears.

    Science.gov (United States)

    Loon, S-C; Teoh, S C B; Oon, L L E; Se-Thoe, S-Y; Ling, A-E; Leo, Y-S; Leong, H-N

    2004-07-01

    Severe acute respiratory syndrome (SARS) is a new infectious disease that caused a global outbreak in 2003. Research has shown that it is caused by a novel coronavirus. A series of cases is reported where polymerase chain reaction (PCR) testing on tears had demonstrated the presence of the virus. Detection of ocular infection from tears using the PCR technique has been widely used by ophthalmologists to diagnose infections for other viruses. This is a case series report from cases classified as probable or suspect SARS cases. Tear samples were collected from 36 consecutive patients who were suspected of having SARS in Singapore over a period of 12 days (7-18 April 2003), and analysed by PCR using protocols developed by the WHO network of laboratories. Three patients with probable SARS (one female and two male patients) had positive results from their tear samples. Tear samples were used to confirm SARS in the female patient, who was positive only from her tears. The positive specimens were found in cases sampled early in their course of infection. This is the first case series reported with the detection of the SARS coronavirus from tears, and has important implications for the practice of ophthalmology and medicine. The ability to detect and isolate the virus in the early phase of the disease may be an important diagnostic tool for future patients and tear sampling is both simple and easily repeatable. Many healthcare workers are in close proximity to the eyes of patients and this may be a source of spread among healthcare workers and inoculating patients. Ophthalmic practices may need to change as more stringent barrier methods, appropriate quarantine, and isolation measures are vital when managing patients with SARS.

  10. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Bryan Wilson

    2016-10-01

    Full Text Available Appropriate nutrition is an essential component of intensive care management of children with Acute Respiratory Distress Syndrome (ARDS and is linked to patient outcomes. One out of every two children in the PICU will develop malnutrition or have worsening of baseline malnutrition, and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN is associated with improved 60-day survival after pediatric critical illness and yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement and maintenance of EN. Strategies to improve early initiation, advancement, and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both over and underfeeding prolongs duration of mechanical ventilation in children and worsens other organ function such that precise calorie goals are needed. The gut is thought to act as a ‘motor’ of organ dysfunction and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review we examine the current evidence regarding dose, route, and timing of nutrition, current

  11. Ventilatory strategies and supportive care in acute respiratory distress syndrome.

    Science.gov (United States)

    Luks, Andrew M

    2013-11-01

    While antiviral therapy is an important component of care in patients with the acute respiratory distress syndrome (ARDS) following influenza infection, it is not sufficient to ensure good outcomes, and additional measures are usually necessary. Patients usually receive high levels of supplemental oxygen to counteract the hypoxemia resulting from severe gas exchange abnormalities. Many patients also receive invasive mechanical ventilation for support for oxygenation, while in resource-poor settings, supplemental oxygen via face mask may be the only available intervention. Patients with ARDS receiving mechanical ventilation should receive lung-protective ventilation, whereby tidal volume is decreased to 6 ml/kg of their predicted weight and distending pressures are maintained ≤ 30 cm H2 O, as well as increased inspired oxygen concentrations and positive end-expiratory pressure (PEEP) to prevent atelectasis and support oxygenation. While these measures are sufficient in most patients, a minority develop refractory hypoxemia and may receive additional therapies, including prone positioning, inhaled vasodilators, extracorporeal membrane oxygenation, recruitment maneuvers followed by high PEEP, and neuromuscular blockade, although recent data suggest that this last option may be warranted earlier in the clinical course before development of refractory hypoxemia. Application of these "rescue strategies" is complicated by the lack of guidance in the literature regarding implementation. While much attention is devoted to these strategies, clinicians must not lose sight of simple interventions that affect patient outcomes including head of bed elevation, prophylaxis against venous thromboembolism and gastrointestinal bleeding, judicious use of fluids in the post-resuscitative phase, and a protocol-based approach to sedation and spontaneous breathing trials. © 2013 Blackwell Publishing Ltd.

  12. The effectiveness of heliox in acute respiratory distress syndrome.

    Science.gov (United States)

    Yilmaz, Sema; Daglioglu, Kenan; Yildizdas, Dincer; Bayram, Ibrahim; Gumurdulu, Derya; Polat, Sait

    2013-01-01

    The management of acute respiratory distress syndrome (ARDS) was investigated with the use of heliox in an experimental model. To investigate whether heliox can be considered a new therapeutic approach in ARDS. ARDS was designed in Wistar albino male rats, 250-300 g in weight, by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats with ARDS were pressure-controlled ventilated. At the end of 210 min, helium gas was tried. All rats were assigned to two groups: Group 1 (n = 10) was the control group, and was given no treatment; group 2 (n = 7) was given heliox (He: O(2) = 50:50). The heliox group received heliox for 1 h continously. Rats were continued to be kept on a ventilator through the experiment. Two hours after the last inhalation, both lungs of the rats were excised for both histopathological examination and immunohistochemical evaluation. Histopathological grading were expressed as median interquartile range. Mann-Whitney U-test was used to assess the relationships between the variables. The infiltation of neutrophils were decreased in rats treated with heliox. Edema in the interstitial and intraalveolar areas was less than that of the control rats. Also, the diminishing of perivascular and/or intraalveolar hemorrhage was apperant. Hyaline membrane (HM) formation decreased in the heliox group compared with the control group. Decreased inducible nitric oxide synthase expression was shown via immunohistochemical examination in the heliox group. The present study histopathologically indicated the effectiveness of heliox in the decreasing of neutrophil infiltation, interstitial/intraalveolar edema, perivascular and/or intraalveolar hemorrhage and HM formation in ARDS. Besides the known effect of heliox in obstructive lung disease, inhaled heliox therapy could be associated with the improvement of inflamation in ARDS.

  13. The severe acute respiratory syndrome epidemic in mainland China dissected

    Directory of Open Access Journals (Sweden)

    Wuchun Cao

    2011-02-01

    Full Text Available This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteo­necrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.

  14. Bedside evaluation of pressure-volume curves in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Blanch, Lluis; López-Aguilar, Josefina; Villagrá, Ana

    2007-06-01

    To describe the physiologic and diagnostic utility of static pressure-volume curves of the respiratory system at the bedside in patients with acute lung injury or acute respiratory distress syndrome. The pressure-volume curve of the respiratory system is a useful tool for the measurement of respiratory system mechanics in patients with acute lung injury or acute respiratory distress syndrome. The pressure-volume curve has a sigmoid shape, with lower and upper points on the inspiratory limb and a point of maximum curvature on the expiratory limb. Visual and mathematical pressure-volume curve analysis may be useful for understanding individual lung mechanics and for selecting ventilator settings. Among the different techniques for acquiring pressure-volume curves at the bedside, the constant slow flow method is the simplest to perform, the most clinically reliable and has the fewest limitations. Measurement of pressure-volume curves at the bedside in critically ill patients with acute lung injury or acute respiratory distress syndrome should be considered a useful respiratory monitoring tool to assess physiologic lung status and to adjust ventilator settings, when appropriate, to minimize superimposed lung injury associated with mechanical ventilators.

  15. Hypoxemic Respiratory Failure from Acute Respiratory Distress Syndrome Secondary to Leptospirosis

    Directory of Open Access Journals (Sweden)

    Shannon M. Fernando

    2017-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS, characterized by hypoxemic respiratory failure, is associated with a mortality of 30–50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Leptospirosis is a zoonotic disease most common in the tropics and typically associated with mild pulmonary complications. We describe a case of a 25-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a Costa Rican holiday. There was no other organ failure. He was intubated and received lung protective ventilation. His condition improved after ampicillin and penicillin G were added empirically. This case illustrates the rare complication of ARDS from leptospirosis, the importance of taking a travel history, and the need for empiric therapy because of diagnostic delay.

  16. Lung Functional and Biologic Responses to Variable Ventilation in Experimental Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Samary, Cynthia S; Moraes, Lillian; Santos, Cintia L; Huhle, Robert; Santos, Raquel S; Ornellas, Debora S; Felix, Nathane S; Capelozzi, Vera L; Schanaider, Alberto; Pelosi, Paolo; de Abreu, Marcelo Gama; Rocco, Patricia R M; Silva, Pedro L

    2016-07-01

    The biologic effects of variable ventilation may depend on the etiology of acute respiratory distress syndrome. We compared variable and conventional ventilation in experimental pulmonary and extrapulmonary acute respiratory distress syndrome. Prospective, randomized, controlled experimental study. University research laboratory. Twenty-four Wistar rats. Acute respiratory distress syndrome was induced by Escherichia coli lipopolysaccharide administered intratracheally (pulmonary acute respiratory distress syndrome, n = 12) or intraperitoneally (extrapulmonary acute respiratory distress syndrome, n = 12). After 24 hours, animals were randomly assigned to receive conventional (volume-controlled ventilation, n = 6) or variable ventilation (n = 6). Nonventilated animals (n = 4 per etiology) were used for comparison of diffuse alveolar damage, E-cadherin, and molecular biology variables. Variable ventilation was applied on a breath-to-breath basis as a sequence of randomly generated tidal volume values (n = 600; mean tidal volume = 6 mL/kg), with a 30% coefficient of variation (normal distribution). After randomization, animals were ventilated for 1 hour and lungs were removed for histology and molecular biology analysis. Variable ventilation improved oxygenation and reduced lung elastance compared with volume-controlled ventilation in both acute respiratory distress syndrome etiologies. In pulmonary acute respiratory distress syndrome, but not in extrapulmonary acute respiratory distress syndrome, variable ventilation 1) decreased total diffuse alveolar damage (median [interquartile range]: volume-controlled ventilation, 12 [11-17] vs variable ventilation, 9 [8-10]; p ventilation, 21.5 [18.3-23.3] vs variable ventilation, 5.6 [4.6-12.1]; p ventilation, 2.0 [1.3-2.1] vs variable ventilation, 0.7 [0.6-1.4]; p ventilation, 0.3 [0.2-0.5] vs variable ventilation, 0.8 [0.5-1.3]; p ventilation increased vascular cell adhesion molecule-1 messenger RNA expression (volume

  17. Fifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Henderson, William R; Chen, Lu; Amato, Marcelo B P; Brochard, Laurent J

    2017-10-01

    Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small Vt, low plateau and driving pressures, and high levels of positive end-expiratory pressure. Collectively, these interventions are termed "lung-protective ventilation." Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population-based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation. This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts, such as plateau pressures, driving pressure, transpulmonary pressures, stress index, and measurement of strain. In addition, the concept of the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.

  18. PIDOTIMOD IN TREATMENT OF CHILDREN WITH ACUTE RESPIRATORY INFECTION WITH CONCOMITANT RECURRENT OBSTRUCTIVE SYNDROME

    OpenAIRE

    E.E. Lokshina; O. V. Kravchenko; O. V. Zaytseva

    2011-01-01

    Respiratory infections are frequent in children; consequently evaluation of prophylactic effectiveness of immunomodulators is needed. Objective: to evaluate of clinical, immunological efficacy and safety of pidotimod in complex treatment of children with acute respiratory infections (ARI) and obstructive syndrome. Methods: patients 3–10 years old hospitalized with ARI and obstructive syndrome participated the study. Children from first group (n = 30) were treated with pidotimod 400 mg 2 times...

  19. Uncommon associations of Hepatitis A in children: Acute respiratory distress syndrome and erosive gastritis

    Directory of Open Access Journals (Sweden)

    Shefali Parikh

    2017-01-01

    Full Text Available Hepatitis A is a common cause of acute hepatitis in children and usually has a benign self-limiting course, moreover so in young children. We report two exceptional cases of erosive gastritis and acute respiratory distress syndrome, respectively, as rare associations of hepatitis A in children. Both children were < 5 years of age and eventually recovered.

  20. Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome.

    Science.gov (United States)

    Chen, L-L; Hsu, C-W; Tian, Y-C; Fang, J-T

    2005-10-01

    An outbreak of severe acute respiratory syndrome (SARS) occurred in Taiwan in 2003. SARS complicated with rhabdomyolysis has rarely been reported. This study reported three cases of rhabdomyolysis developing during the clinical course of SARS. Thirty probable SARS patients were admitted to the isolation wards at Linkou Chang Gung Memorial Hospital between 4 April and 4 June 2003. Thirty patients, including four men and 26 women aged from 12 to 87 years (mean age 40). Eleven (36.7%) patients had respiratory failure and required mechanical ventilation with paralytic therapy; three (10%) patients had rhabdomyolysis complicated with acute renal failure and one received haemodialysis; four (13.3%) patients died. Three cases with rhabdomyolysis all received sedative and paralytic therapy for mechanical ventilation. Haemodialysis was performed on one patient. Two patients died from multiple organ failure, and one patient fully recovered from rhabdomyolysis with acute renal failure. SARS is a serious respiratory illness, and its aetiology is a novel coronavirus. Rhabdomyolysis resulting from SARS virus infection was strongly suspected. Immobilisation under paralytic therapy and steroids may also be important in developing rhabdomyolysis.

  1. Disassociating Lung Mechanics and Oxygenation in Pediatric Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Yehya, Nadir; Thomas, Neal J

    2017-07-01

    Both oxygenation and peak inspiratory pressure are associated with mortality in pediatric acute respiratory distress syndrome. Since oxygenation and respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with outcome. We aimed to determine whether respiratory mechanics (peak inspiratory pressure, positive end-expiratory pressure, ΔP [PIP minus PEEP], tidal volume, dynamic compliance [Cdyn]) or oxygenation (PaO2/FIO2) was associated with mortality. Prospective, observational, cohort study. University affiliated PICU. Mechanically ventilated children with acute respiratory distress syndrome (Berlin). None. Peak inspiratory pressure, positive end-expiratory pressure, ΔP, tidal volume, Cdyn, and PaO2/FIO2 were collected at acute respiratory distress syndrome onset and at 24 hours in 352 children between 2011 and 2016. At acute respiratory distress syndrome onset, neither mechanical variables nor PaO2/FIO2 were associated with mortality. At 24 hours, peak inspiratory pressure, positive end-expiratory pressure, ΔP were higher, and Cdyn and PaO2/FIO2 lower, in nonsurvivors. In multivariable logistic regression, PaO2/FIO2 at 24 hours and ΔPaO2/FIO2 (change in PaO2/FIO2 over the first 24 hr) were associated with mortality, whereas pressure variables were not. Both oxygenation and pressure variables were associated with duration of ventilation in multivariable competing risk regression. Improvements in oxygenation, but not in respiratory mechanics, were associated with lower mortality in pediatric acute respiratory distress syndrome. Future trials of mechanical ventilation in children should focus on oxygenation (higher PaO2/FIO2) rather than lower peak inspiratory pressure or ΔP, as oxygenation was more consistently associated with outcome.

  2. Acute respiratory distress syndrome and acute renal failure from Plasmodium ovale infection with fatal outcome.

    Science.gov (United States)

    Lau, Yee-Ling; Lee, Wenn-Chyau; Tan, Lian-Huat; Kamarulzaman, Adeeba; Syed Omar, Sharifah Faridah; Fong, Mun-Yik; Cheong, Fei-Wen; Mahmud, Rohela

    2013-11-04

    Plasmodium ovale is one of the causative agents of human malaria. Plasmodium ovale infection has long been thought to be non-fatal. Due to its lower morbidity, P. ovale receives little attention in malaria research. Two Malaysians went to Nigeria for two weeks. After returning to Malaysia, they fell sick and were admitted to different hospitals. Plasmodium ovale parasites were identified from blood smears of these patients. The species identification was further confirmed with nested PCR. One of them was successfully treated with no incident of relapse within 12-month medical follow-up. The other patient came down with malaria-induced respiratory complication during the course of treatment. Although parasites were cleared off the circulation, the patient's condition worsened. He succumbed to multiple complications including acute respiratory distress syndrome and acute renal failure. Sequencing of the malaria parasite DNA from both cases, followed by multiple sequence alignment and phylogenetic tree construction suggested that the causative agent for both malaria cases was P. ovale curtisi. In this report, the differences between both cases were discussed, and the potential capability of P. ovale in causing severe complications and death as seen in this case report was highlighted. Plasmodium ovale is potentially capable of causing severe complications, if not death. Complete travel and clinical history of malaria patient are vital for successful diagnoses and treatment. Monitoring of respiratory and renal function of malaria patients, regardless of the species of malaria parasites involved is crucial during the course of hospital admission.

  3. Coccidioidomycosis: an unusual cause of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Kelson Nobre Veras

    2003-01-01

    Full Text Available A male farmer, 20 years old, from the countryside of the State of Piauí, developed acute respiratory infection. Despite adequate antimicrobial therapy, his conditions worsened, requiring mechanical ventilation. His X-rays showed diffuse pulmonary infiltrates. His PaO2/FiO2 ratio was 58. Direct microscopy and culture of tracheal aspirates showed the presence of Coccidioides immitis. Autochthonous cases of coccidioidomycosis have only recently been described in Brazil, most of them from the State of Piauí. C. immitis has been isolated from humans, dogs and armadillos (Dasypus novemcinctus, and also from soil samples of armadillo's burrows. Failure to respond to antimicrobial therapy and a patient's origin from recognized endemic areas should alert to the possibility of acute pulmonary coccidioidomycosis.

  4. Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Jin Jeon

    2014-08-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

  5. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference.

    Science.gov (United States)

    Rimensberger, Peter C; Cheifetz, Ira M

    2015-06-01

    To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. Consensus Conference of experts in pediatric acute lung injury. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used. There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88% to 72% agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88%, whereas the use of recruitment maneuvers during rescue high-frequency oscillatory ventilation is highly recommended (strong agreement). The Consensus Conference developed pediatric-specific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are

  6. Epidemiology and outcomes of acute respiratory distress syndrome in children according to the Berlin definition: a multicenter prospective study.

    Science.gov (United States)

    Barreira, Eliane R; Munoz, Gabriela O C; Cavalheiro, Priscilla O; Suzuki, Adriana S; Degaspare, Natalia V; Shieh, Huei H; Martines, João A D S; Ferreira, Juliana C; Lane, Christianne; Carvalho, Werther B; Gilio, Alfredo E; Precioso, Alexander R

    2015-05-01

    In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15 years according to the Berlin definition. A prospective, multicenter observational study from March to September 2013. Seventy-seven PICU beds in eight centers: two private hospitals and six public academic hospitals in Brazil. All children aged 1 month to 15 years admitted to the participating PICUs in the study period. None. All children admitted to the PICUs were daily evaluated for the presence of acute respiratory distress syndrome according to the American-European Consensus Conference and Berlin definitions. Of the 562 patients included, acute respiratory distress syndrome developed in 57 patients (10%) and 58 patients (10.3%) according to the Berlin definition and the American-European Consensus Conference definition, respectively. Among patients with acute respiratory distress syndrome according to the Berlin definition, nine patients (16%) were mild, 21 (37%) were moderate, and 27 (47%) were severe. Compared with patients without acute respiratory distress syndrome, patients with acute respiratory distress syndrome had significantly higher severity scores, longer PICU and hospital length of stay, longer duration of mechanical ventilation, and higher mortality (p definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.

  7. Incidence and Mortality of Acute Respiratory Distress Syndrome in Children : A Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    Schouten, LR; Veltkamp, F; Bos, AP; van Woensel, Job B M; Serpa Neto, A; Schultz, MJ; Wösten-van Asperen, RM

    Objectives: Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ

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

    Science.gov (United States)

    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. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Acute Respiratory Distress Syndrome Caused by Leukemic Infiltration of the Lung

    Directory of Open Access Journals (Sweden)

    Yao-Kuang Wu

    2008-05-01

    Full Text Available Respiratory distress syndrome resulting from leukemic pulmonary infiltrates is seldom diagnosed antemortem. Two 60- and 80-year-old women presented with general malaise, progressive shortness of breath, and hyperleukocytosis, which progressed to acute respiratory distress syndrome (ARDS after admission. Acute leukemia with pulmonary infection was initially diagnosed, but subsequent examinations including open lung biopsy revealed leukemic pulmonary infiltrates without infection. In one case, the clinical condition and chest radiography improved initially after combination therapy with chemotherapy for leukemia and aggressive pulmonary support. However, new pulmonary infiltration on chest radiography and hypoxemia recurred, which was consistent with acute lysis pneumopathy. Despite aggressive treatment, both patients died due to rapidly deteriorating condition. Leukemic pulmonary involvement should be considered in acute leukemia patients with non-infectious diffusive lung infiltration, especially in acute leukemia with a high blast count.

  10. Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome.

    Science.gov (United States)

    Lakhal, Karim; Ehrmann, Stephan; Benzekri-Lefèvre, Dalila; Runge, Isabelle; Legras, Annick; Dequin, Pierre-François; Mercier, Emmanuelle; Wolff, Michel; Régnier, Bernard; Boulain, Thierry

    2011-01-01

    Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (ΔRESPPP) has scarcely been reported. In patients with ARDS, the pathophysiology of ΔRESPPP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess ΔRESPPP in a large ARDS population. Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for ΔRESPPP was 0.75 (95% confidence interval (CI95): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI95: 3.6 to 6.2) and 0.32 (CI95: 0.1 to 0.8), respectively. Adjusting ΔRESPPP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ΔPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ΔPAOP above its median value (4 mmHg), AUC for ΔRESPPP was 1 (CI95: 0.73 to 1) as compared with 0.79 (CI95: 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a ≥ 2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, ΔRESPPP performance was poor. Careful fluid challenges may be a safe alternative.

  11. Comparative Epidemiology of Human Infections with Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome Coronaviruses among Healthcare Personnel.

    Science.gov (United States)

    Liu, Shelan; Chan, Ta-Chien; Chu, Yu-Tseng; Wu, Joseph Tsung-Shu; Geng, Xingyi; Zhao, Na; Cheng, Wei; Chen, Enfu; King, Chwan-Chuen

    2016-01-01

    The largest nosocomial outbreak of Middle East respiratory syndrome (MERS) occurred in South Korea in 2015. Health Care Personnel (HCP) are at high risk of acquiring MERS-Coronavirus (MERS-CoV) infections, similar to the severe acute respiratory syndrome (SARS)-Coronavirus (SARS-CoV) infections first identified in 2003. This study described the similarities and differences in epidemiological and clinical characteristics of 183 confirmed global MERS cases and 98 SARS cases in Taiwan associated with HCP. The epidemiological findings showed that the mean age of MERS-HCP and total MERS cases were 40 (24~74) and 49 (2~90) years, respectively, much older than those in SARS [SARS-HCP: 35 (21~68) years, p = 0.006; total SARS: 42 (0~94) years, p = 0.0002]. The case fatality rates (CFR) was much lower in MERS-HCP [7.03% (9/128)] or SARS-HCP [12.24% (12/98)] than the MERS-non-HCP [36.96% (34/92), pinfections involving both novel Coronavirus is crucially important to protect HCP.

  12. Respiratory and Systemic Effects of LASSBio596 Plus Surfactant in Experimental Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Johnatas Dutra Silva

    2016-02-01

    Full Text Available Background/Aims: Exogenous surfactant has been proposed as adjunctive therapy for acute respiratory distress syndrome (ARDS, but it is inactivated by different factors present in the alveolar space. We hypothesized that co-administration of LASSBio596, a molecule with significant anti-inflammatory properties, and exogenous surfactant could reduce lung inflammation, thus enabling the surfactant to reduce edema and improve lung function, in experimental ARDS. Methods: ARDS was induced by cecal ligation and puncture surgery in BALB/c mice. A sham-operated group was used as control (CTRL. After surgery (6 hours, CTRL and ARDS animals were assigned to receive: (1 sterile saline solution; (2 LASSBio596; (3 exogenous surfactant or (4 LASSBio596 plus exogenous surfactant (n = 22/group. Results: Regardless of exogenous surfactant administration, LASSBio596 improved survival rate and reduced collagen fiber content, total number of cells and neutrophils in PLF and blood, cell apoptosis, protein content in BALF, and urea and creatinine levels. LASSBio596 plus surfactant yielded all of the aforementioned beneficial effects, as well as increased BALF lipid content and reduced surface tension. Conclusion: LASSBio596 exhibited major anti-inflammatory and anti-fibrogenic effects in experimental sepsis-induced ARDS. Its association with surfactant may provide further advantages, potentially by reducing surface tension.

  13. Cynomolgus Macaque as an Animal Model for Severe Acute Respiratory Syndrome

    Science.gov (United States)

    2006-05-01

    Vogel LN, Elkins WR, et al. (2004) Mucosal immunisation of African green monkeys (Cercopithecus aethiops) with an attenuated parainfluenza virus...Severe acute respiratory syndrome in Singapore. Arch Dis Child 89: 551–556. 42. Babyn PS, Chu WC, Tsou IY, Wansaicheong GK, Allen U, et al. (2004) Severe

  14. Characterization of a novel coronavirus associated with severe acute respiratory syndrome

    NARCIS (Netherlands)

    P.A. Rota (Paul); M.S. Oberste (Steven); S.S. Monroe (Stephan); W.A. Nix (Allan); R. Campagnoli (Ray); J.P. Icenogle (Joseph); S. Penaranda; B. Bankamp (Bettina); K. Maher (Kaija); M.H. Chen (Min-hsin); S. Tong (Suxiong); A. Tamin (Azaibi); L. Lowe (Luis); M. Frace (Michael); J.L. DeRisi (Joseph); Q. Chen (Qi); D. Wang (David); D.D. Erdman (Dean); T.C. Peret (Teresa); C. Burns (Cara); T.G. Ksiazek (Thomas); P.E. Rollin (Pierre); A. Sanchez (Berenguer); S. Liffick (Stephanie); B. Holloway (Brian); J. Limor (Josef); K. McCaustland (Karen); M. Olsen-Rasmussen (Mellissa); S. Gunther; A.D.M.E. Osterhaus (Albert); C. Drosten (Christian); M.A. Pallansch (Mark); L.J. Anderson (Larry); W.J. Belline; R.A.M. Fouchier (Ron)

    2003-01-01

    textabstractIn March 2003, a novel coronavirus (SARS-CoV) was discovered in association with cases of severe acute respiratory syndrome (SARS). The sequence of the complete genome of SARS-CoV was determined, and the initial characterization of the viral genome is presented in this report. The

  15. Contrast media inhibit exogenous surfactant therapy in rats with acute respiratory distress syndrome

    NARCIS (Netherlands)

    Kesecioglu, Jozef; Haitsma, Jack J.; Schultz, Marcus J.; den Heeten, Gerard J.; Lachmann, Burkhard

    2006-01-01

    AIM: To test the effects of various contrast media on the pulmonary surfactant system. MATERIAL AND METHODS: In a rat model of acute respiratory distress syndrome (ARDS) induced by lung lavage, the effects of surfactant suspended in saline were compared with surfactant suspended in the contrast

  16. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome Insights from the LUNG SAFE Study

    NARCIS (Netherlands)

    Bellani, Giacomo; Laffey, John G.; Pham, Tài; Madotto, Fabiana; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; Bumbasirevic, Vesna; Piquilloud, Lise; van Haren, Frank; Larsson, Anders; McAuley, Daniel F.; Bauer, Philippe R.; Arabi, Yaseen M.; Ranieri, Marco; Antonelli, Massimo; Rubenfeld, Gordon D.; Thompson, B. Taylor; Wrigge, Hermann; Slutsky, Arthur S.; Pesenti, Antonio; Rios, Fernando; Sottiaux, T.; Depuydt, p; Lora, Fredy S.; Azevedo, Luciano Cesar; Bugedo, Guillermo; Qiu, Haibo; Gonzalez, Marcos; Silesky, Juan; Cerny, Vladimir; Nielsen, Jonas; Jibaja, Manuel; Matamis, Dimitrios; Ranero, Jorge Luis; Amin, Pravin; Hashemian, S. M.; Clarkson, Kevin; Kurahashi, Kiyoyasu; Villagomez, Asisclo; Zeggwagh, Amine Ali; Heunks, Leo M.; Laake, Jon Henrik; Palo, Jose Emmanuel; do Vale Fernandes, Antero; Sandesc, Dorel; Arabi, Yaasen; Bumbasierevic, Vesna; Nin, Nicolas; Lorente, Jose A.; Abroug, Fekri; McNamee, Lia; Hurtado, Javier; Bajwa, Ed; Démpaire, Gabriel; Francois, Guy M.; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Brizuela, Matias; Gianinetto, Hernan; Gomez, Pablo E.; Cerrato, Valeria I.; Bezzi, Marco G.; Borello, Silvina A.; Loiacono, Flavia A.; Fernandez, Adriana M.; Knowles, Serena; Reynolds, Claire; Inskip, Deborah M.; Miller, Jennene J.; Kong, Jing; Whitehead, Christina; Bihari, Shailesh; Seven, Aylin; Krstevski, Amanda; Rodgers, Helen J.; Millar, Rebecca T.; Mckenna, Toni E.; Bailey, Irene M.; Hanlon, Gabrielle C.; Aneman, Anders; Lynch, Joan M.; Azad, Raman; Neal, John; Woods, Paul W.; Roberts, Brigit L.; Kol, Mark R.; Wong, Helen S.; Riss, Katharina C.; Staudinger, Thomas; Wittebole, Xavier; Berghe, Caroline; Bulpa, Pierre A.; Dive, Alain M.; Verstraete, Rik; Lebbinck, Herve; Depuydt, Pieter; Vermassen, Joris; Meersseman, Philippe; Ceunen, Helga; Rosa, Jonas I.; Beraldo, Daniel O.; Piras, Claudio; Rampinelli, Adenilton M.; Nassar Jr, Antonio P.; Mataloun, Sergio; Moock, Marcelo; Thompson, Marlus M.; Gonçalves, Claudio H.; Antônio, Ana Carolina P.; Ascoli, Aline; Biondi, Rodrigo S.; Fontenele, Danielle C.; Nobrega, Danielle; Sales, Vanessa M.; Shindhe, Suresh; Aiman, Maizatul; Laffey, John; Beloncle, Francois; Davies, Kyle G.; Cirone, Rob; Manoharan, Venika; Ismail, Mehvish; Goligher, Ewan C.; Jassal, Mandeep; Nishikawa, Erin; Javeed, Areej; Curley, Gerard; Rittayamai, Nuttapol; Parotto, Matteo; Ferguson, Niall D.; Mehta, Sangeeta; Knoll, Jenny; Pronovost, Antoine; Canestrini, Sergio; Bruhn, Alejandro R.; Garcia, Patricio H.; Aliaga, Felipe A.; Farías, Pamela A.; Yumha, Jacob S.; Ortiz, Claudia A.; Salas, Javier E.; Saez, Alejandro A.; Vega, Luis D.; Labarca, Eduardo F.; Martinez, Felipe T.; Carreño, Nicolás G.; Lora, Pilar; Liu, Haitao; Liu, Ling; Tang, Rui; Luo, Xiaoming; An, Youzhong; Zhao, Huiying; Gao, Yan; Zhai, Zhe; Ye, Zheng L.; Wang, Wei; Li, Wenwen; Li, Qingdong; Zheng, Ruiqiang; Yu, Wenkui; Shen, Juanhong; Li, Xinyu; Yu, Tao; Wu, Ya Q.; Huang, Xiao B.; He, Zhenyang; Lu, Yuanhua; Han, Hui; Zhang, Fan; Sun, Renhua; Wang, Hua X.; Qin, Shu H.; Zhu, Bao H.; Zhao, Jun; Liu, Jian; Li, Bin; Liu, Jing L.; Zhou, Fa C.; Li, Qiong J.; Zhang, Xing Y.; Li-Xin, Zhou; Xin-Hua, Qiang; Jiang, Liangyan; Gao, Yuan N.; Zhao, Xian Y.; Li, Yuan Y.; Li, Xiao L.; Wang, Chunting; Yao, Qingchun; Yu, Rongguo; Chen, Kai; Shao, Huanzhang; Qin, Bingyu; Huang, Qing Q.; Zhu, Wei H.; Hang, Ai Y.; Hua, Ma X.; Li, Yimin; Xu, Yonghao; Di, Yu D.; Ling, Long L.; Qin, Tie H.; Wang, Shou H.; Qin, Junping; Han, Yi; Zhou, Suming; Vargas, Monica P.; Silesky Jimenez, Juan I.; González Rojas, Manuel A.; Solis-Quesada, Jaime E.; Ramirez-Alfaro, Christian M.; Máca, Jan; Sklienka, Peter; Gjedsted, Jakob; Christiansen, Aage; Villamagua, Boris G.; Llano, Miguel; Burtin, Philippe; Buzancais, Gautier; Beuret, Pascal; Pelletier, Nicolas; Mortaza, Satar; Mercat, Alain; Chelly, Jonathan; Jochmans, Sébastien; Terzi, Nicolas; Daubin, Cédric; Carteaux, Guillaume; de Prost, Nicolas; Chiche, Jean-Daniel; Daviaud, Fabrice; Pham, Tai; Fartoukh, Muriel; Barberet, Guillaume; Biehler, Jerome; Dellamonica, Jean; Doyen, Denis; Arnal, Jean-Michel; Briquet, Anais; Hraiech, Sami; Papazian, Laurent; Follin, Arnaud; Roux, Damien; Messika, Jonathan; Kalaitzis, Evangelos; Dangers, Laurence; Combes, Alain; Au, Siu-Ming; Béduneau, Gaetan; Carpentier, Dorothée; Zogheib, Elie H.; Dupont, Herve; Ricome, Sylvie; Santoli, Francesco L.; Besset, Sebastien L.; Michel, Philippe; Gelée, Bruno; Danin, Pierre-Eric; Goubaux, Bernard; Crova, Philippe J.; Phan, Nga T.; Berkelmans, Frantz; Badie, Julio C.; Tapponnier, Romain; Gally, Josette; Khebbeb, Samy; Herbrecht, Jean-Etienne; Schneider, Francis; Declercq, Pierre-Louis M.; Rigaud, Jean-Philippe; Duranteau, Jacques; Harrois, Anatole; Chabanne, Russell; Marin, Julien; Bigot, Charlene; Thibault, Sandrine; Ghazi, Mohammed; Boukhazna, Messabi; Zein, Salem Ould; Richecoeur, Jack R.; Combaux, Daniele M.; Grelon, Fabien; Le Moal, Charlene; Sauvadet, Elise P.; Robine, Adrien; Lemiale, Virginie; Reuter, Danielle; Dres, Martin; Demoule, Alexandre; Goldgran-Toledano, Dany; Baboi, Loredana; Guérin, Claude; Lohner, Ralph; Kraßler, Jens; Schäfer, Susanne; Zacharowski, Kai D.; Meybohm, Patrick; Reske, Andreas W.; Simon, Philipp; Hopf, Hans-Bernd F.; Schuetz, Michael; Baltus, Thomas; Papanikolaou, Metaxia N.; Papavasilopoulou, Theonymfi G.; Zacharas, Giannis A.; Ourailogloy, Vasilis; Mouloudi, Eleni K.; Massa, Eleni V.; Nagy, Eva O.; Stamou, Electra E.; Kiourtzieva, Ellada V.; Oikonomou, Marina A.; Avila, Luis E.; Cortez, Cesar A.; Citalán, Johanna E.; Jog, Sameer A.; Sable, Safal D.; Shah, Bhagyesh; Gurjar, Mohan; Baronia, Arvind K.; Memon, Mohammedfaruk; Muthuchellappan, Radhakrishnan; Ramesh, Venkatapura J.; Shenoy, Anitha; Unnikrishnan, Ramesh; Dixit, Subhal B.; Rhayakar, Rachana V.; Ramakrishnan, Nagarajan; Bhardwaj, Vallish K.; Mahto, Heera L.; Sagar, Sudha V.; Palaniswamy, Vijayanand; Ganesan, Deeban; Hashemian, Seyed Mohammadreza; Jamaati, Hamidreza; Heidari, Farshad; Meaney, Edel A.; Nichol, Alistair; Knapman, Karl M.; O’Croinin, Donall; Dunne, Eimhin S.; Breen, Dorothy M.; Clarkson, Kevin P.; Jaafar, Rola F.; Dwyer, Rory; Amir, Fahd; Ajetunmobi, Olaitan O.; O’Muircheartaigh, Aogan C.; Black, Colin S.; Treanor, Nuala; Collins, Daniel V.; Altaf, Wahid; Zani, Gianluca; Fusari, Maurizio; Spadaro, Savino; Volta, Carlo A.; Graziani, Romano; Brunettini, Barbara; Palmese, Salvatore; Formenti, Paolo; Umbrello, Michele; Lombardo, Andrea; Pecci, Elisabetta; Botteri, Marco; Savioli, Monica; Protti, Alessandro; Mattei, Alessia; Schiavoni, Lorenzo; Tinnirello, Andrea; Todeschini, Manuel; Giarratano, Antonino; Cortegiani, Andrea; Sher, Sara; Rossi, Anna; Antonelli, Massimo M.; Montini, Luca M.; Casalena, Paolo; Scafetti, Sergio; Panarello, Giovanna; Occhipinti, Giovanna; Patroniti, Nicolò; Pozzi, Matteo; Biscione, Roberto R.; Poli, Michela M.; Raimondi, Ferdinando; Albiero, Daniela; Crapelli, Giulia; Beck, Eduardo; Pota, Vincenzo; Schiavone, Vincenzo; Molin, Alexandre; Tarantino, Fabio; Monti, Giacomo; Frati, Elena; Mirabella, Lucia; Cinnella, Gilda; Fossali, Tommaso; Colombo, Riccardo; Terragni, Pierpaolo; Pattarino, Ilaria; Mojoli, Francesco; Braschi, Antonio; Borotto, Erika E.; Cracchiolo, Andrea N.; Palma, Daniela M.; Raponi, Francesco; Foti, Giuseppe; Vascotto, Ettore R.; Coppadoro, Andrea; Brazzi, Luca; Floris, Leda; Iotti, Giorgio A.; Venti, Aaron; Yamaguchi, Osamu; Takagi, Shunsuke; Maeyama, Hiroki N.; Watanabe, Eizo; Yamaji, Yoshihiro; Shimizu, Kazuyoshi; Shiozaki, Kyoko; Futami, Satoru; Ryosuke, Sekine; Saito, Koji; Kameyama, Yoshinobu; Ueno, Keiko; Izawa, Masayo; Okuda, Nao; Suzuki, Hiroyuki; Harasawa, Tomofumi; Nasu, Michitaka; Takada, Tadaaki; Ito, Fumihito; Nunomiya, Shin; Koyama, Kansuke; Abe, Toshikazu; Andoh, Kohkichi; Kusumoto, Kohei; Hirata, Akira; Takaba, Akihiro; Kimura, Hiroyasu; Matsumoto, Shuhei; Higashijima, Ushio; Honda, Hiroyuki; Aoki, Nobumasa; Imai, Hiroshi; Ogino, Yasuaki; Mizuguchi, Ichiko; Ichikado, Kazuya; Nitta, Kenichi; Mochizuki, Katsunori; Hashida, Tomoaki; Tanaka, Hiroyuki; Nakamura, Tomoyuki; Niimi, Daisuke; Ueda, Takeshi; Kashiwa, Yozo; Uchiyama, Akinori; Sabelnikovs, Olegs; Oss, Peteris; Haddad, Youssef; Liew, Kong Y.; Ñamendys-Silva, Silvio A.; Jarquin-Badiola, Yves D.; Sanchez-Hurtado, Luis A.; Gomez-Flores, Saira S.; Marin, Maria C.; Villagomez, Asisclo J.; Lemus, Jordana S.; Fierro, Jonathan M.; Cervantes, Mavy Ramirez; Flores Mejia, Francisco Javier; Dector, Dulce; Dector, Dulce M.; Gonzalez, Daniel R.; Estrella, Claudia R.; Sanchez-Medina, Jorge R.; Ramirez-Gutierrez, Alvaro; George, Fernando G.; Aguirre, Janet S.; Buensuseso, Juan A.; Poblano, Manuel; Dendane, Tarek; Balkhi, Hicham; Elkhayari, Mina; Samkaoui, Nacer; Ezzouine, Hanane; Benslama, Abdellatif; Amor, Mourad; Maazouzi, Wajdi; Cimic, Nedim; Beck, Oliver; Bruns, Monique M.; Schouten, Jeroen A.; Rinia, Myra; Raaijmakers, Monique; van Wezel, Hellen M.; Heines, Serge J.; Strauch, Ulrich; Buise, Marc P.; Simonis, Fabienne D.; Schultz, Marcus J.; Goodson, Jennifer C.; Browne, Troy S.; Navarra, Leanlove; Hunt, Anna; Hutchison, Robyn A.; Bailey, Mathew B.; Newby, Lynette; Mcarthur, Colin; Kalkoff, Michael; Mcleod, Alex; Casement, Jonathan; Hacking, Danielle J.; Andersen, Finn H.; Dolva, Merete S.; Laake, Jon H.; Barratt-Due, Andreas; Noremark, Kim Andre L.; Søreide, Eldar; Sjøbø, Brit Å; Guttormsen, Anne B.; Yoshido, Hector H. Leon; Aguilar, Ronald Zumaran; Oscanoa, Fredy A. Montes; Alisasis, Alain U.; Robles, Joanne B.; Pasanting-Lim, Rossini Abbie B.; Tan, Beatriz C.; Andruszkiewicz, Pawel; Jakubowska, Karina; Coxo, Cristina M.; Alvarez, António M.; Oliveira, Bruno S.; Montanha, Gustavo M.; Barros, Nelson C.; Pereira, Carlos S.; Messias, António M.; Monteiro, Jorge M.; Araujo, Ana M.; Catorze, Nuno T.; Marum, Susan M.; Bouw, Maria J.; Gomes, Rui M.; Brito, Vania A.; Castro, Silvia; Estilita, Joana M.; Barros, Filipa M.; Serra, Isabel M.; Martinho, Aurelia M.; Tomescu, Dana R.; Marcu, Alexandra; Bedreag, Ovidiu H.; Papurica, Marius; Corneci, Dan E.; Negoita, Silvius Ioan; Grigoriev, Evgeny; Gritsan, Alexey I.; Gazenkampf, Andrey A.; Almekhlafi, Ghaleb; Albarrak, Mohamad M.; Mustafa, Ghanem M.; Maghrabi, Khalid A.; Salahuddin, Nawal; Aisa, Tharwat M.; Al Jabbary, Ahmed S.; Tabhan, Edgardo; Trinidad, Olivia A.; Al Dorzi, Hasan M.; Tabhan, Edgardo E.; Bolon, Stefan; Smith, Oliver; Mancebo, Jordi; Lopez-Delgado, Juan C.; Esteve, Francisco; Rialp, Gemma; Forteza, Catalina; de Haro, Candelaria; Artigas, Antonio; Albaiceta, Guillermo M.; de Cima-Iglesias, Sara; Seoane-Quiroga, Leticia; Ruiz-Aguilar, Antonio L.; Claraco-Vega, Luis M.; Soler, Juan Alfonso; Lorente, Maria del Carmen; Hermosa, Cecilia; Gordo, Federico; Prieto-González, Miryam; López-Messa, Juan B.; Perez, Manuel P.; Perez, Cesar P.; Allue, Raquel Montoiro; Roche-Campo, Ferran; Ibañez-Santacruz, Marcos; Temprano, Susana; Pintado, Maria C.; de Pablo, Raul; Gómez, Pilar Ricart Aroa; Rodriguez Ruiz, Silvia; Iglesias Moles, Silvia; Jurado, Mª Teresa; Arizmendi, Alfons; Piacentini, Enrique A.; Franco, Nieves; Honrubia, Teresa; Perez Cheng, Meisy; Perez Losada, Elena; Blanco, Javier; Yuste, Luis J.; Carbayo-Gorriz, Cecilia; Cazorla-Barranquero, Francisca G.; Alonso, Javier G.; Alda, Rosa S.; Algaba, Ángela; Navarro, Gonzalo; Cereijo, Enrique; Diaz-Rodriguez, Esther; Pastor Marcos, Diego; Alvarez Montero, Laura; Herrera Para, Luis; Jimenez Sanchez, Roberto; Blasco Navalpotro, Miguel Angel; Diaz Abad, Ricardo; Castro, Alejandro G.; Jose D Artiga, Maria; Ceniceros-Barros, Alexandra; Montiel González, Raquel; Parrilla Toribio, Dácil; Penuelas, Oscar; Roser, Tomas P.; Olga, Moreno F.; Gallego Curto, Elena; Manzano Sánchez, Rocío; Imma, Vallverdu P.; Elisabet, Garcia M.; Claverias, Laura; Magret, Monica; Pellicer, Ana M.; Rodriguez, Lucia L.; Sánchez-Ballesteros, Jesús; González-Salamanca, Ángela; Jimenez, Antonio G.; Huerta, Francisco P.; Sotillo Diaz, Juan Carlos J.; Bermejo Lopez, Esther; Llinares Moya, David D.; Tallet Alfonso, Alec A.; Eugenio Luis, Palazon Sanchez; Sanchez Cesar, Palazon; Rafael, Sánchez I.; Virgilio, Corcoles G.; Recio, Noelia N.; Adamsson, Richard O.; Rylander, Christian C.; Holzgraefe, Bernhard; Broman, Lars M.; Wessbergh, Joanna; Persson, Linnea; Schiöler, Fredrik; Kedelv, Hans; Oscarsson Tibblin, Anna; Appelberg, Henrik; Hedlund, Lars; Helleberg, Johan; Eriksson, Karin E.; Glietsch, Rita; Larsson, Niklas; Nygren, Ingela; Nunes, Silvia L.; Morin, Anna-Karin; Kander, Thomas; Adolfsson, Anne; Zender, Hervé O.; Leemann-Refondini, Corinne; Elatrous, Souheil; Bouchoucha, Slaheddine; Chouchene, Imed; Ouanes, Islem; Souissi, Asma Ben; Kamoun, Salma; Demirkiran, Oktay; Aker, Mustafa; Erbabacan, Emre; Ceylan, Ilkay; Girgin, Nermin Kelebek; Ozcelik, Menekse; Ünal, Necmettin; Meco, Basak Ceyda; Akyol, Onat O.; Derman, Suleyman S.; Kennedy, Barry; Parhar, Ken; Srinivasa, Latha; McAuley, Danny; Hopkins, Phil; Mellis, Clare; Kakar, Vivek; Hadfield, Dan; Vercueil, Andre; Bhowmick, Kaushik; Humphreys, Sally K.; Ferguson, Andrew; Mckee, Raymond; Raj, Ashok S.; Fawkes, Danielle A.; Watt, Philip; Twohey, Linda; Jha, Rajeev R.; Thomas, Matthew; Morton, Alex; Kadaba, Varsha; Smith, Mark J.; Hormis, Anil P.; Kannan, Santhana G.; Namih, Miriam; Reschreiter, Henrik; Camsooksai, Julie; Kumar, Alek; Rugonfalvi, Szabolcs; Nutt, Christopher; Oneill, Orla; Seasman, Colette; Dempsey, Ged; Scott, Christopher J.; Ellis, Helen E.; McKechnie, Stuart; Hutton, Paula J.; Di Tomasso, Nora N.; Vitale, Michela N.; Griffin, Ruth O.; Dean, Michael N.; Cranshaw, Julius H.; Willett, Emma L.; Ioannou, Nicholas; Gillis, Sarah; Csabi, Peter; Macfadyen, Rosaleen; Dawson, Heidi; Preez, Pieter D.; Williams, Alexandra J.; Boyd, Owen; Ortiz-Ruiz de Gordoa, Laura; Bramall, Jon; Symmonds, Sophie; Chau, Simon K.; Wenham, Tim; Szakmany, Tamas; Toth-Tarsoly, Piroska; Mccalman, Katie H.; Alexander, Peter; Stephenson, Lorraine; Collyer, Thomas; Chapman, Rhiannon; Cooper, Raphael; Allan, Russell M.; Sim, Malcolm; Wrathall, David W.; Irvine, Donald A.; Zantua, Kim S.; Adams, John C.; Burtenshaw, Andrew J.; Sellors, Gareth P.; Welters, Ingeborg D.; Williams, Karen E.; Hessell, Robert J.; Oldroyd, Matthew G.; Battle, Ceri E.; Pillai, Suresh; Kajtor, Istvan; Sivashanmugavel, Mageswaran; Okane, Sinead C.; Donnelly, Adrian; Frigyik, Aniko D.; Careless, Jon P.; May, Martin M.; Stewart, Richard; Trinder, T. John; Hagan, Samantha J.; Wise, Matt P.; Cole, Jade M.; MacFie, Caroline C.; Dowling, Anna T.; Nin, Nicolás; Nuñez, Edgardo; Pittini, Gustavo; Rodriguez, Ruben; Imperio, María C.; Santos, Cristina; França, Ana G.; Ebeid, Alejandro; Deicas, Alberto; Serra, Carolina; Uppalapati, Aditya; Kamel, Ghassan; Banner-Goodspeed, Valerie M.; Beitler, Jeremy R.; Reddy Mukkera, Satyanarayana; Kulkarni, Shreedhar; Lee, Jarone; Mesar, Tomaz; Shinn Iii, John O.; Gomaa, Dina; Tainter, Christopher; Yeatts, Dale J.; Warren, Jessica; Lanspa, Michael J.; Miller, Russel R.; Grissom, Colin K.; Brown, Samuel M.; Gosselin, Ryan J.; Kitch, Barrett T.; Cohen, Jason E.; Beegle, Scott H.; Gueret, Renaud M.; Tulaimat, Aiman; Choudry, Shazia; Stigler, William; Batra, Hitesh; Huff, Nidhi G.; Lamb, Keith D.; Oetting, Trevor W.; Mohr, Nicholas M.; Judy, Claine; Saito, Shigeki; Kheir, Fayez M.; Kheir, Fayez; Schlichting, Adam B.; Delsing, Angela; Crouch, Daniel R.; Elmasri, Mary; Ismail, Dina; Dreyer, Kyle R.; Blakeman, Thomas C.; Baron, Rebecca M.; Quintana Grijalba, Carolina; Hou, Peter C.; Seethala, Raghu; Aisiku, Imo; Henderson, Galen; Frendl, Gyorgy; Hou, Sen-Kuang; Owens, Robert L.; Schomer, Ashley; Jovanovic, Bojan; Surbatovic, Maja; Veljovic, Milic

    2017-01-01

    Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the

  17. Progress in Global Surveillance and Response Capacity 10 Years After Severe Acute Respiratory Syndrome

    Centers for Disease Control (CDC) Podcasts

    2013-04-10

    Dr. Mike Miller reads an abridged version of the Emerging Infectious Diseases' synopsis, Progress in Global Surveillance and Response Capacity 10 Years after Severe Acute Respiratory Syndrome.  Created: 4/10/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/11/2013.

  18. Identification of a novel coronavirus in patients with severe acute respiratory syndrome

    NARCIS (Netherlands)

    C. Drosten (Christian); N. Escriou (Nicolas); S. Kramme; H.R. Brodt; S. Becker (Stephan); H. Rabenau; M. Eickmann; H. Schmitz; S. Muller; M. Panning; L. Kolesnikova; K. Grywna; H.D. Klenk; J. Cinatl; M. Sturmer; R.A.M. Fouchier (Ron); A.M. Burguiere; H.W. Doerr; J.C. Manuguerra; A. Berger (Annemarie); S. Gunther; W. Preiser (Wolfgang); V. Rickerts; S. Vieth; A.D.M.E. Osterhaus (Albert); S. van der Werf (Sylvie)

    2003-01-01

    textabstractBACKGROUND: The severe acute respiratory syndrome (SARS) has recently been identified as a new clinical entity. SARS is thought to be caused by an unknown infectious agent. METHODS: Clinical specimens from patients with SARS were searched for unknown viruses with the use of cell cultures

  19. Sepsis-related acute respiratory distress syndrome in children with cancer: the respiratory dynamics of a devastating condition

    Science.gov (United States)

    Arduini, Rodrigo Genaro; de Araujo, Orlei Ribeiro; da Silva, Dafne Cardoso Bourguignon; Senerchia, Andreza Almeida; Petrilli, Antonio Sergio

    2016-01-01

    Objective To evaluate the clinical course and respiratory parameters of mechanically ventilated children with cancer suffering from sepsis-related acute respiratory distress syndrome. Methods This 2-year prospective, longitudinal, observational cohort study enrolled 29 children and adolescents. Clinical data, measurements of blood gases and ventilation parameters were collected at four different time points. Fluctuations between measurements as well as differences in estimated means were analyzed by linear mixed models in which death within 28 days from the onset of acute respiratory distress syndrome was the primary endpoint. Results There were 17 deaths within 28 days of acute respiratory distress syndrome onset and another 7 between 29 - 60 days. Only 5 patients survived for more than 60 days. Nine (31%) patients died as a direct consequence of refractory hypoxemia, and the others died of multiple organ failure and catecholamine-refractory shock. In 66% of the measurements, the tidal volume required to obtain oxygen saturation equal to or above 90% was greater than 7mL/kg. The estimated means of dynamic compliance were low and were similar for survivors and non-survivors but with a negative slope between the first and final measurements, accompanied by a negative slope of the tidal volume for non-survivors. Non-survivors were significantly more hypoxemic, with PaO2/FiO2 ratios showing lower estimated means and a negative slope along the four measurements. Peak, expiratory and mean airway pressures showed positive slopes in the non-survivors, who also had more metabolic acidosis. Conclusions In most of our children with cancer, sepsis and acute respiratory distress syndrome progressed with deteriorating ventilation indexes and escalating organic dysfunction, making this triad nearly fatal in children. PMID:28099641

  20. Incorporating Inflammation into Mortality Risk in Pediatric Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Zinter, Matt S; Orwoll, Benjamin E; Spicer, Aaron C; Alkhouli, Mustafa F; Calfee, Carolyn S; Matthay, Michael A; Sapru, Anil

    2017-05-01

    In pediatric acute respiratory distress syndrome, lung injury is mediated by immune activation and severe inflammation. Therefore, we hypothesized that patients with elevated pro- and anti-inflammatory cytokines would have higher mortality rates and that these biomarkers could improve risk stratification of poor outcomes. Multicenter prospective observational study. We enrolled patients from five academic PICUs between 2008 and 2015. Patients were 1 month to 18 years old, used noninvasive or invasive ventilation, and met the American European Consensus Conference definition of acute respiratory distress syndrome. Eight proinflammatory and anti-inflammatory cytokines were measured on acute respiratory distress syndrome day 1 and correlated with mortality, ICU morbidity as measured by survivor Pediatric Logistic Organ Dysfunction score, and biomarkers of endothelial injury, including angiopoietin-2, von Willebrand Factor, and soluble thrombomodulin. We measured biomarker levels in 194 patients, including 38 acute respiratory distress syndrome nonsurvivors. Interleukin-6, interleukin-8, interleukin-10, interleukin-18, and tumor necrosis factor-R2 were each strongly associated with all-cause mortality, multiple markers of ICU morbidity, and endothelial injury. A multiple logistic regression model incorporating oxygenation index, interleukin-8, and tumor necrosis factor-R2 was superior to a model of oxygenation index alone in predicting the composite outcome of mortality or severe morbidity (area under the receiver operating characteristic, 0.77 [0.70-0.83] vs 0.70 [0.62-0.77]; p = 0.042). In pediatric acute respiratory distress syndrome, pro- and anti-inflammatory cytokines are strongly associated with mortality, ICU morbidity, and biochemical evidence of endothelial injury. These cytokines significantly improve the ability of the oxygenation index to discriminate risk of mortality or severe morbidity and may allow for identification and enrollment of high

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

    DEFF Research Database (Denmark)

    Gebistorf, Fabienne; Karam, Oliver; Wetterslev, Jørn

    2016-01-01

    BACKGROUND: Acute hypoxaemic respiratory failure (AHRF) and mostly acute respiratory distress syndrome (ARDS) are critical conditions. AHRF results from several systemic conditions and is associated with high mortality and morbidity in individuals of all ages. Inhaled nitric oxide (INO) has been...... in renal failure in the INO groups (RR 1.59, 95% CI 1.17 to 2.16; I² statistic = 0%; high quality of evidence). AUTHORS' CONCLUSIONS: Evidence is insufficient to support INO in any category of critically ill patients with AHRF. Inhaled nitric oxide results in a transient improvement in oxygenation but does...... not reduce mortality and may be harmful, as it seems to increase renal impairment....

  2. Individualized positive end-expiratory pressure application in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Pintado, M C; de Pablo, R

    2014-11-01

    Current treatment of acute respiratory distress syndrome is based on ventilatory support with a lung protective strategy, avoiding the development of iatrogenic injury, including ventilator-induced lung injury. One of the mechanisms underlying such injury is atelectrauma, and positive end-expiratory pressure (PEEP) is advocated in order to avoid it. The indicated PEEP level has not been defined, and in many cases is based on the patient oxygen requirements for maintaining adequate oxygenation. However, this strategy does not consider the mechanics of the respiratory system, which varies in each patient and depends on many factors-including particularly the duration of acute respiratory distress syndrome. A review is therefore made of the different methods for adjusting PEEP, focusing on the benefits of individualized application. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  3. Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome : Proceedings From the Pediatric Acute Lung Injury Consensus Conference

    NARCIS (Netherlands)

    Tamburro, Robert F.; Kneyber, Martin C. J.

    Objective: To provide an overview of the current literature on pulmonary-specific therapeutic approaches to pediatric acute respiratory distress syndrome to determine recommendations for clinical practice and/or future research. Data Sources: PubMed, EMBASE, CINAHL, SCOPUS, and the Cochrane Library

  4. Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation.

    Science.gov (United States)

    Frantzeskaki, Frantzeska; Armaganidis, Apostolos; Orfanos, Stylianos E

    2017-01-01

    Acute respiratory distress syndrome (ARDS) is defined as a syndrome of acute onset, with bilateral opacities on chest imaging and respiratory failure not caused by cardiac failure, leading to mild, moderate, or severe oxygenation impairment. The syndrome is most commonly a manifestation of sepsis-induced organ dysfunction, characterized by disruption of endothelial barrier integrity and diffuse lung damage. Imbalance between coagulation and inflammation is a predominant characteristic of ARDS, leading to extreme inflammatory response and diffuse fibrin deposition in vascular capillary bed and alveoli. Activated platelets, neutrophils, endothelial cells, neutrophil extracellular traps, microparticles, and coagulation proteases, participate in the complex process of immunothrombosis, which is a key event in ARDS pathophysiology. The present review is focused on the elucidation of immunothrombosis in ARDS and the potential therapeutic implications. © 2016 S. Karger AG, Basel.

  5. Adaptation of a Biomarker-Based Sepsis Mortality Risk Stratification Tool for Pediatric Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Yehya, Nadir; Wong, Hector R

    2018-01-01

    The original Pediatric Sepsis Biomarker Risk Model and revised (Pediatric Sepsis Biomarker Risk Model-II) biomarker-based risk prediction models have demonstrated utility for estimating baseline 28-day mortality risk in pediatric sepsis. Given the paucity of prediction tools in pediatric acute respiratory distress syndrome, and given the overlapping pathophysiology between sepsis and acute respiratory distress syndrome, we tested the utility of Pediatric Sepsis Biomarker Risk Model and Pediatric Sepsis Biomarker Risk Model-II for mortality prediction in a cohort of pediatric acute respiratory distress syndrome, with an a priori plan to revise the model if these existing models performed poorly. Prospective observational cohort study. University affiliated PICU. Mechanically ventilated children with acute respiratory distress syndrome. Blood collection within 24 hours of acute respiratory distress syndrome onset and biomarker measurements. In 152 children with acute respiratory distress syndrome, Pediatric Sepsis Biomarker Risk Model performed poorly and Pediatric Sepsis Biomarker Risk Model-II performed modestly (areas under receiver operating characteristic curve of 0.61 and 0.76, respectively). Therefore, we randomly selected 80% of the cohort (n = 122) to rederive a risk prediction model for pediatric acute respiratory distress syndrome. We used classification and regression tree methodology, considering the Pediatric Sepsis Biomarker Risk Model biomarkers in addition to variables relevant to acute respiratory distress syndrome. The final model was comprised of three biomarkers and age, and more accurately estimated baseline mortality risk (area under receiver operating characteristic curve 0.85, p Sepsis Biomarker Risk Model and Pediatric Sepsis Biomarker Risk Model-II, respectively). The model was tested in the remaining 20% of subjects (n = 30) and demonstrated similar test characteristics. A validated, biomarker-based risk stratification tool designed for

  6. Treatment of Adenoviral Acute Respiratory Distress Syndrome Using Cidofovir With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Lee, Minhyeok; Kim, Seulgi; Kwon, Oh Jung; Kim, Ji Hye; Jeong, Inbeom; Son, Ji Woong; Na, Moon Jun; Yoon, Yoo Sang; Park, Hyun Woong; Kwon, Sun Jung

    2017-03-01

    Adenovirus infections are associated with respiratory (especially upper respiratory) infection and gastrointestinal disease and occur primarily in infants and children. Although rare in adults, severe lower respiratory adenovirus infections including pneumonia are reported in specific populations, such as military recruits and immunocompromised patients. Antiviral treatment is challenging due to limited clinical experience and lack of well-controlled randomized trials. Several previously reported cases of adenoviral pneumonia showed promising efficacy of cidofovir. However, few reports discussed the efficacy of cidofovir in acute respiratory distress syndrome (ARDS). We experienced 3 cases of adenoviral pneumonia associated with ARDS and treated with cidofovir and respiratory support, including extracorporeal membrane oxygenation (ECMO). All 3 patients showed a positive clinical response to cidofovir and survival at 28 days. Cidofovir with early ECMO therapy may be a therapeutic option in adenoviral ARDS. A literature review identified 15 cases of adenovirus pneumonia associated with ARDS.

  7. Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome: Lung-distending Pressure and Patient-Ventilator Interaction

    NARCIS (Netherlands)

    Doorduin, J.; Sinderby, C.A.; Beck, J.; Hoeven, J.G. van der; Heunks, L.M.

    2015-01-01

    BACKGROUND: In patients with acute respiratory distress syndrome (ARDS), the use of assisted mechanical ventilation is a subject of debate. Assisted ventilation has benefits over controlled ventilation, such as preserved diaphragm function and improved oxygenation. Therefore, higher level of

  8. Validation of Impact of Events Scale in nurses under threat of contagion by severe acute respiratory syndrome

    National Research Council Canada - National Science Library

    CHEN, CHENG‐SHENG; YANG, PINCHEN; YEN, CHENG‐FANG; WU, HSIU‐YUEH

    2005-01-01

    ...) in a sample of nurses working under threat of severe acute respiratory syndrome (SARS). The internal consistency, construct validity and convergent validity of the instrument were examined in a sample of 128 nurses during the SARS outbreak in Taiwan...

  9. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

    NARCIS (Netherlands)

    Bellani, Giacomo; Laffey, John G.; Pham, Tài; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; van Haren, Frank; Larsson, Anders; McAuley, Daniel F.; Ranieri, Marco; Rubenfeld, Gordon; Thompson, B. Taylor; Wrigge, Hermann; Slutsky, Arthur S.; Pesenti, Antonio; Francois, Guy M.; Rabboni, Francesca; Madotto, Fabiana; Conti, Sara; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Brizuela, Matias; Gianinetto, Hernan; Gomez, Pablo E.; Cerrato, Valeria I.; Bezzi, Marco G.; Borello, Silvina A.; Loiacono, Flavia A.; Fernandez, Adriana M.; Knowles, Serena; Reynolds, Claire; Inskip, Deborah M.; Miller, Jennene J.; Kong, Jing; Whitehead, Christina; Bihari, Shailesh; Seven, Aylin; Krstevski, Amanda; Rodgers, Helen J.; Millar, Rebecca T.; Mckenna, Toni E.; Bailey, Irene M.; Hanlon, Gabrielle C.; Aneman, Anders; Lynch, Joan M.; Azad, Raman; Neal, John; Woods, Paul W.; Roberts, Brigit L.; Kol, Mark R.; Wong, Helen S.; Riss, Katharina C.; Staudinger, Thomas; Wittebole, Xavier; Berghe, Caroline; Bulpa, Pierre A.; Dive, Alain M.; Verstraete, Rik; Lebbinck, Herve; Depuydt, Pieter; Vermassen, Joris; Meersseman, Philippe; Ceunen, Helga; Rosa, Jonas I.; Beraldo, Daniel O.; Piras, Claudio; Rampinelli, Adenilton M.; Nassar, Antonio P.; Mataloun, Sergio; Moock, Marcelo; Thompson, Marlus M.; Gonçalves, Claudio H.; Antônio, Ana Carolina P.; Ascoli, Aline; Biondi, Rodrigo S.; Fontenele, Danielle C.; Nobrega, Danielle; Sales, Vanessa M.; Shindhe, Suresh; Ismail, Dk Maizatul Aiman B. Pg Hj; Laffey, John; Beloncle, Francois; Davies, Kyle G.; Cirone, Rob; Manoharan, Venika; Ismail, Mehvish; Goligher, Ewan C.; Jassal, Mandeep; Ferguson, Niall D.; Nishikawa, Erin; Javeed, Areej; Curley, Gerard; Rittayamai, Nuttapol; Parotto, Matteo; Mehta, Sangeeta; Knoll, Jenny; Pronovost, Antoine; Canestrini, Sergio; Bruhn, Alejandro R.; Garcia, Patricio H.; Aliaga, Felipe A.; Farías, Pamela A.; Yumha, Jacob S.; Ortiz, Claudia A.; Salas, Javier E.; Saez, Alejandro A.; Vega, Luis D.; Labarca, Eduardo F.; Martinez, Felipe T.; Carreño, Nicolás G.; Lora, Pilar; Liu, Haitao; Qiu, Haibo; Liu, Ling; Tang, Rui; Luo, Xiaoming; An, Youzhong; Zhao, Huiying; Gao, Yan; Zhai, Zhe; Ye, Zheng L.; Wang, Wei; Li, Wenwen; Li, Qingdong; Zheng, Ruiqiang; Yu, Wenkui; Shen, Juanhong; Li, Xinyu; Yu, Tao; Lu, Weihua; Wu, Ya Q.; Huang, Xiao B.; He, Zhenyang; Lu, Yuanhua; Han, Hui; Zhang, Fan; Sun, Renhua; Wang, Hua X.; Qin, Shu H.; Zhu, Bao H.; Zhao, Jun; Liu, Jian; Li, Bin; Liu, Jing L.; Zhou, Fa C.; Li, Qiong J.; Zhang, Xing Y.; Li-Xin, Zhou; Xin-Hua, Qiang; Jiang, Liangyan; Gao, Yuan N.; Zhao, Xian Y.; Li, Yuan Y.; Li, Xiao L.; Wang, Chunting; Yao, Qingchun; Yu, Rongguo; Chen, Kai; Shao, Huanzhang; Qin, Bingyu; Huang, Qing Q.; Zhu, Wei H.; Hang, Ai Y.; Hua, Ma X.; Li, Yimin; Xu, Yonghao; Di, Yu D.; Ling, Long L.; Qin, Tie H.; Wang, Shou H.; Qin, Junping; Han, Yi; Zhou, Suming; Vargas, Monica P.; Jimenez, Juan I. Silesky; Rojas, Manuel A. González; Solis-Quesada, Jaime E.; Ramirez-Alfaro, Christian M.; Máca, Jan; Sklienka, Peter; Gjedsted, Jakob; Christiansen, Aage; Nielsen, Jonas; Villamagua, Boris G.; Llano, Miguel; Burtin, Philippe; Buzancais, Gautier; Beuret, Pascal; Pelletier, Nicolas; Mortaza, Satar; Mercat, Alain; Chelly, Jonathan; Jochmans, Sébastien; Terzi, Nicolas; Daubin, Cédric; Carteaux, Guillaume; de Prost, Nicolas; Chiche, Jean-Daniel; Daviaud, Fabrice; Fartoukh, Muriel; Barberet, Guillaume; Biehler, Jerome; Dellamonica, Jean; Doyen, Denis; Arnal, Jean-Michel; Briquet, Anais; Klasen, Fanny; Papazian, Laurent; Follin, Arnaud; Roux, Damien; Messika, Jonathan; Kalaitzis, Evangelos; Dangers, Laurence; Combes, Alain; Au, Siu-Ming; Béduneau, Gaetan; Carpentier, Dorothée; Zogheib, Elie H.; Dupont, Herve; Ricome, Sylvie; Santoli, Francesco L.; Besset, Sebastien L.; Michel, Philippe; Gelée, Bruno; Danin, Pierre-Eric; Goubaux, Bernard; Crova, Philippe J.; Phan, Nga T.; Berkelmans, Frantz; Badie, Julio C.; Tapponnier, Romain; Gally, Josette; Khebbeb, Samy; Herbrecht, Jean-Etienne; Schneider, Francis; Declercq, Pierre-Louis M.; Rigaud, Jean-Philippe; Duranteau, Jacques; Harrois, Anatole; Chabanne, Russell; Marin, Julien; Constantin, Jean-Michel; Thibault, Sandrine; Ghazi, Mohammed; Boukhazna, Messabi; Zein, Salem Ould; Richecoeur, Jack R.; Combaux, Daniele M.; Grelon, Fabien; Le Moal, Charlene; Sauvadet, Elise P.; Robine, Adrien; Lemiale, Virginie; Reuter, Danielle; Dres, Martin; Demoule, Alexandre; Goldgran-Toledano, Dany; Baboi, Loredana; Guérin, Claude; Lohner, Ralph; Kraßler, Jens; Schäfer, Susanne; Zacharowski, Kai D.; Meybohm, Patrick; Reske, Andreas W.; Simon, Philipp; Hopf, Hans-Bernd F.; Schuetz, Michael; Baltus, Thomas; Papanikolaou, Metaxia N.; Papavasilopoulou, Theonymfi G.; Zacharas, Giannis A.; Ourailogloy, Vasilis; Mouloudi, Eleni K.; Massa, Eleni V.; Nagy, Eva O.; Stamou, Electra E.; Kiourtzieva, Ellada V.; Oikonomou, Marina A.; Avila, Luis E.; Cortez, Cesar A.; Citalán, Johanna E.; Jog, Sameer A.; Sable, Safal D.; Shah, Bhagyesh; Gurjar, Mohan; Baronia, Arvind K.; Memon, Mohammedfaruk; Muthuchellappan, Radhakrishnan; Ramesh, Venkatapura J.; Shenoy, Anitha; Unnikrishnan, Ramesh; Dixit, Subhal B.; Rhayakar, Rachana V.; Ramakrishnan, Nagarajan; Bhardwaj, Vallish K.; Mahto, Heera L.; Sagar, Sudha V.; Palaniswamy, Vijayanand; Ganesan, Deeban; Hashemian, Seyed Mohammadreza; Jamaati, Hamidreza; Heidari, Farshad; Meaney, Edel A.; Nichol, Alistair; Knapman, Karl M.; O'Croinin, Donall; Dunne, Eimhin S.; Breen, Dorothy M.; Clarkson, Kevin P.; Jaafar, Rola F.; Dwyer, Rory; Amir, Fahd; Ajetunmobi, Olaitan O.; O'Muircheartaigh, Aogan C.; Black, Colin S.; Treanor, Nuala; Collins, Daniel V.; Altaf, Wahid; Zani, Gianluca; Fusari, Maurizio; Spadaro, Savino; Volta, Carlo A.; Graziani, Romano; Brunettini, Barbara; Palmese, Salvatore; Formenti, Paolo; Umbrello, Michele; Lombardo, Andrea; Pecci, Elisabetta; Botteri, Marco; Savioli, Monica; Protti, Alessandro; Mattei, Alessia; Schiavoni, Lorenzo; Tinnirello, Andrea; Todeschini, Manuel; Giarratano, Antonino; Cortegiani, Andrea; Sher, Sara; Rossi, Anna; Antonelli, Massimo M.; Montini, Luca M.; Casalena, Paolo; Scafetti, Sergio; Panarello, Giovanna; Occhipinti, Giovanna; Patroniti, Nicolò; Pozzi, Matteo; Biscione, Roberto R.; Poli, Michela M.; Raimondi, Ferdinando; Albiero, Daniela; Crapelli, Giulia; Beck, Eduardo; Pota, Vincenzo; Schiavone, Vincenzo; Molin, Alexandre; Tarantino, Fabio; Monti, Giacomo; Frati, Elena; Mirabella, Lucia; Cinnella, Gilda; Fossali, Tommaso; Colombo, Riccardo; Pattarino, Pierpaolo Terragni Ilaria; Mojoli, Francesco; Braschi, Antonio; Borotto, Erika E.; Cracchiolo, Andrea N.; Palma, Daniela M.; Raponi, Francesco; Foti, Giuseppe; Vascotto, Ettore R.; Coppadoro, Andrea; Brazzi, Luca; Floris, Leda; Iotti, Giorgio A.; Venti, Aaron; Yamaguchi, Osamu; Takagi, Shunsuke; Maeyama, Hiroki N.; Watanabe, Eizo; Yamaji, Yoshihiro; Shimizu, Kazuyoshi; Shiozaki, Kyoko; Futami, Satoru; Ryosuke, Sekine; Saito, Koji; Kameyama, Yoshinobu; Ueno, Keiko; Izawa, Masayo; Okuda, Nao; Suzuki, Hiroyuki; Harasawa, Tomofumi; Nasu, Michitaka; Takada, Tadaaki; Ito, Fumihito; Nunomiya, Shin; Koyama, Kansuke; Abe, Toshikazu; Andoh, Kohkichi; Kusumoto, Kohei; Hirata, Akira; Takaba, Akihiro; Kimura, Hiroyasu; Matsumoto, Shuhei; Higashijima, Ushio; Honda, Hiroyuki; Aoki, Nobumasa; Imai, Hiroshi; Ogino, Yasuaki; Mizuguchi, Ichiko; Ichikado, Kazuya; Nitta, Kenichi; Mochizuki, Katsunori; Hashida, Tomoaki; Tanaka, Hiroyuki; Nakamura, Tomoyuki; Niimi, Daisuke; Ueda, Takeshi; Kashiwa, Yozo; Uchiyama, Akinori; Sabelnikovs, Olegs; Oss, Peteris; Haddad, Youssef; Liew, Kong Y.; Ñamendys-Silva, Silvio A.; Jarquin-Badiola, Yves D.; Sanchez-Hurtado, Luis A.; Gomez-Flores, Saira S.; Marin, Maria C.; Villagomez, Asisclo J.; Lemus, Jordana S.; Fierro, Jonathan M.; Cervantes, Mavy Ramirez; Mejia, Francisco Javier Flores; Dector, Dulce; Dector, Dulce M.; Gonzalez, Daniel R.; Estrella, Claudia R.; Sanchez-Medina, Jorge R.; Ramirez-Gutierrez, Alvaro; George, Fernando G.; Aguirre, Janet S.; Buensuseso, Juan A.; Poblano, Manuel; Dendane, Tarek; Zeggwagh, Amine Ali; Balkhi, Hicham; Elkhayari, Mina; Samkaoui, Nacer; Ezzouine, Hanane; Benslama, Abdellatif; Amor, Mourad; Maazouzi, Wajdi; Cimic, Nedim; Beck, Oliver; Bruns, Monique M.; Schouten, Jeroen A.; Rinia, Myra; Raaijmakers, Monique; Heunks, Leo M.; van Wezel, Hellen M.; Heines, Serge J.; Strauch, Ulrich; Buise, Marc P.; Simonis, Fabienne D.; Schultz, Marcus J.; Goodson, Jennifer C.; Browne, Troy S.; Navarra, Leanlove; Hunt, Anna; Hutchison, Robyn A.; Bailey, Mathew B.; Newby, Lynette; Mcarthur, Colin; Kalkoff, Michael; Mcleod, Alex; Casement, Jonathan; Hacking, Danielle J.; Andersen, Finn H.; Dolva, Merete S.; Laake, Jon H.; Barratt-Due, Andreas; Noremark, Kim Andre L.; Søreide, Eldar; Sjøbø, Brit Å; Guttormsen, Anne B.; Yoshido, Hector H. Leon; Aguilar, Ronald Zumaran; Oscanoa, Fredy A. Montes; Alisasis, Alain U.; Robles, Joanne B.; Pasanting-Lim, Rossini Abbie B.; Tan, Beatriz C.; Andruszkiewicz, Pawel; Jakubowska, Karina; Coxo, Cristina M.; Alvarez, António M.; Oliveira, Bruno S.; Montanha, Gustavo M.; Barros, Nelson C.; Pereira, Carlos S.; Messias, António M.; Monteiro, Jorge M.; Araujo, Ana M.; Catorze, Nuno T.; Marum, Susan M.; Bouw, Maria J.; Gomes, Rui M.; Brito, Vania A.; Castro, Silvia; Estilita, Joana M.; Barros, Filipa M.; Serra, Isabel M.; Martinho, Aurelia M.; Tomescu, Dana R.; Marcu, Alexandra; Bedreag, Ovidiu H.; Papurica, Marius; Corneci, Dan E.; Negoita, Silvius Ioan; Grigoriev, Evgeny; Gritsan, Alexey I.; Gazenkampf, Andrey A.; Almekhlafi, Ghaleb; Albarrak, Mohamad M.; Mustafa, Ghanem M.; Maghrabi, Khalid A.; Salahuddin, Nawal; Aisa, Tharwat M.; Al Jabbary, Ahmed S.; Tabhan, Edgardo; Arabi, Yaseen M.; Trinidad, Olivia A.; Al Dorzi, Hasan M.; Tabhan, Edgardo E.; Bolon, Stefan; Smith, Oliver; Mancebo, Jordi; Aguirre-Bermeo, Hernan; Lopez-Delgado, Juan C.; Esteve, Francisco; Rialp, Gemma; Forteza, Catalina; de Haro, Candelaria; Artigas, Antonio; Albaiceta, Guillermo M.; de Cima-Iglesias, Sara; Seoane-Quiroga, Leticia; Ceniceros-Barros, Alexandra; Ruiz-Aguilar, Antonio L.; Claraco-Vega, Luis M.; Soler, Juan Alfonso; Lorente, Maria del Carmen; Hermosa, Cecilia; Gordo, Federico; Prieto-González, Miryam; López-Messa, Juan B.; Perez, Manuel P.; Perez, Cesar P.; Allue, Raquel Montoiro; Roche-Campo, Ferran; Ibañez-Santacruz, Marcos; Temprano, Susana; Pintado, Maria C.; de Pablo, Raul; Gómez, Pilar Ricart Aroa; Ruiz, Silvia Rodriguez; Moles, Silvia Iglesias; Jurado, Ma Teresa; Arizmendi, Alfons; Piacentini, Enrique A.; Franco, Nieves; Honrubia, Teresa; Cheng, Meisy Perez; Losada, Elena Perez; Blanco, Javier; Yuste, Luis J.; Carbayo-Gorriz, Cecilia; Cazorla-Barranquero, Francisca G.; Alonso, Javier G.; Alda, Rosa S.; Algaba, Ángela; Navarro, Gonzalo; Cereijo, Enrique; Diaz-Rodriguez, Esther; Marcos, Diego Pastor; Montero, Laura Alvarez; Para, Luis Herrera; Sanchez, Roberto Jimenez; Navalpotro, Miguel Angel Blasco; Abad, Ricardo Diaz; González, Raquel Montiel; Toribio, Dácil Parrilla; Castro, Alejandro G.; Artiga, Maria Jose D.; Penuelas, Oscar; Roser, Tomas P.; Olga, Moreno F.; Curto, Elena Gallego; Sánchez, Rocío Manzano; Imma, Vallverdu P.; Elisabet, Garcia M.; Claverias, Laura; Magret, Monica; Pellicer, Ana M.; Rodriguez, Lucia L.; Sánchez-Ballesteros, Jesús; González-Salamanca, Ángela; Jimenez, Antonio G.; Huerta, Francisco P.; Diaz, Juan Carlos J. Sotillo; Lopez, Esther Bermejo; Moya, David D. Llinares; Alfonso, Alec A. Tallet; Luis, Palazon Sanchez Eugenio; Cesar, Palazon Sanchez; Rafael, Sánchez I.; Virgilio, Corcoles G.; Recio, Noelia N.; Adamsson, Richard O.; Rylander, Christian C.; Holzgraefe, Bernhard; Broman, Lars M.; Wessbergh, Joanna; Persson, Linnea; Schiöler, Fredrik; Kedelv, Hans; Tibblin, Anna Oscarsson; Appelberg, Henrik; Hedlund, Lars; Helleberg, Johan; Eriksson, Karin E.; Glietsch, Rita; Larsson, Niklas; Nygren, Ingela; Nunes, Silvia L.; Morin, Anna-Karin; Kander, Thomas; Adolfsson, Anne; Piquilloud, Lise; Zender, Hervé O.; Leemann-Refondini, Corinne; Elatrous, Souheil; Bouchoucha, Slaheddine; Chouchene, Imed; Ouanes, Islem; Ben Souissi, Asma; Kamoun, Salma; Demirkiran, Oktay; Aker, Mustafa; Erbabacan, Emre; Ceylan, Ilkay; Girgin, Nermin Kelebek; Ozcelik, Menekse; Ünal, Necmettin; Meco, Basak Ceyda; Akyol, Onat O.; Derman, Suleyman S.; Kennedy, Barry; Parhar, Ken; Srinivasa, Latha; McNamee, Lia; McAuley, Danny; Steinberg, Jack; Hopkins, Phil; Mellis, Clare; Kakar, Vivek; Hadfield, Dan; Vercueil, Andre; Bhowmick, Kaushik; Humphreys, Sally K.; Ferguson, Andrew; Mckee, Raymond; Raj, Ashok S.; Fawkes, Danielle A.; Watt, Philip; Twohey, Linda; Jha, Rajeev R.; Thomas, Matthew; Morton, Alex; Kadaba, Varsha; Smith, Mark J.; Hormis, Anil P.; Kannan, Santhana G.; Namih, Miriam; Reschreiter, Henrik; Camsooksai, Julie; Kumar, Alek; Rugonfalvi, Szabolcs; Nutt, Christopher; Oneill, Orla; Seasman, Colette; Dempsey, Ged; Scott, Christopher J.; Ellis, Helen E.; McKechnie, Stuart; Hutton, Paula J.; Di Tomasso, Nora N.; Vitale, Michela N.; Griffin, Ruth O.; Dean, Michael N.; Cranshaw, Julius H.; Willett, Emma L.; Ioannou, Nicholas; Gillis, Sarah; Csabi, Peter; Macfadyen, Rosaleen; Dawson, Heidi; Preez, Pieter D.; Williams, Alexandra J.; Boyd, Owen; de Gordoa, Laura Ortiz-Ruiz; Bramall, Jon; Symmonds, Sophie; Chau, Simon K.; Wenham, Tim; Szakmany, Tamas; Toth-Tarsoly, Piroska; Mccalman, Katie H.; Alexander, Peter; Stephenson, Lorraine; Collyer, Thomas; Chapman, Rhiannon; Cooper, Raphael; Allan, Russell M.; Sim, Malcolm; Wrathall, David W.; Irvine, Donald A.; Zantua, Kim S.; Adams, John C.; Burtenshaw, Andrew J.; Sellors, Gareth P.; Welters, Ingeborg D.; Williams, Karen E.; Hessell, Robert J.; Oldroyd, Matthew G.; Battle, Ceri E.; Pillai, Suresh; Kajtor, Istvan; Sivashanmugavel, Mageswaran; Okane, Sinead C.; Donnelly, Adrian; Frigyik, Aniko D.; Careless, Jon P.; May, Martin M.; Stewart, Richard; Trinder, T. John; Hagan, Samantha J.; Wise, Matt P.; Cole, Jade M.; MacFie, Caroline C.; Dowling, Anna T.; Hurtado, Javier; Nin, Nicolás; Nuñez, Edgardo; Pittini, Gustavo; Rodriguez, Ruben; Imperio, María C.; Santos, Cristina; França, Ana G.; Ebeid, Alejandro; Deicas, Alberto; Serra, Carolina; Uppalapati, Aditya; Kamel, Ghassan; Banner-Goodspeed, Valerie M.; Beitler, Jeremy R.; Mukkera, Satyanarayana Reddy; Kulkarni, Shreedhar; Lee, Jarone; Mesar, Tomaz; Shinn, John O.; Gomaa, Dina; Tainter, Christopher; Yeatts, Dale J.; Warren, Jessica; Lanspa, Michael J.; Miller, Russel R.; Grissom, Colin K.; Brown, Samuel M.; Bauer, Philippe R.; Gosselin, Ryan J.; Kitch, Barrett T.; Cohen, Jason E.; Beegle, Scott H.; Stoger, John H.; Gueret, Renaud M.; Tulaimat, Aiman; Choudry, Shazia; Stigler, William; Batra, Hitesh; Huff, Nidhi G.; Lamb, Keith D.; Oetting, Trevor W.; Mohr, Nicholas M.; Judy, Claine; Saito, Shigeki; Kheir, Fayez M.; Kheir, Fayez; Schlichting, Adam B.; Delsing, Angela; Crouch, Daniel R.; Elmasri, Mary; Ismail, Dina; Dreyer, Kyle R.; Blakeman, Thomas C.; Baron, Rebecca M.; Grijalba, Carolina Quintana; Hou, Peter C.; Seethala, Raghu; Aisiku, Imo; Henderson, Galen; Frendl, Gyorgy; Hou, Sen-Kuang; Owens, Robert L.; Schomer, Ashley; Bumbasirevic, Vesna; Jovanovic, Bojan; Surbatovic, Maja; Veljovic, Milic

    2016-01-01

    IMPORTANCE Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation

  10. Recombinant human activated protein C in the treatment of acute respiratory distress syndrome : A randomized clinical trial

    NARCIS (Netherlands)

    A.D. Cornet (Alexander); A.B.J. Groeneveld (Johan); J.J. Hofstra (Jorrit Jan); A.P.J. Vlaar (Alexander); S. Tuinman (Sietske); A. van Lingen (Arthur); M. Levi (Michael); A.R.J. Girbes (Armand); M.J. Schultz (Marcus); A. Beishuizen (Auke)

    2014-01-01

    textabstractRationale: Pulmonary coagulopathy may play a pathogenetic role in acute respiratory distress syndrome (ARDS), by contributing to alveolocapillary inflammation and increased permeability. Recombinant human activated protein C (rh-APC) may inhibit this process and thereby improve patient

  11. The effect of inhaled nitric oxide in acute respiratory distress syndrome in children and adults

    DEFF Research Database (Denmark)

    Karam, O; Gebistorf, F; Wetterslev, J

    2017-01-01

    differences in ventilator-free days, duration of mechanical ventilation, resolution of multi-organ failure, quality of life, length of stay in intensive care unit or hospital, cost-benefit analysis and methaemoglobin and nitrogen dioxide levels. There was an increased risk of renal impairment (risk ratio (95......Acute respiratory distress syndrome is associated with high mortality and morbidity. Inhaled nitric oxide has been used to improve oxygenation but its role remains controversial. Our primary objective in this systematic review was to examine the effects of inhaled nitric oxide administration...... on mortality in adults and children with acute respiratory distress syndrome. We included all randomised, controlled trials, irrespective of date of publication, blinding status, outcomes reported or language. Our primary outcome measure was all-cause mortality. We performed several subgroup and sensitivity...

  12. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report

    OpenAIRE

    Chan-Yeung, Moira; Yu, W. C.

    2003-01-01

    OBJECTIVE: To describe the outbreak of severe acute respiratory syndrome in Hong Kong. DESIGN: Descriptive case series. SETTING: Hong Kong, Special Administrative Region, China RESULTS: The outbreak started with a visitor from southern China on 21 February. At the hospitals where the first cases were treated the disease spread quickly among healthcare workers, and then out into the community as family members became infected. By 1 April, 685 cases had been reported with 16 deaths. Symptoms in...

  13. Surfactant Apoprotein D in Preterm Neonates with Acute Respiratory Distress Syndrome

    OpenAIRE

    S. A. Perepelitsa; Golubev, A M; V. V. Moroz; Ye. Yu. Yefremova; O. B. Avakyan; M. V. Sakayeva; I.I. Klintsevich

    2009-01-01

    Objective: to study the production of surfactant apoprotein D in preterm neonates with acute respiratory distress syndrome (ARDS) during artificial ventilation (AV). Subjects and methods. The paper presents the results of studying the production of surfactant protein D (SP-D) in various biological fluids in 44 preterm neonates. Two groups of newborn infants were identified according to the clinical manifestations of ARDS. The study group comprised 25 infants with the severe course of the dise...

  14. Genomic Analysis Reveals Age-Dependent Innate Immune Responses to Severe Acute Respiratory Syndrome Coronavirus▿ †

    OpenAIRE

    Baas, Tracey; Roberts, Anjeanette; Teal, Thomas H; Vogel, Leatrice; Chen, Jun; Tumpey, Terrence M.; Katze, Michael G.; Subbarao, Kanta

    2008-01-01

    The relationship between immunosenescence and the host response to virus infection is poorly understood at the molecular level. Two different patterns of pulmonary host responses to virus were observed when gene expression profiles from severe acute respiratory syndrome coronavirus (SARS-CoV)-infected young mice that show minimal disease were compared to those from SARS-CoV-infected aged mice that develop pneumonitis. In young mice, genes related to cellular development, cell growth, and cell...

  15. Cross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human

    OpenAIRE

    Song, Huai-Dong; Tu, Chang-chun; Zhang, Guo-wei; Wang, Sheng-Yue; Zheng, Kui; Lei, Lian-Cheng; Chen, Qiu-Xia; Gao, Yu-Wei; Zhou, Hui-qiong; Xiang, Hua; Zheng, Hua-Jun; Chern, Shur-Wern Wang; Cheng, Feng; Pan, Chun-Ming; Xuan, Hua

    2005-01-01

    The genomic sequences of severe acute respiratory syndrome coronaviruses from human and palm civet of the 2003/2004 outbreak in the city of Guangzhou, China, were nearly identical. Phylogenetic analysis suggested an independent viral invasion from animal to human in this new episode. Combining all existing data but excluding singletons, we identified 202 single-nucleotide variations. Among them, 17 are polymorphic in palm civets only. The ratio of nonsynonymous/synonymous nucleotide substitut...

  16. The pragmatics of feeding the pediatric patient with acute respiratory distress syndrome.

    Science.gov (United States)

    Verger, Judy T; Bradshaw, Darla J; Henry, Elizabeth; Roberts, Kathryn E

    2004-09-01

    Acute respiratory distress syndrome (ARDS) represents the ultimate pulmonary response to a wide range of injuries, from septicemia to trauma. Optimal nutrition is vital to enhancing oxygen delivery, supporting adequate cardiac contractility and respiratory musculature, eliminating fluid and electrolyte imbalances, and supporting the proinflammatory response. Research is providing a better understanding of nutrients that specifically address the complex physiologic changes in ARDS. This article highlights the pathophysiology of ARDS as it relates to nutrition, relevant nutritional assessment, and important enteral and parenteral considerations for the pediatric patient who has ARDS.

  17. The Recent Severe Acute Respiratory Syndrome (SARS) Epidemic ...

    African Journals Online (AJOL)

    The symptoms of SARS are quite similar to those of common cold, malaria and respiratory tract infections all of which are common in our environment. SARS, being a new disease, has as yet neither a definite diagnostic test nor treatment. With the international transmission of SARS first reported in March 2003, it became ...

  18. Mortality Factor Survey of Severe Acute Respiratory Syndrome in Taiwan

    Directory of Open Access Journals (Sweden)

    Tei-Chu Liu

    2009-03-01

    Conclusion: The mortality rate of intubation patients was 115 times higher than that of those who did not require intubation. Therefore, special care must be taken with SARS disease with severe infiltration chest X-ray images and respiratory distress. Positive medical treatment should be performed to lower the mortality rate.

  19. Comparative Epidemiology of Human Infections with Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome Coronaviruses among Healthcare Personnel.

    Directory of Open Access Journals (Sweden)

    Shelan Liu

    Full Text Available The largest nosocomial outbreak of Middle East respiratory syndrome (MERS occurred in South Korea in 2015. Health Care Personnel (HCP are at high risk of acquiring MERS-Coronavirus (MERS-CoV infections, similar to the severe acute respiratory syndrome (SARS-Coronavirus (SARS-CoV infections first identified in 2003. This study described the similarities and differences in epidemiological and clinical characteristics of 183 confirmed global MERS cases and 98 SARS cases in Taiwan associated with HCP. The epidemiological findings showed that the mean age of MERS-HCP and total MERS cases were 40 (24~74 and 49 (2~90 years, respectively, much older than those in SARS [SARS-HCP: 35 (21~68 years, p = 0.006; total SARS: 42 (0~94 years, p = 0.0002]. The case fatality rates (CFR was much lower in MERS-HCP [7.03% (9/128] or SARS-HCP [12.24% (12/98] than the MERS-non-HCP [36.96% (34/92, p<0.001] or SARS-non-HCP [24.50% (61/249, p<0.001], however, no difference was found between MERS-HCP and SARS-HCP [p = 0.181]. In terms of clinical period, the days from onset to death [13 (4~17 vs 14.5 (0~52, p = 0.045] and to discharge [11 (5~24 vs 24 (0~74, p = 0.010] and be hospitalized days [9.5 (3~22 vs 22 (0~69, p = 0.040] were much shorter in MERS-HCP than SARS-HCP. Similarly, days from onset to confirmation were shorter in MERS-HCP than MERS-non-HCP [6 (1~14 vs 10 (1~21, p = 0.044]. In conclusion, the severity of MERS-HCP and SARS-HCP was lower than that of MERS-non-HCP and SARS-non-HCP due to younger age and early confirmation in HCP groups. However, no statistical difference was found in MERS-HCP and SARS-HCP. Thus, prevention of nosocomial infections involving both novel Coronavirus is crucially important to protect HCP.

  20. Volume Delivered During Recruitment Maneuver Predicts Lung Stress in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Beitler, Jeremy R; Majumdar, Rohit; Hubmayr, Rolf D; Malhotra, Atul; Thompson, B Taylor; Owens, Robert L; Loring, Stephen H; Talmor, Daniel

    2016-01-01

    Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver (V(RM)) is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Substudy of an acute respiratory distress syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. U.S. academic medical center. Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. V(RM) was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary (airway minus esophageal) pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. V(RM) ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower V(RM) predicted high end-inspiratory and tidal lung stress (end-inspiratory: β = -0.449; 95% CI, -0.664 to -0.234; p volume, or plateau pressure and positive end-expiratory pressure, V(RM) remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low V(RM) predicted increased risk of death (odds ratio, 0.85; 95% CI, 0.72-1.00; p = 0.026). V(RM) remained significantly associated with mortality after adjusting for study arm (odds ratio, 0.84; 95% CI, 0.71-1.00; p = 0.022). Low V(RM) independently predicts high lung stress and may

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

    Science.gov (United States)

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

    2014-05-15

    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

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

    Science.gov (United States)

    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 ECCO2R. 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 to enable

  3. Neonatal respiratory distress syndrome

    Science.gov (United States)

    Hyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants ... after that. Some infants with severe respiratory distress syndrome will die. This most often occurs between days ...

  4. Lung Recruitment Assessed by Respiratory Mechanics and Computed Tomography in Patients with Acute Respiratory Distress Syndrome. What Is the Relationship?

    Science.gov (United States)

    Chiumello, Davide; Marino, Antonella; Brioni, Matteo; Cigada, Irene; Menga, Federica; Colombo, Andrea; Crimella, Francesco; Algieri, Ilaria; Cressoni, Massimo; Carlesso, Eleonora; Gattinoni, Luciano

    2016-06-01

    The assessment of lung recruitability in patients with acute respiratory distress syndrome (ARDS) may be important for planning recruitment maneuvers and setting positive end-expiratory pressure (PEEP). To determine whether lung recruitment measured by respiratory mechanics is comparable with lung recruitment measured by computed tomography (CT). In 22 patients with ARDS, lung recruitment was assessed at 5 and 15 cm H2O PEEP by using respiratory mechanics-based methods: (1) increase in gas volume between two pressure-volume curves (P-Vrs curve); (2) increase in gas volume measured and predicted on the basis of expected end-expiratory lung volume and static compliance of the respiratory system (EELV-Cst,rs); as well as by CT scan: (3) decrease in noninflated lung tissue (CT [not inflated]); and (4) decrease in noninflated and poorly inflated tissue (CT [not + poorly inflated]). The P-Vrs curve recruitment was significantly higher than EELV-Cst,rs recruitment (423 ± 223 ml vs. 315 ± 201 ml; P respiratory mechanics was 54 ± 28% (P-Vrs curve) and 39 ± 25% (EELV-Cst,rs) of the gas volume at 5 cm H2O PEEP. Recruitment measured by CT scan was 5 ± 5% (CT [not inflated]) and 6 ± 6% (CT [not + poorly inflated]) of lung tissue. Respiratory mechanics and CT measure-under the same term, "recruitment"-two different entities. The respiratory mechanics-based methods include gas entering in already open pulmonary units that improve their mechanical properties at higher PEEP. Consequently, they can be used to assess the overall improvement of inflation. The CT scan measures the amount of collapsed tissue that regains inflation. Clinical trial registered with www.clinicaltrials.gov (NCT00759590).

  5. Possible therapeutic effect of orally administered ribavirin for respiratory syncytial virus-induced acute respiratory distress syndrome in an immunocompetent patient: a case report.

    Science.gov (United States)

    Yoon, Byung Woo; Lee, Seung Hyeun

    2017-12-20

    Human respiratory syncytial virus usually causes self-limiting upper respiratory infection and occasionally causes pneumonia in immunocompromised hosts. Respiratory syncytial virus-induced severe pneumonia or acute respiratory distress syndrome in immunocompetent adults has been rarely described. Unfortunately, optimal treatment has not been established for this potentially fatal condition. We report a case of respiratory syncytial virus-induced acute respiratory distress syndrome occurring in a previously healthy man successfully treated with orally administered ribavirin. An 81-year-old previously healthy Korean man presented with cough, dyspnea, and febrile sensation. He had hypoxemia with diffuse ground glass opacity evident on chest radiography, which progressed and required mechanical ventilation. All microbiological tests were negative except multiplex real-time reverse transcriptase polymerase chain reaction using respiratory specimen, which was positive for human adenovirus. Under the diagnosis of respiratory syncytial virus-induced acute respiratory distress syndrome, orally administered ribavirin was administered and he recuperated completely without complications. This case demonstrates the potential usefulness of orally administered ribavirin as a therapeutic option for severe respiratory syncytial virus infection, at least in an immunocompetent host.

  6. Long-Term Pulmonary Function and Quality of Life in Children After Acute Respiratory Distress Syndrome: A Feasibility Investigation.

    Science.gov (United States)

    Ward, Shan L; Turpin, Autumn; Spicer, Aaron C; Treadwell, Marsha J; Church, Gwynne D; Flori, Heidi R

    2017-01-01

    To determine the feasibility of pulmonary function and quality of life evaluations in children after acute respiratory distress syndrome. A prospective follow-up feasibility study. A tertiary PICU. Children less than 18 years old with acute respiratory distress syndrome admitted between 2000 and 2005. Pulmonary function testing and patient and parental quality of life surveys approximately 12-month after acute respiratory distress syndrome. One hundred eighty patients met acute respiratory distress syndrome criteria; 37 (20%) died, 90 (51%) declined participation, 28 (16%) consented but did not return, and 24 (13%) returned for follow-up visit. Twenty-three patients completed quality of life testing and 17 completed pulmonary functions. Clinical characteristics of those who returned were no different from those who did not except for age (median age, 4.9 vs 1.8 yr). One-third had mild to moderate pulmonary function deficits. Quality of life scores were marginal with general health perception, physical functioning, and behavior being areas of concern. These scores were lower than scores in children with chronic asthma. Parental quality of life assessments report lower scores in single-parent homes but no differences were noted by race or parental employment status. Valuable information may be discerned from acute respiratory distress syndrome patients who return for follow-up evaluation. In this pilot study, up to one-third of children with acute respiratory distress syndrome exhibit pulmonary function deficits and 12-month postillness quality of life scores are lower than in children with chronic asthma. Parental perceptions of postillness quality of life may be negatively impacted by socioeconomic constraints. Long-term follow of children with acute respiratory distress syndrome is feasible and bears further investigation.

  7. Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome.

    Science.gov (United States)

    Lim, Peter A; Ng, Yee Sien; Tay, Boon Keng

    2004-08-01

    Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

  8. Estimating dead-space fraction for secondary analyses of acute respiratory distress syndrome clinical trials.

    Science.gov (United States)

    Beitler, Jeremy R; Thompson, B Taylor; Matthay, Michael A; Talmor, Daniel; Liu, Kathleen D; Zhuo, Hanjing; Hayden, Douglas; Spragg, Roger G; Malhotra, Atul

    2015-05-01

    Pulmonary dead-space fraction is one of few lung-specific independent predictors of mortality from acute respiratory distress syndrome. However, it is not measured routinely in clinical trials and thus altogether ignored in secondary analyses that shape future research directions and clinical practice. This study sought to validate an estimate of dead-space fraction for use in secondary analyses of clinical trials. Analysis of patient-level data pooled from acute respiratory distress syndrome clinical trials. Four approaches to estimate dead-space fraction were evaluated: three required estimating metabolic rate; one estimated dead-space fraction directly. U.S. academic teaching hospitals. Data from 210 patients across three clinical trials were used to compare performance of estimating equations with measured dead-space fraction. A second cohort of 3,135 patients from six clinical trials without measured dead-space fraction was used to confirm whether estimates independently predicted mortality. None. Dead-space fraction estimated using the unadjusted Harris-Benedict equation for energy expenditure was unbiased (mean ± SD Harris-Benedict, 0.59 ± 0.13; measured, 0.60 ± 0.12). This estimate predicted measured dead-space fraction to within ±0.10 in 70% of patients and ±0.20 in 95% of patients. Measured dead-space fraction independently predicted mortality (odds ratio, 1.36 per 0.05 increase in dead-space fraction; 95% CI, 1.10-1.68; p dead-space fraction or its association with mortality less well. Dead-space fraction should be measured in future acute respiratory distress syndrome clinical trials to facilitate incorporation into secondary analyses. For analyses where dead-space fraction was not measured, the Harris-Benedict estimate can be used to estimate dead-space fraction and adjust for its association with mortality.

  9. Prone Positioning Improves Ventilation Homogeneity in Children With Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Lupton-Smith, Alison; Argent, Andrew; Rimensberger, Peter; Frerichs, Inez; Morrow, Brenda

    2017-05-01

    To determine the effect of prone positioning on ventilation distribution in children with acute respiratory distress syndrome. Prospective observational study. Paediatric Intensive Care at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Mechanically ventilated children with acute respiratory distress syndrome. Electrical impedance tomography measures were taken in the supine position, after which the child was turned into the prone position, and subsequent electrical impedance tomography measurements were taken. Thoracic electrical impedance tomography measures were taken at baseline and after 5, 20, and 60 minutes in the prone position. The proportion of ventilation, regional filling characteristics, and global inhomogeneity index were calculated for the ventral and dorsal lung regions. Arterial blood gas measurements were taken before and after the intervention. A responder was defined as having an improvement of more than 10% in the oxygenation index after 60 minutes in prone position. Twelve children (nine male, 65%) were studied. Four children were responders, three were nonresponders, and five showed no change to prone positioning. Ventilation in ventral and dorsal lung regions was no different in the supine or prone positions between response groups. The proportion of ventilation in the dorsal lung increased from 49% to 57% in responders, while it became more equal between ventral and dorsal lung regions in the prone position in nonresponders. Responders showed greater improvements in ventilation homogeneity with R improving from 0.86 ± 0.24 to 0.98 ± 0.02 in the ventral lung and 0.91 ± 0.15 to 0.99 ± 0.01 in the dorsal lung region with time in the prone position. The response to prone position was variable in children with acute respiratory distress syndrome. Prone positioning improves homogeneity of ventilation and may result in recruitment of the dorsal lung regions.

  10. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.

    Science.gov (United States)

    Lagier, D; Platon, L; Chow-Chine, L; Sannini, A; Bisbal, M; Brun, J-P; Blache, J-L; Faucher, M; Mokart, D

    2016-09-01

    Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  11. High Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Bime, Christian; Fiero, Mallorie; Lu, Zhenqiang; Oren, Eyal; Berry, Cristine E; Parthasarathy, Sairam; Garcia, Joe G N

    2017-02-01

    In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status. This was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status. Among obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [The acute respiratory distress syndrome in malaria: is it always the prerogative of Plasmodium falciparum?].

    Science.gov (United States)

    Hachimi, M A; Hatim, E A; Moudden, M K; Elkartouti, A; Errami, M; Louzi, L; Hanafi, S M; Mahmoudi, A

    2013-10-01

    Severe malaria causes nearly one million deaths annually in endemic areas and is a public health priority worldwide. Severity associated with the occurrence of acute respiratory distress syndrome (ARDS) is a well-known complication of infection with Plasmodium falciparum and can reach 25% of infected adults. However, ARDS is less often described with other Plasmodium species. We report the case of a young Moroccan soldier who died in an array of ARDS related to malaria of Plasmodium ovale 7 months after his return from an endemic country. Copyright © 2013. Published by Elsevier Masson SAS.

  13. Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome.

    Science.gov (United States)

    Chiumello, Davide; Chidini, Giovanna; Calderini, Edoardo; Colombo, Andrea; Crimella, Francesco; Brioni, Matteo

    2016-12-01

    In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity). The end-expiratory lung volume was measured using a simplified closed circuit helium dilution method. During an inspiratory and expiratory pause, the airway and esophageal pressure were measured. Transpulmonary pressure was computed as the difference between airway and esophageal pressure. Ten intubated sedated paralyzed healthy children and ten children with ARDS underwent a PEEP trial (4 and 12 cmH2O) with a tidal volume of 8, 10 and 12 ml/kgIBW. The two groups were comparable for age and BMI (2.5 [1.0-5.5] vs 3.0 [1.7-7.2] years and 15.1 ± 2.4 vs 15.3 ± 3.0 kg/m(2)). The functional residual capacity in ARDS patients was significantly lower as compared to the control group (10.4 [9.1-14.3] vs 16.6 [11.7-24.6] ml/kg, p = 0.04). The ARDS patients had a significantly lower respiratory system and lung compliance as compared to control subjects (9.9 ± 5.0 vs 17.8 ± 6.5, 9.3 ± 4.9 vs 16.9 ± 4.1 at 4 cmH2O of PEEP and 11.7 ± 5.8 vs 23.7 ± 6.8, 10.0 ± 4.9 vs 23.4 ± 7.5 at 12 cmH2O of PEEP). The compliance of the chest wall was similar in both groups (76.7 ± 30.2 vs 94.4 ± 76.4 and 92.6 ± 65.3 vs 90.0 ± 61.7 at 4 and 12 cmH2O of PEEP). The lung stress and strain were significantly higher in ARDS patients as compared to control subjects and were poorly related to airway pressure and tidal volume normalized for body weight. Airway pressures and tidal volume normalized to body weight are poor surrogates for lung stress and strain in mild pediatric ARDS

  14. The war on severe acute respiratory syndrome: United States Forces Korea's campaign plan.

    Science.gov (United States)

    Casey, John J; Lee, Hee-Choon S; O'Mara, Sean T; Plummer, Andrew D

    2006-02-01

    A mysterious new respiratory illness known as severe acute respiratory syndrome (SARS) has become the most perplexing infectious disease to emerge in the 21st century. From March to May 2003, it competed daily with the war in Iraq as the most sensational media event of the moment. U.S. personnel serving in the Republic of Korea represented the largest U.S. military population at risk for SARS. With tensions growing between Pyongyang and Washington, the United States/Republic of Korea alliance could not afford to be rendered combat ineffective by SARS. To remain mission ready, the U.S. Forces Korea (USFK) commander declared a "War on SARS" and directed his medical staff to develop a plan to prevent a SARS outbreak among USFK personnel. This article outlines the USFK campaign plan for the SARS epidemic and documents lessons learned for future outbreaks of highly infectious diseases.

  15. Efficacy of continuous renal replacement therapy in the treatment of severe acute pancreatitis associated acute respiratory distress syndrome.

    Science.gov (United States)

    Cui, H-X; Xu, J-Y; Li, M-Q

    2014-01-01

    To investigate the efficacy of the treatment of severe acute pancreatitis (SAP) complicated by acute respiratory distress syndrome (ARDS) using continuous renal replacement therapy (CRRT) by evaluating the effect of CRRT on respiratory and circulatory function as well as serum cytokines level. Fifty four randomly selected patients with confirmed SAP complicated by ARDS after being admitted to intensive care unit (ICU) within 72 hr of onset were included in the study. Patients received mechanical respiratory support and CRRT. Arterial blood gas analysis was conducted and serum cytokine levels, including tumor necrosis factor alpha (TNF-α), interleukin 4 (IL-4) and interleukin 6 (IL-6), as well as C reactive protein (CRP) were evaluated respectively both before and 6h, 12h, and 24h after CRRT therapy. Peak inspiratory pressure and pulmonary compliance were also recorded. Arterial oxygen tension (PaO2), oxygenation index (OI) as well as dynamic pulmonary compliance were all elevated significantly, whereas peak inspiratory pressure significantly decreased at 6h, 12h and 24h after CRRT respectively; serum cytokine level and CRP significantly decreased (p < 0.05). CRRT can effectively reduce the level of inflammatory mediators, and improve respiratory and circulatory function.

  16. [Genetic predisposition and Pediatric Acute Respiratory Distress Syndrome: New tools for genetic study].

    Science.gov (United States)

    Erranz, M Benjamín; Wilhelm, B Jan; Riquelme, V Raquel; Cruces, R Pablo

    2015-01-01

    Acute respiratory distress syndrome (ARDS) is the most severe form of respiratory failure. Theoretically, any acute lung condition can lead to ARDS, but only a small percentage of individuals actually develop the disease. On this basis, genetic factors have been implicated in the risk of developing ARDS. Based on the pathophysiology of this disease, many candidate genes have been evaluated as potential modifiers in patient, as well as in animal models, of ARDS. Recent experimental data and clinical studies suggest that variations of genes involved in key processes of tissue, cellular and molecular lung damage may influence susceptibility and prognosis of ARDS. However, the pathogenesis of pediatric ARDS is complex, and therefore, it can be expected that many genes might contribute. Genetic variations such as single nucleotide polymorphisms and copy-number variations are likely associated with susceptibility to ARDS in children with primary lung injury. Genome-wide association (GWA) studies can objectively examine these variations, and help identify important new genes and pathogenetic pathways for future analysis. This approach might also have diagnostic and therapeutic implications, such as predicting patient risk or developing a personalized therapeutic approach to this serious syndrome. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  17. Message about the « severe acute respiratory disease syndrome »

    CERN Multimedia

    2003-01-01

    If you are back from a journey in one of the zones pointed out by WHO concerned by the severe acute respiratory disease syndrome (SARS), it is necessary to monitor your health for at least ten days. This syndrome shows a high fever accompanied by cough or difficulty in breathing. If you become ill, you have to contact as quickly as possible the CERN medical service by dialling 73802 - 73186 during work hours or the Fire Brigade 74444 outside work hours. Tell this service about your recent travel to one of the regions where WHO has reported cases*. * For instant, the areas identified are the cities of Hanoi, Hong Kong, Singapore and the Province of Guangdong (South of China) and Toronto. The medical service recommends to avoid any trip in these world areas until further instruction. CERN Medical Service

  18. Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

    Science.gov (United States)

    Chacko, Binila; Peter, John V; Tharyan, Prathap; John, George; Jeyaseelan, Lakshmanan

    2015-01-14

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of cases of acute respiratory failure in intensive care units (ICUs). A third to half of patients will die in the ICU, in hospital or during follow-up. Mechanical ventilation of people with ALI/ARDS allows time for the lungs to heal, but ventilation is invasive and can result in lung injury. It is uncertain whether ventilator-related injury would be reduced if pressure delivered by the ventilator with each breath is controlled, or whether the volume of air delivered by each breath is limited. To compare pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) in adults with ALI/ARDS to determine whether PCV reduces in-hospital mortality and morbidity in intubated and ventilated adults. In October 2014, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Isssue 9), MEDLINE (1950 to 1 October 2014), EMBASE (1980 to 1 October 2014), the Latin American Caribbean Health Sciences Literature (LILACS) (1994 to 1 October 2014) and Science Citation Index-Expanded (SCI-EXPANDED) at the Institute for Scientific Information (ISI) Web of Science (1990 to 1 October 2014), as well as regional databases, clinical trials registries, conference proceedings and reference lists. Randomized controlled trials (RCTs) and quasi-RCTs (irrespective of language or publication status) of adults with a diagnosis of acute respiratory failure or acute on chronic respiratory failure and fulfilling the criteria for ALI/ARDS as defined by the American-European Consensus Conference who were admitted to an ICU for invasive mechanical ventilation, comparing pressure-controlled or pressure-controlled inverse-ratio ventilation, or an equivalent pressure-controlled mode (PCV), versus volume-controlled ventilation, or an equivalent volume-controlled mode (VCV). Two review authors independently screened and selected trials, assessed risk of bias and extracted

  19. PIDOTIMOD IN TREATMENT OF CHILDREN WITH ACUTE RESPIRATORY INFECTION WITH CONCOMITANT RECURRENT OBSTRUCTIVE SYNDROME

    Directory of Open Access Journals (Sweden)

    E. E. Lokshina

    2011-01-01

    Full Text Available Respiratory infections are frequent in children; consequently evaluation of prophylactic effectiveness of immunomodulators is needed. Objective: to evaluate of clinical, immunological efficacy and safety of pidotimod in complex treatment of children with acute respiratory infections (ARI and obstructive syndrome. Methods: patients 3–10 years old hospitalized with ARI and obstructive syndrome participated the study. Children from first group (n = 30 were treated with pidotimod 400 mg 2 times daily during 14 days, children from control group (n = 30 received standard treatment without immunomodulatory agent. Dynamics of clinical course of a disease, immunological indices of blood (IL 2, 4 and 8, interferon α  and γ, IgA, M, G and total IgЕ and swabs from mucous tunica of nasopharynx (sIgA was estimated. The cases of recurrent ARIs during 12 months after the beginning of a study were controlled. Results: treatment with pidotimod induced statistically significant decrease of cytokines levels (IL 2, IL 8, and interferon γ and increase of sIgA. The rate of recurrent ARIs during 12 months after the beginning of a study was lower than in control group. Recurrent episodes of bronchial obstruction occurred rarely. Conclusion: pidotimod has high clinical and immunological effectiveness and safety in treatment of children with ARI and concomitant obstructive syndrome.

  20. The Relationship between the Plasma Triglyceride Concentration and the Severity of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    V. V. Kuzkov

    2012-01-01

    Full Text Available Triglycerides (TG may be involved in the pathogenesis of critical impairments. Objective: to study the relationship between the plasma concentration of TG, the outcome of the disease, and the markers of its severity in intensive care unit patients with early-stage acute respiratory distress syndrome (ARDS. Subjects and methods. The prospective study included 18 patients with acute lung injury (ALI, who needed respiratory support. For further analysis, all the patients were divided into groups with TG < 1.00 mmol/l (TGlow; n=7 and >1.00 mmol/l (TGhigh; n=11. Results. A negative correlation was found between plasma TG concentration and oxygenation index (PaO2/FiO2. In the TG^jgh group, extravas-cular lung water index was significantly higher and cardiac index was lower than those in the TGlow group. Among the deceased patients, there was a 1.03 mmol/l reduction in TG concentration by day 4 of the study whereas in the survivors, TG concentration increased by an average of 0.15 mmol/l (p=0.02. Conclusion. In the patients with ALI, the plasma concentration of TG is related to oxygenation impairments and the degree of pulmonary edema, as well as with the outcome of the disease. Key words: triglycerides, acute lung injury, extravascular lung water index, pulmonary edema.

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

    Science.gov (United States)

    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 as ventilator-induced lung injury (VILI). Injured lungs can be partially protected by optimal settings and ventilation modes, using low tidal volume (VT) values and high positive-end expiratory pressure (PEEP). The benefits in ARDS outcomes caused by these interventions have been confirmed by several prospective randomized controlled trials (RCTs) and are attributed to reduction in volutrauma. The purpose of this article is to present an approach to VILI pathophysiology focused on the effects of volutrauma that lead to lung injury and the ‘mechanotransduction’ mechanism. A more complete understanding about the molecular effects that physical forces could have, is essential for a better assessment of existing strategies as well as the development of new therapeutic strategies to reduce the damage resulting from VILI, and thereby contribute to reducing mortality in ARDS. PMID:26312103

  2. A novel swine model of ricin-induced acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Shahaf Katalan

    2017-02-01

    Full Text Available Pulmonary exposure to the plant toxin ricin leads to respiratory insufficiency and death. To date, in-depth study of acute respiratory distress syndrome (ARDS following pulmonary exposure to toxins is hampered by the lack of an appropriate animal model. To this end, we established the pig as a large animal model for the comprehensive study of the multifarious clinical manifestations of pulmonary ricinosis. Here, we report for the first time, the monitoring of barometric whole body plethysmography for pulmonary function tests in non-anesthetized ricin-treated pigs. Up to 30 h post-exposure, as a result of progressing hypoxemia and to prevent carbon dioxide retention, animals exhibited a compensatory response of elevation in minute volume, attributed mainly to a large elevation in respiratory rate with minimal response in tidal volume. This response was followed by decompensation, manifested by a decrease in minute volume and severe hypoxemia, refractory to oxygen treatment. Radiological evaluation revealed evidence of early diffuse bilateral pulmonary infiltrates while hemodynamic parameters remained unchanged, excluding cardiac failure as an explanation for respiratory insufficiency. Ricin-intoxicated pigs suffered from increased lung permeability accompanied by cytokine storming. Histological studies revealed lung tissue insults that accumulated over time and led to diffuse alveolar damage. Charting the decline in PaO2/FiO2 ratio in a mechanically ventilated pig confirmed that ricin-induced respiratory damage complies with the accepted diagnostic criteria for ARDS. The establishment of this animal model of pulmonary ricinosis should help in the pursuit of efficient medical countermeasures specifically tailored to deal with the respiratory deficiencies stemming from ricin-induced ARDS.

  3. Pulmonary histopathology in dalmatians with familial acute respiratory distress syndrome (ARDS).

    Science.gov (United States)

    Syrjä, P; Saari, S; Rajamäki, M; Saario, E; Järvinen, A-K

    2009-11-01

    The histopathological changes in the lungs of 12 related Dalmatians with idiopathic acute respiratory distress syndrome (ARDS) are described. Affected dogs had multiple foci of marked atypical hyperplasia and squamous metaplasia of the bronchiolar epithelium, patchy ongoing fibrosis with myofibroblastic metaplasia, smooth muscle hyperplasia and occasional honeycombing of alveolar walls, and hyperplasia of atypical type II pneumocytes. There was an abrupt transition between these proliferative lesions and areas of acute alveolar oedema with hyaline membranes in partially normal lung. Diseased areas were associated with moderate lymphohistiocytic interstitial inflammation. Immunohistochemical labelling for cytokeratin expression indicated that the metaplastic epithelium was of bronchiolar origin and that it extended into peribronchiolar alveolar spaces. Some of the bronchiolar lesions were pre-neoplastic and one adult dog suffered from bronchoalveolar carcinoma. These lesions are compared with the two forms of idiopathic interstitial pneumonia reported as causes of ARDS in man: acute interstitial pneumonia (AIP) and acute exacerbation of idiopathic pulmonary fibrosis (IPF). The observed lesions in the Dalmatians are distinct from the diffuse alveolar damage that characterizes AIP, but show some histological similarities to the usual interstitial pneumonia (UIP) that occurs in IPF with acute exacerbation in man. UIP has not previously been described in the dog.

  4. Three dimensional model of severe acute respiratory syndrome coronavirus helicase ATPase catalytic domain and molecular design of severe acute respiratory syndrome coronavirus helicase inhibitors

    Science.gov (United States)

    Hoffmann, Marcin; Eitner, Krystian; von Grotthuss, Marcin; Rychlewski, Leszek; Banachowicz, Ewa; Grabarkiewicz, Tomasz; Szkoda, Tomasz; Kolinski, Andrzej

    2006-05-01

    The modeling of the severe acute respiratory syndrome coronavirus helicase ATPase catalytic domain was performed using the protein structure prediction Meta Server and the 3D Jury method for model selection, which resulted in the identification of 1JPR, 1UAA and 1W36 PDB structures as suitable templates for creating a full atom 3D model. This model was further utilized to design small molecules that are expected to block an ATPase catalytic pocket thus inhibit the enzymatic activity. Binding sites for various functional groups were identified in a series of molecular dynamics calculation. Their positions in the catalytic pocket were used as constraints in the Cambridge structural database search for molecules having the pharmacophores that interacted most strongly with the enzyme in a desired position. The subsequent MD simulations followed by calculations of binding energies of the designed molecules were compared to ATP identifying the most successful candidates, for likely inhibitors—molecules possessing two phosphonic acid moieties at distal ends of the molecule.

  5. Immunization with an Attenuated Severe Acute Respiratory Syndrome Coronavirus Deleted in E Protein Protects Against Lethal Respiratory Disease

    Science.gov (United States)

    Netland, Jason; DeDiego, Marta L.; Zhao, Jincun; Fett, Craig; Álvarez, Enrique; Nieto-Torres, José L.; Enjuanes, Luis; Perlman, Stanley

    2010-01-01

    The Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) caused substantial morbidity and mortality in 2002-2003. Deletion of the envelope (E) protein modestly diminished virus growth in tissue culture but abrogated virulence in animals. Here, we show that immunization with rSARS-CoV-ΔE or SARS-CoV-Δ[E,6-9b] (deleted in accessory proteins (6,7a,7b,8a,8b,9b) in addition to E) nearly completely protected BALB/c mice from fatal respiratory disease caused by mouse-adapted SARS-CoV and partly protected hACE2 Tg mice from lethal disease. hACE2 Tg mice, which express the human SARS-CoV receptor, are extremely susceptible to infection. We also show that rSARS-CoV-ΔE and rSARS-CoV-Δ[E,6-9b] induced anti-virus T cell and antibody responses. Further, the E-deleted viruses were stable after 16 blind passages through tissue culture cells, with only a single mutation in the surface glycoprotein detected. The passaged virus remained avirulent in mice. These results suggest that rSARS-CoV-ΔE is an efficacious vaccine candidate that might be useful if SARS recurred. PMID:20110095

  6. Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy

    Directory of Open Access Journals (Sweden)

    Jisa George

    2015-06-01

    Full Text Available Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS. The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis.

  7. Influences of pleural effusion on respiratory mechanics, gas exchange, hemodynamics, and recruitment effects in acute respiratory distress syndrome.

    Science.gov (United States)

    Lan, Chou-Chin; Hsu, Hsian-He; Wu, Chin-Pyng; Lee, Shih-Chun; Peng, Chung-Kan; Chang, Hung

    2014-01-01

    Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) cause substantial morbidity and mortality despite improvements in the understanding of lung injury and advances in treatment. Recruitment maneuver (RM) with high sustained airway pressures is proposed as an adjunct to mechanical ventilation to maintain alveolar patency. In addition, RM has been advocated to improve pulmonary gas exchange. However, many factors may influence responses to RM and the effect of pleural effusion (PLE) is unknown. There were four groups in this study (n = 6 in each group). Group A was the control group, group B was the PLE group, group C was ARDS with RM, and group D was ARDS with PLE and RM. RM was performed in groups C and D, consisting of a peak pressure of 45 cm H2O with positive end-expiratory pressure of 35 cm H2O sustained for 1 min. Arterial blood gas, systemic and pulmonary hemodynamics, lung water, and respiratory mechanics were measured throughout. After the induction of ALI/ARDS, there were significant decreases in partial pressure of oxygen in arterial blood, mean arterial pressure, systemic vascular resistance, and lung compliance. There were also significant increases in the alveolar-arterial O2 tension difference, partial pressure of arterial carbon dioxide, mean pulmonary arterial pressure, pulmonary vascular resistance, and lung water. The RM improved oxygenation, which was attenuated by PLE. ALI/ARDS leads to poor oxygenation and hemodynamics. RM results in improved oxygenation, but this improvement is attenuated by PLE. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Assessment of dead-space ventilation in patients with acute respiratory distress syndrome: a prospective observational study

    NARCIS (Netherlands)

    Doorduin, J.; Nollet, J.L.; Vugts, M.P.; Roesthuis, L.H.; Akankan, F.; Hoeven, J.G. van der; Hees, H.W.H. van; Heunks, L.M.

    2016-01-01

    BACKGROUND: Physiological dead space (VD/VT) represents the fraction of ventilation not participating in gas exchange. In patients with acute respiratory distress syndrome (ARDS), VD/VT has prognostic value and can be used to guide ventilator settings. However, VD/VT is rarely calculated in clinical

  9. Imbalance between pulmonary angiotensin-converting enzyme and angiotensin-converting enzyme 2 activity in acute respiratory distress syndrome

    NARCIS (Netherlands)

    Wosten-van Asperen, Roelie M.; Bos, Albert; Bem, Reinout A.; Dierdorp, Barbara S.; Dekker, Tamara; van Goor, Harry; Kamilic, Jelena; van der Loos, Chris M.; van den Berg, Elske; Bruijn, Martijn; van Woensel, Job B.; Lutter, Rene

    2013-01-01

    Objective: Angiotensin-converting enzyme and its effector peptide angiotensin II have been implicated in the pathogenesis of acute respiratory distress syndrome. Recently, angiotensin-converting enzyme 2 was identified as the counter-regulatory enzyme of angiotensin-converting enzyme that converts

  10. Clinical review: Exogenous surfactant therapy for acute lung injury/acute respiratory distress syndrome - where do we go from here?

    Science.gov (United States)

    2012-01-01

    Acute lung injury and acute respiratory distress syndrome (ARDS) are characterised by severe hypoxemic respiratory failure and poor lung compliance. Despite advances in clinical management, morbidity and mortality remains high. Supportive measures including protective lung ventilation confer a survival advantage in patients with ARDS, but management is otherwise limited by the lack of effective pharmacological therapies. Surfactant dysfunction with quantitative and qualitative abnormalities of both phospholipids and proteins are characteristic of patients with ARDS. Exogenous surfactant replacement in animal models of ARDS and neonatal respiratory distress syndrome shows consistent improvements in gas exchange and survival. However, whilst some adult studies have shown improved oxygenation, no survival benefit has been demonstrated to date. This lack of clinical efficacy may be related to disease heterogeneity (where treatment responders may be obscured by nonresponders), limited understanding of surfactant biology in patients or an absence of therapeutic effect in this population. Crucially, the mechanism of lung injury in neonates is different from that in ARDS: surfactant inhibition by plasma constituents is a typical feature of ARDS, whereas the primary pathology in neonates is the deficiency of surfactant material due to reduced synthesis. Absence of phenotypic characterisation of patients, the lack of an ideal natural surfactant material with adequate surfactant proteins, coupled with uncertainty about optimal timing, dosing and delivery method are some of the limitations of published surfactant replacement clinical trials. Recent advances in stable isotope labelling of surfactant phospholipids coupled with analytical methods using electrospray ionisation mass spectrometry enable highly specific molecular assessment of phospholipid subclasses and synthetic rates that can be utilised for phenotypic characterisation and individualisation of exogenous surfactant

  11. Legionella pneumonia associated with severe acute respiratory distress syndrome and diffuse alveolar hemorrhage - A rare association

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2017-01-01

    Full Text Available Legionella pneumophila is a common, usually underreported and undiagnosed cause of community acquired pneumonia which can lead to significant morbidity and mortality. Diffuse alveolar hemorrhage rarely have been associated with legionella infection. We present a 61-year-old man with hypertension, diabetes mellitus and obesity admitted with severe acute respiratory distress syndrome. He was found to have Legionella pneumonia with associated diffuse alveolar hemorrhage diagnosed with bronchoscopic sequential bronchoalveolar lavage. He was successfully managed with antibiotics, lung protective strategies and intravenous pulse dose steroids. This patient highlights the unusual association of Legionella infection and diffuse alveolar hemorrhage. Additionally, the case re-enforces the need for early and aggressive evaluation and management of patients presenting with pneumonia and progressive hypoxia despite adequate treatment.

  12. Supramolecular architecture of severe acute respiratory syndrome coronavirus revealed by electron cryomicroscopy.

    Science.gov (United States)

    Neuman, Benjamin W; Adair, Brian D; Yoshioka, Craig; Quispe, Joel D; Orca, Gretchen; Kuhn, Peter; Milligan, Ronald A; Yeager, Mark; Buchmeier, Michael J

    2006-08-01

    Coronavirus particles are enveloped and pleomorphic and are thus refractory to crystallization and symmetry-assisted reconstruction. A novel methodology of single-particle image analysis was applied to selected virus features to obtain a detailed model of the oligomeric state and spatial relationships among viral structural proteins. Two-dimensional images of the S, M, and N structural proteins of severe acute respiratory syndrome coronavirus and two other coronaviruses were refined to a resolution of approximately 4 nm. Proteins near the viral membrane were arranged in overlapping lattices surrounding a disordered core. Trimeric glycoprotein spikes were in register with four underlying ribonucleoprotein densities. However, the spikes were dispensable for ribonucleoprotein lattice formation. The ribonucleoprotein particles displayed coiled shapes when released from the viral membrane. Our results contribute to the understanding of the assembly pathway used by coronaviruses and other pleomorphic viruses and provide the first detailed view of coronavirus ultrastructure.

  13. Prospects for emerging infections in East and southeast Asia 10 years after severe acute respiratory syndrome.

    Science.gov (United States)

    Horby, Peter W; Pfeiffer, Dirk; Oshitani, Hitoshi

    2013-06-01

    It is 10 years since severe acute respiratory syndrome (SARS) emerged, and East and Southeast Asia retain a reputation as a hot spot of emerging infectious diseases. The region is certainly a hot spot of socioeconomic and environmental change, and although some changes (e.g., urbanization and agricultural intensification) may reduce the probability of emerging infectious diseases, the effect of any individual emergence event may be increased by the greater concentration and connectivity of livestock, persons, and products. The region is now better able to detect and respond to emerging infectious diseases than it was a decade ago, but the tools and methods to produce sufficiently refined assessments of the risks of disease emergence are still lacking. Given the continued scale and pace of change in East and Southeast Asia, it is vital that capabilities for predicting, identifying, and controlling biologic threats do not stagnate as the memory of SARS fades.

  14. Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited.

    Science.gov (United States)

    Amado-Rodríguez, L; Del Busto, C; García-Prieto, E; Albaiceta, G M

    2017-12-01

    Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. In this regard, ventilator-associated lung injury (VALI) is the main concern when this technique is used. The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them. Lastly, a series of knowledge-based recommendations are proposed that can be helpful for the ventilator assisted management of ARDS at the patient bedside. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. Hemodynamics and Gas Exchange Effects of Inhaled Nitrous Oxide in Patients with Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2006-01-01

    Full Text Available Inhaled nitrous oxide (iNO therapy aimed at improving pulmonary oxygenizing function and at decreasing artificial ventilation (AV load has been used in foreign clinical practice in the past decade. The study was undertaken to evaluate the hemodynamic and gas exchange effects of iNO in acute respiratory distress syndrome (ARDS that developed after car-diosurgical operations. Fifty-eight (43 males and 15 females patients aged 21 to 76 (55.2±2.4 years were examined. The study has demonstrated that in 48.3% of cases, the early stage of ARDS is attended by the increased tone pulmonary vessels due to impaired NO-dependent vasodilatation. In these patients, iNO therapy is an effective therapeutic method for correcting hemodynamic disorders and lung oxygenizing function.

  16. Severe acute respiratory syndrome--a new coronavirus from the Chinese dragon's lair

    DEFF Research Database (Denmark)

    Knudsen, T B; Kledal, T N; Andersen, O

    2003-01-01

    The recent identification of a novel clinical entity, the severe acute respiratory syndrome (SARS), the rapid subsequent spread and case fatality rates of 14-15% have prompted a massive international collaborative investigation facilitated by a network of laboratories established by the World...... Health Organization (WHO). As SARS has the potential of becoming the first pandemic of the new millennium, a global warning by the WHO was issued on 12 March 2003. The disease, which is believed to have its origin in the Chinese Guangdong province, spread from Hong Kong via international airports to its...... to the members of the coronavirus family, a model for host cell-virus interaction and possible targets for antiviral drugs are presented. The epidemiological consequences of introducing a novel pathogen in a previously unexposed population and the origin and evolution of a new and more pathogenic strain...

  17. What Is Respiratory Distress Syndrome?

    Science.gov (United States)

    ... Home / Respiratory Distress Syndrome Respiratory Distress Syndrome What Is Respiratory distress syndrome (RDS) ... This condition is called apnea (AP-ne-ah). Respiratory Distress Syndrome Complications Depending on the severity of ...

  18. Surfactant Apoprotein D in Preterm Neonates with Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    S. A. Perepelitsa

    2009-01-01

    Full Text Available Objective: to study the production of surfactant apoprotein D in preterm neonates with acute respiratory distress syndrome (ARDS during artificial ventilation (AV. Subjects and methods. The paper presents the results of studying the production of surfactant protein D (SP-D in various biological fluids in 44 preterm neonates. Two groups of newborn infants were identified according to the clinical manifestations of ARDS. The study group comprised 25 infants with the severe course of the disease, in this connection the preventive administration of the exogenous surfactant Curosurf and AV were made in all the neonates at birth. The control group included 19 preterm babies without signs of ARDS. Results. The study has demonstrated that in parturients and preterm neonatal infants, surfactant apoprotein D is detectable in various biological fluids: amniotic fluid, the gastric aspirate obtained just after birth, residual umbilical cord blood, serum following 8 hours of birth, and bronchoalveolar fluid. Despite the low gestational age of the neonates, the lung surfactant system is able to produce SP-D, as evidenced by its high content in the amniotic fluid and residual umbilical cord blood of preterm neonates. The production of apoprotein D in preterm neonates considerably reduces in the next few hours after birth. Conclusion. The findings suggest that fetal tissues generate SP-D, which improves pulmonary gas exchange in preterm neonates in the first hours after birth and that alveolar-capillary membrane dysfunctions are transient in the neonates on AV. Key words: preterm neonates, acute respiratory distress syndrome, surfactant, surfactant apoprotein D.

  19. Acute Respiratory Distress Syndrome after Early Successful Primary Percutaneous Coronary Intervention Therapy in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2005-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by acute-onset dyspnea, diffuse bilateral pulmonary infiltration, low pulmonary capillary wedge pressure (PCWP, and an arterial oxygen tension/ inspired oxygen fraction (PaO2/FiO2 ratio of less than 200 mmHg. Acute myocardial infarction (AMI, whether complicated by circulatory arrest, cardiogenic shock, and hypotension or not, was reported as an etiologic factor in the development of ARDS in the prethrombolytic era. In the thrombolytic era, two cases of AMI complicated with ARDS have been reported. ARDS in these two patients resulted from anaphylactic reaction to the thrombolytic agent and not from the hemodynamic consequences of AMI. Development of ARDS during the AMI period has not been reported after early successful primary percutaneous coronary intervention (PCI. Herein, we report a 61-year-old male patient with persistent chest pain who was diagnosed with Killip II anterior ST-segment elevation AMI. He was treated successfully with primary PCI 2.5 hours after the onset of chest pain. Unfortunately, on the third hospital day, acuteonset dyspnea (respiratory rate, 33 beats/min, fever (38.5°C, leukocytosis (white blood cell count, 18,360/μL, and diffuse bilateral pulmonary infiltration were noted. ARDS was diagnosed from the low PCWP (8 mmHg and a PaO2/FiO2 of less than 200 mmHg (160 mmHg. No usual causes of ARDS such as infection, aspiration, trauma, shock, or drug reactions were noted. We assumed that, in this particular patient, the systemic inflammatory response syndrome frequently induced by AMI might have caused this episode of ARDS. This may imply that AMI itself is a possible etiology of ARDS.

  20. Preadmission Oral Corticosteroids Are Associated With Reduced Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults With Sepsis.

    Science.gov (United States)

    McKown, Andrew C; McGuinn, Erin M; Ware, Lorraine B; Wang, Li; Janz, David R; Rice, Todd W; Semler, Matthew W

    2017-05-01

    To determine the association between preadmission oral corticosteroid receipt and the development of acute respiratory distress syndrome in critically ill patients with sepsis. Retrospective observational study. Medical, surgical, trauma, and cardiovascular ICUs of an academic medical center. A total of 1,080 critically ill patients with sepsis. None. The unadjusted occurrence rate of acute respiratory distress syndrome within 96 hours of ICU admission was 35% among patients who had received oral corticosteroids compared with 42% among those who had not (p = 0.107). In a multivariable analysis controlling for prespecified confounders, preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome in the 96 hours after ICU admission (odds ratio, 0.53; 95% CI, 0.33-0.84; p = 0.008), a finding that persisted in multiple sensitivity analyses. The median daily dose of oral corticosteroids among the 165 patients receiving oral corticosteroids, in prednisone equivalents, was 10 mg (interquartile range, 5-30 mg). Higher doses of preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome (odds ratio for 30 mg of prednisone compared with 5 mg 0.53; 95% CI, 0.32-0.86). In multivariable analyses, preadmission oral corticosteroids were not associated with in-hospital mortality (odds ratio, 1.41; 95% CI, 0.87-2.28; p = 0.164), ICU length of stay (odds ratio, 0.90; 95% CI, 0.63-1.30; p = 0.585), or ventilator-free days (odds ratio, 1.06; 95% CI, 0.71-1.57; p = 0.783). Among ICU patients with sepsis, preadmission oral corticosteroids were independently associated with a lower incidence of early acute respiratory distress syndrome.

  1. Middle East Respiratory Syndrome

    Centers for Disease Control (CDC) Podcasts

    2014-07-07

    This podcast discusses Middle East Respiratory Syndrome, or MERS, a viral respiratory illness caused by Middle East Respiratory Syndrome Coronavirus—MERS-CoV.  Created: 7/7/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 7/7/2014.

  2. Attenuation and Restoration of Severe Acute Respiratory Syndrome Coronavirus Mutant Lacking 2′-O-Methyltransferase Activity

    OpenAIRE

    Menachery, Vineet D.; Yount, Boyd L.; Josset, Laurence; Gralinski, Lisa E.; Scobey, Trevor; Agnihothram, Sudhakar; Katze, Michael G.; Baric, Ralph S.

    2014-01-01

    The sudden emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and, more recently, Middle Eastern respiratory syndrome CoV (MERS-CoV) underscores the importance of understanding critical aspects of CoV infection and pathogenesis. Despite significant insights into CoV cross-species transmission, replication, and virus-host interactions, successful therapeutic options for CoVs do not yet exist. Recent identification of SARS-CoV NSP16 as a viral 2′-O-methyltransferase (...

  3. Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid-induced acute respiratory distress syndrome.

    Science.gov (United States)

    Xia, Jingen; Zhang, Heng; Sun, Bing; Yang, Rui; He, Hangyong; Zhan, Qingyuan

    2014-06-01

    It has been proved that spontaneous breathing (SB) with biphasic positive airway pressure (BIPAP) can improve lung aeration in acute respiratory distress syndrome compared with controlled mechanical ventilation. The authors hypothesized that SB with BIPAP would attenuate lung injury in acute respiratory distress syndrome compared with pressure-controlled ventilation. Twenty male New Zealand white rabbits with hydrochloric acid aspiration-induced acute respiratory distress syndrome were randomly ventilated using the BIPAP either with SB (BIPAP plus SB group) or without SB (BIPAP minus SB group) for 5 h. Inspiration pressure was adjusted to maintain the tidal volume at 6 ml/kg. Both groups received the same positive end-expiratory pressure level at 5 cm H2O for hemodynamic goals. Eight healthy animals without ventilatory support served as the control group. The BIPAP plus SB group presented a lower ratio of dead space ventilation to tidal volume, a lower respiratory rate, and lower minute ventilation. No significant difference in the protein levels of interleukin-6 and interleukin-8 in plasma, bronchoalveolar lavage fluid, and lung tissue were measured between the two experimental groups. However, SB resulted in lower messenger ribonucleic acid levels of interleukin-6 (mean ± SD; 1.8 ± 0.7 vs. 2.6 ± 0.5; P = 0.008) and interleukin-8 (2.2 ± 0.5 vs. 2.9 ± 0.6; P = 0.014) in lung tissues. In addition, lung histopathology revealed less injury in the BIPAP plus SB group (lung injury score, 13.8 ± 4.6 vs. 21.8 ± 5.7; P hydrochloric acid-induced acute respiratory distress syndrome, SB with BIPAP attenuated lung injury and improved respiratory function compared with controlled ventilation with low tidal volume.

  4. High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience

    Directory of Open Access Journals (Sweden)

    Herbert Spapen

    2014-01-01

    Full Text Available Background: Few studies have investigated high-frequency percussive ventilation (HFPV in adult patients with acute respiratory distress syndrome (ARDS. Materials and Methods: We retrospectively analyzed data from critically ill-patients with moderate and severe ARDS who received HFPV. Ventilation and oxygenation were governed according to a predefined protocol. HFPV was continued until patients could be switched to conventional ventilation. Results: A total of 42 patients (20 with pneumonia-related ARDS and 22 non-septic ARDS cases were evaluable. Baseline demographic characteristics, severity of illness, lung injury score; pH and respiratory variables were comparable between pneumonia and non-sepsis-related ARDS. Within 24 h, HFPV restored normal pH and PaCO 2 and considerably improved oxygenation. Oxygenation improved more in non-septic than in pneumonia-related ARDS. Patients with pneumonia-induced ARDS also remained longer HFPV-dependent (7.0 vs. 4.9 days; P < 0.05. Mortality at 30 days was significantly higher in pneumonia-related than in non-sepsis-related ARDS (50% vs. 18%; P = 0.01. Conclusions: HFPV caused rapid and sustained improvement of oxygenation and ventilation in patients with moderate to severe ARDS. Less improved oxygenation, longer ventilator dependency and worse survival were observed in pneumonia-related ARDS.

  5. Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience.

    Directory of Open Access Journals (Sweden)

    Hans Fuchs

    Full Text Available Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.Out of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%. In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort.A ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS.

  6. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.

    Science.gov (United States)

    Chan-Yeung, Moira; Yu, W C

    2003-04-19

    To describe the outbreak of severe acute respiratory syndrome in Hong Kong. Descriptive case series. Hong Kong, Special Administrative Region, China The outbreak started with a visitor from southern China on 21 February. At the hospitals where the first cases were treated the disease spread quickly among healthcare workers, and then out into the community as family members became infected. By 1 April, 685 cases had been reported with 16 deaths. Symptoms include high fever and one or more respiratory symptoms (including cough, shortness of breath, and difficulty breathing). Changes in lung tissue suggest that part of the lung damage is due to cytokines induced by the microbial agent, which has led to empirical treatment with corticosteroids, broad spectrum antiviral agent, and antibacterial cover. There is strong evidence that a novel coronavirus is the pathogen. Precautions for droplet infection should be instituted, including the wearing of masks and rigorous disinfection and hygiene procedures. On 27 March the Department of Health announced drastic measures, including vigorous contact tracing and examination, quarantine of contacts in their homes, and closure of all schools and universities. The rapidity of the spread of the disease and the morbidity indicate that the agent responsible is highly infectious and virulent. Strict infection control measures for droplet and contact transmission by healthcare workers, a vigilant healthcare profession, and public education are essential for disease prevention.

  7. Acute respiratory distress syndrome due to vivax malaria: case report and literature review

    Directory of Open Access Journals (Sweden)

    André V. Lomar

    Full Text Available Severe pulmonary involvement in malaria has been frequently reported in cases of Plasmodium falciparum infection, but rarely in vivax malaria. Among the 11 previous cases of vivax-related severe respiratory involvement described in the literature, all except one developed it after the beginning of anti-malarial treatment; these appear to correspond to an exacerbation of the inflammatory response. We report the case of a 43-year-old Brazilian woman living in a malaria-endemic area, who presented acute respiratory distress syndrome (ARDS caused by P. vivax before starting anti-malarial treatment. The diagnosis was made based on microscopic methods. A negative rapid immunochromatographic assay, based on the detection of Histidine Rich Protein-2 (HRP-2 of P. falciparum, indicated that falciparum malaria was unlikely. After specific anti-plasmodial therapy and intensive supportive care, the patient was discharged from the hospital. We conclude that vivax malaria-associated ARDS can develop before anti-malarial therapy.

  8. Infection control for the otolaryngologist in the era of severe acute respiratory syndrome.

    Science.gov (United States)

    Alexander, Ashlin J; Tan, Andre K W; Evans, Gerald A; Allen, Janet

    2003-10-01

    Severe acute respiratory syndrome (SARS) has affected more than 8400 persons in 28 countries, with more than 800 deaths. The current SARS outbreak, especially in North American health care centers, has motivated a re-evaluation of infection control practices in the hospital and clinic environment. These considerations are particularly important to otolaryngology, in which examination and diagnostic procedures often bring the otolaryngologist in close--if not direct--contact with the patient's upper airway, mucosa, and secretions. The otolaryngologist is at increased risk of contracting a respiratory pathogen. A joint effort by the Department of Otolaryngology at Queen's University and the Infection Control Services of the Hotel Dieu Hospital, Kingston, Ontario, was carried out to develop specific infection control guidelines for the otolaryngologists using strategies from the Centers for Disease Control and Prevention in the United States and the Laboratory Center for Disease Control, Health Canada. A set of specific recommendations was developed for the otolaryngologists to augment current infection control, including diligent use of personal protective equipment with every patient encounter. Moreover, this equipment should be removed according to specific protocol, to avoid contamination of self, others, and surroundings. Finally, a number of practice modifications are being adopted as prudent precautionary measures. It is essential to adhere to these recommendations in order to protect the health and safety of clinicians, colleagues, and patients.

  9. Acute Respiratory Distress Syndrome after the Use of Gadolinium Contrast Media.

    Science.gov (United States)

    Park, Jihye; Byun, Il Hwan; Park, Kyung Hee; Lee, Jae-Hyun; Nam, Eun Ji; Park, Jung-Won

    2015-07-01

    Acute respiratory distress syndrome (ARDS) is a medical emergency that threatens life. To this day, ARDS is very rarely reported by iodine contrast media, and there is no reported case of ARDS induced by gadolinium contrast media. Here, we present a case with ARDS after the use of gadobutrol (Gadovist) as a magnetic resonance imaging (MRI) contrast medium. A 26 years old female without any medical history, including allergic diseases and without current use of drugs, visited the emergency room for abdominal pain. Her abdominopelvic computed tomography with iodine contrast media showed a right ovarian cyst and possible infective colitis. Eighty-three hours later, she underwent pelvis MRI after injection of 7.5 mL (0.1 mL/kg body weight) of gadobutrol (Gadovist) to evaluate the ovarian cyst. She soon presented respiratory difficulty, edema of the lips, nausea, and vomiting, and we could hear wheezing upon auscultation. She was treated with dexamethasone, epinephrine, and norepinephrine. Her chest X-ray showed bilateral central bat-wing consolidative appearance. Managed with mechanical ventilation, she was extubated 3 days later and discharged without complications.

  10. Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator Therapy

    Directory of Open Access Journals (Sweden)

    Kyung-Yil Lee

    2017-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is caused by infectious insults, such as pneumonia from various pathogens or related to other noninfectious events. Clinical and histopathologic characteristics are similar across severely affected patients, suggesting that a common mode of immune reaction may be involved in the immunopathogenesis of ARDS. There may be etiologic substances that have an affinity for respiratory cells and induce lung cell injury in cases of ARDS. These substances originate not only from pathogens, but also from injured host cells. At the molecular level, these substances have various sizes and biochemical characteristics, classifying them as protein substances and non-protein substances. Immune cells and immune proteins may recognize and act on these substances, including pathogenic proteins and peptides, depending upon the size and biochemical properties of the substances (this theory is known as the protein-homeostasis-system hypothesis. The severity or chronicity of ARDS depends on the amount of etiologic substances with corresponding immune reactions, the duration of the appearance of specific immune cells, or the repertoire of specific immune cells that control the substances. Therefore, treatment with early systemic immune modulators (corticosteroids and/or intravenous immunoglobulin as soon as possible may reduce aberrant immune responses in the potential stage of ARDS.

  11. The Role of Severe Acute Respiratory Syndrome (SARS)-Coronavirus Accessory Proteins in Virus Pathogenesis

    Science.gov (United States)

    McBride, Ruth; Fielding, Burtram C.

    2012-01-01

    A respiratory disease caused by a novel coronavirus, termed the severe acute respiratory syndrome coronavirus (SARS-CoV), was first reported in China in late 2002. The subsequent efficient human-to-human transmission of this virus eventually affected more than 30 countries worldwide, resulting in a mortality rate of ~10% of infected individuals. The spread of the virus was ultimately controlled by isolation of infected individuals and there has been no infections reported since April 2004. However, the natural reservoir of the virus was never identified and it is not known if this virus will re-emerge and, therefore, research on this virus continues. The SARS-CoV genome is about 30 kb in length and is predicted to contain 14 functional open reading frames (ORFs). The genome encodes for proteins that are homologous to known coronavirus proteins, such as the replicase proteins (ORFs 1a and 1b) and the four major structural proteins: nucleocapsid (N), spike (S), membrane (M) and envelope (E). SARS-CoV also encodes for eight unique proteins, called accessory proteins, with no known homologues. This review will summarize the current knowledge on SARS-CoV accessory proteins and will include: (i) expression and processing; (ii) the effects on cellular processes; and (iii) functional studies. PMID:23202509

  12. Continuous blood purification treatment for endotoxin-induced acute respiratory distress syndrome.

    Science.gov (United States)

    Jiang, Y; Lin, R; Xu, Y; Zhang, S; Cui, K; Zhu, M; Li, A; Chen, C; Yang, J; Yang, W

    2017-02-16

    This study aimed to explore the effects of continuous blood purification (CBP) treatment in pigs affected with acute respiratory distress syndrome (ARDS). A total of 12 healthy male pigs, weighing 12±1.8 kg, were randomly and equally assigned to the control and experimental groups. The ARDS pig model was prepared by intravenous injections of endotoxin (20 µg/kg). The control group was given conventional supportive therapy, while the experimental group was given continuous veno-venous hemofiltration therapy. During the treatment process, the variations in dynamic lung compliance, oxygenation index, hemodynamics, and urine volume per hour at different times (Baseline, 0, 2, 4, and 6 h) were recorded. The levels of tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and IL-10 in serum and bronchoalveolar lavage fluid (BALF) were measured using the enzyme-linked immunosorbent assay. The histomorphological changes of the lung, heart, and kidney were visualized using a light microscope. The nuclear factor κB p65 protein content of the heart, lung, and kidney tissues was also detected using western blot. The experimental group outperformed the control group in both respiratory and hemodynamic events. CBP treatment cleared TNF-α, IL-6, and IL-10 partially from serum and BALF. The pathological examination of the heart, lung, and kidney tissues revealed that the injury was less severe in the experimental group. CBP treatment can improve the organ functions of pigs affected with endotoxin-induced ARDS and protect these organs to some extent.

  13. SARS (SEVERE ACUTE RESPIRATORY SYNDROME – A NEW CHALLENGE FOR THE MANKIND

    Directory of Open Access Journals (Sweden)

    Andrej Trampuž

    2003-07-01

    Full Text Available Background. SARS (severe acute respiratory syndrome is a recently recognized new infectious respiratory illness, which first appeared in southern China in November 2002, and has since then within months spread to 29 countries. In total, 8437 cases and 813 deaths occurred (situation as of August 1, 2003. SARS is caused by a novel coronavirus that is primarily spread by large droplet transmission, less commonly by surface contamination or by air (airborne. Around half of the infected were health care workers; the majority of cases acquired the infection in the hospital.Conclusions. Incubation period of SARS is 2 to 10 days. Early manifestations include fever, myalgia, and headache, followed 2 to 4 days later by cough, shortness of breath, and diarrhea. In 10–20% of patients, tracheal intubation and mechanical ventilation is required. Case-fatality is approximately 15%, in patients aged 60 years or older may be higher than 40%. There is no specific therapy or vaccine, and management consists of supportive care. This article summarizes updated information regarding epidemiology, clinical features, etiologic agent, modes of transmission of the disease, and infection control measures to contain SARS.

  14. Intra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Feddy, Lee; Barker, Julian; Fawcett, Pete; Malagon, Ignacio

    2016-01-01

    Severe acute pancreatitis is associated with sever multiorgan failure from 15 to 50%, depending on the series. In some of these patients, conventional methods of ventilation and respiratory support will fail, demanding the use of extracorporeal membrane oxygenation (ECMO). Abdominal compartment syndrome is potentially harmful in this cohort of patients. We describe the successful treatment of three patients with severe acute pancreatitis who underwent respiratory ECMO and where intra abdominal pressure was monitored regularly. Retrospective review of case notes. Three patients with severe acute pancreatitis requiring ECMO suffered from increased intra abdominal pressure during their ICU stay. No surgical interventions were taken to relieve abdominal compartment syndrome. Survival to hospital discharge was 100%. Monitoring intraabdominal pressure is a valuable adjunct to decision making while caring for these high-risk critically ill patients.

  15. Treatment of acute respiratory distress syndrome in secondary surfactant deficiency in neonates

    Directory of Open Access Journals (Sweden)

    Heru Samudro

    2016-09-01

    Full Text Available In this report we present data of three premature infants who received 1 to 2 doses of surfactant for an acute respiratory deterioration and after initial surfactants treatment for RDS.

  16. A Recruiting Maneuver Algorithm in Patients with Early Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    D. I. Levikov

    2011-01-01

    Full Text Available Objective: to evaluate the efficiency of a recruiting maneuver (RM and adjustment of positive end-expiratory pressure (PEEP in patients with early acute respiratory distress syndrome (ARDS. Subjects and methods. The study enrolled 16 patients (14 men and 2 women aged 46 to 78 years (range 62±5.6 years with ARDS of various genesis. RM was made, by stepwisely increasing PEEP and inspiratory pressure under the control of dynamic lung compliance and hemodynamic parameters. The values of blood gas composition and hemodynamics were determined during the study. Results. RM caused an increase in oxygenation index (OI from 153.5±48.3 to 348.5±53.2 mm Hg. Oxygenation values returned to the baseline levels 30—40 min after the PEEP was set at the closure point of +2 cm H2O. If the set PEEP was 8—10 cm H2O higher than the objective, the effect of RM was retained for as long as 24 hours. When RM was performed using the maximum pressure of 50—60 cm H2O, the cardiac index (CI was lower in all the patients and 30—50% of the baseline values were achieved in all cases, which required the optimization of cardiotonic therapy. The time of this pronounced reduction in cardiac output with RM was not longer than 5 min. After RM, during mechanical ventilation with 18—26 cm H2O PEEP, the CI did not practically differ from the baseline values (3.31±0.41 and 3.37±0.36 l/min/m2, respectively, though the dopamine dose required to maintain normal hemodynamics was somewhat higher (7.5±2.3 and 6.3±2.6 ^g/kg/min. Conclusion. Analysis of the given cases suggests that RM is highly effective in patients at the early stages of acute lung injury. The duration of RM effects may depend on the set PEEP level in individual cases. Setting PEEP at a level of +2—4 cm H2O fails to prevent repeated alveolar derecruitment in a number of patients. In these cases, it is expedient to individually adjust PEEP levels, by taking into account the long-term changes in OI and Cdyn. In

  17. One severe acute respiratory syndrome coronavirus protein complex integrates processive RNA polymerase and exonuclease activities.

    Science.gov (United States)

    Subissi, Lorenzo; Posthuma, Clara C; Collet, Axelle; Zevenhoven-Dobbe, Jessika C; Gorbalenya, Alexander E; Decroly, Etienne; Snijder, Eric J; Canard, Bruno; Imbert, Isabelle

    2014-09-16

    In addition to members causing milder human infections, the Coronaviridae family includes potentially lethal zoonotic agents causing severe acute respiratory syndrome (SARS) and the recently emerged Middle East respiratory syndrome. The ∼30-kb positive-stranded RNA genome of coronaviruses encodes a replication/transcription machinery that is unusually complex and composed of 16 nonstructural proteins (nsps). SARS-CoV nsp12, the canonical RNA-dependent RNA polymerase (RdRp), exhibits poorly processive RNA synthesis in vitro, at odds with the efficient replication of a very large RNA genome in vivo. Here, we report that SARS-CoV nsp7 and nsp8 activate and confer processivity to the RNA-synthesizing activity of nsp12. Using biochemical assays and reverse genetics, the importance of conserved nsp7 and nsp8 residues was probed. Whereas several nsp7 mutations affected virus replication to a limited extent, the replacement of two nsp8 residues (P183 and R190) essential for interaction with nsp12 and a third (K58) critical for the interaction of the polymerase complex with RNA were all lethal to the virus. Without a loss of processivity, the nsp7/nsp8/nsp12 complex can associate with nsp14, a bifunctional enzyme bearing 3'-5' exoribonuclease and RNA cap N7-guanine methyltransferase activities involved in replication fidelity and 5'-RNA capping, respectively. The identification of this tripartite polymerase complex that in turn associates with the nsp14 proofreading enzyme sheds light on how coronaviruses assemble an RNA-synthesizing machinery to replicate the largest known RNA genomes. This protein complex is a fascinating example of the functional integration of RNA polymerase, capping, and proofreading activities.

  18. Clinical practice of acute respiratory distress syndrome in Japan: A nationwide survey and scientific evidences.

    Science.gov (United States)

    Tasaka, Sadatomo; Tatsumi, Koichiro

    2017-07-01

    There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals. The incidence of ARDS was estimated to be 3.13 cases/100 hospital beds or 1.91 cases/ICU bed per year. The most frequent underlying disease was pneumonia (34%), followed by sepsis (29%). In hospitals with fewer ICU beds, pulmonologists tended to be in charge of management of ARDS patients. Routine diagnostic measures included computed tomography of the chest (69.6% of the hospitals) and Swan-Ganz catheterization was rarely performed for diagnosis. In 87.4% of the hospitals, non-invasive ventilation was applied to management of ARDS patients, especially those with mild disease. Prone positioning and extracorporeal membrane oxygenation (ECMO) for ARDS patients was more widely adopted in hospitals with larger numbers of ICU beds and intensivists. In 58.2% of the responding hospitals, corticosteroid was considered as a treatment option for ARDS, among which pulse therapy was routinely introduced to ARDS patients in 35.4%. The incidence of ARDS in Japan was estimated to be lower than that in the recent international study. The scale and equipment of hospitals and the number of intensivists might influence clinical practice of ARDS. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  19. Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS).

    Science.gov (United States)

    Liu, Xuemei; Zhang, Mingming; He, Lin; Li, Youping

    2012-10-17

    Severe acute respiratory syndrome (SARS) is an acute respiratory disease caused by a novel coronavirus, which first appeared in Foshan City, China on 22 December 2002. Chinese herbs were used in its treatment. To evaluate the possible effectiveness and safety of Chinese herbs combined with Western medicines versus Western medicines alone for SARS patients. We searched CENTRAL 2012, Issue 3, MEDLINE (1966 to February Week 4, 2012), EMBASE (1990 to March 2012) and the Chinese Biomedical Literature (Issue 3, 2012). Randomised controlled trials (RCTs) and quasi-RCTs of Chinese herbs combined with Western medicines versus Western medicines alone for patients diagnosed with SARS. Two review authors (XL, MZ) independently extracted trial data. We extracted dichotomous and continuous data with 95% confidence intervals (CI). For dichotomous data, we used risk ratio (RR). For continuous data, we calculated mean differences (MD). We calculated overall results based on the random-effects model if heterogeneity existed between studies. If no heterogeneity was detected between the studies, we used the fixed-effect model. We used the Z score and the Chi(2) test with significance being set at P herbs were identified. We did not find Chinese herbs combined with Western medicines decreased mortality versus Western medicines alone. Two herbs may improve symptoms. Five herbs may improve lung infiltrate absorption. Four herbs may decrease the dosage of corticosteroids. Three herbs may improve the quality of life of SARS patients. One herb may shorten the length of hospital stay. Chinese herbs combined with Western medicines made no difference in decreasing mortality versus Western medicines alone. It is possible that Chinese herbs combined with Western medicines may improve symptoms, quality of life and absorption of pulmonary infiltration, and decrease the corticosteroid dosage for SARS patients. The evidence is weak because of the poor quality of the included trials. Long-term follow

  20. Pulse Pressure Variation Adjusted by Respiratory Changes in Pleural Pressure, Rather Than by Tidal Volume, Reliably Predicts Fluid Responsiveness in Patients With Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Liu, Yang; Wei, Lu-qing; Li, Guo-qiang; Yu, Xin; Li, Guo-feng; Li, Yu-ming

    2016-02-01

    1) To evaluate the ability of pulse pressure variation adjusted by respiratory changes in pleural pressure to predict fluid responsiveness compared with pulse pressure variation alone. 2) To identify factors explaining the poor performance of pulse pressure variation in acute respiratory distress syndrome. Prospective study. Forty-bed university hospital general ICU. Ninety-six mechanically ventilated acute respiratory distress syndrome patients requiring fluid challenge. Fluid challenge, 500 mL saline over 20 minutes. Before fluid challenge, esophageal pressure was measured at the end-inspiratory and end-expiratory occlusions. Change in pleural pressure was calculated as the difference between esophageal pressure measured at end-inspiratory and end-expiratory occlusions. Hemodynamic measurements were obtained before and after the fluid challenge. Patients were ventilated with tidal volume 7.0 ± 0.8 mL/kg predicted body weight. The fluids increased cardiac output by greater than 15% in 52 patients (responders). Adjusting pulse pressure variation for changes in pleural pressure (area under the receiver operating characteristic curve, 0.94 [0.88-0.98]) and the ratio of chest wall elastance to total respiratory system elastance (area under the receiver operating characteristic curve, 0.93 [0.88-0.98]) predicted fluid responsiveness better than pulse pressure variation (area under the receiver operating characteristic curve, 0.78 [0.69-0.86]; all p variation/changes in pleural pressure values (1.94-2.1) in 3.1% of patients for whom fluid responsiveness could not be predicted reliably. On logistic regression analysis, two independent factors affected the correct classification of fluid responsiveness at a 12% pulse pressure variation cutoff: tidal volume (adjusted odds ratio 1.57/50 mL; 95% CI, 1.05-2.34; p = 0.027) and chest wall elastance/respiratory system elastance (adjusted odds ratio, 2.035/0.1 unit; 95% CI, 1.36-3.06; p = 0.001). In patients with chest wall

  1. Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome and Acute Lung Injury in Adults and Children: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann

    2011-01-01

    BACKGROUND: Acute hypoxemic respiratory failure, defined as acute lung injury and acute respiratory distress syndrome, are critical conditions associated with frequent mortality and morbidity in all ages. Inhaled nitric oxide (iNO) has been used to improve oxygenation, but its role remains...... be recommended for patients with acute hypoxemic respiratory failure. iNO results in a transient improvement in oxygenation but does not reduce mortality and may be harmful....... to fraction of inspired oxygen (mean difference [MD] 15.91, 95% CI 8.25 to 23.56; I² = 25%). However, iNO appears to increase the risk of renal impairment among adults (RR 1.59, 95% CI 1.17 to 2.16; I² = 0) but not the risk of bleeding or methemoglobin or nitrogen dioxide formation. CONCLUSION: iNO cannot...

  2. Surfactant Protein D Is a Biomarker of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2013-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is one of the major problems of reanimatology. Current technologies allow diagnosis of early-stage ARDS. At the same time, no objective parameters for assessing structural damage to the air-blood barrier are available. Biomarkers are promising in this respect. Objective: to estimate the informative value of the plasma and bronchoalveolar lavage (BAL fluid levels of surfactant protein D (SP-D as a candidate biomarker for early-stage ARDS. Subjects and methods. A multicenter observational study was conducted at the Clinics of the V. A. Negovsky Research Institute of General Reanimatology (RIGR, Russian Academy of Medical Sciences (RAMS, in 2010—2012. It enrolled 70 patients in accordance with inclusion and exclusion criteria and 30 healthy donors. ARDS and its stages were diagnosed using the criteria developed by the RIGR, RAMS. Blood and BAL SP-D levels were measured by the enzyme immunoassay Human Surfactant Protein D ELISA, RD194059101, BioVendor, USA. Statistical analysis of the findings was performed using a Statistica 7.0 package. ROC analysis was made to determine the sensitivity and specificity of SP-D. The difference was considered significant at pResults. During all study days (1, 3, 5, and 7, the plasma SP-D levels were significantly higher in the patients with ARDS than in those without this condition. On the same study days, these were significantly lower in patients with Stage 1 ARDS than in those with its Stage 2. On the same study days, the plasma SP-D content was significantly higher in deceased patients with ARDS than in survivors with this condition. The SP-D level of >115.8 ng/ml on study day 1 had a sensitivity of 82.5% and a specificity of 80.0% in diagnosing ARDS (area under the curve 0.87; 95% confidence interval 0.778-0.984; p=0.0026. That of Conclusion. The plasma SP-D level of >115.8 ng/ml is a sensitive and specific biomarker °f ARDS and that °f Key words: acute respiratory

  3. Hyaluronic acid is associated with organ dysfunction in acute respiratory distress syndrome.

    Science.gov (United States)

    Esposito, Anthony J; Bhatraju, Pavan K; Stapleton, Renee D; Wurfel, Mark M; Mikacenic, Carmen

    2017-12-14

    Hyaluronic acid (HA), an extracellular matrix component, is degraded in response to local tissue injury or stress. In various animal models of lung injury, HA has been shown to play a mechanistic role in modulating inflammation and injury. While HA is present in the lungs of patients with acute respiratory distress syndrome (ARDS), its relationship to patient outcomes is unknown. We studied 86 patients with ARDS previously enrolled in the Phase II Randomized Trial of Fish Oil in Patients with Acute Lung Injury (NCT00351533) at five North American medical centers. We examined paired serum and bronchoalveolar lavage fluid (BALF) samples obtained within 48 hours of diagnosis of ARDS. We evaluated the association of HA levels in serum and BALF with local (lung injury score (LIS)) and systemic (sequential organ failure assessment score (SOFA)) measures of organ dysfunction with regression analysis adjusting for age, sex, race, treatment group, and risk factor for ARDS. We found that both day-0 circulating and alveolar levels of HA were associated with worsening LIS (p = 0.04 and p = 0.003, respectively), particularly via associations with degree of hypoxemia (p = 0.02 and p < 0.001, respectively) and set positive end-expiratory pressure (p = 0.01 and p = 0.02, respectively). Circulating HA was associated with SOFA score (p < 0.001), driven by associations with the respiratory (p = 0.02), coagulation (p < 0.001), liver (p = 0.006), and renal (p = 0.01) components. Notably, the alveolar HA levels were associated with the respiratory component of the SOFA score (p = 0.003) but not the composite SOFA score (p = 0.27). Elevated alveolar levels of HA are associated with LIS while circulating levels are associated with both lung injury and SOFA scores. These findings suggest that HA has a potential role in both local and systemic organ dysfunction in patients with ARDS.

  4. Kinetics and Role of Plasma Matrix Metalloproteinase-9 Expression in Acute Lung Injury and the Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Hsu, Albert T; Barrett, Christopher D; DeBusk, George M; Ellson, Christian D; Gautam, Shiva; Talmor, Daniel S; Gallagher, Diana C; Yaffe, Michael B

    2015-08-01

    Primed neutrophils that are capable of releasing matrix metalloproteinases (MMPs) into the circulation are thought to play a significant role in the pathophysiology of acute respiratory distress syndrome (ARDS). We hypothesized that direct measurement of plasma MMP-9 activity may be a predictor of incipient tissue damage and subsequent lung injury, which was investigated in both an animal model of ARDS and a small cohort of 38 critically ill human patients. In a mouse model of ARDS involving instillation of intratracheal lipopolysaccharide (LPS) to induce lung inflammation, we measured neutrophil-mediated inflammation, along with MMP-9 activity in the airways and lung tissue and MMP-9 expression in the plasma. Neutrophil recruitment, inflammation, and MMP-9 activity in the airways and lung tissue increased throughout the 72 h after LPS instillation, whereas plasma MMP-9 expression was greatest at 12 to 24 h after LPS instillation. The results suggest that the peak in plasma MMP-9 activity may precede the peak of neutrophil inflammation in the airways and lung tissue in the setting of ARDS. Based on this animal study, a retrospective observational cohort study involving 38 patients admitted to a surgical intensive care unit at a tertiary care university hospital with acute respiratory failure requiring intubation and mechanical ventilation was conducted. Plasma samples were collected daily, and MMP-9 activity was compared with lung function as determined by the PaO2/FiO2 ratio. In patients who developed ARDS, a notable increase in plasma MMP-9 activity on a particular day correlated with a decrease in the PaO2/FiO2 ratio on the following day (r = -0.503, P critically ill patients.

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

    Directory of Open Access Journals (Sweden)

    Sarah M McMullen

    Full Text Available 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.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.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.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.

  6. Acute Respiratory Distress Syndrome Caused by Influenza B Virus Infection in a Patient with Diffuse Large B-Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Silvio A. Ñamendys-Silva

    2011-01-01

    Full Text Available Influenza B virus infections are less common than infections caused by influenza A virus in critically ill patients, but similar mortality rates have been observed for both influenza types. Pneumonia caused by influenza B virus is uncommon and has been reported in pediatric patients and previously healthy adults. Critically ill patients with pneumonia caused by influenza virus may develop acute respiratory distress syndrome. We describe the clinical course of a critically ill patient with diffuse large B-cell lymphoma nongerminal center B-cell phenotype who developed acute respiratory distress syndrome caused by influenza B virus infection. This paper emphasizes the need to suspect influenza B virus infection in critically ill immunocompromised patients with progressive deterioration of cardiopulmonary function despite treatment with antibiotics. Early initiation of neuraminidase inhibitor and the implementation of guidelines for management of severe sepsis and septic shock should be considered.

  7. Physiotherapy Practice Patterns for Acute Respiratory Distress Syndrome in Intensive Care Unit in India – A Survey

    OpenAIRE

    Rashmi Nigam; Gopala Krishna Alaparthi; Shyam Krishnan K; Zulfeequer CP

    2017-01-01

    Objective: To determine the practice patterns of physiotherapists for acute respiratory distress syndrome (ARDS) in the Intensive care unit in India. Materials and methods: A cross sectional survey was conducted across India, in which 600 questionnaires were sent via email to cardio-pulmonary physiotherapists. The questionnaire addressed assessment and treatment techniques of ventilated and non-ventilated ARDS patients. Results: A total of 252 completed questionnaires were returned with a res...

  8. Severe acute respiratory syndrome coronavirus envelope protein regulates cell stress response and apoptosis.

    Directory of Open Access Journals (Sweden)

    Marta L DeDiego

    2011-10-01

    Full Text Available Severe acute respiratory syndrome virus (SARS-CoV that lacks the envelope (E gene (rSARS-CoV-ΔE is attenuated in vivo. To identify factors that contribute to rSARS-CoV-ΔE attenuation, gene expression in cells infected by SARS-CoV with or without E gene was compared. Twenty-five stress response genes were preferentially upregulated during infection in the absence of the E gene. In addition, genes involved in signal transduction, transcription, cell metabolism, immunoregulation, inflammation, apoptosis and cell cycle and differentiation were differentially regulated in cells infected with rSARS-CoV with or without the E gene. Administration of E protein in trans reduced the stress response in cells infected with rSARS-CoV-ΔE or with respiratory syncytial virus, or treated with drugs, such as tunicamycin and thapsigargin that elicit cell stress by different mechanisms. In addition, SARS-CoV E protein down-regulated the signaling pathway inositol-requiring enzyme 1 (IRE-1 of the unfolded protein response, but not the PKR-like ER kinase (PERK or activating transcription factor 6 (ATF-6 pathways, and reduced cell apoptosis. Overall, the activation of the IRE-1 pathway was not able to restore cell homeostasis, and apoptosis was induced probably as a measure to protect the host by limiting virus production and dissemination. The expression of proinflammatory cytokines was reduced in rSARS-CoV-ΔE-infected cells compared to rSARS-CoV-infected cells, suggesting that the increase in stress responses and the reduction of inflammation in the absence of the E gene contributed to the attenuation of rSARS-CoV-ΔE.

  9. Prediction model for critically ill patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Zhang, Zhongheng; Ni, Hongying

    2015-01-01

    Acute respiratory distress syndrome (ARDS) is a major cause respiratory failure in intensive care unit (ICU). Early recognition of patients at high risk of death is of vital importance in managing them. The aim of the study was to establish a prediction model by using variables that were readily available in routine clinical practice. The study was a secondary analysis of data obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. Patients were enrolled between August 2007 and July 2008 from 33 hospitals. Demographics and laboratory findings were extracted from dataset. Univariate analyses were performed to screen variables with pstepwise forward selection with significance level of 0.1. Interaction terms and fractional polynomials were examined for variables in the main effect model. Multiple imputations and bootstraps procedures were used to obtain estimations of coefficients with better external validation. Overall model fit and logistic regression diagnostics were explored. A total of 282 ARDS patients were included for model development. The final model included eight variables without interaction terms and non-linear functions. Because the variable coefficients changed substantially after exclusion of most poorly fitted and influential subjects, we estimated the coefficient after exclusion of these outliers. The equation for the fitted model was: g(Χ)=0.06×age(in years)+2.23(if on vasopressor)+1.37×potassium (mmol/l)-0.007×platelet count (×109)+0.03×heart rate (/min)-0.29×Hb(g/dl)-0.67×T(°C)+0.01×PaO_2+13, and the probability of death π(Χ)=eg(Χ)/(1+eg(Χ)). The study established a prediction model for ARDS patients requiring mechanical ventilation. The model was examined with rigorous methodology and can be used for risk stratification in ARDS patients.

  10. Tidal volume in acute respiratory distress syndrome: how best to select it.

    Science.gov (United States)

    Umbrello, Michele; Marino, Antonella; Chiumello, Davide

    2017-07-01

    Mechanical ventilation is the type of organ support most widely provided in the intensive care unit. However, this form of support does not constitute a cure for acute respiratory distress syndrome (ARDS), as it mainly works by buying time for the lungs to heal while contributing to the maintenance of vital gas exchange. Moreover, it can further damage the lung, leading to the development of a particular form of lung injury named ventilator-induced lung injury (VILI). Experimental evidence accumulated over the last 30 years highlighted the factors associated with an injurious form of mechanical ventilation. The present paper illustrates the physiological effects of delivering a tidal volume to the lungs of patients with ARDS, and suggests an approach to tidal volume selection. The relationship between tidal volume and the development of VILI, the so called volotrauma, will be reviewed. The still actual suggestion of a lung-protective ventilatory strategy based on the use of low tidal volumes scaled to the predicted body weight (PBW) will be presented, together with newer strategies such as the use of airway driving pressure as a surrogate for the amount of ventilatable lung tissue or the concept of strain, i.e., the ratio between the tidal volume delivered relative to the resting condition, that is the functional residual capacity (FRC). An ultra-low tidal volume strategy with the use of extracorporeal carbon dioxide removal (ECCO2R) will be presented and discussed. Eventually, the role of other ventilator-related parameters in the generation of VILI will be considered (namely, plateau pressure, airway driving pressure, respiratory rate (RR), inspiratory flow), and the promising unifying framework of mechanical power will be presented.

  11. Scandinavian clinical practice guideline on mechanical ventilation in adults with the acute respiratory distress syndrome.

    Science.gov (United States)

    Claesson, J; Freundlich, M; Gunnarsson, I; Laake, J H; Vandvik, P O; Varpula, T; Aasmundstad, T A

    2015-03-01

    The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on mechanical ventilation in adults with the acute respiratory distress syndrome (ARDS) is to formulate treatment recommendations based on available evidence from systematic reviews and randomised trials. This guideline was developed according to standards for trustworthy guidelines through a systematic review of the literature and the use of the Grading of Recommendations Assessment, Development and Evaluation system for assessment of the quality of evidence and for moving from evidence to recommendations in a systematic and transparent process. We found evidence of moderately high quality to support a strong recommendation for pressure limitation and small tidal volumes in patients with ARDS. Also, we suggest positive end-expiratory pressure (PEEP) > 5 cm H2O in moderate to severe ARDS and prone ventilation 16/24 h for the first week in moderate to severe ARDS (weak recommendation, low quality evidence). Volume controlled ventilation or pressure control may be equally beneficial or harmful and partial modes of ventilatory support may be used if clinically feasible (weak recommendation, very low quality evidence). We suggest utilising recruitment manoeuvres as a rescue measure in catastrophic hypoxaemia only (weak recommendation, low quality evidence). Based on high-quality evidence, we strongly recommend not to use high-frequency oscillatory ventilation. We could find no relevant data from randomised trials to guide decisions on choice of FiO2 or utilisation of non-invasive ventilation. We strongly recommend pressure- and volume limitation and suggest using higher PEEP and prone ventilation in patients with severe respiratory failure. © 2014 The Authors. The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

    Science.gov (United States)

    Nin, Nicolas; Muriel, Alfonso; Peñuelas, Oscar; Brochard, Laurent; Lorente, José Angel; Ferguson, Niall D.; Raymondos, Konstantinos; Ríos, Fernando; Violi, Damian A.; Thille, Arnaud W.; González, Marco; Villagomez, Asisclo J.; Hurtado, Javier; Davies, Andrew R.; Du, Bin; Maggiore, Salvatore M.; Soto, Luis; D’Empaire, Gabriel; Matamis, Dimitrios; Abroug, Fekri; Moreno, Rui P.; Soares, Marco Antonio; Arabi, Yaseen; Sandi, Freddy; Jibaja, Manuel; Amin, Pravin; Koh, Younsuck; Kuiper, Michael A.; Bülow, Hans-Henrik; Zeggwagh, Amine Ali; Anzueto, Antonio; Sznajder, Jacob I.; Esteban, Andres

    2017-01-01

    Purpose To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032). Conclusions Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. PMID:28108768

  13. Continuous blood purification treatment for endotoxin-induced acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Y. Jiang

    Full Text Available This study aimed to explore the effects of continuous blood purification (CBP treatment in pigs affected with acute respiratory distress syndrome (ARDS. A total of 12 healthy male pigs, weighing 12±1.8 kg, were randomly and equally assigned to the control and experimental groups. The ARDS pig model was prepared by intravenous injections of endotoxin (20 µg/kg. The control group was given conventional supportive therapy, while the experimental group was given continuous veno-venous hemofiltration therapy. During the treatment process, the variations in dynamic lung compliance, oxygenation index, hemodynamics, and urine volume per hour at different times (Baseline, 0, 2, 4, and 6 h were recorded. The levels of tumor necrosis factor (TNF-α, interleukin 6 (IL-6, and IL-10 in serum and bronchoalveolar lavage fluid (BALF were measured using the enzyme-linked immunosorbent assay. The histomorphological changes of the lung, heart, and kidney were visualized using a light microscope. The nuclear factor κB p65 protein content of the heart, lung, and kidney tissues was also detected using western blot. The experimental group outperformed the control group in both respiratory and hemodynamic events. CBP treatment cleared TNF-α, IL-6, and IL-10 partially from serum and BALF. The pathological examination of the heart, lung, and kidney tissues revealed that the injury was less severe in the experimental group. CBP treatment can improve the organ functions of pigs affected with endotoxin-induced ARDS and protect these organs to some extent.

  14. Extended prone position ventilation in severe acute respiratory distress syndrome: a pilot feasibility study.

    Science.gov (United States)

    Romero, Carlos M; Cornejo, Rodrigo A; Gálvez, L Ricardo; Llanos, Osvaldo P; Tobar, Eduardo A; Berasaín, M Angélika; Arellano, Daniel H; Larrondo, Jorge F; Castro, José S

    2009-03-01

    The aim of the study was to evaluate the safety of extended prone position ventilation (PPV) and its impact on respiratory function in patients with severe acute respiratory distress syndrome (ARDS). This was a prospective interventional study. Patients were recruited from a mixed medical-surgical intensive care unit in a university hospital. Fifteen consecutive patients with severe ARDS, previously unresponsive to positive end-expiratory pressure adjustment, were treated with PPV. Prone position ventilation for 48 hours or until the oxygenation index was 10 or less (extended PPV). The elapsed time from the initiation of mechanical ventilation to pronation was 35 +/- 11 hours. Prone position ventilation was continuously maintained for 55 +/- 7 hours. Two patients developed grade II pressure ulcers of small extent. None of the patients experienced life-threatening complications or hemodynamic instability during the procedure. The patients showed a statistically significant improvement in Pao(2)/Fio(2) (92 +/- 12 vs 227 +/- 43, P < .0001) and oxygenation index (22 +/- 5 vs 8 +/- 2, P < .0001), reduction of PaCo(2) (54 +/- 9 vs 39 +/- 4, P < .0001) and plateau pressure (32 +/- 2 vs 27 +/- 3, P < .0001), and increment of the static compliance (21 +/- 3 vs 37 +/- 6, P < .0001) with extended PPV. All the parameters continued to improve significantly while they remained in prone position and did not change upon returning the patients to the supine position. The results obtained suggest that extended PPV is safe and effective in patients with severe ARDS when it is carried out by a trained staff and within an established protocol. Extended PPV is emerging as an effective therapy in the rescue of patients from severe ARDS.

  15. The Open Lung Approach Improves Pulmonary Vascular Mechanics in an Experimental Model of Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Santos, Arnoldo; Lucchetta, Luca; Monge-Garcia, M Ignacio; Borges, Joao Batista; Tusman, Gerardo; Hedenstierna, Goran; Larsson, Anders; Suarez-Sipmann, Fernando

    2017-03-01

    To test whether positive end-expiratory pressure consistent with an open lung approach improves pulmonary vascular mechanics compared with higher or lower positive end-expiratory pressures in experimental acute respiratory distress syndrome. Experimental study. Animal research laboratory. Ten pigs, 35 ± 5.2 kg. Acute respiratory distress syndrome was induced combining saline lung lavages with injurious mechanical ventilation. The positive end-expiratory pressure level resulting in highest compliance during a decremental positive end-expiratory pressure trial after lung recruitment was determined. Thereafter, three positive end-expiratory pressure levels were applied in a random order: hyperinflation, 6 cm H2O above; open lung approach, 2 cm H2O above; and collapse, 6 cm H2O below the highest compliance level. High fidelity pressure and flow sensors were placed at the main pulmonary artery for measuring pulmonary artery resistance (Z0), effective arterial elastance, compliance, and reflected pressure waves. After inducing acute respiratory distress syndrome, Z0 and effective arterial elastance increased (from 218 ± 94 to 444 ± 115 dyn.s.cm and from 0.27 ± 0.14 to 0.62 ± 0.22 mm Hg/mL, respectively; p mechanics compared with higher or lower positive end-expiratory pressure settings.

  16. [Effects of Gardenia-aweto compound by different extraction method on antagonizing acute respiratory distress syndrome].

    Science.gov (United States)

    Yan, Dong; Li, Lan-juan; Du, Wei-bo; Ren, Guo-ping; Cao, Hong-cui; Zhu, Di-feng; Xia, Lei; Zeng, Zhen; Shao, Qing; Zhang, Hai-jiang; Chen, Yi-yu

    2005-05-01

    To study the effect of Gardenia-Aweto compound (GAC) and two component on preventing acute respiratory distress syndrome (ARDS) by the rabbit model of ARDS induced by intravenous injection of oleic acid. To detect the efficiency component of GAC in preventing ARDS. GAC was divided into two compounts, ethanol-soluble components (ESC) and ethanol-deposition components (EDC), based on polarity. Forty-three new zealand rabbits were randomly divided into five groups, the blank control group, the model group, the GAC groups, the ESC group, and the EDC group. The ARDS model was induced by intravenous injection of oleic acid. Dynamic changes of arterial blood gas, lung index, albumin in bronchoalveolar lavage fluid (BALF) in different groups and lung histological changes were observed and compared. As compared with the blank group, in the model group, GAC group, ESC group, EDC group the arterial PO2 and oxygen saturation deprived continuously. While SO2 in GAC group at time points 30, 60, 90, 120 min (P inflammatory, immuno-modulatory, anti-oxidant and antithrombotic effects.

  17. Spatio-temporal and stochastic modelling of severe acute respiratory syndrome

    Directory of Open Access Journals (Sweden)

    Poh-Chin Lai

    2013-11-01

    Full Text Available This study describes the development of a spatio-temporal disease model based on the episodes of severe acute respiratory syndrome (SARS that took place in Hong Kong in 2003. In contrast to conventional, deterministic modelling approaches, the model described here is predominantly spatial. It incorporates stochastic processing of environmental and social variables that interact in space and time to affect the patterns of disease transmission in a community. The model was validated through a comparative assessment between actual and modelled distribution of diseased locations. Our study shows that the inclusion of location-specific characteristics satisfactorily replicates the spatial dynamics of an infectious disease. The Pearson’s correlation coefficients for five trials based on 3-day aggregation of disease counts for 1-3, 4-6 and 7-9 day forecasts were 0.57- 0.95, 0.54-0.86 and 0.57-0.82, respectively, while the correlation based on 5-day aggregation for the 1-5 day forecast was 0.55- 0.94 and 0.58-0.81 for the 6-10 day forecast. The significant and strong relationship between actual results and forecast is encouraging for the potential development of an early warning system for detecting this type of disease outbreaks.

  18. Serum Uric Acid Level as a Prognostic Marker in Patients With Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Lee, Hyun Woo; Choi, Sun Mi; Lee, Jinwoo; Park, Young Sik; Lee, Chang-Hoon; Yim, Jae-Joon; Yoo, Chul-Gyu; Kim, Young Whan; Han, Sung Koo; Lee, Sang-Min

    2017-01-01

    Uric acid acts as both a pathogenic inflammatory mediator and an antioxidative agent. Several studies have shown that uric acid level correlates with the incidence, severity, and prognosis of pulmonary diseases. However, the association between uric acid level and acute respiratory distress syndrome (ARDS) has not been studied. This study was conducted to elucidate how serum uric acid level is related with clinical prognosis of ARDS. A retrospective cohort study with propensity score matching was conducted at a medical intensive care unit of a tertiary teaching hospital. The medical records of patients diagnosed with ARDS admitted from 2005 through 2011 were reviewed. Two hundred thirty-seven patients with ARDS met the inclusion criteria. Patients with a serum uric acid level uric acid group, and those with a level ≥3 mg/dL were classified into the normal to high uric acid group. We selected 40 patients in each group using propensity score matching. A higher percentage of patients in the low uric acid group experienced clinical improvement in ARDS. More patients died from sepsis in the normal to high uric acid group. Kaplan-Meier analysis showed that a low serum uric acid level was significantly associated with better survival rate. In patients with ARDS, a low serum uric acid level may be a prognostic marker of a low risk of in-hospital mortality.

  19. Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak.

    Science.gov (United States)

    Phua, D H; Tang, H K; Tham, K Y

    2005-04-01

    During the 2003 severe acute respiratory syndrome (SARS) outbreak, health care workers (HCWs) experienced unusual stressors. The study hospital introduced psychosocial interventions to help HCWs. This study aimed to examine the coping strategies adopted by the emergency department (ED) HCWs who cared for the SARS patients. In November 2003, a self-administered questionnaire of physicians and nurses was conducted in the hospital ED that is the national SARS screening center in Singapore. Data collected included demographics and responses to these instruments: 1) the Coping Orientation to Problems Experienced (COPE) to assess coping strategies, 2) the Impact of Event Scale (IES) to measure psychological reactions, and 3) the General Health Questionnaire 28 (GHQ 28) to measure psychiatric morbidity. Thirty-eight of 41 (92.7%) physicians and 58 of 83 (69.9%) nurses responded. The respondents reported a preference for problem-focused and emotion-focused coping measures. The physicians chose humor as a coping response significantly more frequently (p GHQ 28, with the trend for physicians to report lower psychiatric morbidity. With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.

  20. Punicalagin ameliorates lipopolysaccharide-induced acute respiratory distress syndrome in mice.

    Science.gov (United States)

    Peng, Jingjing; Wei, Dong; Fu, Zengqiang; Li, Dong; Tan, Yong; Xu, Tao; Zhou, Jinjun; Zhang, Tao

    2015-04-01

    Punicalagin, a bioactive ellagitannin isolated from pomegranate, has been reported to have anti-inflammatory property. In the present study, we analyzed the role of punicalagin against acute respiratory distress syndrome (ARDS) induced by lipopolysaccharide (LPS) in mice. Male BALB/c mice with ARDS, induced by intranasal instillation of LPS, were treated with punicalagin 1 h prior to LPS exposure. The effects of punicalagin on pro-inflammatory cytokines, myeloperoxidase activity, nuclear factor kappa B (NF-κB) activation, and the histopathological changes were evaluated. The results showed that punicalagin treatment attenuated LPS-induced lung edema, elevating TNF-α, IL-6, and IL-1β levels in the bronchoalveolar lavage fluid (BALF). Meanwhile, punicalagin significantly inhibited LPS-induced increases in the macrophage and neutrophil infiltration of lung tissues and myeloperoxidase activity. Furthermore, punicalagin inhibits Toll-like receptor 4 (TLR4) expression and NF-κB activation induced by LPS. In conclusion, this is the first study to demonstrate that punicalagin protects against LPS-induced ARDS in mice. The underlying mechanisms may include inhibition of TLR4-mediated NF-κB signaling pathways.

  1. Computer-aided diagnosis system for the Acute Respiratory Distress Syndrome from chest radiographs.

    Science.gov (United States)

    Zaglam, Nesrine; Jouvet, Philippe; Flechelles, Olivier; Emeriaud, Guillaume; Cheriet, Farida

    2014-09-01

    This paper presents a computer-aided diagnosis (CAD) system for the assessment of Acute Respiratory Distress Syndrome (ARDS) from chest radiographs. Our method consists in automatically extracting intercostal patches from chest radiographs belonging to the test database using a semiautomatic segmentation method of the ribs. Statistical and spectral features are computed from each patch then a method of feature transformation is applied using the Linear Discriminant Analysis (LDA). A training database of 321 patches was classified by an expert in two classes, a class of normal patches and a class of abnormal patches. Patches belonging to the test database are then classified using the SVM classifier. Finally, the rate of abnormal patches is calculated for each quadrant to decide if the chest radiograph presents an ARDS. The method has been evaluated on 90 radiographs where 53 images present ARDS. The results show a sensitivity of 90.6% at a specificity of 86.5%. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. The impact of severe acute respiratory syndrome on medical house staff: a qualitative study.

    Science.gov (United States)

    Rambaldini, Gloria; Wilson, Kumanan; Rath, Darlyne; Lin, Yulia; Gold, Wayne L; Kapral, Moira K; Straus, Sharon E

    2005-05-01

    To explore the impact of severe acute respiratory syndrome (SARS) on a medical training program and to develop principles for professional training programs to consider in dealing with future, similar crises. Qualitative interviews analyzed using grounded theory methodology. University-affiliated hospitals in Toronto, Canada during the SARS outbreak in 2003. Medical house staff who were allocated to a general internal medicine clinical teaching unit, infectious diseases consultation service, or intensive care unit. Seventeen medical residents participated in this study. Participants described their experiences during the outbreak and highlighted several themes including concerns about their personal safety and about the negative impact of the outbreak on patient care, house staff education, and their emotional well-being. The ability of residents to cope with the stress of the SARS outbreak was enhanced by the communication of relevant information and by the leadership of their supervisors and infection control officers. It is hoped that training programs for health care professionals will be able to implement these tenets of crisis management as they develop strategies for dealing with future health threats.

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

    Directory of Open Access Journals (Sweden)

    Cíntia Lourenço Santos

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Structural and Functional Analyses of the Severe Acute Respiratory Syndrome Coronavirus Endoribonuclease Nsp15

    Energy Technology Data Exchange (ETDEWEB)

    Bhardwaj, Kanchan; Palaninathan, Satheesh; Alcantara, Joanna Maria Ortiz; Yi, Lillian Li; Guarino, Linda; Sacchettini, James C.; Kao, C. Cheng (TAM)

    2008-03-31

    The severe acute respiratory syndrome (SARS) coronavirus encodes several RNA-processing enzymes that are unusual for RNA viruses, including Nsp15 (nonstructural protein 15), a hexameric endoribonuclease that preferentially cleaves 3' of uridines. We solved the structure of a catalytically inactive mutant version of Nsp15, which was crystallized as a hexamer. The structure contains unreported flexibility in the active site of each subunit. Substitutions in the active site residues serine 293 and proline 343 allowed Nsp15 to cleave at cytidylate, whereas mutation of leucine 345 rendered Nsp15 able to cleave at purines as well as pyrimidines. Mutations that targeted the residues involved in subunit interactions generally resulted in the formation of catalytically inactive monomers. The RNA-binding residues were mapped by a method linking reversible cross-linking, RNA affinity purification, and peptide fingerprinting. Alanine substitution of several residues in the RNA-contacting portion of Nsp15 did not affect hexamer formation but decreased the affinity of RNA binding and reduced endonuclease activity. This suggests a model for Nsp15 hexamer interaction with RNA.

  6. Expression profile of immune response genes in patients with Severe Acute Respiratory Syndrome

    Directory of Open Access Journals (Sweden)

    Tai Dessmon

    2005-01-01

    Full Text Available Abstract Background Severe acute respiratory syndrome (SARS emerged in later February 2003, as a new epidemic form of life-threatening infection caused by a novel coronavirus. However, the immune-pathogenesis of SARS is poorly understood. To understand the host response to this pathogen, we investigated the gene expression profiles of peripheral blood mononuclear cells (PBMCs derived from SARS patients, and compared with healthy controls. Results The number of differentially expressed genes was found to be 186 under stringent filtering criteria of microarray data analysis. Several genes were highly up-regulated in patients with SARS, such as, the genes coding for Lactoferrin, S100A9 and Lipocalin 2. The real-time PCR method verified the results of the gene array analysis and showed that those genes that were up-regulated as determined by microarray analysis were also found to be comparatively up-regulated by real-time PCR analysis. Conclusions This differential gene expression profiling of PBMCs from patients with SARS strongly suggests that the response of SARS affected patients seems to be mainly an innate inflammatory response, rather than a specific immune response against a viral infection, as we observed a complete lack of cytokine genes usually triggered during a viral infection. Our study shows for the first time how the immune system responds to the SARS infection, and opens new possibilities for designing new diagnostics and treatments for this new life-threatening disease.

  7. National survey of outcomes and practices in acute respiratory distress syndrome in Singapore.

    Science.gov (United States)

    Siddiqui, Shahla; Puthucheary, Zudin; Phua, Jason; Ho, Benjamin; Tan, Jonathan; Chuin, Siau; Lim, Noelle Louise; Soh, Chai Rick; Loo, Chian Min; Tan, Addy Y H; Mukhopadhyay, Amartya; Khan, Faheem Ahmed; Johan, Azman; Tan, Aik Hau; MacLaren, Graeme; Taculod, Juvel; Ramos, Blesilda; Han, Tun Aung; Cove, Matthew E

    2017-01-01

    In the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country. We conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected. A total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days. The incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies.

  8. Cynomolgus macaque as an animal model for severe acute respiratory syndrome.

    Directory of Open Access Journals (Sweden)

    James V Lawler

    2006-05-01

    Full Text Available The emergence of severe acute respiratory syndrome (SARS in 2002 and 2003 affected global health and caused major economic disruption. Adequate animal models are required to study the underlying pathogenesis of SARS-associated coronavirus (SARS-CoV infection and to develop effective vaccines and therapeutics. We report the first findings of measurable clinical disease in nonhuman primates (NHPs infected with SARS-CoV.In order to characterize clinically relevant parameters of SARS-CoV infection in NHPs, we infected cynomolgus macaques with SARS-CoV in three groups: Group I was infected in the nares and bronchus, group II in the nares and conjunctiva, and group III intravenously. Nonhuman primates in groups I and II developed mild to moderate symptomatic illness. All NHPs demonstrated evidence of viral replication and developed neutralizing antibodies. Chest radiographs from several animals in groups I and II revealed unifocal or multifocal pneumonia that peaked between days 8 and 10 postinfection. Clinical laboratory tests were not significantly changed. Overall, inoculation by a mucosal route produced more prominent disease than did intravenous inoculation. Half of the group I animals were infected with a recombinant infectious clone SARS-CoV derived from the SARS-CoV Urbani strain. This infectious clone produced disease indistinguishable from wild-type Urbani strain.SARS-CoV infection of cynomolgus macaques did not reproduce the severe illness seen in the majority of adult human cases of SARS; however, our results suggest similarities to the milder syndrome of SARS-CoV infection characteristically seen in young children.

  9. Early extracorporeal life support as rescue for Wegener granulomatosis with diffuse alveolar hemorrhage and acute respiratory distress syndrome: a case report and literature review.

    Science.gov (United States)

    Joseph, Mark; Charles, Anthony G

    2011-12-01

    The study's objective was to report a case and review the literature on the use of extracorporeal life support in the face of severe pulmonary hemorrhage for acute respiratory distress syndrome. This study is a single case report of a pediatric patient who was successfully managed on venovenous extracorporeal life support for severe acute respiratory distress syndrome with acute pulmonary hemorrhage secondary to Wegener disease. Extracorporeal life support can be used successfully in selected patients with respiratory failure with pulmonary hemorrhage. The cautious use of anticoagulation should be balanced with the risk of bleeding, mindful of the need for other measures to mitigate severe bleeding if this should occur.

  10. Immunomodulation by fish-oil containing lipid emulsions in murine acute respiratory distress syndrome.

    Science.gov (United States)

    Hecker, Matthias; Ott, Juliane; Sondermann, Christoph; Schaefer, Martina; Obert, Martin; Hecker, Andreas; Morty, Rory E; Vadasz, Istvan; Herold, Susanne; Rosengarten, Bernhard; Witzenrath, Martin; Seeger, Werner; Mayer, Konstantin

    2014-04-29

    Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care units. Patients with ARDS often require parenteral nutrition with lipid emulsions as essential components. Besides being an energy supply, these lipid emulsions might display differential modulatory effects on lung integrity and inflammation. In a pre-emptive strategy, we investigated the impact of three different intravenously infused lipid emulsions on lung morphology, leukocyte invasion, protein leakage and cytokines in a murine model of ARDS. Mice received an infusion of normal saline solution, a pure long-chain triglycerides (LCT) emulsion, a medium-chain triglycerides (MCT) containing mixed emulsion (LCT/MCT), or a fish oil (FO) containing mixed emulsion (LCT/MCT/FO) before lipopolysaccharide (LPS) challenge. Mice pre-infused with fish oil-containing lipid emulsion showed decreased leukocyte invasion, protein leakage, myeloperoxidase activity, and cytokine production in their alveolar space after LPS challenge compared to mice receiving LCT or LCT/MCT. In line with these findings, lung morphology assessed by histological staining after LPS-induced lung injury improved faster in the LCT/MCT/FO group. Concerning the above mentioned parameters, no significant difference was observed between mice infused with LCT or the combination of LCT and MCT. Fish oil-containing lipid emulsions might exert anti-inflammatory and pro-resolving effects in the murine model of acute lung injury. Partial replacement of n-6 fatty acids with n-3 fatty acids may thus be of benefit for critically ill patients at risk for ARDS which require parenteral nutrition.

  11. A Novel Large Animal Model of Acute Respiratory Distress Syndrome Induced by Mitochondrial Products.

    Science.gov (United States)

    Sanchez, Pablo G; Pasrija, Chetan; Mulligan, Matthew J; Wadhwa, Mandheer; Pratt, Diana L; Li, Tieluo; Gammie, James S; Kon, Zachary N; Pham, Si M; Griffith, Bartley P

    2017-12-01

    We aimed to create a reproducible lung injury model utilizing injection of mitochondrial damage-associated molecular products. Our goal was to characterize the pathophysiologic response to damage-associated molecular pattern mediated organ injury. There remain significant gaps in our understanding of acute respiratory distress syndrome, in part due to the lack of clinically applicable animal models of this disease. Animal models of noninfectious, tissue damage-induced lung injury are needed to understand the signals and responses associated with this injury. Ten pigs (35-45 kg) received an intravenous dose of disrupted mitochondrial products and were followed for 6 hours under general anesthesia. These animals were compared to a control group (n = 5) and a model of lung injury induced by bacterial products (lipopolysaccharide n = 5). Heart rate and temperature were significantly elevated in the mitochondrial product (204 ± 12 and 41 ± 1) and lipopolysaccharide groups (178 ± 18 and 42 ± 0.5) compared with controls (100 ± 13 and 38 ± 0.5) (P products and lipopolysaccharide groups compared with controls (170 ± 39, 196 ± 27, and 564 ± 75 mm Hg respectively, P = 0.001). Lung injury scoring of histological sections was significantly worse in mitochondrial and lipopolysaccharide groups compared with controls (mitochondrial-64 ± 6, lipopolysaccharide-54 ± 8, control-14 ± 1.5, P= 0.002). Our data demonstrated that the presence of mitochondrial products in the circulation leads to systemic inflammatory response and lung injury. In its acute phase lung injury induced by tissue or bacterial products is clinically indistinguishable.

  12. Effect of type II diabetes mellitus on outcomes in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Singla, Abhishek; Turner, Paul; Pendurthi, Madhu Kalyan; Agrawal, Vrinda; Modrykamien, Ariel

    2014-02-01

    The acute respiratory distress syndrome (ARDS) is a life-threatening condition, whereas the presence of diabetes has been shown to be protective in its development. We undertook this study to assess the association of type II diabetes mellitus with clinical outcomes in patients with ARDS. We retrospectively examined the medical records of consecutive series of patients with ARDS requiring mechanical ventilation from January 2008 to March 2011. Patients with type I diabetes were excluded from the study. Clinical outcomes such as ventilator-free days, mortality, length of stay in the hospital and intensive care unit (ICU), and reintubations were compared based on the presence of diabetes. Multivariate regression model was used to find if the presence of type II diabetes mellitus predicts ventilator-free days at day 28. Two hundred forty-nine patients with ARDS were admitted to the ICU during the study period. Fifty (20%) subjects had type II diabetes mellitus. Differences in ventilator-free days, in-hospital mortality, reintubation rate, and length of stay in the hospital or ICU were not statistically significant between diabetic and nondiabetic patients with ARDS. Acute Physiologic and Chronic Health Evaluation II, ICU specialty, use of vasopressors, and the need for reintubation were predictors of ventilator-free days at day 28. The presence of type II diabetes mellitus and its adjustment by body mass index did not show association with ventilator-free days at day 28. The presence of type II diabetes mellitus is not associated with clinical outcomes in ARDS, even when its presence is adjusted by body mass index. © 2013.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Zhang, Xianming; Wu, Weiliang; Zhu, Yongcheng; Jiang, Ying; Du, Juan; Chen, Rongchang

    2016-01-01

    Objective 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. Methods 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. Results 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). Conclusion 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. PMID:26745868

  15. Research of the risk factors predicting progression and prognosis of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Ran WANG

    2017-06-01

    Full Text Available Objective To explore the early diagnosis and risk factors for judging prognosis of acute respiratory distress syndrome (ARDS, and to provide references for clinical intervention. Methods Using the method for prospective cohort study, clinical data were collected from 64 ARDS and 66 high-risk ARDS patients in Department of Respiratory Diseases of Xinqiao Hospital from January 2013 to March 2016. They included patients' demographic data, Acute Physiology and Chronic Health Evaluation system Ⅱ (APACHE Ⅱ score, oxygenation index, blood routine test, coagulation function and inflammatory markers (procalcitonin, C-reaction protein, tumor necrosis factor and interleukin -6 within 24h and the state of survival or death of the 24th day. Risk factors for predicting progression of the high-risk ARDS patients into ARDS patients and influencing the prognosis of the ARDS patients were analyzed by using logistic regression. Results Univariate logistic regression analysis found that the independent risk factors for progression of ARDS were APACHE Ⅱ score (OR=6.764, P=0.001, hypoproteinemia (OR=10.54, P=0.002, white blood cell count (OR=3.912, P=0.012, fibrinogen (OR=9.953, P=0.064, and D-dimer (OR=4.239, P=0.029. The mortality rate was 43.75% (36/64 in ARDS group, and the oxygenation index (OR=6.573, P=0.014, platelet count (OR=9.376, P=0.003, hypoproteinemia (OR=10.738, P=0.056 were the independent risk factors of death in ARDS patients. Multivariate logistic regression showed that combination of multiple indicators for predicting ARDS improved the specificity, but reduce the sensitivity. APACHE Ⅱ and hypoproteinemia (sensitivity 62.50%, specificity 92.42% and APACHE Ⅱ and D dimmer (sensitivity 62.07%, specificity 93.33% had better specificity and sensitivity. The specificity and sensitivity of combining hypoproteinemia and platelet count to predict the risk of death in these patients were 77.78% and 60.71%. Conclusions In high-risk ARDS patients

  16. Renal tumor leading to acute respiratory distress syndrome – A rare ...

    African Journals Online (AJOL)

    Adult respiratory distress syndrome (ARDS) generally develops in the setting of sepsis, aspiration, shock or some other identifiable cause. Pulmonary involvement with neoplastic disease is an unusual but recognized cause of ARDS and has been rarely reported. Here we report a case of ARDS due to renal tumor most ...

  17. Acute Respiratory Distress Syndrome in Wartime Military Burns: Application of the Berlin Criteria

    Science.gov (United States)

    2014-01-01

    collected retrospectively on mechanically ventilated military casualties admitted to our burn intensive care unit from January 2003 to December 2011. Patients...mortality. CONCLUSION: In this cohort of military casualties with thermal injuries, nearly a third required mechanical ventilation ; of those, nearly...EVIDENCE: Epidemiologic/prognostic study, level III. KEY WORDS: Mechanical ventilation ; adult respiratory distress syndrome; the Berlin definition; combat

  18. Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation.

    Science.gov (United States)

    Hodgson, Carol; Goligher, Ewan C; Young, Meredith E; Keating, Jennifer L; Holland, Anne E; Romero, Lorena; Bradley, Scott J; Tuxen, David

    2016-11-17

    Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009. Our primary objective was to determine the effects of recruitment manoeuvres on mortality in adults with acute respiratory distress syndrome.Our secondary objective was to determine, in the same population, the effects of recruitment manoeuvres on oxygenation and adverse events (e.g. rate of barotrauma). For this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO), Latin American and Caribbean Health Sciences (LILACS) and the International Standard Randomized Controlled Trial Number (ISRCTN) registry from inception to August 2016. We included randomized controlled trials (RCTs) of adults who were mechanically ventilated that compared recruitment manoeuvres versus standard care for patients given a diagnosis of ARDS. Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Ten trials met the inclusion criteria for this review (n = 1658 participants). We found five trials to be at low risk of bias and five to be at moderate risk of bias. Six of the trials included recruitment manoeuvres as part of an open lung ventilation strategy that was different from control ventilation in aspects other than the recruitment manoeuvre (such as mode of ventilation, higher positive end-expiratory pressure (PEEP) titration and lower tidal volume or plateau

  19. Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in Adults

    Science.gov (United States)

    Wu, Meng-Yu; Huang, Chung-Chi; Wu, Tzu-I; Wang, Chin-Liang; Lin, Pyng-Jing

    2016-01-01

    Abstract Despite a therapeutic option for severe acute respiratory distress syndrome (ARDS), the survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) is still controversial in adults. This study was aimed at investigating the prognostic factors for ECMO-treated ARDS in adult patients. From 2012 to 2015, 49 patients (median age: 57 years) received VV-ECMO in our institution and were included in this retrospective study. The indication of VV-ECMO was a severe hypoxemia (PaO2/FiO2 ratio 35 cmH2O and a FiO2 >0.8. To decrease the impact of pulmonary injuries associated with the high-pressure ventilation, the settings of MV on VV-ECMO were downgraded according to our protocol. Outcomes of this study were death on VV-ECMO and death in hospital. Important demographic and clinical data during the treatment were collected for outcome analyses. All patients experienced significant improvements in arterial oxygenation on VV-ECMO. Twenty-four hours after initiation of VV-ECMO, the median PaO2/FiO2 ratio increased from 58 to 172 mmHg (P ECMO and 21 patients died before hospital discharge. Among all of the pre-ECMO variables, the pre-ECMO pulmonary dynamic compliance (PCdyn) ECMO (odds ratio [OR]: 6, 95% confidence interval [CI]: 1–35, P = 0.03), and the pre-ECMO duration of MV >90 hours was the prognostic factor of death before hospital discharge (OR: 7, 95% CI: 1–29, P = 0.01). VV-ECMO was a useful salvage therapy for severe ARDS in adults. However, the value of PCdyn and the duration of MV before intervention with VV-ECMO may significantly affect the patients’ outcomes. PMID:26937920

  20. Joblessness and Lost Earnings after Acute Respiratory Distress Syndrome in a 1-Year National Multicenter Study.

    Science.gov (United States)

    Kamdar, Biren B; Huang, Minxuan; Dinglas, Victor D; Colantuoni, Elizabeth; von Wachter, Till M; Hopkins, Ramona O; Needham, Dale M

    2017-10-15

    Following acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood. To evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data. Of 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean ± SD age, 45 ± 13 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949 ± $22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P lost earnings and a shift toward government-funded healthcare coverage.

  1. Thrombocytopenia is associated with acute respiratory distress syndrome mortality: an international study.

    Directory of Open Access Journals (Sweden)

    Tiehua Wang

    Full Text Available Early detection of the Acute Respiratory Distress Syndrome (ARDS has the potential to improve the prognosis of critically ill patients admitted to the intensive care unit (ICU. However, no reliable biomarkers are currently available for accurate early detection of ARDS in patients with predisposing conditions.This study examined risk factors and biomarkers for ARDS development and mortality in two prospective cohort studies.We examined clinical risk factors for ARDS in a cohort of 178 patients in Beijing, China who were admitted to the ICU and were at high risk for ARDS. Identified biomarkers were then replicated in a second cohort of1,878 patients in Boston, USA.Of 178 patients recruited from participating hospitals in Beijing, 75 developed ARDS. After multivariate adjustment, sepsis (odds ratio [OR]:5.58, 95% CI: 1.70-18.3, pulmonary injury (OR: 3.22; 95% CI: 1.60-6.47, and thrombocytopenia, defined as platelet count <80×10(3/µL, (OR: 2.67; 95% CI: 1.27-5.62were significantly associated with increased risk of developing ARDS. Thrombocytopenia was also associated with increased mortality in patients who developed ARDS (adjusted hazard ratio [AHR]: 1.38, 95% CI: 1.07-1.57 but not in those who did not develop ARDS(AHR: 1.25, 95% CI: 0.96-1.62. The presence of both thrombocytopenia and ARDS substantially increased 60-day mortality. Sensitivity analyses showed that a platelet count of <100×10(3/µL in combination with ARDS provide the highest prognostic value for mortality. These associations were replicated in the cohort of US patients.This study of ICU patients in both China and US showed that thrombocytopenia is associated with an increased risk of ARDS and platelet count in combination with ARDS had a high predictive value for patient mortality.

  2. Proteomic profiles in acute respiratory distress syndrome differentiates survivors from non-survivors.

    Directory of Open Access Journals (Sweden)

    Maneesh Bhargava

    Full Text Available Acute Respiratory Distress Syndrome (ARDS continues to have a high mortality. Currently, there are no biomarkers that provide reliable prognostic information to guide clinical management or stratify risk among clinical trial participants. The objective of this study was to probe the bronchoalveolar lavage fluid (BALF proteome to identify proteins that differentiate survivors from non-survivors of ARDS. Patients were divided into early-phase (1 to 7 days and late-phase (8 to 35 days groups based on time after initiation of mechanical ventilation for ARDS (Day 1. Isobaric tags for absolute and relative quantitation (iTRAQ with LC MS/MS was performed on pooled BALF enriched for medium and low abundance proteins from early-phase survivors (n = 7, early-phase non-survivors (n = 8, and late-phase survivors (n = 7. Of the 724 proteins identified at a global false discovery rate of 1%, quantitative information was available for 499. In early-phase ARDS, proteins more abundant in survivors mapped to ontologies indicating a coordinated compensatory response to injury and stress. These included coagulation and fibrinolysis; immune system activation; and cation and iron homeostasis. Proteins more abundant in early-phase non-survivors participate in carbohydrate catabolism and collagen synthesis, with no activation of compensatory responses. The compensatory immune activation and ion homeostatic response seen in early-phase survivors transitioned to cell migration and actin filament based processes in late-phase survivors, revealing dynamic changes in the BALF proteome as the lung heals. Early phase proteins differentiating survivors from non-survivors are candidate biomarkers for predicting survival in ARDS.

  3. Proteomic Profiles in Acute Respiratory Distress Syndrome Differentiates Survivors from Non-Survivors

    Science.gov (United States)

    Bhargava, Maneesh; Becker, Trisha L.; Viken, Kevin J.; Jagtap, Pratik D.; Dey, Sanjoy; Steinbach, Michael S.; Wu, Baolin; Kumar, Vipin; Bitterman, Peter B.; Ingbar, David H.; Wendt, Christine H.

    2014-01-01

    Acute Respiratory Distress Syndrome (ARDS) continues to have a high mortality. Currently, there are no biomarkers that provide reliable prognostic information to guide clinical management or stratify risk among clinical trial participants. The objective of this study was to probe the bronchoalveolar lavage fluid (BALF) proteome to identify proteins that differentiate survivors from non-survivors of ARDS. Patients were divided into early-phase (1 to 7 days) and late-phase (8 to 35 days) groups based on time after initiation of mechanical ventilation for ARDS (Day 1). Isobaric tags for absolute and relative quantitation (iTRAQ) with LC MS/MS was performed on pooled BALF enriched for medium and low abundance proteins from early-phase survivors (n = 7), early-phase non-survivors (n = 8), and late-phase survivors (n = 7). Of the 724 proteins identified at a global false discovery rate of 1%, quantitative information was available for 499. In early-phase ARDS, proteins more abundant in survivors mapped to ontologies indicating a coordinated compensatory response to injury and stress. These included coagulation and fibrinolysis; immune system activation; and cation and iron homeostasis. Proteins more abundant in early-phase non-survivors participate in carbohydrate catabolism and collagen synthesis, with no activation of compensatory responses. The compensatory immune activation and ion homeostatic response seen in early-phase survivors transitioned to cell migration and actin filament based processes in late-phase survivors, revealing dynamic changes in the BALF proteome as the lung heals. Early phase proteins differentiating survivors from non-survivors are candidate biomarkers for predicting survival in ARDS. PMID:25290099

  4. [Effects of baicalin on the changes in hemorheology of acute respiratory distress syndrome in rats].

    Science.gov (United States)

    Zhao, Z M; Zheng, Y M; Zhang, Y L; Li, S Q

    2017-11-20

    Objective: To investigate the effect of baicalin on the changes in hemorheology and its mechanism during the development of Acute Respiratory Distress Syndrome(ARDS) induced by oleic acid (OA) in rats. Methods: Rats were randomized into 3 groups: control, ARDS (OA induction, 0.12 mg/kg) and ba-icalin-treated group (300 mg/kg). The blood samples were collected at 30 min, 1, 2, 3, 6, 12 and 6 h after OA injection. The whole blood viscosity, plasma viscosity, Maximum erythrocyte deformability index (DImax) were detected. Meanwhile, blood gas analysis and Routine blood test were also performed. Results: The level of arte-rial oxygen partial pressure and oxygenation index decreased (P<0.01 vs. control) and oxygenation index (178 mm Hg, 1 mm Hg=0.133 kPa) reached the diagnostic standard of ARDS at 2 h in ARDS group. In baicalin-treated group, the level of arterial oxygen partial pressure and oxygenation index increased versus the ARDS group. The platelet count (PLT) decreased in baicalin-treated and ARDS groups. Compared with the ARDS group, the level of PLT increased significantly in baicalin-treated group at 30min, 1, 2, and 3 h. Hematocrit (HCT) increased in baicalin-treated and ARDS groups. Compared with the ARDS group, the level of HCT de-creased significantly in baicalin-treated group at 2, 3, 6 and 12 h. Meanwhile, all the index of hemorheology improved in baicalin-treated group. Conclusion: Baicalin may improve hypoxemia of ARDS induced by OA in rats. It may be due to the Improvement of microcirculation of lung.

  5. Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Munshi, Laveena; Kobayashi, Tadahiro; DeBacker, Julian; Doobay, Ravi; Telesnicki, Teagan; Lo, Vincent; Cote, Nathalie; Cypel, Marcelo; Keshavjee, Shaf; Ferguson, Niall D; Fan, Eddy

    2017-02-01

    There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality. We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO. Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy. Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile.

  6. Effect of different seated positions on lung volume and oxygenation in acute respiratory distress syndrome.

    Science.gov (United States)

    Dellamonica, J; Lerolle, N; Sargentini, C; Hubert, S; Beduneau, G; Di Marco, F; Mercat, A; Diehl, J L; Richard, J C M; Bernardin, G; Brochard, L

    2013-06-01

    Lung volume available for ventilation is markedly decreased during acute respiratory distress syndrome. Body positioning may contribute to increase lung volume and partial verticalization is simple to perform. This study evaluated whether verticalization had parallel effects on oxygenation and end expiratory lung volume (EELV). Prospective multicenter study in 40 mechanically ventilated patients with ALI/ARDS in five university hospital MICUs. We evaluated four 45-min successive trunk position epochs (supine slightly elevated at 15°; semi recumbent with trunk elevated at 45°; seated with trunk elevated at 60° and legs down at 45°; back to supine). Arterial blood gases, EELV measured using the nitrogen washin/washout, and static compliance were measured. Responders were defined by a PaO₂/FiO₂ increase >20 % between supine and seated position. Results are median [25th-75th percentiles]. With median PEEP = 10 cmH₂O, verticalization increased lung volume but only responders (13 patients, 32 %) had a significant increase in EELV/PBW (predicted body weight) compared to baseline. This increase persisted at least partially when patients were positioned back to supine. Responders had a lower EELV/PBW supine [14 mL/kg (13-15) vs. 18 mL/kg (15-27) (p = 0.005)] and a lower compliance [30 mL/cmH₂O (22-38) vs. 42 (30-46) (p = 0.01)] than non-responders. Strain decreased with verticalization for responders. EELV/PBW increase and PaO₂/FiO₂ increase were not correlated. Verticalization is easily achieved and improves oxygenation in approximately 32 % of the patients together with an increase in EELV. Nonetheless, effect of verticalization on EELV/PBW is not predictable by PaO₂/FiO₂ increase, its monitoring may be helpful for strain optimization.

  7. Pulmonary Mechanics and Mortality in Mechanically Ventilated Patients without Acute Respiratory Distress Syndrome: A Cohort Study.

    Science.gov (United States)

    Fuller, Brian M; Page, David; Stephens, Robert J; Roberts, Brian W; Drewry, Anne M; Ablordeppey, Enyo; Mohr, Nicholas M; Kollef, Marin H

    2017-08-25

    Driving pressure has been proposed as a major determinant of outcome in patients with acute respiratory distress syndrome (ARDS), but there is little data examining the association between pulmonary mechanics, include driving pressure, and outcomes in mechanically ventilated patients without ARDS. Secondary analysis from 1,705 mechanically ventilated patients enrolled in a clinical study that examined outcomes associated with the use of early lung-protective mechanical ventilation. The primary outcome was mortality and the secondary outcome was the incidence of ARDS. Multivariable models were constructed to: 1) define the association between pulmonary mechanics (driving pressure, plateau pressure, and compliance) and mortality; and 2) evaluate if driving pressure contributed information beyond that provided by other pulmonary mechanics. The mortality rate for the entire cohort was 26.0%. Compared with survivors, non-survivors had significantly higher driving pressure [15.9 (5.4) vs. 14.9 (4.4), p = 0.005] and plateau pressure [21.4 (5.7) vs. 20.4 (4.6)), p = 0.001]. Driving pressure was independently associated with mortality [adjusted OR, 1.04 (1.01-1.07)]. Models related to plateau pressure also revealed an independent association with mortality, with similar effect size and interval estimates as driving pressure. There were 152 patients that progressed to ARDS (8.9%). Along with driving pressure and plateau pressure, mechanical power [adjusted OR, 1.03 (1.00-1.06)] was also independently associated with ARDS development CONCLUSIONS:: In mechanically ventilated patients, driving pressure and plateau pressure are risk factors for mortality and ARDS, and provide similar information. Mechanical power is also a risk factor for ARDS.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Mechanisms of Host Receptor Adaptation by Severe Acute Respiratory Syndrome Coronavirus

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Kailang; Peng, Guiqing; Wilken, Matthew; Geraghty, Robert J.; Li, Fang (UMMC)

    2012-12-10

    The severe acute respiratory syndrome coronavirus (SARS-CoV) from palm civets has twice evolved the capacity to infect humans by gaining binding affinity for human receptor angiotensin-converting enzyme 2 (ACE2). Numerous mutations have been identified in the receptor-binding domain (RBD) of different SARS-CoV strains isolated from humans or civets. Why these mutations were naturally selected or how SARS-CoV evolved to adapt to different host receptors has been poorly understood, presenting evolutionary and epidemic conundrums. In this study, we investigated the impact of these mutations on receptor recognition, an important determinant of SARS-CoV infection and pathogenesis. Using a combination of biochemical, functional, and crystallographic approaches, we elucidated the molecular and structural mechanisms of each of these naturally selected RBD mutations. These mutations either strengthen favorable interactions or reduce unfavorable interactions with two virus-binding hot spots on ACE2, and by doing so, they enhance viral interactions with either human (hACE2) or civet (cACE2) ACE2. Therefore, these mutations were viral adaptations to either hACE2 or cACE2. To corroborate the above analysis, we designed and characterized two optimized RBDs. The human-optimized RBD contains all of the hACE2-adapted residues (Phe-442, Phe-472, Asn-479, Asp-480, and Thr-487) and possesses exceptionally high affinity for hACE2 but relative low affinity for cACE2. The civet-optimized RBD contains all of the cACE2-adapted residues (Tyr-442, Pro-472, Arg-479, Gly-480, and Thr-487) and possesses exceptionally high affinity for cACE2 and also substantial affinity for hACE2. These results not only illustrate the detailed mechanisms of host receptor adaptation by SARS-CoV but also provide a molecular and structural basis for tracking future SARS-CoV evolution in animals.

  10. Prediction model for critically ill patients with acute respiratory distress syndrome.

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    Full Text Available Acute respiratory distress syndrome (ARDS is a major cause respiratory failure in intensive care unit (ICU. Early recognition of patients at high risk of death is of vital importance in managing them. The aim of the study was to establish a prediction model by using variables that were readily available in routine clinical practice.The study was a secondary analysis of data obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. Patients were enrolled between August 2007 and July 2008 from 33 hospitals. Demographics and laboratory findings were extracted from dataset. Univariate analyses were performed to screen variables with p<0.3. Then these variables were subject to automatic stepwise forward selection with significance level of 0.1. Interaction terms and fractional polynomials were examined for variables in the main effect model. Multiple imputations and bootstraps procedures were used to obtain estimations of coefficients with better external validation. Overall model fit and logistic regression diagnostics were explored.A total of 282 ARDS patients were included for model development. The final model included eight variables without interaction terms and non-linear functions. Because the variable coefficients changed substantially after exclusion of most poorly fitted and influential subjects, we estimated the coefficient after exclusion of these outliers. The equation for the fitted model was: g(Χ=0.06×age(in years+2.23(if on vasopressor+1.37×potassium (mmol/l-0.007×platelet count (×109+0.03×heart rate (/min-0.29×Hb(g/dl-0.67×T(°C+0.01×PaO_2+13, and the probability of death π(Χ=eg(Χ/(1+eg(Χ.The study established a prediction model for ARDS patients requiring mechanical ventilation. The model was examined with rigorous methodology and can be used for risk stratification in ARDS patients.

  11. Clinical effect of alprostadil in patients with septic shock associated with acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Li-ping LIU

    2017-10-01

    Full Text Available Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS, and to explore its possible mechanism. Methods From January 2015 to June 2016, patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group. The standard treatment was given in control group, alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment. Monitoring indexes were recorded in 1, 3 and 6 days after enrollment. General condition of patients, APACHE Ⅱ score, ventilator conditions (PO2, PCO2, RR, PEEP, FiO2, oxygenation index, airway resistance, lung compliance, mechanical ventilation time, ICU stay time, hospital follow-up, 28-day follow-up, immune index (CD4+/CD8+, inflammatory markers (CRP, PCT, IL-6 were monitored. Results Sixty-five patients were included in this study, 32 in control group and 33 in alprostadil group. At 3 and 6 days after the treatment, APACHE Ⅱ score, respiratory rate (RR, the inspired oxygen concentration (FiO2, airway resistance, and C reactive protein (CRP, procalcitonin (PCT -6 and interleukin (IL-6 levels significantly decreased, compared with pretreatment and 1 day posttreatment, in the two groups and lower in alprostadil group than in the control group on the 6th day (P<0.05; at the same time, these indexes such as arterial partial pressure of oxygen (PaO2, lung compliance, oxygenation index, CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups, and on the 6th day, significantly higher in the alprostadil group than in the control group (P<0.05. Time of mechanical ventilation, ICU stay and hospital stay in the alprostadil group was respectively lower than that in

  12. Alveolar dead-space response to activated protein C in acute respiratory distress syndrome.

    Science.gov (United States)

    Kallet, Richard H; Jasmer, Robert M; Pittet, Jean-François

    2010-05-01

    We report a complicated case of acute respiratory distress syndrome (ARDS) from severe sepsis, in which we measured the ratio of physiologic dead space to tidal volume (V(D)/V(T)) with volumetric capnography prior to, during, and after therapy with human recombinant activated protein C. Previous studies hypothesized that early in ARDS, elevated V(D)/V(T) primarily reflects increased alveolar V(D), probably caused by pronounced thrombi formation in the pulmonary microvasculature. This may be particularly true when severe sepsis is the cause of ARDS. We repeatedly measured V(D)/V(T) in a 29-year-old man with sepsis-induced ARDS over the course of activated protein C therapy. Treatment with activated protein C resulted in a pronounced reduction in V(D)/V(T), from 0.55 to 0.27. Alveolar V(D) decreased from 165 mL to 11 mL (93% reduction). Activated protein C was terminated at 41 h because of gastrointestinal bleeding. When the measurement was repeated 29 h after therapy was discontinued, V(D)/V(T) had increased modestly, to 0.34, whereas alveolar V(D) had increased to 71 mL, or 43% of the pre-activated-protein-C baseline measurement. Alveolar V(T) rose from 260 mL to 369 mL and decreased slightly after termination of activated protein C (336 mL). Over the course of activated protein C therapy there was a persistent decrease in alveolar V(D) and increase in alveolar V(T), even while positive end-expiratory pressure was reduced and respiratory-system compliance decreased. Thus, improved alveolar perfusion persisted despite signs of alveolar de-recruitment. This suggests that activated protein C may have reduced microvascular obstruction. This report provides indirect evidence that microvascular obstruction may play an important role in elevated V(D)/V(T) in early ARDS caused by severe sepsis.

  13. The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood : multicenter evaluation and expert consensus

    NARCIS (Netherlands)

    De Luca, Daniele; Piastra, Marco; Chidini, Giovanna; Tissieres, Pierre; Calderini, Edoardo; Essouri, Sandrine; Medina Villanueva, Alberto; Vivanco Allende, Ana; Pons-Odena, Marti; Perez-Baena, Luis; Hermon, Michael; Tridente, Ascanio; Conti, Giorgio; Antonelli, Massimo; Kneyber, Martin

    2013-01-01

    A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to

  14. Herpes simplex type 1 pneumonitis and acute respiratory distress syndrome in a patient with chronic lymphatic leukemia: a case report.

    Science.gov (United States)

    Luginbuehl, Miriam; Imhof, Alexander; Klarer, Alexander

    2017-11-23

    Pulmonary pathogenicity of herpes simplex virus type 1 in patients in intensive care without classic immunosuppression as well as the necessity of antiviral treatment in the case of herpes simplex virus detection in respiratory specimens in these patients is controversial. We present a case of acute respiratory distress syndrome in a patient with stable chronic lymphatic leukemia not requiring treatment, in whom we diagnosed herpes simplex virus type 1 bronchopneumonitis based on herpes simplex virus type 1 detection in bronchoalveolar lavage fluid and clinical response to antiviral treatment. A 72-year-old white man presented with symptoms of lower respiratory tract infection. His medical history was significant for chronic lymphatic leukemia, which had been stable without treatment, arterial hypertension, multiple squamous cell carcinomas of the scalp, and alcohol overuse. Community-acquired pneumonia was suspected and appropriate broad-spectrum antibacterial treatment was initiated. Within a few hours, rapid respiratory deterioration led to cardiac arrest. He was successfully resuscitated, but developed acute respiratory distress syndrome. Furthermore, he remained febrile and inflammation markers remained elevated despite antibacterial treatment. Polymerase chain reaction from bronchoalveolar lavage fluid and viral culture from tracheobronchial secretions tested positive for herpes simplex virus type 1. We initiated antiviral treatment with acyclovir. Concomitantly we further escalated the antibacterial treatment, although no bacterial pathogen had been isolated at any point. Defervescence occurred rapidly and his C-reactive protein and leukocyte levels decreased. He was successfully weaned from mechanical ventilation, transferred to the ward, and eventually discharged to home. Herpes simplex virus should be considered a cause for lower respiratory tract infection in critically ill patients, especially in the setting of an underlying disease.

  15. Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience

    Directory of Open Access Journals (Sweden)

    Rahul Magazine

    2017-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. Aim: To study the epidemiological profile of ARDS patients. Setting: A tertiary care hospital in Karnataka, India. Materials and Methods: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters. Results: The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%, scrub typhus (n = 33, 22%, leptospirosis (n = 11, 7.3%, malaria (n = 6, 4%, influenza (H1N1 (n = 10, 6.7%, pulmonary tuberculosis (n = 2, 1.3%, dengue (n = 1, 0.7%, abdominal sepsis (n = 16, 10.7%, skin infection (n = 3, 2%, unknown cause of sepsis (n = 18, 12%, and nonseptic causes (n = 15, 10%. A total of 77 (51.3% patients survived, 66 (44% expired, and 7 (4.7% were discharged against medical advice (AMA. Preexisting comorbidities (46 were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively. Conclusion: The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors.

  16. Statistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial.

    Science.gov (United States)

    Damiani, Lucas Petri; Berwanger, Otavio; Paisani, Denise; Laranjeira, Ligia Nasi; Suzumura, Erica Aranha; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro; Cavalcanti, Alexandre Biasi

    2017-01-01

    The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy). To describe the data management process and statistical analysis plan. The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes. According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results. ClinicalTrials.gov number, NCT01374022.

  17. Hypoxemic Patients With Bilateral Infiltrates Treated With High-Flow Nasal Cannula Present a Similar Pattern of Biomarkers of Inflammation and Injury to Acute Respiratory Distress Syndrome Patients.

    Science.gov (United States)

    García-de-Acilu, Marina; Marin-Corral, Judith; Vázquez, Antonia; Ruano, Laura; Magret, Mònica; Ferrer, Ricard; Masclans, Joan R; Roca, Oriol

    2017-11-01

    To examine whether patients with acute hypoxemia and bilateral opacities treated with high-flow nasal cannula and acute respiratory distress syndrome patients who were directly mechanically ventilated are similar in terms of lung epithelial, endothelial, and inflammatory biomarkers. Prospective, multicenter study. ICUs at three university tertiary hospitals. Intubated and nonintubated patients admitted to the ICU with acute hypoxemia (PaO2/FIO2 ≤ 300) and bilateral opacities. None. Either high-flow nasal cannula or mechanical ventilation was initiated, at the discretion of the attending physician. We measured plasma biomarkers of lung epithelial injury (receptor for advanced glycation end products and surfactant protein D) and endothelial injury (angiopoietin-2) and inflammation (interleukin-6, interleukin-8, and interleukin-33 and soluble suppression of tumorigenicity-2) within 24 hours of acute respiratory distress syndrome onset. Propensity score matching was performed using six different variables (Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, PaO2/FIO2, origin of acute respiratory distress syndrome, steroids, renal failure and need for vasopressors). Nonhypoxemic mechanically ventilated critically ill patients and healthy volunteers served as controls. Of the 170 patients enrolled, 127 (74.7%) were intubated and 43 (25.3%) were treated with high-flow nasal cannula at acute respiratory distress syndrome onset. After propensity score matching (39 high-flow nasal cannula patients vs 39 mechanical ventilation patients), no significant differences were observed in receptor for advanced glycation end products, surfactant protein D, angiopoietin-2, interleukin-6, interleukin-8, interleukin-33, and soluble suppression of tumorigenicity-2 between matched patients who were treated with high-flow nasal cannula and those who were intubated at acute respiratory distress syndrome onset. After matching, no differences in mortality

  18. Toll-Like Receptor 3 Signaling via TRIF Contributes to a Protective Innate Immune Response to Severe Acute Respiratory Syndrome Coronavirus Infection

    OpenAIRE

    Totura, Allison L; Whitmore, Alan; Agnihothram, Sudhakar; Sch?fer, Alexandra; Katze, Michael G.; Heise, Mark T.; Baric, Ralph S.

    2015-01-01

    ABSTRACT Toll-like receptors (TLRs) are sensors that recognize molecular patterns from viruses, bacteria, and fungi to initiate innate immune responses to invading pathogens. The emergence of highly pathogenic coronaviruses severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) is a concern for global public health, as there is a lack of efficacious vaccine platforms and antiviral therapeutic strategies. Previously, it was shown th...

  19. Effects of different concentrations of isoflurane pretreatment on respiratory mechanics, oxygenation and hemodynamics in LPS-induced acute respiratory distress syndrome model of juvenile piglets.

    Science.gov (United States)

    Fu, Haibin; Sun, Minli; Miao, Changhong

    2015-01-01

    This study was prospectively designed to investigate the effects of different concentrations of isoflurane (ISO) pretreatment on respiratory mechanics, oxygenation, and hemodynamics in lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) model of juvenile piglets. Twenty-four piglets (9-14 kg, 5-6 weeks old) were randomly assigned to four groups (n = 6): LPS group, which was injected with LPS (20 μg/kg) to induce ARDS; 0.5 ISO-LPS, 1.0 ISO-LPS, and 1.3 ISO-LPS groups, which were pretreated with 0.5, 1.0, and 1.3 minimum alveolar concentrations (MAC) ISO for 30 min before immediate LPS infusion, respectively. After establishment of ARDS, respiratory mechanism, oxygenation and hemodynamics parameters were measured at baseline, and 0, 1, 2, 3, and 4 hours after induction of ARDS. After induction of ARDS, there were increases in alveolar-arterial oxygen difference (A-aDO2), oxygenation index (OI), mean airway pressure (MAP), dead space-to-tidal volume ratio, heart rate (HR), dP/dtmax, extravascular lung water index, pulmonary vascular permeability index, and PaCO2, and decreases in PaO2/FIO2, respiratory rate (RR), dynamic lung compliance (Cdyn), mean arterial blood pressure (MABP) and systemic vascular resistance (SVR) compared with baseline (P(time) respiratory mechanics, oxygenation, and hemodynamics in piglets with LPS-induced ARDS.

  20. Isolation and Characterization of a Novel Bat Coronavirus Closely Related to the Direct Progenitor of Severe Acute Respiratory Syndrome Coronavirus.

    Science.gov (United States)

    Yang, Xing-Lou; Hu, Ben; Wang, Bo; Wang, Mei-Niang; Zhang, Qian; Zhang, Wei; Wu, Li-Jun; Ge, Xing-Yi; Zhang, Yun-Zhi; Daszak, Peter; Wang, Lin-Fa; Shi, Zheng-Li

    2015-12-30

    We report the isolation and characterization of a novel bat coronavirus which is much closer to the severe acute respiratory syndrome coronavirus (SARS-CoV) in genomic sequence than others previously reported, particularly in its S gene. Cell entry and susceptibility studies indicated that this virus can use ACE2 as a receptor and infect animal and human cell lines. Our results provide further evidence of the bat origin of the SARS-CoV and highlight the likelihood of future bat coronavirus emergence in humans. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  1. Acute respiratory distress syndrome and chemical burns after exposure to chlorine-containing bleach: a case report.

    Science.gov (United States)

    Shin, Hong-Joon; Chang, Jin-Sun; Ahn, Seong; Kim, Tae-Ok; Park, Cheol-Kyu; Lim, Jung-Hwan; Oh, In-Jae; Kim, Yu-Il; Lim, Sung-Chul; Kim, Young-Chul; Kwon, Yong-Soo

    2017-01-01

    Chlorine-containing bleach can cause acute respiratory distress syndrome (ARDS) and chemical burns. However, simultaneous occurrence of the two conditions caused by this agent is very rare. We describe the case of a 74-year-old female who presented with shortness of breath and hemoptysis following accidental exposure to chlorine-containing bleach. She had second- to third-degree chemical burns on both buttocks and thighs, and received mechanical ventilation because of the development of ARDS. Mechanical ventilation was discontinued on day 6 of hospitalization because of the rapid improvement of hypoxemia, and the patient was transferred to another hospital for further management of the chemical burns on day 18.

  2. Management of Acute Respiratory Distress Syndrome and Refractory Hypoxemia. A Multicenter Observational Study.

    Science.gov (United States)

    Duan, Erick H; Adhikari, Neill K J; D'Aragon, Frederick; Cook, Deborah J; Mehta, Sangeeta; Alhazzani, Waleed; Goligher, Ewan; Charbonney, Emmanuel; Arabi, Yaseen M; Karachi, Tim; Turgeon, Alexis F; Hand, Lori; Zhou, Qi; Austin, Peggy; Friedrich, Jan; Lamontagne, Francois; Lauzier, François; Patel, Rakesh; Muscedere, John; Hall, Richard; Aslanian, Pierre; Piraino, Thomas; Albert, Martin; Bagshaw, Sean M; Jacka, Mike; Wood, Gordon; Henderson, William; Dorscheid, Delbert; Ferguson, Niall D; Meade, Maureen O

    2017-12-01

    Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described. To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS, including refractory hypoxemia. This was a prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring an Fi O 2 of 0.50 or greater in 24 intensive care units. We enrolled 664 patients: 222 (33%) with moderate and 442 (67%) with severe ARDS. On Study Day 1, mean Vt was 7.5 (SD = 2.1) ml/kg predicted body weight (n = 625); 80% (n = 501) received Vt greater than 6 ml/kg. Mean positive end-expiratory pressure (PEEP) was 10.5 (3.7) cm H 2 O (n = 653); 568 patients (87%) received PEEP less than 15 cm H 2 O. Treatment adjuncts were common (n = 440, 66%): neuromuscular blockers (n = 276, 42%), pulmonary vasodilators (n = 118, 18%), prone positioning (n = 67, 10%), extracorporeal life support (n = 29, 4%), and high-frequency oscillatory ventilation (n = 29, 4%). Refractory hypoxemia, defined as Pa O 2 less than 60 mm Hg on Fi O 2 of 1.0, occurred in 138 (21%) patients. At onset of refractory hypoxemia, mean Vt was 7.1 (SD = 2.0) ml/kg (n = 124); 95 patients (77%) received Vt greater than 6 ml/kg. Mean PEEP was 12.1 (SD = 4.4) cm H 2 O (n = 133); 99 patients (74%) received PEEP less than 15 cm H 2 O. Among patients with refractory hypoxemia, 91% received treatment adjuncts (126/138), with increased use of neuromuscular blockers (n = 87, 63%), pulmonary vasodilators (n = 57, 41%), and prone positioning (n = 32, 23%). Patients with moderate-to-severe ARDS receive treatment adjuncts frequently, especially with refractory hypoxemia. Paradoxically, therapies with less evidence supporting their use (e.g., pulmonary vasodilators) were over-used, whereas those with more evidence (e.g., prone positioning

  3. Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study

    Directory of Open Access Journals (Sweden)

    Agnese Ozolina

    2016-11-01

    Full Text Available Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS. We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF, tissue plasminogen activator (t-PA and plasminogen activator inhibitor-1 (PAI-1 in mechanically ventilated patients at increased risk of developing ARDS. Materials and Methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria: patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU for mechanical ventilation for 24 hours, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria: age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA and PAI-1 at inclusion (T0 and on third (T3 and seventh day (T7 of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic (ROC curve analysis. Statistical significance: p < 0.05.Results: Of 24 patients at risk, six developed mild ARDS and four of each moderate or severe ARDS, respectively, 3 ± 2 (Mean ± SD days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO2/FiO2 and PEEP and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0

  4. A Severe Acute Respiratory Syndrome extranet: supporting local communication and information dissemination

    Directory of Open Access Journals (Sweden)

    Kealey Cathy M

    2005-06-01

    Full Text Available Abstract Background The objective of this study was to explore the use and perceptions of a local Severe Acute Respiratory Syndrome (SARS Extranet and its potential to support future information and communication applications. The SARS Extranet was a single, managed electronic and limited access system to manage local, provincial and other SARS control information. Methods During July, 2003, a web-based and paper-based survey was conducted with 53 SARS Steering Committee members in Hamilton. It assessed the use and perceptions of the Extranet that had been built to support the committee during the SARS outbreak. Before distribution, the survey was user-tested based on a think-aloud protocol, and revisions were made. Quantitative and qualitative questions were asked related to frequency of use of the Extranet, perceived overall usefulness of the resource, rationale for use, potential barriers, strengths and limitations, and potential future uses of the Extranet. Results The response rate was 69.4% (n = 34. Of all respondents, 30 (88.2% reported that they had visited the site, and rated it highly overall (mean = 4.0; 1 = low to 5 = high. However, the site was rated 3.4 compared with other communications strategies used during the outbreak. Almost half of all respondents (44.1% visited the site at least once every few days. The two most common reasons the 30 respondents visited the Extranet were to access SARS Steering Committee minutes (63.3% and to access Hamilton medical advisories (53.3%. The most commonly cited potential future uses for the Extranet were the sending of private emails to public health experts (63.3%, and surveillance (63.3%. No one encountered personal barriers in his or her use of the site, but several mentioned that time and duplication of email information were challenges. Conclusion Despite higher rankings of various communication strategies during the SARS outbreak, such as email, meetings, teleconferences, and other web

  5. End-Expiratory Lung Volume in Patients with Acute Respiratory Distress Syndrome: A Time Course Analysis.

    Science.gov (United States)

    Kalenka, Armin; Gruner, Felix; Weiß, Christel; Viergutz, Tim

    2016-08-01

    Lung injury can be caused by ventilation and non-physiological lung stress (transpulmonary pressure) and strain [inflated volume over functional residual capacity ratio (FRC)]. FRC is severely decreased in patients with acute respiratory distress syndrome (ARDS). End-expiratory lung volume (EELV) is FRC plus lung volume increased by the applied positive end-expiratory pressure (PEEP). Measurement using the modified nitrogen multiple breath washout technique may help titrating PEEP during ARDS and allow determining dynamic lung strain (tidal volume over EELV) in patients ventilated with PEEP. In this observational study, we measured EELV for up to seven consecutive days in patients with ARDS at different PEEP levels. Thirty sedated patients with ARDS (10 mild, 14 moderate, 6 severe) underwent decremental PEEP testing (20, 15, 10, 5 cm H2O) for up to 7 days after inclusion. At all PEEP levels examined, over a period of 7 days the measured absolute EELVs showed no significant change over time [PEEP 20 cm H2O 2464 ml at day 1 vs. 2144 ml at day 7 (p = 0.78), PEEP 15 cm H2O 2226 ml vs. 1990 ml (p = 0.36), PEEP 10 1835 ml vs. 1858 ml (p = 0.76) and PEEP 5 cm H2O 1487 ml vs. 1612 ml (p = 0.37)]. In relation to the predicted body weight (pbw), no significant change in EELV/kg pbw over time could be detected either at any PEEP level or over time [PEEP 20 36 ml/kg pbw at day 1 vs. 33 ml/kg pbw at day 7 (p = 0.66); PEEP 15 33 vs. 29 ml/kg pbw (p = 0.32); PEEP 10 27 vs. 27 ml/kg pbw (p = 0.70) and PEEP 5 22 vs. 24 ml/kg pbw (p = 0.70)]. Oxygenation significantly improved over time from PaO2/FiO2 of 169 mmHg at day 1 to 199 mmHg at day 7 (p lung-protective ventilation on the basis of calculation of dynamic strain as the ratio of VT to EELV.

  6. Potential Application of Viral Empty Capsids for the Treatment of Acute Lung Injury/Acute Respiratory Distress Syndrome

    Science.gov (United States)

    2017-04-01

    harvested 24 hrs post insult; C. VLP-treated and 2CLP-operated harvested 24 hrs post insult; D1,2. VLPtreated and 2CLP-operated harvested 4 days post ...insult; E. VLP-treated and 2CLP-operated harvested 12 days post insult. Magnification x400. 11 12 Lungs of the sacrificed rats were...AWARD NUMBER: W81XWH-15-1-0125 TITLE: "Potential Application of Viral Empty Capsids for the Treatment of Acute Lung Injury/Acute Respiratory

  7. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature.

    Science.gov (United States)

    Paolone, Summer

    2017-12-01

    Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury. In critical care settings, ECMO is proven to improve survival rates and outcomes in patients with severe ARDS. This review defines severe ARDS; describes the ECMO circuit; and discusses recent research, optimal use of the ECMO circuit, limitations of therapy including potential complications, economic impact, and logistical factors; and discusses future research considerations.

  8. Use of thoracic electrical impedance tomography as an auxiliary tool for alveolar recruitment maneuvers in acute respiratory distress syndrome: case report and brief literature review

    Science.gov (United States)

    Rosa, Regis Goulart; Rutzen, William; Madeira, Laura; Ascoli, Aline Maria; Dexheimer Neto, Felippe Leopoldo; Maccari, Juçara Gasparetto; de Oliveira, Roselaine Pinheiro; Teixeira, Cassiano

    2015-01-01

    Thoracic electrical impedance tomography is a real-time, noninvasive monitoring tool of the regional pulmonary ventilation distribution. Its bedside use in patients with acute respiratory distress syndrome has the potential to aid in alveolar recruitment maneuvers, which are often necessary in cases of refractory hypoxemia. In this case report, we describe the monitoring results and interpretation of thoracic electrical impedance tomography used during alveolar recruitment maneuvers in a patient with acute respiratory distress syndrome, with transient application of high alveolar pressures and optimal positive end-expiratory pressure titration. Furthermore, we provide a brief literature review regarding the use of alveolar recruitment maneuvers and monitoring using thoracic electrical impedance tomography in patients with acute respiratory distress syndrome. PMID:26761481

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Characteristics and Outcome of Patients After Allogeneic Hematopoietic Stem Cell Transplantation Treated With Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Wohlfarth, Philipp; Beutel, Gernot; Lebiedz, Pia; Stemmler, Hans-Joachim; Staudinger, Thomas; Schmidt, Matthieu; Kochanek, Matthias; Liebregts, Tobias; Taccone, Fabio Silvio; Azoulay, Elie; Demoule, Alexandre; Kluge, Stefan; Svalebjørg, Morten; Lueck, Catherina; Tischer, Johanna; Combes, Alain; Böll, Boris; Rabitsch, Werner; Schellongowski, Peter

    2017-05-01

    The acute respiratory distress syndrome is a frequent condition following allogeneic hematopoietic stem cell transplantation. Extracorporeal membrane oxygenation may serve as rescue therapy in refractory acute respiratory distress syndrome but has not been assessed in allogeneic hematopoietic stem cell transplantation recipients. Multicenter, retrospective, observational study. ICUs in 12 European tertiary care centers (Austria, Germany, France, and Belgium). All allogeneic hematopoietic stem cell transplantation recipients treated with venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome between 2010 and 2015. None. Thirty-seven patients, nine of whom underwent noninvasive ventilation at the time of extracorporeal membrane oxygenation initiation, were analyzed. ICU admission occurred at a median of 146 (interquartile range, 27-321) days after allogeneic hematopoietic stem cell transplantation. The main reason for acute respiratory distress syndrome was pneumonia in 81% of patients. All but one patient undergoing noninvasive ventilation at extracorporeal membrane oxygenation initiation had to be intubated thereafter. Overall, seven patients (19%) survived to hospital discharge and were alive and in remission of their hematologic disease after a follow-up of 18 (range, 5-30) months. Only one of 24 patients (4%) initiated on extracorporeal membrane oxygenation within 240 days after allogeneic hematopoietic stem cell transplantation survived compared to six of 13 (46%) of those treated thereafter (p stem cell transplantation do not support the use of extracorporeal membrane oxygenation for acute respiratory distress syndrome in this group. On the contrary, long-term allogeneic hematopoietic stem cell transplantation recipients otherwise eligible for full-code ICU management may be potential candidates for extracorporeal membrane oxygenation therapy in case of severe acute respiratory distress syndrome failing conventional measures.

  11. A Quantile Analysis of Plateau and Driving Pressures: Effects on Mortality in Patients With Acute Respiratory Distress Syndrome Receiving Lung-Protective Ventilation.

    Science.gov (United States)

    Villar, Jesús; Martín-Rodríguez, Carmen; Domínguez-Berrot, Ana M; Fernández, Lorena; Ferrando, Carlos; Soler, Juan A; Díaz-Lamas, Ana M; González-Higueras, Elena; Nogales, Leonor; Ambrós, Alfonso; Carriedo, Demetrio; Hernández, Mónica; Martínez, Domingo; Blanco, Jesús; Belda, Javier; Parrilla, Dácil; Suárez-Sipmann, Fernando; Tarancón, Concepción; Mora-Ordoñez, Juan M; Blanch, Lluís; Pérez-Méndez, Lina; Fernández, Rosa L; Kacmarek, Robert M

    2017-05-01

    The driving pressure (plateau pressure minus positive end-expiratory pressure) has been suggested as the major determinant for the beneficial effects of lung-protective ventilation. We tested whether driving pressure was superior to the variables that define it in predicting outcome in patients with acute respiratory distress syndrome. A secondary analysis of existing data from previously reported observational studies. A network of ICUs. We studied 778 patients with moderate to severe acute respiratory distress syndrome. None. We assessed the risk of hospital death based on quantiles of tidal volume, positive end-expiratory pressure, plateau pressure, and driving pressure evaluated at 24 hours after acute respiratory distress syndrome diagnosis while ventilated with standardized lung-protective ventilation. We derived our model using individual data from 478 acute respiratory distress syndrome patients and assessed its replicability in a separate cohort of 300 acute respiratory distress syndrome patients. Tidal volume and positive end-expiratory pressure had no impact on mortality. We identified a plateau pressure cut-off value of 29 cm H2O, above which an ordinal increment was accompanied by an increment of risk of death. We identified a driving pressure cut-off value of 19 cm H2O where an ordinal increment was accompanied by an increment of risk of death. When we cross tabulated patients with plateau pressure less than 30 and plateau pressure greater than or equal to 30 with those with driving pressure less than 19 and driving pressure greater than or equal to 19, plateau pressure provided a slightly better prediction of outcome than driving pressure in both the derivation and validation cohorts (p Plateau pressure was slightly better than driving pressure in predicting hospital death in patients managed with lung-protective ventilation evaluated on standardized ventilator settings 24 hours after acute respiratory distress syndrome onset.

  12. Early Evaluation and Monitoring of Critical Patients with Acute Respiratory Distress Syndrome (ARDS) Using Specific Genetic Polymorphisms.

    Science.gov (United States)

    Horhat, Florin G; Gundogdu, Fuat; David, Laurentiu V; Boia, Eugen S; Pirtea, Laurentiu; Horhat, Razvan; Cucui-Cozma, Alexandru; Ciuca, Ioana; Diaconu, Mircea; Nitu, Razvan; Licker, Monica; Horhat, Delia I; Rogobete, Alexandru F; Moise, Marius L; Tataru, Calin

    2017-06-01

    A high percentage of critical patients are found to develop acute respiratory distress syndrome (ARDS). Several studies have reported high mortality rates in these cases which are most frequently associated with multiple organ dysfunctions syndrome. Lately, many efforts have been made to evaluate and monitor ARDS in critical patients. In this regard, the assessment of genetic polymorphisms responsible for developing ARDS present as a challenge and are considered future biomarkers. Early detection of the specific polymorphic gene responsible for ARDS in critically ill patients can prove to be a useful tool in the future, able to help decrease the mortality rates in these cases. Moreover, identifying the genetic polymorphism in these patients can help in the implementation of a personalized intensive therapy scheme for every type of patient, based on its genotype.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Acute Respiratory Distress Syndrome Complicated by Amiodarone Induced Pulmonary Fibrosis: Don't Let Your Guard Down.

    Science.gov (United States)

    Singh, Vipin Kumar; Maheshwari, Vijeta

    2017-04-01

    Amiodarone is an antiarrhythmic agent which is commonly used to treat both supraventricular and ventricular arrhythmias. This iodine containing compound has been associated with several adverse events like it tends to accumulate in several organs. Among those, the most serious is Amiodarone Pulmonary Toxicity (APT). While the incidence of this complication has decreased with the use of lower doses of amiodarone but it can occur with any dose. Pulmonary complications usually present as an acute or subacute pneumonitis. On chest X-ray and high-resolution Computed Tomography (CT), diffuse infiltrates were found. Here, we present a case in which acute respiratory distress syndrome like features were detected which got subsided after stopping tablet amiodarone. The patient was a known case of atrial fibrillation for which she was taking tablet amiodarone for the last six months.

  15. End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics.

    Science.gov (United States)

    Aguirre-Bermeo, Hernan; Morán, Indalecio; Bottiroli, Maurizio; Italiano, Stefano; Parrilla, Francisco José; Plazolles, Eugenia; Roche-Campo, Ferran; Mancebo, Jordi

    2016-12-01

    End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO2. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. The investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases. First phase, baseline measurements were taken. Second phase, the EIP was prolonged until one of the following was achieved: (1) EIP of 0.7 s; (2) intrinsic positive end-expiratory pressure ≥1 cmH2O; or (3) inspiratory-expiratory ratio 1:1. Third phase, the Vt was decreased (30 mL every 30 min) until PaCO2 equal to baseline was reached. FiO2, PEEP, airflow and respiratory rate were kept constant. EIP was prolonged from 0.12 ± 0.04 to 0.7 s in all patients. This decreased the Vd/Vt and PaCO2 (0.70 ± 0.07 to 0.64 ± 0.08, p ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.

  16. Oxygen Exposure Resulting in Arterial Oxygen Tensions Above the Protocol Goal Was Associated With Worse Clinical Outcomes in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Aggarwal, Neil R; Brower, Roy G; Hager, David N; Thompson, B Taylor; Netzer, Giora; Shanholtz, Carl; Lagakos, Adrian; Checkley, William

    2017-12-19

    High fractions of inspired oxygen may augment lung damage to exacerbate lung injury in patients with acute respiratory distress syndrome. Participants enrolled in Acute Respiratory Distress Syndrome Network trials had a goal partial pressure of oxygen in arterial blood range of 55-80 mm Hg, yet the effect of oxygen exposure above this arterial oxygen tension range on clinical outcomes is unknown. We sought to determine if oxygen exposure that resulted in a partial pressure of oxygen in arterial blood above goal (> 80 mm Hg) was associated with worse outcomes in patients with acute respiratory distress syndrome. Longitudinal analysis of data collected in these trials. Ten clinical trials conducted at Acute Respiratory Distress Syndrome Network hospitals between 1996 and 2013. Critically ill patients with acute respiratory distress syndrome. None. We defined above goal oxygen exposure as the difference between the fraction of inspired oxygen and 0.5 whenever the fraction of inspired oxygen was above 0.5 and when the partial pressure of oxygen in arterial blood was above 80 mm Hg. We then summed above goal oxygen exposures in the first five days to calculate a cumulative above goal oxygen exposure. We determined the effect of a cumulative 5-day above goal oxygen exposure on mortality prior to discharge home at 90 days. Among 2,994 participants (mean age, 51.3 yr; 54% male) with a study-entry partial pressure of oxygen in arterial blood/fraction of inspired oxygen that met acute respiratory distress syndrome criteria, average cumulative above goal oxygen exposure was 0.24 fraction of inspired oxygen-days (interquartile range, 0-0.38). Participants with above goal oxygen exposure were more likely to die (adjusted interquartile range odds ratio, 1.20; 95% CI, 1.11-1.31) and have lower ventilator-free days (adjusted interquartile range mean difference of -0.83; 95% CI, -1.18 to -0.48) and lower hospital-free days (adjusted interquartile range mean difference of -1.38; 95

  17. Transcriptomic Analysis Reveals a Mechanism for a Prefibrotic Phenotype in STAT1 Knockout Mice during Severe Acute Respiratory Syndrome Coronavirus Infection▿ †

    OpenAIRE

    Zornetzer, Gregory A.; Frieman, Matthew B.; Rosenzweig, Elizabeth; Korth, Marcus J.; Page, Carly; Baric, Ralph S.; Katze, Michael G.

    2010-01-01

    Severe acute respiratory syndrome coronavirus (SARS-CoV) infection can cause the development of severe end-stage lung disease characterized by acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. The mechanisms by which pulmonary lesions and fibrosis are generated during SARS-CoV infection are not known. Using high-throughput mRNA profiling, we examined the transcriptional response of wild-type (WT), type I interferon receptor knockout (IFNAR1−/−), and STAT1 knockout (STAT1−/−) ...

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

    Directory of Open Access Journals (Sweden)

    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

  19. High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study.

    Science.gov (United States)

    El-Nawawy, Ahmed; Moustafa, Azza; Heshmat, Hassan; Abouahmed, Ahmed

    2017-01-01

    El-Nawawy A, Moustafa A, Heshmat H, Abouahmed A. High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study. Turk J Pediatr 2017; 59: 130-143. The aim of this prospective randomized study is to compare the outcomes of the early use of either high frequency oscillation (HFO) or conventional mechanical ventilation (CMV) in patients with pediatric acute respiratory distress syndrome (PARDS). We allocated two hundred PARDS patients over 5 years in 1:1 ratio to either mode. The HFO group showed a significantly higher median partial arterial oxygen pressure to fraction of inspired oxygen (PaO2/FiO2) values after 24 hours of enrollment (p=0.011), higher oxygenation index (OI) decrease percent (p=0.004) and lower cross-over rates (p ventilation days (p=0.77, p=0.28, p=0.65 respectively). The second day values (after 24 hours) of both OI and PaO 2 /FiO 2 were found to be more significant discriminators for mortality when compared to the baseline values (cutoff values > 8.5, ≤139 respectively). PARDS patients with baseline OI > 16 had a better chance of survival if initially ventilated with the HFO (p=0.004). Although the HFO mode appeared to be a safe mode with a significant better oxygenation improvement (after the first 24 hours) and fewer cross-over rates, it failed to show differences as regards mortality or LOS when compared to the CMV adopting protective lung strategy. In PARDS, HFO had a superior advantage in improving oxygenation, yet with no significant mortality improvement, as multi-organ dysfunction syndrome (MODS) was the most common cause of death in our study and not refractory hypoxemia which is the main problem in PARDS; highlighting that mortality in PARDS is multi-factorial and may not depend only on how fast oxygenation improves.

  20. Assessing gas exchange in acute lung injury/acute respiratory distress syndrome: diagnostic techniques and prognostic relevance.

    Science.gov (United States)

    Gattinoni, Luciano; Carlesso, Eleonora; Cressoni, Massimo

    2011-02-01

    To provide the most recent insights on the assessment of gas exchange in acute lung injury. Central venous blood may be used as a surrogate of arterial blood to assess carbon dioxide tension and acid-base status. In contrast arterial oxygenation cannot be estimated with confidence from venous blood. However, the use of venous blood associated with pulse oximetry may provide the SvO2 which is useful for monitoring and targeting the resuscitation therapy. Impaired CO2 clearance and increased dead space have been confirmed as useful prognostic indices of structural lung damage and mortality in acute respiratory failure. A simplified technique based on multiple inert gas technique has been described to assess ventilation-perfusion mismatch while a new analysis of pulse oximetry has been suggested to detect lung opening and closing. Finally, new insight has been provided on the relationship between lung anatomy, as detected by computed tomography, oxygenation and CO2 clearance. Although oxygenation assessment is of primary importance during respiratory lung injury, dead space and CO2 retention are more strictly associated with outcome. The association of central venous blood analysis and pulse oximetry may provide more information than arterial blood alone.

  1. How Is Respiratory Distress Syndrome Treated?

    Science.gov (United States)

    ... Home / Respiratory Distress Syndrome Respiratory Distress Syndrome What Is Respiratory distress syndrome (RDS) ... This condition is called apnea (AP-ne-ah). Respiratory Distress Syndrome Complications Depending on the severity of ...

  2. Middle East Respiratory Syndrome (MERS)

    Science.gov (United States)

    Middle East Respiratory Syndrome Coronavirus; MERS-CoV; Novel coronavirus; nCoV ... Centers for Disease Control and Prevention. Middle East Respiratory Syndrome (MERS): Frequently Asked Questions and Answers. Updated ...

  3. Effect of flumazenil on diaphragm electrical activation during weaning from mechanical ventilation after acute respiratory distress syndrome.

    Science.gov (United States)

    Rozé, H; Germain, A; Perrier, V; Dewitte, A; Joannes-Boyau, O; Fleureau, C; Ouattara, A

    2015-02-01

    Diaphragm electrical activation (EAdi) and the ratio of tidal volume to EAdi (VT/EAdi) may provide clinical information on neuroventilatory efficiency (NVE) in patients being weaned from mechanical ventilation. We tested the hypothesis that residual sedation could interfere with respiratory recovery, by assessing the effects of flumazenil on EAdi and VT/EAdi ratio. This observational study included 13 patients breathing with pressure-support ventilation (PSV) after a long period of controlled mechanical ventilation (i.e. >4 days) plus midazolam-based sedation for acute respiratory distress syndrome. EAdi and respiratory patterns were compared before and after a bolus of flumazenil, which was given because neurological status needed to be evaluated. Flumazenil induced a significant increase in EAdi [+71 (41-123)%, P=0.0002] and VT [+17 (8-32)%, P=0.0005], resulting in significantly decreased NVE [-34 (15-43)%]. The increased VT was significantly correlated with the increased EAdi (ρ=0.70, P=0.009). During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression. The increased EAdi with reversal of residual sedation was associated with a proportional increase in VT. These findings should be considered by the attending physician when interpreting daily EAdi and VT changes during weaning from mechanical ventilation. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Negative-pressure pulmonary edema complicated by acute respiratory distress syndrome in an orangutan (Pongo pygmaeus abelii).

    Science.gov (United States)

    Kenny, David E; Knightly, Felicia; Haas, Bradley; Hergott, Lawrence; Kutinsky, Ilana; Eller, Jimmie L

    2003-12-01

    A 22-yr-old, 86-kg, morbidly obese female orangutan (Pongo pygmaeus abelii) was immobilized and transported to the Denver Zoological Gardens hospital for a routine physical examination. Immediately after arriving at the hospital, cyanosis and apparent inadequate ventilatory efforts were noted. Clinically significant hypoxia occurred despite attempts to ventilate the orangutan through face mask, and attempts to place an endotracheal tube began. A large volume of pink-tinged frothy fluid flowed from the trachea when the laryngoscope was inserted into the oropharynx. Severe pulmonary edema due to negative-pressure pulmonary edema, precipitating life-threatening hypoxia was suspected. The orangutan was maintained on a mechanical ventilator using the neuromuscular blocking agent cisatracurium besylate and sedation with periodic doses of isoflurane and midazolam for 48 hr. Positive end-expiratory pressure was used while the orangutan was ventilated mechanically to improve respiratory function. The edema and hypoxia improved, but respiratory arrest ensued 30 min after extubation, when the orangutan was removed from mechanical ventilation. Necropsy and histopathology demonstrated that serious lung injury had led to acute respiratory distress syndrome.

  5. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumonia: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Dong Won Park

    2016-05-01

    Full Text Available Pnuemocystis jirovecii pneumonia (PJP is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV, and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

  6. Extremely low exposure of a community to severe acute respiratory syndrome coronavirus: false seropositivity due to use of bacterially derived antigens.

    NARCIS (Netherlands)

    Leung, D.T.; Maren, W.W.C. van; Chan, F.K.; Chan, W.S.; Lo, A.W.; Ma, C.H.; Tam, F.C.; To, K.F.; Chan, P.K.; Sung, J.J.; Lim, P.L.

    2006-01-01

    Estimates of seropositivity to a new infectious agent in a community are useful to public health. For severe acute respiratory syndrome (SARS), the figures are conflicting. Herein, we screened 12,000 people in a community stricken by SARS 10 months previously and found 53 individuals (0.44%) who had

  7. Elevated CXCL-8 expression in bronchoalveolar lavage correlates with disease severity in patients with acute respiratory distress syndrome resulting from tuberculosis

    NARCIS (Netherlands)

    Hashemian, Seyed Mohamad Reza; Mortaz, Esmaeil; Tabarsi, Payam; Jamaati, Hamidreza; Maghsoomi, Zohreh; Khosravi, Adnan; Garssen, Johan; Masjedi, Mohamad Reza; Velayati, Ali Akbar; Folkerts, Gert; Barnes, Peter J; Adcock, Ian M

    BACKGROUND: Tuberculosis (TB) is a rare but known cause of acute respiratory distress syndrome (ARDS). The role of inflammatory cytokines in the progression of ARDS in TB patients is unknown. OBJECTIVES: In this study we investigated the possible link between the levels of inflammatory cytokines in

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

    NARCIS (Netherlands)

    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

  9. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    Science.gov (United States)

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research…

  10. Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome A Meta-analysis

    NARCIS (Netherlands)

    Serpa Neto, Ary; Cardoso, Sérgio Oliveira; Manetta, José Antônio; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Pasqualucci, Manoela de Oliveira Prado; Damasceno, Maria Cecília Toledo; Schultz, Marcus J.

    2012-01-01

    Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective To determine

  11. Neuromuscular blocking agents in patients with acute respiratory distress syndrome: a summary of the current evidence from three randomized controlled trials

    NARCIS (Netherlands)

    Serpa Neto, Ary; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Damasceno, Maria Cecília Toledo; Schultz, Marcus J.

    2012-01-01

    Background: Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality. Our aim was to summarize the current evidence for use of neuromuscular blocking agents (NMBA) in the early phase of ARDS. Methods: Systematic review and meta-analysis of publications between

  12. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis.

    Science.gov (United States)

    Mora-Arteaga, J A; Bernal-Ramírez, O J; Rodríguez, S J

    2015-01-01

    Prone position ventilation has been shown to improve oxygenation and ventilatory mechanics in patients with acute respiratory distress syndrome. We evaluated whether prone ventilation reduces the risk of mortality in adult patients with acute respiratory distress syndrome versus supine ventilation. A metaanalysis of randomized controlled trials comparing patients in supine versus prone position was performed. A search was conducted of the Pubmed, Embase, Cochrane Library, and LILACS databases. Mortality, hospital length of stay, days of mechanical ventilation and adverse effects were evaluated. Seven randomized controlled trials (2,119 patients) were included in the analysis. The prone position showed a nonsignificant tendency to reduce mortality (OR: 0.76; 95%CI: 0.54 to 1.06; P=.11, I(2) 63%). When stratified by subgroups, a significant decrease was seen in the risk of mortality in patients ventilated with low tidal volume (OR: 0.58; 95%CI: 0.38 to 0.87; P=.009, I(2) 33%), prolonged pronation (OR: 0.6; 95%CI: 0.43 to 0.83; p=.002, I(2) 27%), start within the first 48hours of disease evolution (OR 0.49; 95%CI 0.35 to 0.68; P=.0001, I(2) 0%) and severe hypoxemia (OR: 0.51: 95%CI: 0.36 to 1.25; P=.0001, I(2) 0%). Adverse effects associated with pronation were the development of pressure ulcers and endotracheal tube obstruction. Prone position ventilation is a safe strategy and reduces mortality in patients with severely impaired oxygenation. It should be started early, for prolonged periods, and should be associated to a protective ventilation strategy. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  13. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Leenen LPH

    2011-08-01

    Full Text Available Tjeerd S Aukema1, Ludo FM Beenen2, Falco Hietbrink1, Luke PH Leenen11Department of Surgery, University Medical Center Utrecht, Utrecht, 2Department of Radiology, Academic Medical Center, Amsterdam, The NetherlandsBackground: The aim of the present study was to evaluate and to validate the Thorax Trauma Severity Score for mortality (TTSS.Methods: By database analysis 712 patients with an injury to the chest admitted to the Universal Medical Center Utrecht between 2000 and 2004 were studied. All patients with a score of ≥1 on the AISthorax were included in the study. The patients' file was evaluated for: TTSS, intensive care unit stay, days on ventilation, thorax trauma-related complications (eg, acute respiratory distress syndrome [ARDS], total hospital stay, and mortality.Results: Of the 516 patients included in the study, 140 (27% developed thorax-related complications. The overall in-hospital mortality rate was 10%. The receiver operating characteristic curve for predicting mortality demonstrated an adequate discrimination by a value of 0.844. The TTSS was statistically significant higher in patients who died of thorax-related complications than in patients who died because of nonthorax-related complications and survivors (P <0.001, confidence interval [CI] 95%. In patients who developed ARDS the TTSS was significant higher (P = 0.005, CI 95%.Conclusion: This study supports the use of the TTSS for predicting mortality in thoracic injury patients. Furthermore, the TTSS appears capable of predicting ARDS.Keywords: wounds and injuries, thorax, trauma severity indices, acute respiratory distress syndrome, mortality

  14. Analysis of complications of prone position in acute respiratory distress syndrome: quality standard, incidence and related factors.

    Science.gov (United States)

    Jové Ponseti, E; Villarrasa Millán, A; Ortiz Chinchilla, D

    The monitoring system based on standards of quality allows clinicians to evaluate and improve the patient's care. According to the quality indicators recommended by Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias, and due to the importance of prone position (PP) as a treatment in patients with acute respiratory distress syndrome, it is fundamental to keep accurate record of serious adverse events occurring during the prone position procedure and its posterior analysis. To establish fulfilment of the Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias standards of quality according to the register of serious complications. To identify the incidence of serious complications registered as well as to identify possible factors related to these complications. Retrospective, cross-sectionsl descriptive study, polyvalent ICU (16 beds). Study population Patients with acute respiratory distress syndrome treated with PP (January 2012-December 2013). Study variables PP recording, accidental extubation, removal of catheters, decubitus ulcers (DU), ETT obstruction, urgency of the procedure, hours in PP, nutritional intake, type of feeding tube, food regurgitation/retention and use of prokinetics/muscle relaxant. The study sample comprised 38 cases, with an adequate record of complications in 92.1% of the cases. DU were the only serious complication recorded, with a 25.7% incidence. Possible factors related to DU: more hours in PP in patients developing DU (p= .067). Less incidence of DU in well-nourished patients (p= .577). 82.9% of patients were not appropriately nourished. The percentage of records duly completed is very high. The presence of DU (grade 1-2 mostly) is to be noted. There is no stastistical significance, although a trend is obversed, between DU and hours in PP. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Effects on Pulmonary Vascular Mechanics of Two Different Lung-Protective Ventilation Strategies in an Experimental Model of Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Santos, Arnoldo; Gomez-Peñalver, Eva; Monge-Garcia, M Ignacio; Retamal, Jaime; Borges, João Batista; Tusman, Gerardo; Hedenstierna, Goran; Larsson, Anders; Suarez-Sipmann, Fernando

    2017-11-01

    To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. Experimental study. University animal research laboratory. Twelve pigs (30.8 ± 2.5 kg). Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation. Thereafter, animals were randomized to 4 hours ventilation according to the Acute Respiratory Distress Syndrome Network protocol or to an open lung approach strategy. Pressure and flow sensors placed at the pulmonary artery trunk allowed continuous assessment of pulmonary artery resistance, effective elastance, compliance, and reflected pressure waves. Respiratory mechanics and gas exchange data were collected. Acute respiratory distress syndrome led to pulmonary vascular mechanics deterioration. Four hours after randomization, pulmonary vascular mechanics was similar in Acute Respiratory Distress Syndrome Network and open lung approach: resistance (578 ± 252 vs 626 ± 153 dyn.s/cm; p = 0.714), effective elastance, (0.63 ± 0.22 vs 0.58 ± 0.17 mm Hg/mL; p = 0.710), compliance (1.19 ± 0.8 vs 1.50 ± 0.27 mL/mm Hg; p = 0.437), and reflection index (0.36 ± 0.04 vs 0.34 ± 0.09; p = 0.680). Open lung approach as compared to Acute Respiratory Distress Syndrome Network was associated with improved dynamic respiratory compliance (17.3 ± 2.6 vs 10.5 ± 1.3 mL/cm H2O; p mechanics similarly. The use of higher positive end-expiratory pressures in the open lung approach strategy did not worsen pulmonary vascular mechanics, improved lung mechanics, and gas exchange but at the expense of a lower cardiac index.

  16. Acute respiratory distress syndrome: we can't miss regional lung perfusion!

    Science.gov (United States)

    Pelosi, Paolo; de Abreu, Marcelo Gama

    2015-01-01

    In adult respiratory distress syndrome (ARDS), life-threatening hypoxemia may occur, dictating the need for differentiated ventilator strategies. Pronounced consolidation and/or atelectasis have been well documented in ARDS, but the contribution of regional perfusion to oxygenation has been poorly addressed. Evidence has accumulated that, in ARDS, regional perfusion is extremely variable and may affect oxygenation, independently from the amount of atelectatic-consolidated lung regions. Thus, the response in oxygenation to different ventilatory settings, both during controlled and assisted mechanical ventilation, should be interpreted with caution. In fact, gas exchange may be not determined solely by changes in aeration, but also redistribution of perfusion. Furthermore, regional perfusion can play an important role in worsening of lung injury due to increased transmural pressures. In addition, distribution of perfusion in lungs might affect the delivery of drugs through the pulmonary circulation, including antibiotics. In recent years, several techniques have been developed to determine pulmonary blood flow with increasing level of spatial resolution, allowing a better understanding of normal physiology and various pathophysiological conditions, but most of them are restricted to experimental or clinical research. Lung ultrasound and novel algorithms for electrical impedance tomography represent new promising techniques that could enable physicians to assess the distribution of pulmonary blood flow at the bedside. In ARDS, we cannot afford missing regional lung perfusion! Please see related article: http://dx.doi.org/10.1186/s12871-015-0013-0.

  17. Ventilator induced lung injury (VILI) in acute respiratory distress ...

    African Journals Online (AJOL)

    Acute respiratory distress syndrome is the most severe manifestation of acute lung injury and it is associated with high mortality rate. ARDS is characterized by the acute onset of diffuse neutrophilic alveolar infiltrates protein-rich edema due to enhanced alveolar-capillary permeability and hypoxemic respiratory failure.

  18. Retrospective report of contraindications to extracorporeal membrane oxygenation (ECMO) among adults with acute respiratory distress syndrome (ARDS).

    Science.gov (United States)

    Bohman, J Kyle; Vogt, Matthew N; Hyder, Joseph A

    2016-01-01

    To determine the incidence of contraindications to extracorporeal membrane oxygenation (ECMO) among adults with acute respiratory distress syndrome (ARDS) and assess the impact of contraindications on the number of patients receiving ECMO (case volume). The extent to which contraindications may affect case volumes has not been described. Retrospective, observational study at an academic tertiary medical center. The records of 730 consecutive patients with ARDS were queried for respiratory ECMO eligibility and ECMO contraindications. Of the 730 patients with ARDS, 168 (23.0%) met ECMO inclusion criteria and 515 (70.5%) never met ECMO eligibility due to inadequately severe disease. Among 168 patients who met ECMO inclusion criteria, 1 or more relative contraindications were present in 144 (85.7%) patients. The three most common relative contraindications were immunocompromised state (58.3%), multiorgan dysfunction (29.2%) and contraindication to anticoagulation (16.7%). Application of relative contraindications may greatly affect ECMO case volumes. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The Association between Acute Respiratory Distress Syndrome, Delirium, and In-Hospital Mortality in Intensive Care Unit Patients

    Science.gov (United States)

    Soto, Graciela J.; Hope, Aluko A.; Ponea, Ana; Gong, Michelle N.

    2015-01-01

    Rationale: Both acute respiratory distress syndrome (ARDS) and intensive care unit (ICU) delirium are associated with significant morbidity and mortality. However, the risk of delirium and its impact on mortality in ARDS patients is unknown. Objectives: To determine if ARDS is associated with a higher risk for delirium compared with respiratory failure without ARDS, and to determine the association between ARDS and in-hospital mortality after adjusting for delirium. Methods: Prospective observational cohort study of adult ICU patients admitted to two urban academic hospitals. Measurements and Main Results: Delirium was assessed daily using the Confusion Assessment Method for the ICU and Richmond Agitation and Sedation Scale. Of the 564 patients in our cohort, 48 had ARDS (9%). Intubated patients with ARDS had the highest prevalence of delirium compared with intubated patients without ARDS and nonintubated patients (73% vs. 52% vs. 21%, respectively; P patients. Although ARDS was significantly associated with hospital mortality (OR, 10.44 [3.16–34.50]), the effect was largely reduced after adjusting for delirium and persistent coma (OR, 5.63 [1.55–20.45]). Conclusions: Our findings suggest that ARDS is associated with a greater risk for ICU delirium than mechanical ventilation alone, and that the association between ARDS and in-hospital mortality is weakened after adjusting for delirium and coma. Future studies are needed to determine if prevention and reduction of delirium in ARDS patients can improve outcomes. PMID:25393331

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

    Science.gov (United States)

    Yang, Yi; Li, Yang; Liu, Song-Qiao; Liu, Ling; Huang, Ying-Zi; Guo, Feng-Mei; Qiu, Hai-Bo

    2013-01-01

    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. 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. 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 by ARDSnet protocol. 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.

  1. The Specific Features of Artificial Ventilation in Premature Neonates with Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    S. A. Perepelitsa

    2010-01-01

    Full Text Available Objective: to evaluate the efficiency of artificial ventilation (AV after administration of the exogenous surfactants Curosurf and Surfactant BL in premature neonates with respiratory distress syndrome (RSD. Subjects and methods. The paper presents the results of evaluation of the efficiency of therapy with exogenous surfactants, by examining the blood gas composition and AV parameters. The study included 122 premature neonates with severe RSD. According to the type of a used surfactant, two groups of neonates were identified: Group 1 comprised 67 neonates who were given Curosurf and Group 2 consisted of 55 neonates who had Surfactant BL. Results. The study has revealed some differences between the drugs. Four hours after administration of Curosurf, the neonates with RSD showed heterodirectional changes in partial blood oxygen tension; no abnormal changes in this index were found in most neonates; however, hyperoxia or hypoxia appeared in some newborn infants. After administration of Surfactant BL, no hyperoxia was virtually detected. Hyperoxia did not depend on the baseline oxygen fraction in the inspired gas mixture in most cases. The found changes were transient. To choose ventilation parameters was based on an attempt to bring partial blood oxygen tension closer to the normal values. The main task of the treatment was achieved: this was to carry out sparing AV in premature neonates, allowing no mechanical injury to the immature lung or ventilation complications. Conclusion. pO2 variability after administration of exogenous surfactants calls for a considerate attitude to the choice of AV parameters and an individual approach to a patient. The specific features of the pharmacological action of exogenous surfactants should be taken into account when they are used. In this connection, blood gas composition should be frequently investigated – particularly within the first 24 hours after administration of the agents in order to timely modify AV

  2. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition.

    Science.gov (United States)

    Kushimoto, Shigeki; Endo, Tomoyuki; Yamanouchi, Satoshi; Sakamoto, Teruo; Ishikura, Hiroyasu; Kitazawa, Yasuhide; Taira, Yasuhiko; Okuchi, Kazuo; Tagami, Takashi; Watanabe, Akihiro; Yamaguchi, Junko; Yoshikawa, Kazuhide; Sugita, Manabu; Kase, Yoichi; Kanemura, Takashi; Takahashi, Hiroyuki; Kuroki, Yuuichi; Izumino, Hiroo; Rinka, Hiroshi; Seo, Ryutarou; Takatori, Makoto; Kaneko, Tadashi; Nakamura, Toshiaki; Irahara, Takayuki; Saito, Nobuyuki

    2013-06-20

    The Berlin definition divides acute respiratory distress syndrome (ARDS) into three severity categories. The relationship between these categories and pulmonary microvascular permeability as well as extravascular lung water content, which is the hallmark of lung pathophysiology, remains to be elucidated. The aim of this study was to evaluate the relationship between extravascular lung water, pulmonary vascular permeability, and the severity categories as defined by the Berlin definition, and to confirm the associated predictive validity for severity. The extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) were measured using a transpulmonary thermodilution method for three consecutive days in 195 patients with an EVLWi of ≥10 mL/kg and who fulfilled the Berlin definition of ARDS. Collectively, these patients were seen at 23 ICUs. Using the Berlin definition, patients were classified into three categories: mild, moderate, and severe. Compared to patients with mild ARDS, patients with moderate and severe ARDS had higher acute physiology and chronic health evaluation II and sequential organ failure assessment scores on the day of enrollment. Patients with severe ARDS had higher EVLWi (mild, 16.1; moderate, 17.2; severe, 19.1; P definition have good predictive validity and may be associated with increased extravascular lung water and pulmonary vascular permeability. UMIN-CTR ID UMIN000003627.

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

    Science.gov (United States)

    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.

  4. [Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant in treatment of acute lung injury/acute respiratory distress syndrome in neonates: a comparative analysis].

    Science.gov (United States)

    Chang, Ming; Lu, Hong-Yan; Xiang, Hong; Lan, Hou-Ping

    2016-11-01

    To compare the therapeutic effects of high-frequency oscillatory ventilation+pulmonary surfactant (HFOV+PS), conventional mechanical ventilation+pulmonary surfactant (CMV+PS), and conventional mechanical ventilation (CMV) alone for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in neonates. A total of 136 neonates with ALI/ARDS were enrolled, among whom 73 had ALI and 63 had ARDS. They were divided into HFOV+PS group (n=45), CMV+PS group (n=53), and CMV group (n=38). The neonates in the first two groups were given PS at a dose of 70-100 mg/kg. The partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), oxygenation index (OI), and respiratory index (RI) were measured at 0, 12, 24, 48, and 72 hours of mechanical ventilation. At 12, 24, and 48 hours of mechanical ventilation, the HFOV+PS group had higher PaO2 and lower PaCO2 than the CMV+PS and CMV groups (Pneonates with ALI/ARDS, HFOV combined with PS can improve pulmonary function more effectively and shorten the durations of mechanical ventilation and oxygen use compared with CMV+PS and CMV alone. It does not increase the incidence of complications.

  5. Lung recruitment maneuver during proportional assist ventilation of preterm infants with acute respiratory distress syndrome.

    Science.gov (United States)

    Wu, R; Li, S-B; Tian, Z-F; Li, N; Zheng, G-F; Zhao, Y-X; Zhu, H-L; Hu, J-H; Zha, L; Dai, M-Y; Xu, W-Y

    2014-07-01

    To investigate the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants ventilated by proportional assist ventilation (PAV) for respiratory distress syndrome (RDS). Preterm infants on PAV for RDS after surfactant randomly received an LRM (group A, n=12) or did not (group B, n=12). LRM entailed increments of 0.2 cm H2O PEEP every 5 min, until fraction of inspired oxygen (FiO2)=0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve. When saturation of peripheral oxygen fell and FiO2 rose, we reincremented PEEP until SpO2 became stable. Group A and B infants were similar: gestational age 29.5 ± 1.0 vs 29.4 ± 0.9 weeks; body weight 1314 ± 96 vs 1296 ± 88 g; Silverman Anderson score for babies at start of ventilation 8.6 ± 0.8 vs 8.2 ± 0.7; initial FiO2 0.56 ± 0.16 vs 0.51 ± 0.14, respectively. The less doses of surfactant administered in group A than that in group B (P<0.05). Groups A and B showed different max PEEP during the first 12 h of life (8.4 ± 0.5 vs 6.7 ± 0.6 cm H2O, P=0.00), time to lowest FiO2 (101 ± 18 versus 342 ± 128 min; P=0.000) and O2 dependency (7.83 ± 2.04 vs 9.92 ± 2.78 days; P=0.04). FiO2 levels progressively decreased (F=43.240, P=0.000) and a/AO2 ratio gradually increased (F=30.594, P=0.000). No adverse events and no differences in the outcomes were observed. LRM led to the earlier lowest FiO2 of the first 12 h of life and a shorter O2 dependency.

  6. Mechanical ventilation with permissive hypercapnia increases intrapulmonary shunt in septic and nonseptic patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Pfeiffer, Birgit; Hachenberg, Thomas; Wendt, Michael; Marshall, Bryan

    2002-02-01

    To compare the effects of conventional mechanical ventilation with low-volume, pressure-limited ventilation (LVPLV) and permissive hypercapnia on ventilation-perfusion (V/Q) distributions in patients with acute respiratory distress syndrome. We hypothesized that the advantageous cardiopulmonary effects of LVPLV would be greater in patients with sepsis than in those without sepsis. Twenty-two patients with acute respiratory distress syndrome were studied (group 1: 12 patients with hyperdynamic sepsis; group 2: 10 nonseptic patients). Intrapulmonary shunt (Qsp/Qt) (percentage of cardiac output), perfusion of "low" V/Q areas (percentage of cardiac output), ventilation of "high" V/Q areas (percentage of total ventilation [VE]), and deadspace ventilation (percentage of VE) were calculated from the retention/excretion data of six inert gases. Data were obtained during conventional mechanical ventilation and during LVPLV. In group 1, LVPLV increased PaCO(0)rom 38 +/- 6 torr (5.1 +/- 0.8 kPa) to 61 +/- 12 torr (8.1 +/- 1.6 kPa). Qsp/Qt increased from 28 +/- 16% to 36 +/- 17%, whereas Pao2 (84 +/- 15 torr [11.1 +/- 2.0 kPa] vs. 86 +/- 21 torr [11.5 +/- 2.8 kPa]) and Qt (10.6 +/- 2.3 vs. 11.5 +/- 2.5 L x -1) remained unchanged and PVO(2) (40 +/- 4 [5.3 +/- 0.5 kPa] vs. 49 +/- 6 torr [6.5 +/- 0.3]) increased. In group 2, LVPLV increased PaCO(2) from 38 +/- 6 torr (5.1 +/- 0.8 kPa) to 63 +/- 11 torr (8.4 +/- 1.5 kPa). For Qsp/Qt (24 +/- 9% to 34 +/- 16%), the increase was not significant, whereas Qt (7.4 +/- 1.8 vs. 10.2 +/- 2.2 L x -1), PVO(2)(38 +/- 4 torr [5.1 +/- 0.5 kPa] vs. 50 +/- 6 mm Hg [6.7 +/- 0.8 kPa]), and PaO(2) (89 +/- 16 torr [11.9 +/- 2.1 kPa] vs. 98 +/- 19 torr [13.1 +/- 2.5 kPa]) increased. In both groups, the scatter of perfusion distribution (log SDQ) was greater than expected for normal subjects but was not different between the groups or altered by the treatments. In patients with acute respiratory distress syndrome, LVPLV with permissive hypercapnia

  7. Severe acute respiratory syndrome-coronavirus infection in aged nonhuman primates is associated with modulated pulmonary and systemic immune responses

    Science.gov (United States)

    2014-01-01

    Background Many respiratory viruses disproportionately impact the elderly. Likewise, advanced age correlated with more adverse disease outcomes following severe acute respiratory syndrome coronavirus (SARS-CoV) infection in humans. We used an aged African green monkey SARS-CoV infection model to better understand age-related mechanisms of increased susceptibility to viral respiratory infections. Nonhuman primates are critical translational models for such research given their similarities to humans in immune-ageing as well as lung structure. Results Significant age- and infection-dependent differences were observed in both systemic and mucosal immune compartments. Peripheral lymphocytes, specifically CD8 T and B cells were significantly lower in aged monkeys pre- and post- SARS-CoV infection, while neutrophil and monocyte numbers were not impacted by age or infection status. Serum proinflammatory cytokines were similar in both age groups, whereas significantly lower levels of IL-1beta, IL-18, IL-6, IL-12 and IL-15 were detected in the lungs of SARS-CoV-infected aged monkeys at either 5 or 10 days post infection. Total lung leukocyte numbers and relative frequency of CD8 T cells, B cells, macrophages and dendritic cells were greatly reduced in the aged host during SARS-CoV infection, despite high levels of chemoattractants for many of these cells in the aged lung. Dendritic cells and monocytes/macrophages showed age-dependent differences in activation and chemokine receptor profiles, while the CD8 T cell and B cell responses were significantly reduced in the aged host. In examination of viral titers, significantly higher levels of SARS-CoV were detected in the nasal swabs early, at day 1 post infection, in aged as compared to juvenile monkeys, but virus levels were only slightly higher in aged animals by day 3. Although there was a trend of higher titers in respiratory tissues at day 5 post infection, this did not reach statistical significance and virus was

  8. Efficiency of Combined Use of a Surfactant and the «Lung Opening» Maneuver in the Treatment of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    A. V. Vlasenko

    2007-01-01

    Full Text Available The paper discusses whether the «lung opening» maneuver in combination with the endobronchial administration of a pulmonary surfactant can be used in the treatment of patients with acute respiratory distress syndrome (ARDS of various genesis. The authors outline data of their studies of the separate use of both methods and present the results of successful treatment in a patient with severe concomitant injury and posttraumatic ARDS in the combined use of the «lung opening» maneuver and Surfactant-BL. With intensive care, the combined use of these methods is a more effective way of improving gas exchange as compared with their use alone. Key words: acute respiratory distress syndrome, surfactant-BL, «lung opening» maneuver, combined use of both methods.

  9. Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System(®) to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Akkanti, Bindu; Rajagopal, Keshava; Patel, Kirti P; Aravind, Sangeeta; Nunez-Centanu, Emmanuel; Hussain, Rahat; Shabari, Farshad Raissi; Hofstetter, Wayne L; Vaporciyan, Ara A; Banjac, Igor S; Kar, Biswajit; Gregoric, Igor D; Loyalka, Pranav

    2017-06-01

    Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO2R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO2R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

  10. The Severe Acute Respiratory Syndrome (SARS-coronavirus 3a protein may function as a modulator of the trafficking properties of the spike protein

    Directory of Open Access Journals (Sweden)

    Tan Yee-Joo

    2005-02-01

    Full Text Available Abstract Background A recent publication reported that a tyrosine-dependent sorting signal, present in cytoplasmic tail of the spike protein of most coronaviruses, mediates the intracellular retention of the spike protein. This motif is missing from the spike protein of the severe acute respiratory syndrome-coronavirus (SARS-CoV, resulting in high level of surface expression of the spike protein when it is expressed on its own in vitro. Presentation of the hypothesis It has been shown that the severe acute respiratory syndrome-coronavirus genome contains open reading frames that encode for proteins with no homologue in other coronaviruses. One of them is the 3a protein, which is expressed during infection in vitro and in vivo. The 3a protein, which contains a tyrosine-dependent sorting signal in its cytoplasmic domain, is expressed on the cell surface and can undergo internalization. In addition, 3a can bind to the spike protein and through this interaction, it may be able to cause the spike protein to become internalized, resulting in a decrease in its surface expression. Testing the hypothesis The effects of 3a on the internalization of cell surface spike protein can be examined biochemically and the significance of the interplay between these two viral proteins during viral infection can be studied using reverse genetics methodology. Implication of the hypothesis If this hypothesis is proven, it will indicate that the severe acute respiratory syndrome-coronavirus modulates the surface expression of the spike protein via a different mechanism from other coronaviruses. The interaction between 3a and S, which are expressed from separate subgenomic RNA, would be important for controlling the trafficking properties of S. The cell surface expression of S in infected cells significantly impacts viral assembly, viral spread and viral pathogenesis. Modulation by this unique pathway could confer certain advantages during the replication of the severe

  11. Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients.

    Science.gov (United States)

    Garnero, Aude; Tuxen, David; Corno, Gaëlle; Durand-Gasselin, Jacques; Hodgson, Carol; Arnal, Jean-Michel

    2015-09-18

    Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale. In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH2O and then decreased from 40 to 5 cmH2O in steps of 5 cmH2O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume. Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1-1] breath, and 95 % of the additional decreased volume was achieved within 8 [2-15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths. In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.

  12. Physiotherapy Practice Patterns for Acute Respiratory Distress Syndrome in Intensive Care Unit in India – A Survey

    Directory of Open Access Journals (Sweden)

    Rashmi Nigam

    2017-05-01

    Full Text Available Objective: To determine the practice patterns of physiotherapists for acute respiratory distress syndrome (ARDS in the Intensive care unit in India. Materials and methods: A cross sectional survey was conducted across India, in which 600 questionnaires were sent via email to cardio-pulmonary physiotherapists. The questionnaire addressed assessment and treatment techniques of ventilated and non-ventilated ARDS patients. Results: A total of 252 completed questionnaires were returned with a response rate of 42%. The assessment and treatment techniques used were almost similar for ventilated and non-ventilated patients. More than 75% of the responders monitored vital and ventilatory parameters and respiratory impairments for both ventilated and non-ventilated patients. An objective measure of dyspnea was taken by less than 70% responders with minimal attention given to functional exercise capacity, measures of function and health related quality of life measures. Supine Positioning (81.7%was used more in ventilated patients whereas upright position (75% was used more in non-ventilated patients. 75% of responders use secretion clearance and manual techniques for both ventilated and non-ventilated patients. In non-ventilated patients, breathing strategies were used by 85% responders, 86.1% performed ambulation and more than 60% physiotherapists used strength training. Conclusion:Assessment predominately focuses on monitoring vital signs and ventilator parameters, and taking impairment measures for ventilated and non-ventilated patients, with little attention given to functional exercise capacity, measures of function and health related quality of life measures. Treatment predominately focuses on body positioning, airway clearance techniques, manual techniques and range of motion exercises for ventilated patients and in addition to all aforementioned breathing strategies and functional training for non-ventilated patients.

  13. 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

    Directory of Open Access Journals (Sweden)

    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.

  14. Improvement of Oxygenation in Severe Acute Respiratory Distress Syndrome With High-Volume Continuous Veno-venous Hemofiltration

    Science.gov (United States)

    Yang, Wenmin; Hong, Jie; Zeng, Qiyi; Tao, Jianping; Chen, Feiyan; Dang, Run; Liang, Yufeng; Wu, Zhiyuan; Yang, Yiyu

    2016-01-01

    The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT) for improvement of oxygenation in acute respiratory distress syndrome (ARDS) remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) 24 hours after CRRT onset compared with baseline (median change = 51.5; range = −19 to 450.5; P CRRT. White blood cell (WBC) count decreased in the subgroup with high baseline WBC count (P < .05). PaO2/FiO2 was higher in ARDS patients with extrapulmonary etiology than in those with pulmonary etiology (P < .05). Improvement in oxygenation is likely related to both restoration of fluid balance and clearance of inflammatory mediators. PMID:27336018

  15. Improvement of Oxygenation in Severe Acute Respiratory Distress Syndrome With High-Volume Continuous Veno-venous Hemofiltration

    Directory of Open Access Journals (Sweden)

    Wenmin Yang MD

    2016-05-01

    Full Text Available The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT for improvement of oxygenation in acute respiratory distress syndrome (ARDS remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2 24 hours after CRRT onset compared with baseline (median change = 51.5; range = −19 to 450.5; P < .001 as well as decreases in FiO2, peak inspiratory pressure, positive end-expiratory pressure, and mean airway pressure (P < .05. The majority of patients had a negative fluid balance after 24 hours of CRRT. White blood cell (WBC count decreased in the subgroup with high baseline WBC count (P < .05. PaO2/FiO2 was higher in ARDS patients with extrapulmonary etiology than in those with pulmonary etiology (P < .05. Improvement in oxygenation is likely related to both restoration of fluid balance and clearance of inflammatory mediators.

  16. [Dynamics of peripheral blood B lymphocytes and natural killer cells in patients with severe acute respiratory syndrome].

    Science.gov (United States)

    Dong, Qing-Ming; He, Zhong-Ping; Zhuang, Hui; Song, Shu-Jing; Dai, Wang-Su; Zhang, Si-Ping; Chen, Zhi-Hai; Sun, Jing-Yuan

    2004-08-01

    To study the dynamics of peripheral blood B lymphocytes and natural killer (NK) cells in patients with severe acute respiratory syndrome (SARS). The absolute numbers of peripheral blood B lymphocytes and NK cells in 602 serial samples from 240 patients with SARS were counted, using flow cytometry, and compared with that of normal population. The absolute numbers of peripheral blood B lymphocytes and NK cells in SARS patients were significantly lower than that of the normal population (P < 0.001) and were much lower in SARS patients with severe or extremely severe types, as compared with that of moderate or mild type cases (P < 0.001). The amount of B lymphocytes in recovery SARS patients increased at the 2nd week after onset, and gradually becoming normal at the 5th week of the disease onset. The number of NK cells was in the low level at onset, and keep decreasing at the 2nd week. However, it was increasing with the recovery of the disease, but did not reach to normal level at the 5th week after onset. The absolute numbers of peripheral blood B lymphocytes and NK cells were associated with the severity of the disease, and detection of these two kinds of cells was useful for predicting the prognosis of SARS.

  17. Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center.

    Science.gov (United States)

    Spece, Laura J; Mitchell, Kristina H; Caldwell, Ellen S; Gundel, Stephanie J; Jolley, Sarah E; Hough, Catherine L

    2018-04-01

    Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation. A cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center between 2008 and 2012. The primary outcome was the receipt of LTVV (tidal volume of ≤6.5mL/kg predicted body weight) within 48h of ARDS onset. We constructed a multivariable logistic regression model to identify factors associated with the outcome. Only 27% of patients received tidal volumes of ≤6.5mL/kg PBW within 48h of ARDS onset. Increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value<0.01) was positively associated with LTVV use while increasing PaO 2 :F I O 2 ratio was negatively associated (OR 0.75; 95% CI 0.57 to 0.98; p-value 0.03). Physicians documented an ARDS diagnosis in only 21% of the cohort. Neither patient height nor gender was associated with LTVV use. Most ARDS patients did not receive LTVV despite implementation of a protocol. ARDS was also recognized in a minority of patients, suggesting an opportunity for improvement of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. [Risk factors for acute respiratory distress syndrome following surgeries for pediatric critical and complex congenital heart disease].

    Science.gov (United States)

    Gong, Shu-Rong; Zhang, Ying-Rui; Yu, Rong-Guo

    2016-12-20

    To explore the risk factors for acute respiratory distress syndrome (ARDS) in children receiving surgeries for critical and complex congenital heart disease (CCHD). According to the 2011's Berlin definition of ARDS, the clinical data were collected from 75 children without ARDS (group I) and 80 children with ARDS (group II) following surgeries for CCHD performed in the Department of Cardiac Surgery of our hospital from January, 2009 to May, 2014. Univariate analyses and logistic regression were used to analyze the risk factors contributing to the occurrence of ARDS following the surgeries. In the 80 patients who developed ARDS postoperatively in group II, 27 had mild ARDS, 25 had moderate ARDS, and 28 had severe ARDS; death occurred in 17 (21%) cases. Univariate analyses showed that 23 parameters were significantly different between groups I and II (Pfactors for postoperative ARDS. The risk factors of ARDS identified in these children can predict the occurrence of ARDS following the surgeries and timely interventions can improve the success rate in treatment of postoperative ARDS in children with CCHD.

  19. Perception of spokespersons' performance and characteristics in crisis communication: experience of the 2003 severe acute respiratory syndrome outbreak in Taiwan.

    Science.gov (United States)

    Lyu, Shu-Yu; Chen, Ruey-Yu; Wang, Shih-fan Steve; Weng, Ya-Ling; Peng, Eugene Yu-Chang; Lee, Ming-Been

    2013-10-01

    To explore perception of spokespersons' performance and characteristics in response to the 2003 severe acute respiratory syndrome (SARS) outbreak. This study was conducted from March to July, 2005, using semi-structured in-depth interviews to collect data. All interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was employed to analyze the transcribed data. Interviewees included media reporters, media supervisors, health and medical institution executives or spokespersons, and social observers. Altogether, 35 interviewees were recruited for in-depth interviews, and the duration of the interview ranged from 1 hour to 2 hours. Results revealed that the most important characteristics of health/medical institutions spokespersons are professional competence and good interaction with the media. In contrast, the most important behaviors they should avoid are concealing the truth and misreporting the truth. Three major flaws of spokespersons' performance were identified: they included poor understanding of media needs and landscape; blaming the media to cover up a mistake they made in an announcement; and lack of sufficient participation in decision-making or of authorization from the head of organization. Spokespersons of health and medical institutions play an important role in media relations during the crisis of a newly emerging infectious disease. Copyright © 2013. Published by Elsevier B.V.

  20. Increased antibody affinity confers broad in vitro protection against escape mutants of severe acute respiratory syndrome coronavirus.

    Science.gov (United States)

    Rani, Mridula; Bolles, Meagan; Donaldson, Eric F; Van Blarcom, Thomas; Baric, Ralph; Iverson, Brent; Georgiou, George

    2012-09-01

    Even though the effect of antibody affinity on neutralization potency is well documented, surprisingly, its impact on neutralization breadth and escape has not been systematically determined. Here, random mutagenesis and DNA shuffling of the single-chain variable fragment of the neutralizing antibody 80R followed by bacterial display screening using anchored periplasmic expression (APEx) were used to generate a number of higher-affinity variants of the severe acute respiratory syndrome coronavirus (SARS-CoV)-neutralizing antibody 80R with equilibrium dissociation constants (K(D)) as low as 37 pM, a >270-fold improvement relative to that of the parental 80R single-chain variable fragment (scFv). As expected, antigen affinity was shown to correlate directly with neutralization potency toward the icUrbani strain of SARS-CoV. Additionally, the highest-affinity antibody fragment displayed 10-fold-increased broad neutralization in vitro and completely protected against several SARS-CoV strains containing substitutions associated with antibody escape. Importantly, higher affinity also led to the suppression of viral escape mutants in vitro. Escape from the highest-affinity variant required reduced selective pressure and multiple substitutions in the binding epitope. Collectively, these results support the hypothesis that engineered antibodies with picomolar dissociation constants for a neutralizing epitope can confer escape-resistant protection.

  1. High-dose Oral Ambroxol for Early Treatment of Pulmonary Acute Respiratory Distress Syndrome: an Exploratory, Randomized, Controlled Pilot Trial.

    Science.gov (United States)

    Baranwal, Arun K; Murthy, Aparna S; Singhi, Sunit C

    2015-10-01

    To evaluate efficacy of high-dose oral ambroxol in acute respiratory distress syndrome (ARDS) with respect to ventilator-free days (VFD). Prospective, randomized, placebo-controlled, blinded pilot trial. Sixty-six mechanically ventilated patients (1 month to 12 years) with ARDS who were hand-ventilated for ambroxol (40 mg/kg/day, in four divided doses) (n = 32) or placebo (n = 34) until 10 days, extubation or death whichever is earlier. Majority (91%) had pneumonia and bronchiolitis. Two study groups were similar in baseline characteristics. Mean partial pressure of arterial oxygen/fraction of inspired oxygen and oxygenation index were >175 and ambroxol. Among ventilated pulmonary ARDS patients with oxygenation index of Ambroxol did not improve VFD. Study with higher and more frequently administered doses of ambroxol in larger sample is suggested after having generated relevant pharmacokinetic data among critically ill children. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Setting ventilation parameters guided by electrical impedance tomography in an animal trial of acute respiratory distress syndrome

    Science.gov (United States)

    Czaplik, Michael; Biener, Ingeborg; Leonhardt, Steffen; Rossaint, Rolf

    2014-03-01

    Since mechanical ventilation can cause harm to lung tissue it should be as protective as possible. Whereas numerous options exist to set ventilator parameters, an adequate monitoring is lacking up to date. The Electrical Impedance Tomography (EIT) provides a non-invasive visualization of ventilation which is relatively easy to apply and commercially available. Although there are a number of published measures and parameters derived from EIT, it is not clear how to use EIT to improve clinical outcome of e.g. patients suffering from acute respiratory distress syndrome (ARDS), a severe disease with a high mortality rate. On the one hand, parameters should be easy to obtain, on the other hand clinical algorithms should consider them to optimize ventilator settings. The so called Global inhomogeneity (GI) index bases on the fact that ARDS is characterized by an inhomogeneous injury pattern. By applying positive endexpiratory pressures (PEEP), homogeneity should be attained. In this study, ARDS was induced by a double hit procedure in six pigs. They were randomly assigned to either the EIT or the control group. Whereas in the control group the ARDS network table was used to set the PEEP according to the current inspiratory oxygen fraction, in the EIT group the GI index was calculated during a decremental PEEP trial. PEEP was kept when GI index was lowest. Interestingly, PEEP was significantly higher in the EIT group. Additionally, two of these animals died ahead of the schedule. Obviously, not only homogeneity of ventilation distribution matters but also limitation of over-distension.

  3. Lung Injury Prediction Score Is Useful in Predicting Acute Respiratory Distress Syndrome and Mortality in Surgical Critical Care Patients

    Directory of Open Access Journals (Sweden)

    Zachary M. Bauman

    2015-01-01

    Full Text Available Background. Lung injury prediction score (LIPS is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS. This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8±2.8 versus 5.4±2.8 for those who did not (p<0.001. An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p<0.001 and odds of ICU mortality increase by 1.22 (p<0.001. Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

  4. RNA 3'-end mismatch excision by the severe acute respiratory syndrome coronavirus nonstructural protein nsp10/nsp14 exoribonuclease complex.

    Science.gov (United States)

    Bouvet, Mickaël; Imbert, Isabelle; Subissi, Lorenzo; Gluais, Laure; Canard, Bruno; Decroly, Etienne

    2012-06-12

    The replication/transcription complex of severe acute respiratory syndrome coronavirus is composed of at least 16 nonstructural proteins (nsp1-16) encoded by the ORF-1a/1b. This complex includes replication enzymes commonly found in positive-strand RNA viruses, but also a set of RNA-processing activities unique to some nidoviruses. The nsp14 protein carries both exoribonuclease (ExoN) and (guanine-N7)-methyltransferase (N7-MTase) activities. The nsp14 ExoN activity ensures a yet-uncharacterized function in the virus life cycle and must be regulated to avoid nonspecific RNA degradation. In this work, we show that the association of nsp10 with nsp14 stimulates >35-fold the ExoN activity of the latter while playing no effect on N7-MTase activity. Nsp10 mutants unable to interact with nsp14 are not proficient for ExoN activation. The nsp10/nsp14 complex hydrolyzes double-stranded RNA in a 3' to 5' direction as well as a single mismatched nucleotide at the 3'-end mimicking an erroneous replication product. In contrast, di-, tri-, and longer unpaired ribonucleotide stretches, as well as 3'-modified RNAs, resist nsp10/nsp14-mediated excision. In addition to the activation of nsp16-mediated 2'-O-MTase activity, nsp10 also activates nsp14 in an RNA processing function potentially connected to a replicative mismatch repair mechanism.

  5. Structural Insights into Immune Recognition of the Severe Acute Respiratory Syndrome Coronavirus S Protein Receptor Binding Domain

    Energy Technology Data Exchange (ETDEWEB)

    Pak, J.; Sharon, C; Satkunarajah, M; Thierry, C; Cameron, C; Kelvin, D; Seetharaman, J; Cochrane, A; Plummer, F; et. al.

    2009-01-01

    The spike (S) protein of the severe acute respiratory syndrome coronavirus (SARS-CoV) is responsible for host cell attachment and fusion of the viral and host cell membranes. Within S the receptor binding domain (RBD) mediates the interaction with angiotensin-converting enzyme 2 (ACE2), the SARS-CoV host cell receptor. Both S and the RBD are highly immunogenic and both have been found to elicit neutralizing antibodies. Reported here is the X-ray crystal structure of the RBD in complex with the Fab of a neutralizing mouse monoclonal antibody, F26G19, elicited by immunization with chemically inactivated SARS-CoV. The RBD-F26G19 Fab complex represents the first example of the structural characterization of an antibody elicited by an immune response to SARS-CoV or any fragment of it. The structure reveals that the RBD surface recognized by F26G19 overlaps significantly with the surface recognized by ACE2 and, as such, suggests that F26G19 likely neutralizes SARS-CoV by blocking the virus-host cell interaction.

  6. Suppression of innate antiviral response by severe acute respiratory syndrome coronavirus M protein is mediated through the first transmembrane domain.

    Science.gov (United States)

    Siu, Kam-Leung; Chan, Chi-Ping; Kok, Kin-Hang; Chiu-Yat Woo, Patrick; Jin, Dong-Yan

    2014-03-01

    Coronaviruses have developed various measures to evade innate immunity. We have previously shown that severe acute respiratory syndrome (SARS) coronavirus M protein suppresses type I interferon (IFN) production by impeding the formation of functional TRAF3-containing complex. In this study, we demonstrate that the IFN-antagonizing activity is specific to SARS coronavirus M protein and is mediated through its first transmembrane domain (TM1) located at the N terminus. M protein from human coronavirus HKU1 does not inhibit IFN production. Whereas N-linked glycosylation of SARS coronavirus M protein has no influence on IFN antagonism, TM1 is indispensable for the suppression of IFN production. TM1 targets SARS coronavirus M protein and heterologous proteins to the Golgi apparatus, yet Golgi localization is required but not sufficient for IFN antagonism. Mechanistically, TM1 is capable of binding with RIG-I, TRAF3, TBK1 and IKKε, and preventing the interaction of TRAF3 with its downstream effectors. Our work defines the molecular architecture of SARS coronavirus M protein required for suppression of innate antiviral response.

  7. Structural Basis of Neutralization by a Human Anti-severe Acute Respiratory Syndrome Spike Protein Antibody,80R.

    Energy Technology Data Exchange (ETDEWEB)

    Hwang,W.; Lin, Y.; Santelli, E.; Sui, J.; Jaroszewski, L.; Stec, B.; Farzan, M.; Marasco, W.; Liddington, R.

    2006-01-01

    Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease that caused pandemic spread in 2003. The etiological agent of SARS is a novel coronavirus (SARS-CoV). The coronaviral surface spike protein S is a type I transmembrane glycoprotein that mediates initial host binding via the cell surface receptor angiotensin-converting enzyme 2 (ACE2), as well as the subsequent membrane fusion events required for cell entry. Here we report the crystal structure of the S1 receptor binding domain (RBD) in complex with a neutralizing antibody, 80R, at 2.3 {angstrom} resolution, as well as the structure of the uncomplexed S1 RBD at 2.2 {angstrom} resolution. We show that the 80R-binding epitope on the S1 RBD overlaps very closely with the ACE2-binding site, providing a rationale for the strong binding and broad neutralizing ability of the antibody. We provide a structural basis for the differential effects of certain mutations in the spike protein on 80R versus ACE2 binding, including escape mutants, which should facilitate the design of immunotherapeutics to treat a future SARS outbreak. We further show that the RBD of S1 forms dimers via an extensive interface that is disrupted in receptor- and antibody-bound crystal structures, and we propose a role for the dimer in virus stability and infectivity.

  8. Rewiring the severe acute respiratory syndrome coronavirus (SARS-CoV) transcription circuit: Engineering a recombination-resistant genome

    Science.gov (United States)

    Yount, Boyd; Roberts, Rhonda S.; Lindesmith, Lisa; Baric, Ralph S.

    2006-08-01

    Live virus vaccines provide significant protection against many detrimental human and animal diseases, but reversion to virulence by mutation and recombination has reduced appeal. Using severe acute respiratory syndrome coronavirus as a model, we engineered a different transcription regulatory circuit and isolated recombinant viruses. The transcription network allowed for efficient expression of the viral transcripts and proteins, and the recombinant viruses replicated to WT levels. Recombinant genomes were then constructed that contained mixtures of the WT and mutant regulatory circuits, reflecting recombinant viruses that might occur in nature. Although viable viruses could readily be isolated from WT and recombinant genomes containing homogeneous transcription circuits, chimeras that contained mixed regulatory networks were invariantly lethal, because viable chimeric viruses were not isolated. Mechanistically, mixed regulatory circuits promoted inefficient subgenomic transcription from inappropriate start sites, resulting in truncated ORFs and effectively minimize viral structural protein expression. Engineering regulatory transcription circuits of intercommunicating alleles successfully introduces genetic traps into a viral genome that are lethal in RNA recombinant progeny viruses. regulation | systems biology | vaccine design

  9. Hemoptysis and acute respiratory syndrome (ARDS) as delayed-type hypersensitivity after FOLFOX4 plus bevacizumab treatment.

    Science.gov (United States)

    Kobayashi, Takaaki; Masaki, Tadahiko; Kogawa, Koji; Matsuoka, Hiroyoshi; Sugiyama, Masanori

    2013-01-01

    As there have been many multidrug regimens introduced in colorectal cancer treatment, hypersensitivity is more often encountered than in the past. Though most allergic adverse events of oxaliplatin are mainly classified as type I reaction, a limited number of case reports of type IV reaction (delayed-type hypersensitivity) have been reported. A 73-year-old man was hospitalized for receiving the third cycle of FOLFOX4 plus bevacizumab. Forty-two hours after administration, he had dyspnea and hemoptysis. Acute respiratory distress syndrome was suspected, and the patient underwent mechanical ventilation and steroid pulse therapy. Delayed-type hypersensitivity is induced by induction of inflammation via IL-1, TNF-α and IL-6. The serum level of IL-6 in patients with advanced colorectal cancers is usually greater than the normal range. Therefore, delayed-type hypersensitivity may be easily induced in those patients. We should pay special attention to delayed-type hypersensitivity in advanced colorectal cancer patients undergoing FOLFOX treatment.

  10. Comparison of the Berlin definition with the American European consensus definition for acute respiratory distress syndrome in burn patients.

    Science.gov (United States)

    Bordes, Julien; Lacroix, Guillaume; Esnault, Pierre; Goutorbe, Philippe; Cotte, Jean; Dantzer, Eric; Meaudre, Eric

    2014-06-01

    Acute respiratory distress syndrome (ARDS) is a leading cause of mortality in burn patients. Smoke inhalation, pneumonia and inflammation process are the major causes of ARDS in burn patients. The American European Consensus Conference (AECC) definition proposed in 1994 has recently been revised by the Berlin definition. Our objective was to describe the epidemiology of ARDS comparing the Berlin definition with the AECC definition in a retrospective cohort of burn patients. We reviewed admitted burn adult patients for a two year period, and investigated patient who received mechanical ventilation for more than 48 h and in whom pneumonia was diagnosed. 40 patients were analyzed. According to the AECC definition, 11 patients met criteria for ALI (27.5%), and 29 patients for ARDS (72.5%). According to the Berlin definition, all patients met criteria for ARDS: 4 (10%) for a severe ARDS, 25 (62.5%) for a moderate ARDS, 11 (27.5%) for a mild ARDS. Inhalation injury was diagnosed in 10 patients (25%). Categorizing patients with the Berlin definition showed statistically significative difference of mortality within the three groups, but not with the AECC definition. The Berlin definition seems to be more accurate than the AECC definition to assess the severity of ARDS in term of outcome in burn patients. This definition may facilitate prompt recognition of ARDS in burn patients, and promote protective ventilation strategy to a larger number of patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  11. Early infectious acute respiratory distress syndrome is characterized by activation and proliferation of alveolar T-cells.

    Science.gov (United States)

    Risso, K; Kumar, G; Ticchioni, M; Sanfiorenzo, C; Dellamonica, J; Guillouet-de Salvador, F; Bernardin, G; Marquette, C-H; Roger, P-M

    2015-06-01

    Acute respiratory distress syndrome (ARDS) in humans is characterized by the infiltration of polymorphonuclears in the alveolar spaces. However, the role of T-cells in ARDS is unknown. Our aim was to characterize the T-cell phenotype in bronchoalveolar lavage (BAL) during the early phase of acute lung infection(ALI)/ARDS-infected patients in comparison to a control group (CG). BAL lymphocyte phenotypes of two ALI, 16 ARDS, and eight CG were examined by flow cytometry. ALI/ARDS showed a significant increase in CD4 and CD8 T-cell activation as compared to CG. Moreover, a significant level of proliferation was observed using the Ki67 marker in ARDS patients as compared to controls (median): 37 versus 6 % for CD4 T-cells (p = 0.022) and 34 versus 2 % for CD8 T-cells (p = 0.009). In contrast, the percentage of T-regulatory cells and apoptotic T-cells were similar in both groups. Among costimulatory molecules, we observed an overexpression of CTLA-4/CD152 on CD4 T-cells in ALI/ARDS as compared to CG: 30 versus 7 %, respectively (p = 0.063). In further characterizing T-cell subsets expressing high levels of CD152, we found the presence of IL-17 secreting CD4 T-cells in ALI/ARDS. In humans, ALI/ARDS due to infection is associated with a high level of T-cell activation and proliferation, along with the presence of Th17 cells, which are known to attract polymorphonuclears.

  12. Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk☆,☆☆

    Science.gov (United States)

    Karnatovskaia, Lioudmila V.; Festic, Emir; Gajic, Ognjen; Carter, Rickey E.; Lee, Augustine S.

    2015-01-01

    Purpose Amiodarone has been implicated as a risk factor for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) when used in the hospital. This study aims to estimate whether prehospital amiodarone also increases the risk of ALI/ARDS. Materials Adult patients admitted to 22 centers with at least 1 risk factor for developing ALI were recruited. In a secondary analysis of this cohort, the prehospital use of amiodarone was documented on admission, and the patients followed for the primary outcome of ALI and secondary outcomes of ARDS, the need for invasive ventilation, and mortality. Dose/duration of amiodarone therapy was not available. Propensity matching was performed to account for imbalances in being assigned to amiodarone. The adjusted risk for ALI/ARDS was then estimated from a conditional logistic regression model of this propensity-matched set. Results Forty of 5584 patients were on amiodarone at the time of hospitalization; of those, 6 developed ALI, with 5 progressing to ARDS. In comparison, 371 patients not on amiodarone developed ALI, with 224 having ARDS. After propensity score matching, the prehospital use of amiodarone was not statistically associated with an increased risk for all ALI (odds ratio [OR], 1.8; 95% confidence interval [CI], 0.7–5.0; P = .25), invasive ventilation (OR, 1.9; 95% CI, 1.0–3.6; P = .059), or in-hospital mortality (OR, 1.2; 95% CI, 0.5–2.9; P = .75); but its use appeared to significantly increase the risk for ARDS (OR 3.8; 95% CI, 1.1–13.1; P = .036). Conclusions Prehospital use of amiodarone may independently increase the risk for ARDS in patients who have at least 1 predisposing condition for ALI. PMID:22226422

  13. Virus-specific memory CD8 T cells provide substantial protection from lethal severe acute respiratory syndrome coronavirus infection.

    Science.gov (United States)

    Channappanavar, Rudragouda; Fett, Craig; Zhao, Jincun; Meyerholz, David K; Perlman, Stanley

    2014-10-01

    Severe acute respiratory syndrome coronavirus (SARS-CoV) caused an acute human respiratory illness with high morbidity and mortality in 2002-2003. Several studies have demonstrated the role of neutralizing antibodies induced by the spike (S) glycoprotein in protecting susceptible hosts from lethal infection. However, the anti-SARS-CoV antibody response is short-lived in patients who have recovered from SARS, making it critical to develop additional vaccine strategies. SARS-CoV-specific memory CD8 T cells persisted for up to 6 years after SARS-CoV infection, a time at which memory B cells and antivirus antibodies were undetectable in individuals who had recovered from SARS. In this study, we assessed the ability of virus-specific memory CD8 T cells to mediate protection against infection in the absence of SARS-CoV-specific memory CD4 T or B cells. We demonstrate that memory CD8 T cells specific for a single immunodominant epitope (S436 or S525) substantially protected 8- to 10-month-old mice from lethal SARS-CoV infection. Intravenous immunization with peptide-loaded dendritic cells (DCs) followed by intranasal boosting with recombinant vaccinia virus (rVV) encoding S436 or S525 resulted in accumulation of virus-specific memory CD8 T cells in bronchoalveolar lavage fluid (BAL), lungs, and spleen. Upon challenge with a lethal dose of SARS-CoV, virus-specific memory CD8 T cells efficiently produced multiple effector cytokines (gamma interferon [IFN-γ], tumor necrosis factor alpha [TNF-α], and interleukin 2 [IL-2]) and cytolytic molecules (granzyme B) and reduced lung viral loads. Overall, our results show that SARS-CoV-specific memory CD8 T cells protect susceptible hosts from lethal SARS-CoV infection, but they also suggest that SARS-CoV-specific CD4 T cell and antibody responses are necessary for complete protection. Virus-specific CD8 T cells are required for pathogen clearance following primary SARS-CoV infection. However, the role of SARS-CoV-specific memory CD

  14. [Effect of prone position ventilation on respiratory mechanics and prognosis in patients with acute respiratory distress syndrome concurrent with interstitial lung disease].

    Science.gov (United States)

    Sun, Qingwen; Zhu, Mangui; Xi, Yin; Yu, Yuheng; Liu, Xuesong; Sang, Ling; Xu, Yonghao; Chen, Sibei; Nong, Lingbo; He, Weiqun; Xu, Yuanda; Li, Yimin; Liu, Xiaoqing

    2015-10-01

    To explore the effect of prone position ventilation (PPV) on respiratory mechanics and prognosis in patients with acute respiratory distress syndrome (ARDS) concurrent with interstitial lung disease (ILD). The data of 36 severe ARDS patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University from February 2013 to January 2015, were retrospectively analyzed. They were then divided into two groups according to the presence of ILD or not. The changes in respiratory mechanics and oxygenation indexes were compared before and after PPV treatment in all the patients. Kaplan-Meier method was applied to draw the 60-day survival curves of both groups. There were 17 cases with ILD among these 36 severe ARDS patients. (1) No significant difference was found in baseline data between ILD group and non-ILD group. (2) Respiratory mechanics and oxygenation pre-PPV and post-PPV: compared with pre-PPV, oxygenation index (PaO2/FiO2, mmHg, 1 mmHg = 0.133 kPa) post-PPV was significantly increased in both groups [ILD group : 132.0 (93.5, 172.0) vs. 118.7 (92.0, 147.8); non-ILD group: 126.1 (100.9, 170.0) vs. 109.2 (89.0, 135.0), both P mechanics and oxygenation pre-PPV and post-PPV in total: after all the PPV therapy, PaO2/FiO2 (mmHg) was significantly increased in non-ILD group [135.0 (86.0, 200.0) vs. 97.4 (69.2, 127.5), P 0.05], and Crs was lower after PPV treatment in both groups, but without significant difference [non-ILD group: 22.7 (15.2, 27.1) vs. 24.3 (15.9, 48.9); ILD group: 16.2 (12.8, 25.6) vs. 18.9 (12.7, 27.3), both P > 0.05]. (4) The 60-day mortality in ILD group was significantly higher than that in non-ILD group [88.2% (15/17) vs. 57.9% (11/19), P = 0.047). It was shown by Kaplan-Meier curves that 60-day survival patients in ILD group was significantly lower than those in non-ILD group (χ2 = 5.658, P = 0.017). PPV can improve oxygenation in severe ARDS. Compared with non-ILD group, though the compliance of

  15. Acute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: impact on managing uncertainty for patient-centered communication.

    Science.gov (United States)

    Johnson, Robert F; Gustin, Jillian

    2013-09-01

    A case of acute lung injury (ALI) progressing to acute respiratory distress syndrome (ARDS) requiring tracheal intubation and mechanical ventilation (ETMV) is presented. The palliative medicine service was asked to address concerns expressed by the patient's spouse reflecting uncertainty regarding outcome expectations. Acknowledging and confronting the uncertainties of a critical illness is an essential component of patient-centered communication. Addressing and managing uncertainty for the case scenario requires consideration of both short- and long-term outcomes including mortality, ventilator independence, and adverse effects on quality of life for survivors. In this paper, ALI/ARDS requiring ETMV in the ICU was used as a focal point for preparing a prognostic assessment incorporating these issues. This assessment was based on a review of recently published literature regarding mortality and ventilator independence of survivors for adult patients receiving ETMV for ALI/ARDS in the ICU. In the studies reviewed, long-term survival reported at 60 days to 1 year was 50-73% with greater than 84% of the survivors in each study breathing independently. Selected articles discussing outcomes other than mortality or recovery of respiratory function, particularly quality of life implications for ALI/ARDS survivors, were also reviewed. A case of of ALI/ARDS requiring ETMV in the ICU is used to illustrate the situation of an incapacitated critically ill patient where the outcome is uncertain. Patient-centered communication should acknowledge and address this uncertainty. Managing uncertainty consists of effectively expressing a carefully formulated prognostic assessment and using sound communication principles to alleviate the distress associated with the uncertain outcome probabilities.

  16. Page 1 severe Acute RESPIRAtoRY syndrome (sARs): Clinical ...

    African Journals Online (AJOL)

    2003-04-08

    Apr 8, 2003 ... symptoms and signs consistent with SARS but who have a normal chestradiograph. The typical finding of the CT is indistinguishable from other forms of severe pneumonia such as pneumonia of bronchiolitis obliterans and acute interstitial pneumonia. 19,. 20. The lesions tend to be peripheral and small in.

  17. ACUTE ATAXIA, TAKING PLACE AFTER ACUTE RESPIRATORY VIRAL INFECTION IN 2 Y. O. GIRL, AS A DEBUT NEUROLOGIC SIGN OF THE ANGELMAN SYNDROME

    Directory of Open Access Journals (Sweden)

    E. B. Voropanova

    2015-01-01

    Full Text Available Angleman syndrome (АS – is a chromosomal syndrome, which is manifested through atypical autism with feeble minding, epilepsy, outrage of the speech development, movement disorders, ataxia, as well as special (happy behavior of patients, combined with outbursts of laugh. The disease is caused by the mutation of 15q11.2–13 maternal locus or by the gene of UBE3A ubiquitinated complex. Such genes regulate the functional activity of hippocampus neurons, of olfactory bulbs, of the parastriate cortex, of the tentorium. We demonstrate the atypical AS case, which clinical presentation developed after acute respiratory viral infection with febrile temperature. The disease started with episodes of acute ataxia, interrupting daily activities of the child. Step by step the speech development was regressing – several words have fallen out,leaving the space for babbling sounds. Also appeared stereotypic movements of upper extremities (bending of arms in elbow joints, its retraction and joggling of hands, unmotivated laugh. Due to the nonrelevant starting presentation in the acute period following conditions were differentially diagnosed: 1 opsoclonus-myoclonus syndrome; 2 cerebral circulation diseases; 3 epilepsy with absences and atonic attacks; 4 paroxysmal dyskenisias and ataxias; 5 start of the neurodegenerative disease; 6 early childhood autism. Results of laboratory research allowed to exclude opsoclonus-myoclonus, the magnetic and resonance tomography and vessels research allowed to exclude the cerebrovascular pathology. Changes, revealed in the course of the videoelectroencephalographic monitoring, as well as anamnesis data (clinical symptoms after fever allowed to narrow the diagnostic search; AS suspected. Provided the combination of ataxia with movement disorders, it was decided to carry out not molecular & genetic, but also micromatrix analysis, in order to exclude the channelopathy, as well as other genetic reasons. The method of

  18. Complete protection against severe acute respiratory syndrome coronavirus-mediated lethal respiratory disease in aged mice by immunization with a mouse-adapted virus lacking E protein.

    Science.gov (United States)

    Fett, Craig; DeDiego, Marta L; Regla-Nava, Jose A; Enjuanes, Luis; Perlman, Stanley

    2013-06-01

    Zoonotic coronaviruses, including the one that caused severe acute respiratory syndrome (SARS), cause significant morbidity and mortality in humans. No specific therapy for any human coronavirus is available, making vaccine development critical for protection against these viruses. We previously showed that recombinant SARS coronavirus (SARS-CoV) (Urbani strain based) lacking envelope (E) protein expression (rU-ΔE) provided good but not perfect protection in young mice against challenge with virulent mouse-adapted SARS-CoV (MA15). To improve vaccine efficacy, we developed a second set of E-deleted vaccine candidates on an MA15 background (rMA15-ΔE). rMA15-ΔE is safe, causing no disease in 6-week-, 12-month-, or 18-month-old BALB/c mice. Immunization with this virus completely protected mice of three ages from lethal disease and effected more-rapid virus clearance. Compared to rU-ΔE, rMA15-ΔE immunization resulted in significantly greater neutralizing antibody and SARS-CoV-specific CD4 and CD8 T cell responses. After challenge, inflammatory cell infiltration, edema, and lung destruction were decreased in the lungs of rMA15-ΔE-immunized mice compared to those in rU-ΔE-immunized 12-month-old mice. Collectively, these results show that immunization with a species-adapted attenuated coronavirus lacking E protein expression is safe and provides optimal immunogenicity and long-term protection against challenge with lethal virus. This approach will be generally useful for development of vaccines protective against human coronaviruses as well as against coronaviruses that cause disease in domestic and companion animals.

  19. Glycopeptide Antibiotics Potently Inhibit Cathepsin L in the Late Endosome/Lysosome and Block the Entry of Ebola Virus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV).

    Science.gov (United States)

    Zhou, Nan; Pan, Ting; Zhang, Junsong; Li, Qianwen; Zhang, Xue; Bai, Chuan; Huang, Feng; Peng, Tao; Zhang, Jianhua; Liu, Chao; Tao, Liang; Zhang, Hui

    2016-04-22

    Ebola virus infection can cause severe hemorrhagic fever with a high mortality in humans. The outbreaks of Ebola viruses in 2014 represented the most serious Ebola epidemics in history and greatly threatened public health worldwide. The development of additional effective anti-Ebola therapeutic agents is therefore quite urgent. In this study, via high throughput screening of Food and Drug Administration-approved drugs, we identified that teicoplanin, a glycopeptide antibiotic, potently prevents the entry of Ebola envelope pseudotyped viruses into the cytoplasm. Furthermore, teicoplanin also has an inhibitory effect on transcription- and replication-competent virus-like particles, with an IC50 as low as 330 nm Comparative analysis further demonstrated that teicoplanin is able to block the entry of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) envelope pseudotyped viruses as well. Teicoplanin derivatives such as dalbavancin, oritavancin, and telavancin can also inhibit the entry of Ebola, MERS, and SARS viruses. Mechanistic studies showed that teicoplanin blocks Ebola virus entry by specifically inhibiting the activity of cathepsin L, opening a novel avenue for the development of additional glycopeptides as potential inhibitors of cathepsin L-dependent viruses. Notably, given that teicoplanin has routinely been used in the clinic with low toxicity, our work provides a promising prospect for the prophylaxis and treatment of Ebola, MERS, and SARS virus infection. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

  20. Glycopeptide Antibiotics Potently Inhibit Cathepsin L in the Late Endosome/Lysosome and Block the Entry of Ebola Virus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)*

    Science.gov (United States)

    Zhou, Nan; Pan, Ting; Zhang, Junsong; Li, Qianwen; Zhang, Xue; Bai, Chuan; Huang, Feng; Peng, Tao; Zhang, Jianhua; Liu, Chao; Tao, Liang; Zhang, Hui

    2016-01-01

    Ebola virus infection can cause severe hemorrhagic fever with a high mortality in humans. The outbreaks of Ebola viruses in 2014 represented the most serious Ebola epidemics in history and greatly threatened public health worldwide. The development of additional effective anti-Ebola therapeutic agents is therefore quite urgent. In this study, via high throughput screening of Food and Drug Administration-approved drugs, we identified that teicoplanin, a glycopeptide antibiotic, potently prevents the entry of Ebola envelope pseudotyped viruses into the cytoplasm. Furthermore, teicoplanin also has an inhibitory effect on transcription- and replication-competent virus-like particles, with an IC50 as low as 330 nm. Comparative analysis further demonstrated that teicoplanin is able to block the entry of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) envelope pseudotyped viruses as well. Teicoplanin derivatives such as dalbavancin, oritavancin, and telavancin can also inhibit the entry of Ebola, MERS, and SARS viruses. Mechanistic studies showed that teicoplanin blocks Ebola virus entry by specifically inhibiting the activity of cathepsin L, opening a novel avenue for the development of additional glycopeptides as potential inhibitors of cathepsin L-dependent viruses. Notably, given that teicoplanin has routinely been used in the clinic with low toxicity, our work provides a promising prospect for the prophylaxis and treatment of Ebola, MERS, and SARS virus infection. PMID:26953343

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

    Directory of Open Access Journals (Sweden)

    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.

  2. A Correlation between the Severity of Lung Lesions on Radiographs and Clinical Findings in Patients with Severe Acute Respiratory Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Yung-Liang; Tsay, Pei-Kwei; Cheung, Yun-Chung; Chiang, Ping-Cherng; Wang, Chun-Hua; Tsai, Ying-Huang; Kuo, Han-Ping; Tsao, Kuo-Chien; Lin, Tzou-Yien [College of Medicine, Chang Gung University, 5 Fuhsing Rd., Kweishan, Taoyuan, (China)

    2007-12-15

    The purpose of this study was to quantify lesions on chest radiographs in patients with severe acute respiratory syndrome (SARS) and analyze the severity of the lesions with clinical parameters. Two experienced radiologists reviewed chest radiographs of 28 patients with SARS. Each lung was divided into upper, middle, and lower zones. A SARS-related lesion in each zone was scored using a four-point scale: zero to three. The mean and maximal radiographic scores were analyzed statistically to determine if the scorings were related to the laboratory data and clinical course. Forward stepwise multiple linear regression showed that the mean radiographic score correlated most significantly with the number of hospitalized days (p < 0.001). The second most significant factor was the absolute lymphocyte count (p < 0.001) and the third most significant factor was the number of days of intubation (p = 0.025). The maximal radiographic score correlated best with the percentage of lymphocytes in a leukocyte count (p < 0.001), while the second most significant factor was the number of hospitalized days (p < 0.001) and the third most significant factor was the absolute lymphocyte count (p = 0.013). The mean radiographic scores of the patients who died, with comorbidities and without a comorbidity were 11.1, 6.3 and 2.9, respectively (p = 0.032). The corresponding value for maximal radiographic scores were 17.7, 9.7 and 6.0, respectively (p = 0.033). The severity of abnormalities quantified on chest radiographs in patients with SARS correlates with the clinical parameters.

  3. Recombinant human activated protein C in the treatment of acute respiratory distress syndrome: a randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Alexander D Cornet

    Full Text Available RATIONALE: Pulmonary coagulopathy may play a pathogenetic role in acute respiratory distress syndrome (ARDS, by contributing to alveolocapillary inflammation and increased permeability. Recombinant human activated protein C (rh-APC may inhibit this process and thereby improve patient outcome. METHODS: A prospective randomized, saline-controlled, single-blinded clinical trial was performed in the intensive care units of two university hospitals, and patients with ARDS were included within 24 h after meeting inclusion criteria. INTERVENTION: A 4-day course of intravenous rh-APC (24 mcg/kg/h (n = 33 versus saline (n = 38. OUTCOMES: The primary outcome parameter was the pulmonary leak index (PLI of 67Gallium-transferrin as a measure of alveolocapillary permeability and secondary outcomes were disease severity scores and ventilator-free days, among others. RESULTS: Baseline characteristics were similar; in 87% of patients the PLI was above normal and in 90% mechanical or non-invasive ventilation was instituted at a median lung injury score of 2.5. There was no evidence that Rh-APC treatment affected the PLI or attenuated lung injury and sequential organ failure assessment scores. Mean ventilator-free days amounted to 14 (rh-APC and 12 days (saline, P = 0.35. 28-day mortality was 6% in rh-APC- and 18% in saline-treated patients (P = 0.12. There was no difference in bleeding events. The study was prematurely discontinued because rh-APC was withdrawn from the market. CONCLUSION: There is no evidence that treatment with intravenous rh-APC during 4 days for infectious or inflammatory ARDS ameliorates increased alveolocapillary permeability or the clinical course of ARDS patients. We cannot exclude underpowering. TRIAL REGISTRATION: Nederlands Trial Register ISRCTN 52566874.

  4. External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.

    Science.gov (United States)

    Bos, Lieuwe D; Schouten, Laura R; Cremer, Olaf L; Ong, David S Y; Schultz, Marcus J

    2016-12-01

    A recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as 'APPS') was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands. Consecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals. The APPS was calculated per patient with the maximal airway pressure instead of the plateau pressure as all patients were ventilated in pressure-controlled mode. The predictive accuracy for hospital mortality was evaluated by calculating the area under the receiver operating characteristics curve (AUC-ROC). Additionally, the score was recalibrated and reassessed. In total, 439 patients with moderate or severe ARDS were analyzed. All-cause hospital mortality was 43 %. The APPS predicted all-cause hospital mortality with moderate accuracy, with an AUC-ROC of 0.62 [95 % confidence interval (CI) 0.56-0.67]. Calibration was moderate using the original cutoff values (Hosmer-Lemeshow goodness of fit P APPS was moderate, also after recalibration of the score, and thus the APPS does not seem to be fitted for that purpose. The APPS might serve as simple tool for stratification of mortality in patients with moderate or severe ARDS. Without recalibrations, the performance of the APPS was moderate and we should therefore hesitate to blindly apply the score to other cohorts of ARDS patients.

  5. Successful vaccination strategies that protect aged mice from lethal challenge from influenza virus and heterologous severe acute respiratory syndrome coronavirus.

    Science.gov (United States)

    Sheahan, Timothy; Whitmore, Alan; Long, Kristin; Ferris, Martin; Rockx, Barry; Funkhouser, William; Donaldson, Eric; Gralinski, Lisa; Collier, Martha; Heise, Mark; Davis, Nancy; Johnston, Robert; Baric, Ralph S

    2011-01-01

    Newly emerging viruses often circulate as a heterogeneous swarm in wild animal reservoirs prior to their emergence in humans, and their antigenic identities are often unknown until an outbreak situation. The newly emerging severe acute respiratory syndrome coronavirus (SARS-CoV) and reemerging influenza virus cause disproportionate disease in the aged, who are also notoriously difficult to successfully vaccinate, likely due to immunosenescence. To protect against future emerging strains, vaccine platforms should induce broad cross-reactive immunity that is sufficient to protect from homologous and heterologous challenge in all ages. From initial studies, we hypothesized that attenuated Venezuelan equine encephalitis virus (VEE) replicon particle (VRP) vaccine glycoproteins mediated vaccine failure in the aged. We then compared the efficacies of vaccines bearing attenuated (VRP(3014)) or wild-type VEE glycoproteins (VRP(3000)) in young and aged mice within novel models of severe SARS-CoV pathogenesis. Aged animals receiving VRP(3000)-based vaccines were protected from SARS-CoV disease, while animals receiving the VRP(3014)-based vaccines were not. The superior protection for the aged observed with VRP(3000)-based vaccines was confirmed in a lethal influenza virus challenge model. While the VRP(3000) vaccine's immune responses in the aged were sufficient to protect against lethal homologous and heterologous challenge, our data suggest that innate defects within the VRP(3014) platform mediate vaccine failure. Exploration into the mechanism(s) of successful vaccination in the immunosenescent should aid in the development of successful vaccine strategies for other viral diseases disproportionately affecting the elderly, like West Nile virus, influenza virus, norovirus, or other emerging viruses of the future.

  6. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study.

    Science.gov (United States)

    Brodsky, Martin B; Huang, Minxuan; Shanholtz, Carl; Mendez-Tellez, Pedro A; Palmer, Jeffrey B; Colantuoni, Elizabeth; Needham, Dale M

    2017-03-01

    Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation. This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death. Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day. One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.

  7. Global and regional assessment of sustained inflation pressure-volume curves in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Becher, T; Rostalski, P; Kott, M; Adler, A; Schädler, D; Weiler, N; Frerichs, I

    2017-06-01

    Static or quasi-static pressure-volume (P-V ) curves can be used to determine the lung mechanical properties of patients suffering from acute respiratory distress syndrome (ARDS). According to the traditional interpretation, lung recruitment occurs mainly below the lower point of maximum curvature (LPMC) of the inflation P-V curve. Although some studies have questioned this assumption, setting of positive end-expiratory pressure 2 cmH2O above the LPMC was part of a 'lung-protective' ventilation strategy successfully applied in several clinical trials. The aim of our study was to quantify the amount of unrecruited lung at different clinically relevant points of the P-V curve. P-V curves and electrical impedance tomography (EIT) data from 30 ARDS patients were analysed. We determined the regional opening pressures for every EIT image pixel and fitted the global P-V curves to five sigmoid model equations to determine the LPMC, inflection point (IP) and upper point of maximal curvature (UPMC). Points of maximal curvature and IP were compared between the models by one-way analysis of variance (ANOVA). The percentages of lung pixels remaining closed ('unrecruited lung') at LPMC, IP and UPMC were calculated from the number of lung pixels exhibiting regional opening pressures higher than LPMC, IP and UPMC and were also compared by one-way ANOVA. As results, we found a high variability of LPMC values among the models, a smaller variability of IP and UPMC values. We found a high percentage of unrecruited lung at LPMC, a small percentage of unrecruited lung at IP and no unrecruited lung at UPMC. Our results confirm the notion of ongoing lung recruitment at pressure levels above LPMC for all investigated model equations and highlight the importance of a regional assessment of lung recruitment in patients with ARDS.

  8. Innate Lymphoid Cells Are the Predominant Source of IL-17A during the Early Pathogenesis of Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    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

    2016-02-15

    IL-17A is purported to help drive early pathogenesis in acute respiratory distress syndrome (ARDS) by enhancing neutrophil recruitment. Although IL-17A is the archetypal cytokine of T-helper 17 cells, it is produced by a number of lymphocytes, the source during ARDS being unknown. To identify the cellular source and the role of IL-17A in the early phase of lung injury. Lung injury was induced in wild-type (C57BL/6) and IL-17 knockout (KO) mice with aerosolized LPS (100 μg) or Pseudomonas aeruginosa infection. Detailed phenotyping of the cells expressing RORγt, the transcriptional regulator of IL-17 production, in the mouse lung at 24 hours was performed by flow cytometry. A 100-fold reduction in neutrophil infiltration was observed in the lungs of the IL-17A KO compared with wild-type mice. The majority of RORγt(+) cells in the mouse lung were the recently identified group 3 innate lymphoid cells (ILC3s). Detailed characterization revealed these pulmonary ILC3s (pILC3s) to be discrete from those described in the gut. The critical role of these cells was verified by inducing injury in recombinase-activating gene 2 KO mice, which lack T cells but retain innate lymphoid cells. No amelioration of pathology was observed in the recombinase-activating gene 2 KO mice. IL-17 is rapidly produced during lung injury and significantly contributes to early immunopathogenesis. This is orchestrated largely by a distinct population of pILC3s. Modulation of the activity of pILC3s may potentiate early control of the inflammatory dysregulation seen in ARDS, opening up new therapeutic targets.

  9. Coinfection and Mortality in Pneumonia-Related Acute Respiratory Distress Syndrome Patients with Bronchoalveolar Lavage: A Prospective Observational Study.

    Science.gov (United States)

    Kao, Kuo-Chin; Chiu, Li-Chung; Hung, Chen-Yiu; Chang, Chih-Hao; Yang, Cheng-Ta; Huang, Chung-Chi; Hu, Han-Chung

    2017-05-01

    Pneumonia is the leading risk factor of acute respiratory distress syndrome (ARDS). It is increasing studies in patients with pneumonia to reveal that coinfection with viral and bacterial infection can lead to poorer outcomes than no coinfection. This study evaluated the role of coinfection identified through bronchoalveolar lavage (BAL) examination on the outcomes of pneumonia-related ARDS. We performed a prospective observational study at Chang Gung Memorial Hospital from October 2012 to May 2015. Adult patients were included if they met the Berlin definition of ARDS. The indications for BAL were clinically suspected pneumonia-related ARDS and no definite microbial sample identified from tracheal aspirate or sputum. The presence of microbial pathogens and clinical outcomes were analyzed. Of the 19,936 patients screened, 902 (4.5%) fulfilled the Berlin definition of ARDS. Of these patients, 255 (22.7%) had pneumonia-related ARDS and were included for analysis. A total of 142 (55.7%) patients were identified to have a microbial pathogen through BAL and were classified into three groups: a virus-only group (n = 41 [28.9%]), no virus group (n = 60 [42.2%]), and coinfection group (n = 41 [28.9%]). ARDS severity did not differ significantly between the groups (P = 0.43). The hospital mortality rates were 53.7% in virus-only identified group, 63.3% in no virus identified group, and 80.5% in coinfection identified group. The coinfection group had significantly higher mortality than virus-only group (80.5% vs. 53.7%; P = 0.01). In patients with pneumonia-related ARDS, the BAL pathogen-positive patients had a trend of higher mortality rate than pathogen-negative patients. Coinfection with a virus and another pathogen was associated with increased hospital mortality in pneumonia-related ARDS patients.

  10. PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment.

    Science.gov (United States)

    Dellamonica, J; Lerolle, N; Sargentini, C; Beduneau, G; Di Marco, F; Mercat, A; Richard, J C M; Diehl, J L; Mancebo, J; Rouby, J J; Lu, Q; Bernardin, G; Brochard, L

    2011-10-01

    Lung volumes, especially functional residual capacity (FRC), are decreased in acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) contributes to increased end-expiratory lung volume (EELV) and to improved oxygenation, but differentiating recruitment of previously nonaerated lung units from distension of previously open lung units remains difficult. This study evaluated simple methods derived from bedside EELV measurements to assess PEEP-induced lung recruitment while monitoring strain. Prospective multicenter study in 30 mechanically ventilated patients with ARDS in five university hospital ICUs. Two PEEP levels were studied, each for 45 min, and EELV (nitrogen washout/washin technique) was measured at both levels, with the difference (Δ) reflecting PEEP-induced lung volume changes. Alveolar recruitment was measured using pressure-volume (PV) curves. High and low recruiters were separated based on median recruitment at high PEEP. Minimum predicted increase in lung volume computed as the product of ΔPEEP by static compliance was subtracted from ΔEELV as an independent estimate of recruitment. Estimated and measured recruitments were compared. Strain induced by PEEP was also calculated from the same measurements. FRC was 31 ± 11% of predicted. Median [25th-75th percentiles] PEEP-induced recruitment was 272 [187-355] mL. Estimated recruitment correlated with recruited volume measured on PV curves (ρ = 0.68), with a slope close to identity. The ΔEELV/FRC ratio differentiated high from low recruiters (110 [76-135] vs. 55 [23-70]%, p = 0.001). Strain increase due to PEEP was larger in high recruiters (p = 0.002). PEEP-induced recruitment and strain can be assessed at the bedside using EELV measurement. We describe two bedside methods for predicting low or high alveolar recruitment during ARDS.

  11. Structural Analysis of Major Species Barriers between Humans and Palm Civets for Severe Acute Respiratory Syndrome Coronavirus Infections

    Energy Technology Data Exchange (ETDEWEB)

    Li, Fang (UMM)

    2008-09-23

    It is believed that a novel coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV), was passed from palm civets to humans and caused the epidemic of SARS in 2002 to 2003. The major species barriers between humans and civets for SARS-CoV infections are the specific interactions between a defined receptor-binding domain (RBD) on a viral spike protein and its host receptor, angiotensin-converting enzyme 2 (ACE2). In this study a chimeric ACE2 bearing the critical N-terminal helix from civet and the remaining peptidase domain from human was constructed, and it was shown that this construct has the same receptor activity as civet ACE2. In addition, crystal structures of the chimeric ACE2 complexed with RBDs from various human and civet SARS-CoV strains were determined. These structures, combined with a previously determined structure of human ACE2 complexed with the RBD from a human SARS-CoV strain, have revealed a structural basis for understanding the major species barriers between humans and civets for SARS-CoV infections. They show that the major species barriers are determined by interactions between four ACE2 residues (residues 31, 35, 38, and 353) and two RBD residues (residues 479 and 487), that early civet SARS-CoV isolates were prevented from infecting human cells due to imbalanced salt bridges at the hydrophobic virus/receptor interface, and that SARS-CoV has evolved to gain sustained infectivity for human cells by eliminating unfavorable free charges at the interface through stepwise mutations at positions 479 and 487. These results enhance our understanding of host adaptations and cross-species infections of SARS-CoV and other emerging animal viruses.

  12. Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study

    Directory of Open Access Journals (Sweden)

    Joohae Kim

    2017-05-01

    Full Text Available Background Acute respiratory distress syndrome (ARDS remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS blockage on the prognosis of patients with ARDS. Methods We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching. Results A total of 182 patients were included in the study. Thirty-seven patients (20.3% took ACE inhibitor or angiotensin receptor blocker (ARB during ICU admission, and 145 (79.7% did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166. The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013 and longer ICU stay (32.1 vs. 20.2 days, P < 0.001. In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001. Conclusions ACE inhibitor or ARB may have beneficial effect on ARDS patients.

  13. Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes.

    Science.gov (United States)

    Brown, Samuel M; Wilson, Emily L; Presson, Angela P; Dinglas, Victor D; Greene, Tom; Hopkins, Ramona O; Needham, Dale M

    2017-08-04

    With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding survivors' posthospitalisation outcomes is increasingly important. However, little is known regarding associations among physical, cognitive and mental health outcomes. Identification of outcome subtypes may advance understanding of post-ARDS morbidities. We analysed baseline variables and 6-month health status for participants in the ARDS Network Long-Term Outcomes Study. After division into derivation and validation datasets, we used weighted network analysis to identify subtypes from predictors and outcomes in the derivation dataset. We then used recursive partitioning to develop a subtype classification rule and assessed adequacy of the classification rule using a kappa statistic with the validation dataset. Among 645 ARDS survivors, 430 were in the derivation and 215 in the validation datasets. Physical and mental health status, but not cognitive status, were closely associated. Four distinct subtypes were apparent (percentages in the derivation cohort): (1) mildly impaired physical and mental health (22% of patients), (2) moderately impaired physical and mental health (39%), (3) severely impaired physical health with moderately impaired mental health (15%) and (4) severely impaired physical and mental health (24%). The classification rule had high agreement (kappa=0.89 in validation dataset). Female Latino smokers had the poorest status, while male, non-Latino non-smokers had the best status. We identified four post-ARDS outcome subtypes that were predicted by sex, ethnicity, pre-ARDS smoking status and other baseline factors. These subtypes may help develop tailored rehabilitation strategies, including investigation of combined physical and mental health interventions, and distinct interventions to improve cognitive outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

  14. THE EPIDEMIOLOGY OF ACUTE RESPIRATORY DISTRESS SYNDROME IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH SEVERE SEPSIS

    Science.gov (United States)

    Mikkelsen, Mark E.; Shah, Chirag V.; Meyer, Nuala J.; Gaieski, David F.; Lyon, Sarah; Miltiades, Andrea N.; Goyal, Munish; Fuchs, Barry D.; Bellamy, Scarlett L.; Christie, Jason D.

    2013-01-01

    Background Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis and sepsis-associated ARDS is associated with significant morbidity and mortality. To date, no study has directly examined the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the Emergency Department (ED). Methods Single-center retrospective, observational cohort study of 778 adults with severe sepsis presenting to the ED. The primary outcome was the development of ARDS requiring mechanical ventilation during the first 5 hospital days. ARDS was defined using the Berlin definition. We used multivariable logistic regression to identify risk factors associated independently with ARDS development. Results The incidence of ARDS was 6.2% (48 of 778 patients) in the entire cohort. ARDS development varied across the continuum of care: 0.9% of patients fulfilled criteria for ARDS in the ED, 1.4% admitted to the ward developed ARDS, and 8.9% admitted to the ICU developed ARDS. ARDS developed a median of 1 day after admission and was associated with a four-fold higher risk of in-hospital mortality (14% vs. 60%, p<0.001). Independent risk factors associated with increased risk of ARDS development included: intermediate (2–3.9 mmol/L) (p=0.04) and high (≥ 4) serum lactate levels (p=0.008), lung injury prediction score (LIPS) (p<0.001) and microbiologically-proven infection (p=0.01). Conclusions In patients presenting to the ED with severe sepsis, the rate of sepsis-associated ARDS development varied across the continuum of care. ARDS developed rapidly and was associated with significant mortality. Elevated serum lactate levels in the ED and a recently validated clinical prediction score were independently associated with the development of ARDS in severe sepsis. PMID:23903852

  15. The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review

    Directory of Open Access Journals (Sweden)

    M. García de Acilu

    2015-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process. Recent report on the prognostic value of eicosanoids in patients with ARDS suggests that modulating the inflammatory response through the use of polyunsaturated fatty acids may be a useful strategy for ARDS treatment. The use of enteral diets enriched with eicosapentaenoic acid (EPA and gamma-linolenic acid (GLA has reported promising results, showing an improvement in respiratory variables and haemodynamics. However, the interpretation of the studies is limited by their heterogeneity and methodology and the effect of ω-3 fatty acid-enriched lipid emulsion or enteral diets on patients with ARDS remains unclear. Therefore, the routine use of ω-3 fatty acid-enriched nutrition cannot be recommended and further large, homogeneous, and high-quality clinical trials need to be conducted to clarify the effectiveness of ω-3 polyunsaturated fatty acids.

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

    Directory of Open Access Journals (Sweden)

    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

  17. Severe acute respiratory syndrome (SARS) and the GDP. Part II: implications for GDPs.

    Science.gov (United States)

    Li, R W K; Leung, K W C; Sun, F C S; Samaranayake, L P

    2004-08-14

    The transmission modes of SARS-coronavirus appear to be through droplet spread, close contact and fomites although air borne transmission has not been ruled out. This clearly places dental personnel at risks as they work in close proximity to their patients employing droplet and aerosol generating procedures. Although the principle of universal precautions is widely advocated and followed throughout the dental community, additional precautionary measures - termed standard precaution may be necessary to help control the spread of this highly contagious disease. Patient assessment should include questions on recent travel to SARS infected areas and, contacts of patients, fever and symptoms of respiratory infections. Special management protocols and modified measures that regulate droplet and aerosol contamination in a dental setting have to be introduced and may include the reduction or avoidance of droplet/aerosol generation, the disinfection of the treatment field, application of rubber dam, pre-procedural antiseptic mouthrinse and the dilution and efficient removal of contaminated ambient air. The gag, cough or vomiting reflexes that lead to the generation of aerosols should also be prevented.

  18. Recent advances in mechanical ventilation in patients without acute respiratory distress syndrome

    Science.gov (United States)

    Filho, Roberto R.; Rocha, Leonardo L.; Schultz, Marcus J.

    2014-01-01

    While being an essential part of general anesthesia for surgery and at times even a life-saving intervention in critically ill patients, mechanical ventilation has a strong potential to cause harm. Certain ventilation strategies could prevent, at least to some extent, the injury caused by this intervention. One essential element of so-called ‘lung-protective’ ventilation is the use of lower tidal volumes. It is uncertain whether higher levels of positive end-expiratory pressures have lung-protective properties as well. There are indications that too high oxygen fractions of inspired air, or too high blood oxygen targets, are harmful. Circumstantial evidence further suggests that spontaneous modes of ventilation are to be preferred over controlled ventilation to prevent harm to respiratory muscle. Finally, the use of restrictive sedation strategies in critically ill patients indirectly prevents ventilation-induced injury, as daily spontaneous awakening and breathing trials and bolus instead of continuous sedation are associated with shorter duration of ventilation and shorten the exposure to the injurious effects of ventilation. PMID:25580269

  19. Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition.

    Science.gov (United States)

    Riviello, Elisabeth D; Kiviri, Willy; Twagirumugabe, Theogene; Mueller, Ariel; Banner-Goodspeed, Valerie M; Officer, Laurent; Novack, Victor; Mutumwinka, Marguerite; Talmor, Daniel S; Fowler, Robert A

    2016-01-01

    Estimates of the incidence of the acute respiratory distress syndrome (ARDS) in high- and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country at the level of the population, hospital, or intensive care unit (ICU). The Berlin definition may not allow identification of ARDS in resource-constrained settings. To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive end-expiratory pressure, hypoxia cutoff of SpO2/FiO2 less than or equal to 315, and bilateral opacities on lung ultrasound or chest radiograph. We screened every adult patient for hypoxia at a public referral hospital in Rwanda for 6 weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors, performed lung ultrasonography, and evaluated chest radiography when available. Forty-two (4.0%) of 1,046 hospital admissions met criteria for ARDS. Using various prespecified cutoffs for the SpO2/FiO2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 37 years, and infection was the most common risk factor (44.1%). Only 30.9% of patients with ARDS were admitted to an ICU, and hospital mortality was 50.0%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. ARDS seems to be a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition is likely to underestimate the impact of ARDS in low-income countries, where resources to meet the definition requirements are lacking. Although the Kigali modification requires validation before widespread use, we hope this study stimulates further work in refining an ARDS definition that can be consistently used in all settings.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Early severe acute respiratory distress syndrome: What's going on? Part II: controlled vs. spontaneous ventilation?

    Science.gov (United States)

    Petitjeans, Fabrice; Pichot, Cyrille; Ghignone, Marco; Quintin, Luc

    2016-01-01

    The second part of this overview on early severe ARDS delineates the pros and cons of the following: a) controlled mechanical ventilation (CMV: lowered oxygen consumption and perfect patient-to-ventilator synchrony), to be used during acute cardio-ventilatory distress in order to "buy time" and correct circulatory insufficiency and metabolic defects (acidosis, etc.); b) spontaneous ventilation (SV: improved venous return, lowered intrathoracic pressure, absence of muscle atrophy). Given a stabilized early severe ARDS, as soon as the overall clinical situation improves, spontaneous ventilation will be used with the following stringent conditionalities: upfront circulatory optimization, upright positioning, lowered VO2, lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone, as well as high PEEP (titrated on transpulmonary pressure, or as a second best: "trial"-PEEP) with spontaneous ventilation + pressure support (or newer modes of ventilation). As these propositions require evidence-based demonstration, the reader is reminded that the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation and prone position.

  2. Genomic Characterization of a Newly Discovered Coronavirus Associated with Acute Respiratory Distress Syndrome in Humans

    Science.gov (United States)

    van Boheemen, Sander; de Graaf, Miranda; Lauber, Chris; Bestebroer, Theo M.; Raj, V. Stalin; Zaki, Ali Moh; Osterhaus, Albert D. M. E.; Haagmans, Bart L.; Gorbalenya, Alexander E.; Snijder, Eric J.; Fouchier, Ron A. M.

    2012-01-01

    ABSTRACT A novel human coronavirus (HCoV-EMC/2012) was isolated from a man with acute pneumonia and renal failure in June 2012. This report describes the complete genome sequence, genome organization, and expression strategy of HCoV-EMC/2012 and its relation with known coronaviruses. The genome contains 30,119 nucleotides and contains at least 10 predicted open reading frames, 9 of which are predicted to be expressed from a nested set of seven subgenomic mRNAs. Phylogenetic analysis of the replicase gene of coronaviruses with completely sequenced genomes showed that HCoV-EMC/2012 is most closely related to Tylonycteris bat coronavirus HKU4 (BtCoV-HKU4) and Pipistrellus bat coronavirus HKU5 (BtCoV-HKU5), which prototype two species in lineage C of the genus Betacoronavirus. In accordance with the guidelines of the International Committee on Taxonomy of Viruses, and in view of the 75% and 77% amino acid sequence identity in 7 conserved replicase domains with BtCoV-HKU4 and BtCoV-HKU5, respectively, we propose that HCoV-EMC/2012 prototypes a novel species in the genus Betacoronavirus. HCoV-EMC/2012 may be most closely related to a coronavirus detected in Pipistrellus pipistrellus in The Netherlands, but because only a short sequence from the most conserved part of the RNA-dependent RNA polymerase-encoding region of the genome was reported for this bat virus, its genetic distance from HCoV-EMC remains uncertain. HCoV-EMC/2012 is the sixth coronavirus known to infect humans and the first human virus within betacoronavirus lineage C. PMID:23170002

  3. Meta-analysis of high doses of ambroxol treatment for acute lung injury/acute respiratory distress syndrome based on randomized controlled trials.

    Science.gov (United States)

    Wu, Xiangdong; Li, Suwei; Zhang, Jiuzhi; Zhang, Yongli; Han, Lili; Deng, Qiuming; Wan, Xianyao

    2014-11-01

    This study seeks to evaluate the potential benefits of high doses of ambroxol treatment for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) by conducting a meta-analysis based on randomized controlled trials (RCTs). We searched the Pubmed, Embase, China National Knowledge Infrastructure, and Wanfang databases through December 2013. Only RCTs evaluating high doses of ambroxol (≥15 mg/kg or 1000 mg/day) treatment for patients with ALI/ARDS were selected. We included 10 RCTs involving 508 patients. Adjuvant treatment with high doses of ambroxol increased PaO(2)/FiO(2) (weight mean differences [WMD] = 69.18, 95% confidence intervals [CI]: 41.71-96.65), PO(2) (WMD = 11.74, 95% CI: 8.50-14.99), and SaO(2) (WMD = 2.15, 95% CI: 1.60-2.71) compared with usual treatment. Treatment with high doses of ambroxol appeared to reduce serum tumor necrosis factor-α level (WMD -7.92 µg/L; 95% CI, -10.94 to -4.9) and interleukin-6 level (WMD = -20.65 µg/L, 95% CI: -24.74 to -16.55) and to increase serum superoxide dismutase level (WMD = 19.07 NU/mL, 95% CI: 6.16-31.97). The findings suggest that treatment with high doses of ambroxol appears to improve PaO(2)/FiO(2), PO(2), and SaO(2), and the benefits might be related to ambroxol's anti-oxidant and anti-inflammatory properties. © 2014, The American College of Clinical Pharmacology.

  4. Effect of oxidative stress on respiratory epithelium from children with Down syndrome

    NARCIS (Netherlands)

    Bruijn, Martijn; Lutter, René; Eldering, Eric; Bos, Albert P.; van Woensel, Job B. M.

    2013-01-01

    Children with Down syndrome are at high risk for acute respiratory distress syndrome. In Down syndrome, both regulation of inflammation and apoptosis, important in acute respiratory distress syndrome pathophysiology, are abnormal. This has been linked to an imbalance in free radical scavengers. We

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

    Directory of Open Access Journals (Sweden)

    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. Are the World Health Organisation case definitions for severe acute respiratory distress syndrome sufficient at initial assessment?

    Science.gov (United States)

    Goh, H K; Tham, K Y; Seow, E

    2005-08-01

    On March 13, 2003, Singapore doctors were alerted about an outbreak of atypical pneumonia that became known as severe acute respiratory syndrome (SARS). We now describe a series of patients that did not fit World Health Organisation (WHO) case definitions for SARS at initial assessment. The Ministry of Health, Singapore centralised SARS cases in the study hospital and its emergency department (ED) became the national screening centre. A screening questionnaire and a set of admission criteria based on WHO case definitions were applied. Patients discharged from ED were tracked via telephone surveillance and recalled if necessary. A retrospective review was done of patients who did not fit WHO definitions initially, were discharged and had re-attended. During the outbreak, 11,461 people were screened for SARS. Among 10,075 (87.9 percent) discharged from the ED, there were 28 re-attendees diagnosed to have SARS later, giving an undertriage rate of 0.3 percent. Among the 28, six (21.4 percent) did not complain of fever and 22 (78.6 percent) had temperatures less than 38.0 degrees Celsius during their first ED visit. One patient was screened to have all three criteria but during consultation, the contact history was found to be unrelated to the known "hot spots". The initial mean temperature was 37.6 degrees Celsius (standard deviation [SD] 0.8), which increased significantly (p-value equals 0.04) to 38.0 degrees Celsius (SD 0.8) during their subsequent visit. Chest radiographs with infective changes increased significantly (p-value equals 0.009) from 16 percent to 52.4 percent over the two ED visits. The WHO case definitions were helpful in evaluating majority of SARS patients initially. However under-triage at ED is inevitable, with a 0.3 percent under-triage in our study population. In this group and asymptomatic individuals who came for screening, a tracking and recall system helped to ensure their timely return to the ED.

  7. The Conserved Coronavirus Macrodomain Promotes Virulence and Suppresses the Innate Immune Response during Severe Acute Respiratory Syndrome Coronavirus Infection.

    Science.gov (United States)

    Fehr, Anthony R; Channappanavar, Rudragouda; Jankevicius, Gytis; Fett, Craig; Zhao, Jincun; Athmer, Jeremiah; Meyerholz, David K; Ahel, Ivan; Perlman, Stanley

    2016-12-13

    ADP-ribosylation is a common posttranslational modification that may have antiviral properties and impact innate immunity. To regulate this activity, macrodomain proteins enzymatically remove covalently attached ADP-ribose from protein targets. All members of the Coronavirinae, a subfamily of positive-sense RNA viruses, contain a highly conserved macrodomain within nonstructural protein 3 (nsp3). However, its function or targets during infection remain unknown. We identified several macrodomain mutations that greatly reduced nsp3's de-ADP-ribosylation activity in vitro Next, we created recombinant severe acute respiratory syndrome coronavirus (SARS-CoV) strains with these mutations. These mutations led to virus attenuation and a modest reduction of viral loads in infected mice, despite normal replication in cell culture. Further, macrodomain mutant virus elicited an early, enhanced interferon (IFN), interferon-stimulated gene (ISG), and proinflammatory cytokine response in mice and in a human bronchial epithelial cell line. Using a coinfection assay, we found that inclusion of mutant virus in the inoculum protected mice from an otherwise lethal SARS-CoV infection without reducing virus loads, indicating that the changes in innate immune response were physiologically significant. In conclusion, we have established a novel function for the SARS-CoV macrodomain that implicates ADP-ribose in the regulation of the innate immune response and helps to demonstrate why this domain is conserved in CoVs. The macrodomain is a ubiquitous structural domain that removes ADP-ribose from proteins, reversing the activity of ADP-ribosyltransferases. All coronaviruses contain a macrodomain, suggesting that ADP-ribosylation impacts coronavirus infection. However, its function during infection remains unknown. Here, we found that the macrodomain is an important virulence factor for a highly pathogenic human CoV, SARS-CoV. Viruses with macrodomain mutations that abrogate its ability to

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

    Directory of Open Access Journals (Sweden)

    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

  9. Extracorporeal membrane oxygenation in an HIV-positive man with severe acute respiratory distress syndrome secondary to pneumocystis and cytomegalovirus pneumonia.

    Science.gov (United States)

    Morley, Deirdre; Lynam, Almida; Carton, Edmund; Martin-Loeches, Ignacio; Sheehan, Gerard; Lynn, Niamh; O'Brien, Serena; Mulcahy, Fiona

    2018-02-01

    The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO. He was successfully decannulated following 21 days of ECMO and survived to hospital discharge. Despite poor evidence surrounding the use of ECMO in immunocompromised patients, it is evident that ECMO could represent an important rescue therapy in HIV-positive patients with refractory ARDS.

  10. A BDNF loop-domain mimetic acutely reverses spontaneous apneas and respiratory abnormalities during behavioral arousal in a mouse model of Rett syndrome

    Directory of Open Access Journals (Sweden)

    Miriam Kron

    2014-09-01

    Full Text Available Reduced levels of brain-derived neurotrophic factor (BDNF are thought to contribute to the pathophysiology of Rett syndrome (RTT, a severe neurodevelopmental disorder caused by loss-of-function mutations in the gene encoding methyl-CpG-binding protein 2 (MeCP2. In Mecp2 mutant mice, BDNF deficits have been associated with breathing abnormalities, a core feature of RTT, as well as with synaptic hyperexcitability within the brainstem respiratory network. Application of BDNF can reverse hyperexcitability in acute brainstem slices from Mecp2-null mice, suggesting that therapies targeting BDNF or its receptor, TrkB, could be effective at acute reversal of respiratory abnormalities in RTT. Therefore, we examined the ability of LM22A-4, a small-molecule BDNF loop-domain mimetic and TrkB partial agonist, to modulate synaptic excitability within respiratory cell groups in the brainstem nucleus tractus solitarius (nTS and to acutely reverse abnormalities in breathing at rest and during behavioral arousal in Mecp2 mutants. Patch-clamp recordings in Mecp2-null brainstem slices demonstrated that LM22A-4 decreases excitability at primary afferent synapses in the nTS by reducing the amplitude of evoked excitatory postsynaptic currents and the frequency of spontaneous and miniature excitatory postsynaptic currents. In vivo, acute treatment of Mecp2-null and -heterozygous mutants with LM22A-4 completely eliminated spontaneous apneas in resting animals, without sedation. Moreover, we demonstrate that respiratory dysregulation during behavioral arousal, a feature of human RTT, is also reversed in Mecp2 mutants by acute treatment with LM22A-4. Together, these data support the hypothesis that reduced BDNF signaling and respiratory dysfunction in RTT are linked, and establish the proof-of-concept that treatment with a small-molecule structural mimetic of a BDNF loop domain and a TrkB partial agonist can acutely reverse abnormal breathing at rest and in response to

  11. Acute Respiratory Insufficiency After Adenotonsillectomy

    Directory of Open Access Journals (Sweden)

    Öznur Şen

    2013-12-01

    Full Text Available Adenotonsillectomy is one of the frequently performed surgical procedures in children and the most common complications of this procedure are bleeding and respiratory insufficiency. Here, we present a 20-month-old boy who was born prematurely. He underwent adenotonsillectomy and bilateral grommet insertion due to recurrent tonsilitis, snoring, and obstructive sleep apnea syndrome. The patient required a prolonged intensive care unit stay due to postoperative respiratory insufficiency. In this paper, we aimed to evaluate the potential complications of adenotonsillectomy. (The Medical Bulletin of Haseki 2013;51:193-6

  12. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Science.gov (United States)

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-07-22

    It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence. Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance. For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary

  13. [Treatment of patients with different degree of acute respiratory distress syndrome caused by inhalation of white smoke].

    Science.gov (United States)

    Yang, F W; Xin, H M; Zhu, J H; Feng, X Y; Jiang, X C; Gong, Z Y; Tong, Y L

    2017-12-20

    Objective: To summarize the treatment experience of patients with different degree of acute respiratory distress syndrome (ARDS) caused by inhalation of white smoke from burning smoke bomb. Methods: A batch of 13 patients with different degree of ARDS caused by inhalation of white smoke from burning smoke bomb, including 2 patients complicated by pulmonary fibrosis at the late stage, were admitted to our unit in February 2016. Patients were divided into mild (9 cases), moderate (2 cases), and serious (2 cases) degree according to the ARDS Berlin diagnostic criteria. Patients with mild and moderate ARDS were conventionally treated with glucocorticoid. Patients with severe ARDS were sequentially treated with glucocorticoid and pirfenidone, and ventilator-assisted breathing, etc. were applied. The vital signs, arterial oxygenation index, changes of lung imaging, pulmonary ventilation function, general condition, and the other important organs/systems function were timely monitored according to the condition of patients. The above indexes were also monitored during the follow-up time of 10-15 months post injury. Data were processed with SPSS 18.0 statistical software. Results: (1) The symptoms of respiratory system of patients with mild and moderate ARDS almost disappeared after 3 days' treatment. Their arterial oxygenation index was decreased from post injury day 1 to 4, which almost recovered on post injury day 7 and completely recovered one month post injury. The symptoms of respiratory system of patients with severe ARDS almost disappeared at tranquillization condition 1-3 month (s) post injury. Their arterial oxygenation index was decreased from post injury day 3 to 21, which gradually recovered 1-3 month (s) post injury and was normal 15 months post injury. (2) Within 24 hours post injury, there was no obvious abnormality or only a little texture enlargement of lung in image of chest CT or X-rays of patients with mild and moderate ARDS. One patient with moderate

  14. Suscetibilidade genética na lesão pulmonar aguda e síndrome da angústia respiratória aguda Genetic susceptibility in acute lung injury and acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Fernando Suparregui Dias

    2009-12-01

    Full Text Available A lesão pulmonar aguda e sua forma mais grave, a síndrome da angústia respiratória aguda, são o denominador comum de várias doenças que podem provocar uma inflamação exagerada nos pulmões. Nos últimos anos, essa variabilidade tem sido atribuída, pelo menos em parte, a fatores genéticos. O presente estudo tem por objetivos revisar o papel dos principais genes envolvidos na suscetibilidade, morbidade e mortalidade na lesão pulmonar aguda e na síndrome da angústia respiratória aguda. Através de pesquisa nas bases de dados PubMed e LiLACS, empregando-se os unitermos lesão pulmonar aguda, síndrome da angústia respiratória aguda e síndrome da angústia respiratória do adulto em combinação com polimorfismos genéticos, foram selecionados 69 artigos, dos quais 38 foram incluídos nesta revisão. Foram também considerados artigos relevantes extraídos das referências bibliográficas nos artigos selecionados das bases de dados. Os polimorfismos genéticos são variantes gênicas presentes em pelo menos 1% da população. A presença destas variantes genéticas pode influenciar a expressão de mediadores da resposta inflamatória, afetando diretamente a suscetibilidade à lesão pulmonar aguda, a intensidade da inflamação no parênquima pulmonar, a evolução e o desfecho destes pacientes. Estudos de associação com grandes populações e passíveis de reprodução permitirão de modo definitivo a inclusão da genômica no arsenal diagnóstico, prognóstico e terapêutico de pacientes com lesão pulmonar aguda/síndrome da angústia respiratória agudaAcute lung injury and its most severe presentation, acute respiratory distress syndrome, are a common denominator for several diseases which can lead to exaggerated lung inflammation. In the last years this variability has been ascribed, at least partially, to genetic issues. This study aims to review the role of the main genes involved in acute lung injury and acute respiratory

  15. Gas exchange and lung mechanics in patients with acute respiratory distress syndrome: comparison of three different strategies of positive end expiratory pressure selection.

    Science.gov (United States)

    Valentini, Ricardo; Aquino-Esperanza, José; Bonelli, Ignacio; Maskin, Patricio; Setten, Mariano; Danze, Florencia; Attie, Shiry; Rodriguez, Pablo O

    2015-04-01

    The purpose of the study was to compare gas exchange and lung mechanics between different strategies to select positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS). In 20 consecutive ARDS patients, 3 PEEP selection strategies were evaluated. One strategy was based on oxygenation using the ARDS network PEEP/fraction of inspired oxygen (Fio2) table; and two were based on lung mechanics, either PEEP titrated to reach a plateau pressure of 28 to 30 cm H2O as in the ExPress trial or best respiratory compliance method during a derecruitment maneuver. Gas exchange, airway pressures, stress index (SI), and end-expiratory transpulmonary pressure (P(tpe)) and end-inspiratory transpulmonary pressure (P(tpi)) values were assessed. Data are expressed as median (interquartile range [IQR]). Lower total PEEP levels were observed with the use of the PEEP/Fio2 table (8.7 [6-10] cm H2O); intermediate PEEP levels, with the Best Compliance approach (13.0 [10.2-13.8] cm H2O); and higher PEEP levels, with the ExPress strategy (16.5 [15.0-18.5] cm H2O) (P respiratory compliance approach resulted in better oxygenation levels without risk of overdistension according to SI and P(tpi), achieving a mild risk of lung collapse according to P(tpe). Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study

    NARCIS (Netherlands)

    Neto, Ary Serpa; Barbas, Carmen S. V.; Simonis, Fabienne D.; Artigas-Raventós, Antonio; Canet, Jaume; Determann, Rogier M.; Anstey, James; Hedenstierna, Goran; Hemmes, Sabrine N. T.; Hermans, Greet; Hiesmayr, Michael; Hollmann, Markus W.; Jaber, Samir; Martin-Loeches, Ignacio; Mills, Gary H.; Pearse, Rupert M.; Putensen, Christian; Schmid, Werner; Severgnini, Paolo; Smith, Roger; Treschan, Tanja A.; Tschernko, Edda M.; Melo, Marcos F. V.; Wrigge, Hermann; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J.; Bell, Adam; Gecaj-Gashi, Agreta; Dilek, Ahmet; Denker, Ahmet Sukru; Aytulun, Akut; Kienbaum, Peter; Rose, Alastair; Bacuzzi, Alessandro; Cavalcanti, Alexandre Biasi; Chan, Alexandre; Molin, Alexandre; Ghosh, Alison; Roy, Alistair; Cowton, Amanda; Skinner, Amanda; Whileman, Amanda; McInerney, Amy; Peçanha, Ana Carolina; Cortegiani, Andrea; Sribar, Andrej; Bentley, Andrew; Corner, Andrew; Pinder, Angela; Hormis, Anil; Walker, Anna; Dixon, Barry; Creagh-Brown, Ben; Volta, Carlo Alberto; Munhoz, Carlos; Brown, Carly; Scott, Carmen; Wreybrown, Caroline; Plowright, Catherine; Downes, Charlotte; Padilla-Harris, Cheryl; Hughes, Chloe; Frey, Christian; Schlegel, Christian; Boyd, Christine; Ryan, Christine; Muench, Christoph; Smalley, Christopher; Zincircioglu, Çiler; Harris, Clair; Kaloo, Claire; Matthews, Claire; Miller, Claire; Pegg, Claire; Bullock, Clare; Mellis, Clare; Piras, Claudio; Seasman, Colette; Santos, Cristina; Beraldo, Daniel; Collins, Daniel; Hadfield, Daniel; Hull, Daniel; Prado, Daniel; Pogson, David; Rogerson, David; Shaw, David; D'Antini, Davide; Griffin, Dawn Trodd Denise; Weller, Debbie; Smith, Deborah; Wilson, Deborah; Aydin, Demet; Donaldson, Denise; Mestria, Donatella; Lauro, Eduardo Di; Caser, Eliane Bernadete; Seghelini, Elisa; Cirstea, Emanuel; Young, Eoin; Alberts, Erna; Senturk, Evren; Brohi, Farooq; Ulger, Fatma; Kahveci, Feda; da Silva Ramos, Fernando José; van Haren, Frank; Turan, Güldem; Sales, Gabriele; Clifford, Gayle; Cinnella, Gilda; Mecatti, Giovana Colozza; Melchionda, Giuseppe; Eren, Gulay; Crowther, Hannah; Spencer, Hazel; Blaylock, Heather; Green, Helen; Robertson, Helen; Rodgers, Helen; Talbot, Helen; Wong, Helen; Barcraft-Barnes, Helena; Ceunen, Helga; Reschreiter, Henrik; Ulusoy, Hulya; Toman, Huseyin; McCullagh, Iain; White, Ian; Welters, Ingeborg; van den Hul, Ingrid; Gava, Isabela Ambrósio; Reed, Isabelle; Kose, Isil; Maia, Israel; Limb, James; Máca, Jan; Adderly, Jane; Hunt, Jane; Martin, Jane; Montgomery, Jane; Snell, Jane; Salgado, Jean; Ritzema, Jenny; Bewley, Jeremy; Howe, Joanne; Decruyenaere, Johan; Mouland, Johanna; Stickley, Johanna; Mellinghoff, Johannes; Criswell, John; Knighton, John; Cooper, Jonathan; Harrison, Jonathan; Paddle, Jonathan; Pellegrini, Jose Augusto Santos; Needleman, Joseph; Giles, Julian; Camsooksai, Julie; Furneval, Julie; Toms, Julie; Burt, Karen; Simeson, Karen; Williams, Karen; Blenk, Karl; Turner, Kate; Lynch, Katie; Sweet, Katie; Hugill, Keith; Matthews, Kelly; Ruas, Kessia; Clarkson, Kevin; Preller, Kobus; Joyce, Kristen; Ortiz-Ruiz, Laura; Youds, Laura; Tbaily, Lee; Barrell, Lisa; Grimmer, Lisa; Soyoral, Lokman; Peluso, Lorenzo; Murray, Lorna; Niska, Lotta; Tonks, Louise; Fasting, Lousie; DeCrop, Luc; Brazzi, Luca; Mirabella, Lucia; Cooper, Lucy; Falcão, Luis Fernando; Everett, Lynn; Watters, Malcolm; Carnahan, Mandy; Bourgeois, Marc; Abreu, Marcelo Gama de; Romano, Marcelo Luz Pereira; Botteri, Marco; Melo, Marcos F. Vidal; Faulkner, Maria; Krkusek, Marijana; Bahl, Marina; Holliday, Mark; Kol, Mark; Pulletz, Mark; Kozlowski, Marta; Dvorscak, Matea Bogdanovic; Jurjevic, Matija; Koopmans, Matty; Morales, Mauricio; Schaefer, Maximilian; Brazier, Melinda; Harris, Meredith; Devile, Michael; Kuiper, Michael; Parris, Michael; Sharman, Michael; Kratochvil, Milan; Ramali, Mohamed; Dos Santos, Moreno Calcagnotto; Bynorth, Natalie; Wilson, Natalie; Anquez, Nathalie; Huneke, Nathan; Dogan, Nazim; Karanovic, Nenad; Tarmey, Nicholas; Carreño, Nicolás; Fisher, Nicola; Lamb, Nicola; Venner, Nicola; Hollister, Nigel; Akgun, Nur; Ekinci, Osman; Boyd, Owen; Gill, Pardeep; Raimondo, Pasquale; Verrastro, Pasquale; Pulak, Paul; Fitzell, Pauline; Dark, Paulo; Alzugaray, Pedro; Özcan, Perihan Ergin; MacNaughton, Peter; Stourac, Petr; Hopkins, Phil; Tuinman, Pieter Roel; Pearson, Rachel; Walker, Rachel; Santos, Rafaella Souza Dos; Caione, Raffaele; Matsa, Ramprasad; Oliver, Rebecca; Jacob, Reni; Howard-Griffin, Richard; Wilde, Robert Bp de; Plant, Robert; Hollands, Robin; Biondi, Rodrigo; Jaafar, Rola; Avendaño, Rossana; Salt, Ruth; Humphries, Ryan; Pinto, Sérgio Felix; Pearson, Sallyane; Hendry, Sam; Lakhani, Sandeep; Beavis, Sarah; Moreton, Sarah; Prudden, Sarah; Thornthwaite, Sarah; Spadaro, Savino; Saylan, Sedat; Chenna, Shailaja; Gopal, Shammer; James, Shanaz; Suresh, Sheeba; Birch, Sian; Skilijic, Sonja; Aguirre, Stefania; Metherell, Stella; Bell, Stephanie; Janes, Stephanie; Wright, Stephen; Rose, Steve; Windebank, Steve; Glenn, Sue; Melbourne, Susan; Tyson, Susan; Leaver, Susannah; Patel, Tasmin; Simurina, Tatjana; Sewell, Terri-Ann; Macruz, Tiago; Hatton, Tom; Evans, Tracey; Goktas, Ugur; Poultney, Una; Buyukkocak, Unase; Linnett, Vanessa; Oliveira, Vanessa; Russotto, Vincenzo; Klaric, Vlasta; Orak, Yavuz; Demirtürk, Zerrin

    2016-01-01

    Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients

  17. Use of Nebulized Heparin, Nebulized N-Acetylcysteine, and Nebulized Epoprostenol in a Patient With Smoke Inhalational Injury and Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Dube, Kevin M; Ditch, Kristen L; Hills, Luanne

    2017-12-01

    Smoke inhalation injury (SIJ) is associated with an increase in morbidity and mortality in patients with burns. SIJ causes airway damage, inflammation, and bronchial obstruction, resulting in decreased oxygenation and perfusion status in these patients. Retrospective studies have compared the use of nebulized heparin (NH) plus nebulized N-acetylcysteine (NAC) and albuterol in patients with SIJ to those who received standard ventilator support with bronchodilator therapy. These studies are associated with a decrease in mortality when NH and nebulized NAC are administered to patients with SIJ. Approximately 20% of patients who develop SIJ will also develop acute respiratory distress syndrome (ARDS). Epoprostenol, a selective pulmonary vasodilator, has been utilized in the treatment of ARDS with mixed results for improving gas exchange. To our knowledge, this is the first case report of the concomitant administration of NH, nebulized NAC, and nebulized epoprostenol following SIJ in a burn patient with ARDS.

  18. Role of angiotensin-converting enzyme (ACE) and ACE2 in a rat model of smoke inhalation induced acute respiratory distress syndrome.

    Science.gov (United States)

    Yilin, Zhao; Yandong, Nan; Faguang, Jin

    2015-11-01

    Smoke inhalation induced acute respiratory distress syndrome (ARDS) has become more and more common throughout the world and it is hard to improve the outcome. The present research was to investigate possible roles of angiotensin-converting enzyme (ACE) and ACE2 in lung injury resulted from smoke exposure. Rats were exposed to dense smoke to induce ARDS. Histological changes, blood gases, bronchoalveolar lavage fluids (BALF) and wet-to-dry weight were analyzed to evaluate lung injury after smoke inhalation; beside, we also measured the expression of ACE and ACE2 at different time points to explore the possible mechanism of those changes. The results showed that pH of arterial blood, partial blood oxygen (PaO₂) and blood oxygen saturation (SO₂) decreased after smoke inhalation at different time points (Psmoke exposure (Psmoke inhalation induced lung injury were possibly attributed to abnormal expression of ACE and ACE2 related pathway. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  19. Using the Expression of miRNAs as Biomarkers for the Evaluation Acute Respiratory Distress Syndrome in the Critically Ill Polytrauma Patient.

    Science.gov (United States)

    Papurica, Marius; Rogobete, Alexandru F; Cradigati, Carmen A; Sarandan, Mirela; Dumache, Raluca; Bratu, Lavinia M; Popovici, Sonia E; Sandesc, Dorel; Vernic, Corina; Bedreag, Ovidiu H

    2016-08-01

    A high percentage of critically ill polytrauma patients develop acute respiratory distress syndrome (ARDS), both because of the primary traumatic injuries and because of the secondary post-traumatic injuries. For adequate management of these patients, new complex evaluation and monitoring methods are needed, methods that could answer as many questions as possible regarding the pathophysiological changes associated with ARDS. Currently, a series of clinical and biochemical markers are being used which unfortunately do not respond to the needs of an intensive care clinician. Therefore, the changes of miRNAs have been intensely researched in the case of patients with ARDS. Moreover, using them as biomarkers for ARDS brings a series of answers regarding the pathophysiological changes associated to ARDS, making them biomarkers of the future in laboratory medicine. In order for this research study to be carried out the literature found on Scopus and PubMed on the topic was consulted, up to the year 2015. The key words used for the articles were "acute respiratory distress syndrome ARDS", "biomarkers for ARDS", "critically ill polytrauma patients", "miRNAs expression in ARDS", "miRNAs expression in sepsis", "miRNAs in critically ill patients" and "miRNAs biomarker". Research articles in English, German, and French were included in the search. Following the search using the above mentioned key words, 567 articles were found. After a rigorous analysis of these articles 55 of them were selected for our study. Using miRNAs for the evaluation and monitoring of ARDS makes them a biomarker of the future, because of the complex answers they bring to questions related both to the main injury caused by ARDS and to the associated pathophysiology.

  20. Boussignac CPAP system for brain death confirmation with apneic test in case of acute lung injury/adult respiratory distress syndrome – series of cases

    Directory of Open Access Journals (Sweden)

    Wieczorek A

    2015-06-01

    Full Text Available Andrzej Wieczorek,1 Tomasz Gaszynski2 1Department of Anesthesia and Intensive Care, Medical University of Lodz, Lodz, Poland; 2Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland Introduction: There are some patients with severe respiratory disturbances like adult respiratory distress syndrome (ARDS and suspicion of brain death, for whom typical performance of the apneic test is difficult to complete because of quick desaturation and rapid deterioration without effective ventilation. To avoid failure of brain death confirmation and possible loss of organ donation another approach to apneic test is needed. We present two cases of patients with clinical symptoms of brain death, with lung pathology (acute lung injury, ARDS, lung embolism and lung infection, in whom apneic tests for recognizing brain death were difficult to perform. During typical performance of apneic test involving the use of oxygen catheter for apneic oxygenation we observed severe desaturation with growing hypotension and hemodynamic destabilization. But with the use of Boussignac CPAP system all necessary tests were successfully completed, confirming the patient’s brain death, which gave us the opportunity to perform procedures for organ donation. The main reason of apneic test difficulties was severe gas exchange disturbances secondary to ARDS. Thus lack of positive end expiratory pressure during classical performance of apneic test leads to quick desaturation and rapid hemodynamic deterioration, limiting the observation period below dedicated at least 10-minute interval.  Conclusion: The Boussignac CPAP system may be an effective tool for performing transparent apneic test in case of serious respiratory disturbances, especially in the form of acute lung injury or ARDS. Keywords: brain death, organ donor, ARDS, ALI, Boussignac CPAP

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Immunoprophylaxis of bovine respiratory syndrome

    Directory of Open Access Journals (Sweden)

    Rogan Dragan

    2010-01-01

    Full Text Available Bovine Respiratory Syndrome (BRS is a multifactorial disease caused by the interaction of infective agents, the environment and the individual immunological response of animals in the herd. Despite five decades of research on BRS, no clear understanding of how environmental factors influence pathogenic outcomes of the disease has been defined. As such, the development of immunoprophylaxis and vaccine programmes to prevent outbreaks of BRS in cattle has not been successful. The current paper discusses vaccination programmes for all categories of cattle and presents a review of existing vaccines being used for immunoprophylaxis of respiratory syndrome in cattle and discusses the advantages and disadvantages of the currently used vaccines and vaccination programmes. Lastly, a discussion detailing the design of future perfect vaccines is presented.

  4. Adult respiratory distress syndrome.

    Science.gov (United States)

    Sutlić, Z; Rudez, I; Biocina, B; Husedzinović, I

    1997-01-01

    In this article the authors present a case of successful treatment of a 54-year old male patient with non-insulin dependent diabetes mellitus (NIDDM) and triple-vessel coronary artery disease who underwent surgical myocardial revascularization and was reoperated on the same day because of excessive bleeding. The patient was given cca 5000 mL of whole blood and cca 3000 mL of blood derivatives. The first postoperative chest X-ray showed radiological signs of ARDS. The therapy was based upon authors' experience and was consisted of controlled mechanical ventilation (respiratory volume 12-15 mL/kg, 10-14 cycles/min, I/E ratio 1:2, FIO2 0.6, PEEP 2-5 cm H2O), daily bronchoscopies with bronchoaspiration, aggressive diuresis, negative fluid balance, specific antibiotic therapy, and last but not least, of prostaglandin E1 (PGE1) 0.5-20 micrograms/kg/min combined with dopamine inotropic support (2-5 micrograms/kg/h). Simple but careful clinical observation still remains a milestone for all therapeutic measures taken in ARDS patients.

  5. Acute Radiation Syndrome

    Science.gov (United States)

    ... Matters Information on Specific Types of Emergencies Acute Radiation Syndrome (ARS): A Fact Sheet for the Public ... is called the radiation dose. People exposed to radiation will get ARS only if: The radiation dose ...

  6. Ebola virus and severe acute respiratory syndrome coronavirus display late cell entry kinetics: evidence that transport to NPC1+ endolysosomes is a rate-defining step.

    Science.gov (United States)

    Mingo, Rebecca M; Simmons, James A; Shoemaker, Charles J; Nelson, Elizabeth A; Schornberg, Kathryn L; D'Souza, Ryan S; Casanova, James E; White, Judith M

    2015-03-01

    Ebola virus (EBOV) causes hemorrhagic fevers with high mortality rates. During cellular entry, the virus is internalized by macropinocytosis and trafficked through endosomes until fusion between the viral and an endosomal membrane is triggered, releasing the RNA genome into the cytoplasm. We found that while macropinocytotic uptake of filamentous EBOV viruslike particles (VLPs) expressing the EBOV glycoprotein (GP) occurs relatively quickly, VLPs only begin to enter the cytoplasm after a 30-min lag, considerably later than particles bearing the influenza hemagglutinin or GP from lymphocytic choriomeningitis virus, which enter through late endosomes (LE). For EBOV, the long lag is not due to the large size or unusual shape of EBOV filaments, the need to prime EBOV GP to the 19-kDa receptor-binding species, or a need for unusually low endosomal pH. In contrast, since we observed that EBOV entry occurs upon arrival in Niemann-Pick C1 (NPC1)-positive endolysosomes (LE/Lys), we propose that trafficking to LE/Lys is a key rate-defining step. Additional experiments revealed, unexpectedly, that severe acute respiratory syndrome (SARS) S-mediated entry also begins only after a 30-min lag. Furthermore, although SARS does not require NPC1 for entry, SARS entry also begins after colocalization with NPC1. Since the only endosomal requirement for SARS entry is cathepsin L activity, we tested and provide evidence that NPC1(+) LE/Lys have higher cathepsin L activity than LE, with no detectable activity in earlier endosomes. Our findings suggest that both EBOV and SARS traffic deep into the endocytic pathway for entry and that they do so to access higher cathepsin activity. Ebola virus is a hemorrhagic fever virus that causes high fatality rates when it spreads from zoonotic vectors into the human population. Infection by severe acute respiratory syndrome coronavirus (SARS-CoV) causes severe respiratory distress in infected patients. A devastating outbreak of EBOV occurred in West

  7. Advantages and pitfalls of combining intravenous antithrombin with nebulized heparin and tissue plasminogen activator in acute respiratory distress syndrome.

    Science.gov (United States)

    Rehberg, Sebastian; Yamamoto, Yusuke; Sousse, Linda E; Jonkam, Collette; Cox, Robert A; Prough, Donald S; Enkhbaatar, Perenlei

    2014-01-01

    Pulmonary coagulopathy has become an important therapeutic target in adult respiratory distress syndrome (ARDS). We hypothesized that combining intravenous recombinant human antithrombin (rhAT), nebulized heparin, and nebulized tissue plasminogen activator (TPA) more effectively improves pulmonary gas exchange compared with a single rhAT infusion, while maintaining the anti-inflammatory properties of rhAT in ARDS. Therefore, the present prospective, randomized experiment was conducted using an established ovine model. Following burn and smoke inhalation injury (40% of total body surface area, third-degree flame burn, and 4 × 12 breaths of cold cotton smoke), 18 chronically instrumented sheep were randomly assigned to receive intravenous saline plus saline nebulization (control), intravenous rhAT (6 IU/kg/h) started 1 hour after injury plus saline nebulization (AT i.v.) or intravenous rhAT combined with nebulized heparin (10,000 IU every 4 hours, started 2 hours after injury), and nebulized TPA (2 mg every 4 hours, started 4 hours after injury) (triple therapy, n = 6 each). All animals were mechanically ventilated and fluid resuscitated according to standard protocols during the 48-hour study period. Both treatment approaches attenuated ARDS compared with control animals. Notably, triple therapy was associated with an improved PaO2/FiO2 ratio (p = 0.007), attenuated pulmonary obstruction (p = 0.02) and shunting (p = 0.025), as well as reduced ventilatory pressures (p heparin and nebulized TPA more effectively restores pulmonary gas exchange, but the anti-inflammatory effects of sole rhAT are abolished with the triple therapy. Interferences between the different anticoagulants may represent a potential explanation for these findings.

  8. Characteristics and Outcomes of Eligible Nonenrolled Patients in a Mechanical Ventilation Trial of Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Arabi, Yaseen M; Cook, Deborah J; Zhou, Qi; Smith, Orla; Hand, Lori; Turgeon, Alexis F; Matte, Andrea; Mehta, Sangeeta; Graham, Russell; Brierley, Kristin; Adhikari, Neill K J; Meade, Maureen O; Ferguson, Niall D

    2015-12-01

    Patients eligible for randomized controlled trials may not be enrolled for various reasons. Nonenrollment may affect study generalizability and lengthen the time required for trial completion. To describe characteristics and outcomes of eligible nonenrolled (ENE) patients in a multicenter trial of mechanical ventilation strategies. Within the OSCILLATE trial of high-frequency oscillation (HFO) versus conventional ventilation (CV) in adults with adult respiratory distress syndrome, and with approval from research ethics boards, we collected a minimal dataset on patients who satisfied eligibility criteria but were not enrolled. We categorized ENE patients as ENE-HFO and ENE-CV based on receipt of HFO at any time. We used multivariable logistic regression to assess the association between ENE status and mortality. A total of 548 patients were randomized, and 546 were ENE. The most common reasons for ENE were no consent (42%), physician refusal (24%), missed randomization window (15%), and current HFO use (14%). Compared with randomized patients in respective arms of the trial, ENE-HFO patients were younger and had worse lung injury, whereas ENE-CV patients had lower illness severity. ENE status was independently associated with mortality (adjusted odds ratio, 1.39; 95% confidence interval, 1.06-1.84; P = 0.02), with no significant interaction with ventilation treatment group. Nonenrollment was common, with approximately one ENE patient for every randomized patient. Our study suggests that enrollment in trials of mechanical ventilation may be associated with improved outcomes compared with standard care and highlights the need for prospective tracking and transparent reporting of ENE patients as part of trial management.

  9. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome.

    Science.gov (United States)

    Kushimoto, Shigeki; Taira, Yasuhiko; Kitazawa, Yasuhide; Okuchi, Kazuo; Sakamoto, Teruo; Ishikura, Hiroyasu; Endo, Tomoyuki; Yamanouchi, Satoshi; Tagami, Takashi; Yamaguchi, Junko; Yoshikawa, Kazuhide; Sugita, Manabu; Kase, Yoichi; Kanemura, Takashi; Takahashi, Hiroyuki; Kuroki, Yuichi; Izumino, Hiroo; Rinka, Hiroshi; Seo, Ryutarou; Takatori, Makoto; Kaneko, Tadashi; Nakamura, Toshiaki; Irahara, Takayuki; Saito, Nobuyuki; Watanabe, Akihiro

    2012-12-11

    Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is characterized by features other than increased pulmonary vascular permeability. Pulmonary vascular permeability combined with increased extravascular lung water content has been considered a quantitative diagnostic criterion of ALI/ARDS. This prospective, multi-institutional, observational study aimed to clarify the clinical pathophysiological features of ALI/ARDS and establish its quantitative diagnostic criteria. The extravascular lung water index (EVLWI) and the pulmonary vascular permeability index (PVPI) were measured using the transpulmonary thermodilution method in 266 patients with PaO2/FiO2 ratio ≤ 300 mmHg and bilateral infiltration on chest radiography, in 23 ICUs of academic tertiary referral hospitals. Pulmonary edema was defined as EVLWI ≥ 10 ml/kg. Three experts retrospectively determined the pathophysiological features of respiratory insufficiency by considering the patients' history, clinical presentation, chest computed tomography and radiography, echocardiography, EVLWI and brain natriuretic peptide level, and the time course of all preceding findings under systemic and respiratory therapy. Patients were divided into the following three categories on the basis of the pathophysiological diagnostic differentiation of respiratory insufficiency: ALI/ARDS, cardiogenic edema, and pleural effusion with atelectasis, which were noted in 207 patients, 26 patients, and 33 patients, respectively. EVLWI was greater in ALI/ARDS and cardiogenic edema patients than in patients with pleural effusion with atelectasis (18.5 ± 6.8, 14.4 ± 4.0, and 8.3 ± 2.1, respectively; P definitive diagnosis of ALI/ARDS (specificity, 0.90 to 0.95), and a value < 1.7 ruled out an ALI/ARDS diagnosis (specificity, 0.95). PVPI may be a useful quantitative diagnostic tool for ARDS in patients with hypoxemic respiratory failure and radiographic infiltrates. UMIN-CTR ID UMIN000003627.

  10. Acute heart failure syndrome

    African Journals Online (AJOL)

    Heart failure can be defined as a clinical syndrome in which a structural or functional cardiac abnormality impairs the capacity of the ventricle to fill or eject enough blood for the requirements of the body. Acute heart failure syndrome represents a complex, heterogeneous set of clinical conditions, all with the common.

  11. Practice variability in management of acute respiratory distress syndrome: bringing evidence and clinician education to the bedside using a web-based teaching tool.

    Science.gov (United States)

    Belda, Thomas E; Gajic, Ognjen; Rabatin, Jeffrey T; Harrison, Barry A

    2004-09-01

    Clinical practice often lags behind publication of evidence-based research and national consensus guidelines. To assess practice variability in the clinical management of acute respiratory distress syndrome (ARDS) and test an evidence-based, online clinician-education tool designed to improve intensive-care clinicians' understanding of current evidence about ARDS management. We surveyed 117 intensive care clinicians (16 critical care physician specialists, 28 resident physicians, 50 critical care nurses, and 23 respiratory therapists) with an online questionnaire in our tertiary academic institution. Fifty of the original respondents (12 residents, 26 critical care nurses, and 12 respiratory therapists) also responded to a repeat survey that included context-sensitive hypertext links to a summary of critically appraised primary articles regarding ARDS management, to determine if the responses changed after the clinicians had read the evidence-based summary information. Critical care physician specialists were most likely to choose the low-tidal-volume (low-VT) ventilation strategy and protocol-based ventilator weaning and were least likely to choose neuromuscular blockade or parenteral nutrition (p 48 h, during the 6 months before and after the survey, from which we identified 45 ARDS patients. Following the clinician-education intervention, ARDS patients were less likely to receive potentially injurious high-VT ventilation (mean day-3 VT 10.3 +/- 2.3 mL/kg before vs 8.9 +/- 1.7 mL/kg after, p = 0.02). Web-based teaching tools are useful to educate intensive-care practitioners and to promote evidence-based practice. Copyright 2004 Daedalus Enterprises

  12. Effects of increased positive end-expiratory pressure on intracranial pressure in acute respiratory distress syndrome: a protocol of a prospective physiological study.

    Science.gov (United States)

    Chen, Han; Xu, Ming; Yang, Yan-Lin; Chen, Kai; Xu, Jing-Qing; Zhang, Ying-Rui; Yu, Rong-Guo; Zhou, Jian-Xin

    2016-11-15

    There are concerns that the use of positive end-expiratory pressure (PEEP) in patients with brain injury may potentially elevate intracranial pressure (ICP). However, the transmission of PEEP into the thoracic cavity depends on the properties of the lungs and the chest wall. When chest wall elastance is high, PEEP can significantly increase pleural pressure. In the present study, we investigate the different effects of PEEP on the pleural pressure and ICP in different respiratory mechanics. This study is a prospective, single-centre, physiological study in patients with severe brain injury. Patients with acute respiratory distress syndrome with ventricular drainage will be enrolled. An oesophageal balloon catheter will be inserted to measure oesophageal pressure. Patients will be sedated and paralysed; airway pressure and oesophageal pressure will be measured during end-inspiratory occlusion and end-expiratory occlusion. Elastance of the chest wall, the lungs and the respiratory system will be calculated at PEEP levels of 5, 10 and 15 cm H2O. We will classify each patient based on the maximal ΔICP/ΔPEEP being above or below the median for the study population. 2 groups will thus be compared. The study protocol and consent forms were approved by the Institutional Review Board of Fujian Provincial Hospital. Study findings will be disseminated through peer-reviewed publications and conference presentations. NCT02670733; pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Validation and application of a high-fidelity, computational model of acute respiratory distress syndrome to the examination of the indices of oxygenation at constant lung-state.

    Science.gov (United States)

    McCahon, R A; Columb, M O; Mahajan, R P; Hardman, J G

    2008-09-01

    Calculated venous admixture (Qs/Qt) is considered the best index of oxygenation; surrogates have been developed (Pa(O(2))/Fi(O(2)), respiratory index, and arterioalveolar PO(2) difference), but these vary with Fi(O(2)), falsely indicating a change in lung-state. Using a novel model, we aimed to quantify the behaviour of the indices of oxygenation listed above during physiological and treatment factor variation. The study is the first step in developing an accurate and non-invasive tool to quantify oxygenation defects. We present the static and dynamic validation of a novel computational model of gas exchange in acute respiratory distress syndrome (ARDS) based upon the Nottingham Physiology Simulator. Arterial gas tension predictions were compared with data derived from ARDS patients. The subsequent study examined the indices' susceptibility to variation induced by independent changes in Fi(O(2)) (0.3-1.0), haemoglobin concentration (Hb: 6-14 g dl(-1)), oxygen consumption (VO(2): 250-350 ml min(-1)), and Pa(CO(2)) (4-8 kPa). Static validation produced a mean error of -0.3%, a 10-fold improvement over previous models. Dynamic validation produced a mean prediction error of -0.05 kPa for Pa(O(2)) and 0.09 kPa for Pa(CO(2)). Every parameter, especially Fi(O(2)), induced variation in all indices. The least Fi(O(2))-dependent index was Qs/Qt (variation: 5.1%). In contrast, Pa(O(2))/Fi(O(2)) varied by 77% through the range of Fi(O(2)). We have improved simulation of gas exchange in ARDS by using a sophisticated respiratory model. Using the validated model, we have demonstrated that the current indices of oxygenation vary with alteration in Hb, Pa(CO(2)), and VO(2) in addition to their previously well-documented dependence on Fi(O(2)).

  14. Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS).

    Science.gov (United States)

    Wu, Xiaohua; Dong, Dawei; Ma, Daqing

    2016-08-08

    BACKGROUND SARS is not only an acute disease, but also leads to long-term impaired lung diffusing capacity in some survivors. However, there is a paucity of data regarding long-term CT findings in survivors after SARS. The aim of this study was to assess the changes in lung function and lung thin-section computed tomography (CT) features in patients recovering from severe acute respiratory syndrome (SARS), especially the dynamic changes in ground-glass opacity (GGO). MATERIAL AND METHODS Clinical and radiological data from 11 patients with SARS were collected. The serial follow-up thin-section CTs were evaluated at 3, 6, and 84 months after SARS presentation. The distribution and predominant thin-section CT findings of lesions were evaluated. RESULTS The extent of the lesions on the CT scans of the 11 patients decreased at 6 and 84 months compared to 3 months. The number of segments involved on 84-month follow-up CTs was less than those at 6 months (PSARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.

  15. Preliminary study of ventilation with 4 ml/kg tidal volume in acute respiratory distress syndrome: feasibility and effects on cyclic recruitment - derecruitment and hyperinflation.

    Science.gov (United States)

    Retamal, Jaime; Libuy, Javiera; Jiménez, Magdalena; Delgado, Matías; Besa, Cecilia; Bugedo, Guillermo; Bruhn, Alejandro

    2013-01-28

    Cyclic recruitment-derecruitment and overdistension contribute to ventilator-induced lung injury. Tidal volume (Vt) may influence both, cyclic recruitment-derecruitment and overdistension. The goal of this study was to determine if decreasing Vt from 6 to 4 ml/kg reduces cyclic recruitment-derecruitment and hyperinflation, and if it is possible to avoid severe hypercapnia. Patients with pulmonary acute respiratory distress syndrome (ARDS) were included in a crossover study with two Vt levels: 6 and 4 ml/kg. The protocol had two parts: one bedside and other at the CT room. To avoid severe hypercapnia in the 4 ml/kg arm, we replaced the heat and moisture exchange filter by a heated humidifier, and respiratory rate was increased to keep minute ventilation constant. Data on lung mechanics and gas exchange were taken at baseline and after 30 minutes at each Vt (bedside). Thereafter, a dynamic CT (4 images/sec for 8 sec) was taken at each Vt at a fixed transverse region between the middle and lower third of the lungs. Afterward, CT images were analyzed and cyclic recruitment-derecruitment was determined as non-aerated tissue variation between inspiration and expiration, and hyperinflation as maximal hyperinflated tissue at end-inspiration, expressed as % of lung tissue weight. We analyzed 10 patients. Decreasing Vt from 6 to 4 ml/kg consistently decreased cyclic recruitment-derecruitment from 3.6 (2.5 to 5.7) % to 2.9 (0.9 to 4.7) % (P <0.01) and end-inspiratory hyperinflation from 0.7 (0.3 to 2.2) to 0.6 (0.2 to 1.7) % (P = 0.01). No patient developed severe respiratory acidosis or severe hypercapnia when decreasing Vt to 4 ml/kg (pH 7.29 (7.21 to 7.46); PaCO2 48 (26 to 51) mmHg). Decreasing Vt from 6 to 4 ml/kg reduces cyclic recruitment-derecruitment and hyperinflation. Severe respiratory acidosis may be effectively prevented by decreasing instrumental dead space and by increasing respiratory rate.

  16. Síndrome agudo respiratorio severo: un panorama mundial de la epidemia Severe acute respiratory syndrome: a global view of the epidemic

    Directory of Open Access Journals (Sweden)

    Carlos Franco-Paredes

    2003-06-01

    Full Text Available A principios de febrero de 2003 la Organización Mundial de la Salud comenzó a recibir reportes de pacientes con un síndrome caracterizado por neumonía atípica, con rápida progresión hacia insuficiencia respiratoria sin una causa identificada. Los casos aparentemente se iniciaron en el sur de China y se han diseminado a otras regiones en Asia, Europa, Sudáfrica, Norte América y Sur América. La causa de este síndrome es una nueva variedad de Coronavirus, aislado en secreciones respiratorias y en otras. El síndrome ha sido definido en inglés como SARS (Severe acute respiratory syndrome por la Organización Mundial de la Salud y se caracteriza por un periodo de incubación de 1 a 10 días (promedio de cinco días, una fase febril prodrómica que aparece entre los días 1 a 3. Posteriormente, aparecen síntomas respiratorios como tos, disnea, y signos como hipoxemia, que en 10 a 40% de los casos requieren de ventilación mecánica. La tasa de letalidad ha variado de 3% hasta 16%. Los hallazgos de laboratorio incluyen trombocitopenia, leucopenia, elevación de creatinin-fosfokinasa, y, en ocasiones, de transaminasas hepáticas y deshidrogenasa láctica. El tratamiento incluye medidas de apoyo; la utilización empírica del antiviral ribavirina es controvertida, debido a que hasta el momento no existe un tratamiento específico. Se recomienda el aislamiento respiratorio de los pacientes, la utilización de máscaras protectoras y el lavado estricto de manos como principales medidas de prevención. Desde el inicio de esta epidemia México estableció un sistema de vigilancia, así como recomendaciones al personal de salud para la identificación, prevención de casos secundarios y manejo clínico de casos sospechosos.In early February 2003, the World Health Organization (WHO began receiving reports of patients with a syndrome characterized by an atypical pneumonia with rapid progression to respiratory failure without an identified cause

  17. Very low tidal volume ventilation with associated hypercapnia--effects on lung injury in a model for acute respiratory distress syndrome.

    Directory of Open Access Journals (Sweden)

    Hans Fuchs

    Full Text Available BACKGROUND: Ventilation using low tidal volumes with permission of hypercapnia is recommended to protect the lung in acute respiratory distress syndrome. However, the most lung protective tidal volume in association with hypercapnia is unknown. The aim of this study was to assess the effects of different tidal volumes with associated hypercapnia on lung injury and gas exchange in a model for acute respiratory distress syndrome. METHODOLOGY/PRINCIPAL FINDINGS: In this randomized controlled experiment sixty-four surfactant-depleted rabbits were exposed to 6 hours of mechanical ventilation with the following targets: Group 1: tidal volume = 8-10 ml/kg/PaCO(2 = 40 mm Hg; Group 2: tidal volume = 4-5 ml/kg/PaCO(2 = 80 mm Hg; Group 3: tidal volume = 3-4 ml/kg/PaCO(2 = 120 mm Hg; Group 4: tidal volume = 2-3 ml/kg/PaCO(2 = 160 mm Hg. Decreased wet-dry weight ratios of the lungs, lower histological lung injury scores and higher PaO(2 were found in all low tidal volume/hypercapnia groups (group 2, 3, 4 as compared to the group with conventional tidal volume/normocapnia (group 1. The reduction of the tidal volume below 4-5 ml/kg did not enhance lung protection. However, oxygenation and lung protection were maintained at extremely low tidal volumes in association with very severe hypercapnia and no adverse hemodynamic effects were observed with this strategy. CONCLUSION: Ventilation with low tidal volumes and associated hypercapnia was lung protective. A tidal volume below 4-5 ml/kg/PaCO(2 80 mm Hg with concomitant more severe hypercapnic acidosis did not increase lung protection in this surfactant deficiency model. However, even at extremely low tidal volumes in association with severe hypercapnia lung protection and oxygenation were maintained.

  18. Acute respiratory infections at children

    OpenAIRE

    Delyagin, V.

    2009-01-01

    The common signs of virus respiratory diseases, role of pathological inclination to infections, value of immunodeficiency are presented at lecture. Features of most often meeting respiratory virus infections are given.

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

    Directory of Open Access Journals (Sweden)

    Melissa Brosset Ugas MD

    2016-05-01

    Full Text Available 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.

  20. mRNA display design of fibronectin-based intrabodies that detect and inhibit severe acute respiratory syndrome coronavirus nucleocapsid protein.

    Science.gov (United States)

    Liao, Hsiang-I; Olson, C Anders; Hwang, Seungmin; Deng, Hongyu; Wong, Elaine; Baric, Ralph S; Roberts, Richard W; Sun, Ren

    2009-06-26

    The nucleocapsid (N) protein of severe acute respiratory syndrome (SARS) coronavirus plays important roles in both viral replication and modulation of host cell processes. New ligands that target the N protein may thus provide tools to track the protein inside cells, detect interaction hot spots on the protein surface, and discover sites that could be used to develop new anti-SARS therapies. Using mRNA display selection and directed evolution, we designed novel antibody-like protein affinity reagents that target SARS N protein with high affinity and selectivity. Our libraries were based on an 88-residue variant of the 10th fibronectin type III domain from human fibronectin (10Fn3). This selection resulted in eight independent 10Fn3 intrabodies, two that require the N-terminal domain for binding and six that recognize the C terminus, one with Kd=1.7 nM. 10Fn3 intrabodies are well expressed in mammalian cells and are relocalized by N in SARS-infected cells. Seven of the selected intrabodies tested do not perturb cellular function when expressed singly in vivo and inhibit virus replication from 11- to 5900-fold when expressed in cells prior to infection. Targeting two sites on SARS-N simultaneously using two distinct 10Fn3s results in synergistic inhibition of virus replication.

  1. mRNA Display Design of Fibronectin-based Intrabodies That Detect and Inhibit Severe Acute Respiratory Syndrome Coronavirus Nucleocapsid Protein*

    Science.gov (United States)

    Liao, Hsiang-I.; Olson, C. Anders; Hwang, Seungmin; Deng, Hongyu; Wong, Elaine; Baric, Ralph S.; Roberts, Richard W.; Sun, Ren

    2009-01-01

    The nucleocapsid (N) protein of severe acute respiratory syndrome (SARS) coronavirus plays important roles in both viral replication and modulation of host cell processes. New ligands that target the N protein may thus provide tools to track the protein inside cells, detect interaction hot spots on the protein surface, and discover sites that could be used to develop new anti-SARS therapies. Using mRNA display selection and directed evolution, we designed novel antibody-like protein affinity reagents that target SARS N protein with high affinity and selectivity. Our libraries were based on an 88-residue variant of the 10th fibronectin type III domain from human fibronectin (10Fn3). This selection resulted in eight independent 10Fn3 intrabodies, two that require the N-terminal domain for binding and six that recognize the C terminus, one with Kd = 1.7 nm. 10Fn3 intrabodies are well expressed in mammalian cells and are relocalized by N in SARS-infected cells. Seven of the selected intrabodies tested do not perturb cellular function when expressed singly in vivo and inhibit virus replication from 11- to 5900-fold when expressed in cells prior to infection. Targeting two sites on SARS-N simultaneously using two distinct 10Fn3s results in synergistic inhibition of virus replication. PMID:19364769

  2. An Overview of Severe Acute Respiratory Syndrome-Coronavirus (SARS-CoV) 3CL Protease Inhibitors: Peptidomimetics and Small Molecule Chemotherapy.

    Science.gov (United States)

    Pillaiyar, Thanigaimalai; Manickam, Manoj; Namasivayam, Vigneshwaran; Hayashi, Yoshio; Jung, Sang-Hun

    2016-07-28

    Severe acute respiratory syndrome (SARS) is caused by a newly emerged coronavirus that infected more than 8000 individuals and resulted in more than 800 (10-15%) fatalities in 2003. The causative agent of SARS has been identified as a novel human coronavirus (SARS-CoV), and its viral protease, SARS-CoV 3CL(pro), has been shown to be essential for replication and has hence been recognized as a potent drug target for SARS infection. Currently, there is no effective treatment for this epidemic despite the intensive research that has been undertaken since 2003 (over 3500 publications). This perspective focuses on the status of various efficacious anti-SARS-CoV 3CL(pro) chemotherapies discovered during the last 12 years (2003-2015) from all sources, including laboratory synthetic methods, natural products, and virtual screening. We describe here mainly peptidomimetic and small molecule inhibitors of SARS-CoV 3CL(pro). Attempts have been made to provide a complete description of the structural features and binding modes of these inhibitors under many conditions.

  3. Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

    Directory of Open Access Journals (Sweden)

    F.C. Lanza

    2009-08-01

    Full Text Available The use of positive end-expiratory pressure (PEEP or lung recruitment maneuvers (RM to improve oxygenation in acute respiratory distress syndrome (ARDS is used but it may reduce cardiac output (CO. Intermittent PEEP may avoid these complications. Our objective was to determine if variable PEEP compared with constant PEEP is capable of maintaining arterial oxygenation and minimizing hemodynamic alterations with or without RM. Eighteen dogs with ARDS induced by oleic acid were randomized into three equal groups: group 1, low variable PEEP; group 2, high variable PEEP, and group 3, RM + high variable PEEP. All groups were submitted to constant PEEP, followed by variable PEEP (PEEP was increased from 5 to 10 cmH2O in group 1, and from 5 to 18 cmH2O in the other two groups. PaO2 was higher in group 3 (356.2 ± 65.4 mmHg than in group 1 (92.7 ± 29.7 mmHg and group 2 (228.5 ± 72.4 mmHg, P 0.05. Variable PEEP is able to maintain PaO2 when performed in combination with RM in dogs with ARDS. After RM, CO was reduced and there was no relevant difference between the variable and constant PEEP periods.

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

    Directory of Open Access Journals (Sweden)

    Melissa Brosset Ugas MD

    2016-05-01

    Full Text Available 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.

  5. A new lead for nonpeptidic active-site-directed inhibitors of the severe acute respiratory syndrome coronavirus main protease discovered by a combination of screening and docking methods.

    Science.gov (United States)

    Kaeppler, Ulrich; Stiefl, Nikolaus; Schiller, Markus; Vicik, Radim; Breuning, Alexander; Schmitz, Werner; Rupprecht, Daniel; Schmuck, Carsten; Baumann, Knut; Ziebuhr, John; Schirmeister, Tanja

    2005-11-03

    The coronavirus main protease, M(pro), is considered to be a major target for drugs suitable for combating coronavirus infections including severe acute respiratory syndrome (SARS). An HPLC-based screening of electrophilic compounds that was performed to identify potential M(pro) inhibitors revealed etacrynic acid tert-butylamide (6a) as an effective nonpeptidic inhibitor. Docking studies suggested a binding mode in which the phenyl ring acts as a spacer bridging the inhibitor's activated double bond and its hydrophobic tert-butyl moiety. The latter is supposed to fit into the S4 pocket of the target protease. Furthermore, these studies revealed etacrynic acid amide (6b) as a promising lead for nonpeptidic active-site-directed M(pro) inhibitors. In a fluorimetric enzyme assay using a novel fluorescence resonance energy transfer (FRET) pair labeled substrate, compound 6b showed a K(i) value of 35.3 muM. Since the novel lead compound does not target the S1', S1, and S2 subsites of the enzyme's substrate-binding pockets, there is room for improvement that underlines the lead character of compound 6b.

  6. Oscillation after inhalation: high frequency oscillatory ventilation in burn patients with the acute respiratory distress syndrome and co-existing smoke inhalation injury.

    Science.gov (United States)

    Cartotto, Robert; Walia, Gautam; Ellis, Sandi; Fowler, Rob

    2009-01-01

    The purpose of this study was to evaluate the effectiveness of, and complications associated with High Frequency Oscillatory Ventilation (HFOV) in burn patients with the Acute Respiratory Distress Syndrome (ARDS) who have had a smoke inhalation injury, and to compare with those without an inhalation injury. Burn patients with progressive oxygenation failure from ARDS while on conventional mechanical ventilation were placed on HFOV as a "rescue" ventilation modality. There were 19 patients with burn + inhalation injury and 30 patients with burn only. Burned patients with ARDS but without inhalation injury had significant temporal improvement in the oxygenation index from 27 +/- 8 on conventional mechanical ventilation to 17 +/- 6 within 48 hours of initiating HFOV. However, burned patients with ARDS and smoke inhalation injury did not achieve significant or even eventual improvements in oxygenation index with HFOV. There was also a trend towards higher rates of early HFOV failure and severe hypercapnia while on HFOV among the patients with inhalation injury. Delivery of nebulized bronchodilators, heparin and n-acetyl cysteine, normally mainstays of smoke inhalation therapy, was impossible during HFOV. The presence of a smoke inhalation injury appears to impair the response to HFOV when this ventilation modality is instituted for ARDS-related oxygenation failure. Severe hypercapnia tended to be more frequent during HFOV among patients with smoke inhalation. These findings, combined with the difficulties in delivery of nebulized medications during HFOV suggest that HFOV may not be the optimal "rescue" ventilation modality in cases of ARDS if there has been an inhalation injury.

  7. Mechanism for Controlling the Dimer-Monomer Switch and Coupling Dimerization to Catalysis of the Severe Acute Respiratory Syndrome Coronavirus 3C-Like Protease

    Energy Technology Data Exchange (ETDEWEB)

    Shi,J.; Sivaraman, J.; Song, J.

    2008-01-01

    Unlike 3C protease, the severe acute respiratory syndrome coronavirus (SARS-CoV) 3C-like protease (3CLpro) is only enzymatically active as a homodimer and its catalysis is under extensive regulation by the unique extra domain. Despite intense studies, two puzzles still remain: (i) how the dimer-monomer switch is controlled and (ii) why dimerization is absolutely required for catalysis. Here we report the monomeric crystal structure of the SARS-CoV 3CLpro mutant R298A at a resolution of 1.75 Angstroms . Detailed analysis reveals that Arg298 serves as a key component for maintaining dimerization, and consequently, its mutation will trigger a cooperative switch from a dimer to a monomer. The monomeric enzyme is irreversibly inactivated because its catalytic machinery is frozen in the collapsed state, characteristic of the formation of a short 310-helix from an active-site loop. Remarkably, dimerization appears to be coupled to catalysis in 3CLpro through the use of overlapped residues for two networks, one for dimerization and another for the catalysis.

  8. Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zhang Zhongheng

    2013-02-01

    Full Text Available Abstract Background Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS. The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown. Methods/design The study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days. Discussion We investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO. Trial registration http://www.clinicaltrials.gov NCT01526382

  9. Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Jian-biao Meng

    2016-01-01

    Full Text Available Objective. To investigate the effects of 72-hour early-initiated continuous venovenous hemofiltration (ECVVH treatment in patients with septic-shock-induced acute respiratory distress syndrome (ARDS (not acute kidney injury, AKI with regard to serum E-selectin and measurements of lung function and hemodynamic stability. Methods. This prospective nonblinded single institutional randomized study involved 51 patients who were randomly assigned to receive or not receive ECVVH, an ECVVH group (n=24 and a non-ECVVH group (n=27. Besides standard therapies, patients in ECVVH group underwent CVVH for 72 h. Results. At 0 and 24 h after initiation of treatment, arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2 ratio, extravascular lung water index (EVLWI, and E-selectin level were not significantly different between groups (all P>0.05. Compared to non-ECVVH group, PaO2/FiO2 is significantly higher and EVLWI and E-selectin level are significantly lower in ECVVH group (all P<0.05 at 48 h and 72 h after initiation of treatment. The lengths of mechanical ventilation and stay in intensive care unit (ICU were shorter in ECVVH group (all P<0.05, but there was no difference in 28-day mortality between two groups. Conclusions. In patients with septic-shock-induced ARDS (not AKI, treatment with ECVVH in addition to standard therapies improves endothelial function, lung function, and hemodynamic stability and reduces the lengths of mechanical ventilation and stay in ICU.

  10. [Correlation of severity classification of acute respiratory distress syndrome by the Berlin definition with extra vascular lung water index and pulmonary vascular permeability index].

    Science.gov (United States)

    Zhu, Jinyuan; Wang, Xiaohong; Yang, Xiaojun; Wang, Xiaoqi; Ma, Xigang

    2015-05-19

    To explore the correlation of severity classification of acute respiratory distress syndrome (ARDS) by the Berlin definition with extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). A total of 70 cases with ARDS at intensive care unit of our hospital from July 2012 to July 2014 were divided into three groups of mild (n = 20), moderate (n = 30) and severe (n = 20) according to the Berlin definition. The scores of acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) within 24 h of admission were recorded. And the values of EVLWI and PVPI of three groups from Day 1-4 were monitored by pulse indicator continuous cardiac output (PiCCO). Receiver operating characteristic (ROC) curve was drawn for these parameters and the area under curve was compared. Meanwhile blood gas was analyzed and oxygenation index (OI) calculated. And the correlations of EVLWI and PVPI with OI were analyzed. Comparisons of EVLWI, PVPI and OI were made for three groups at different timepoints: As the severity of ARDS aggravated, EVLWI and PVPI of three groups increased significantly at any timepoint while OI decreased sharply (P 0.05). There was no sharp decline of EVLWI or PVPI in severe ARDS group (P > 0.05). And OI increased significantly from Day 1-4 in three groups (P 2.95 at Day 4 of admission was used as the best threshold value for judging prognosis. And the sensitivity was 70% and specificity 92%. OI had negative correlation with EVLWI and PVPI in three groups from Day 1-4 [(r = -0.685, P = 0.000) and (r = -0.631, P = 0.000)]. Both EVLWI and PVPI reflect adequately the severity of ARDS by the Berlin definition. And the dynamic trend of PVPI is superior to that of EVLWI.

  11. Optimal plateau pressure for patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-analysis with meta-regression.

    Science.gov (United States)

    Yasuda, Hideto; Nishimura, Tetsuro; Kamo, Tetsuro; Sanui, Masamitsu; Nango, Eishu; Abe, Takayuki; Takebayashi, Toru; Lefor, Alan Kawarai; Hashimoto, Satoru

    2017-05-29

    Lower tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS) is a strategy to reduce the plateau pressure and driving pressure to limit ventilator-induced lung injury (VILI). Several randomised controlled trials (RCTs) and meta-analyses showed that limiting both the plateau pressure and the tidal volume decreased mortality, but the optimal plateau pressure to demonstrate a benefit is uncertain. The aim of this systematic review is to investigate the optimal upper limit of plateau pressure in patients with ARDS to prevent VILI and improve clinical outcomes using meta-analysis with and without meta-regression. RCTs comparing two mechanical ventilation strategies will be included, with lower plateau pressure and with higher plateau pressure, among patients with ARDS and acute lung injury. Data sources include MEDLINE via the NCBI Entrez system, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Ichushi, a database of papers in Japanese. Two of three physicians will independently screen trials obtained by search for eligibility, and extract data from included studies onto standardised data recording forms. For each included trial, the risk of bias and the quality of evidence will be evaluated using the Grading of Recommendation Assessment Development and Evaluation system. This study does not require ethical approval. The results of this systematic review and meta-analysis with and without meta-regression will be disseminated through conference presentation and publication in a peer-reviewed journal. CRD42016041924. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Role of oxidant stress in the adult respiratory distress syndrome: evaluation of a novel antioxidant strategy in a porcine model of endotoxin-induced acute lung injury.

    Science.gov (United States)

    Gonzalez, P K; Zhuang, J; Doctrow, S R; Malfroy, B; Benson, P F; Menconi, M J; Fink, M P

    1996-01-01

    Reactive oxygen metabolites (ROMs) are thought to play a key role in the pathogenesis of the adult respiratory distress syndrome (ARDS). Accordingly, the use of ROM scavengers, such as N-acetyl-cysteine or dimethylthiourea, as therapeutic adjuncts to prevent oxidant-mediated damage to the lung have been evaluated extensively in animal models of ARDS. Results with this approach have been quite variable among studies. Another strategy that has been examined in animal models of ARDS is the administration of various enzymes, particularly superoxide dismutase (SOD) or catalase (CAT), in an effort to promote the conversion of ROMs to inactive metabolites. In theory, this strategy should be more effective than the use of ROM scavengers since a single molecule of a catalytically active molecule can neutralize a large number of molecules of a reactive species, whereas most scavengers act in a stoichiometric fashion to neutralize radicals on a mole-for-mole basis. This notion is supported by studies showing that prophylactic treatment with CAT provides impressive protection against acute lung injury induced in experimental animals by the administration of lipopolysaccharide (LPS). Results with SOD have been more variable. Recently, we have utilized a porcine model of LPS-induced ARDS to investigate the therapeutic potential of EUK-8, a novel, synthetic, low molecular salen-manganese complex that exhibits both SOD-like and CAT-like activities in vitro. Using both pre- and post-treatment designs, we have documented that treatment with EUK-8 significantly attenuates many of the features of LPS-induced acute lung injury, including arterial hypoxemia, pulmonary hypertension, decreased dynamic pulmonary compliance, and pulmonary edema. These findings support the view that salen-manganese complexes warrant further evaluation as therapeutic agents for treatment or prevention of sepsis-related ARDS in humans.

  13. Potential contribution of mitochondrial DNA damage associated molecular patterns in transfusion products to the development of acute respiratory distress syndrome after multiple transfusions.

    Science.gov (United States)

    Simmons, Jon D; Lee, Yann-Leei L; Pastukh, Viktor M; Capley, Gina; Muscat, Cherry A; Muscat, David C; Marshall, Michael L; Brevard, Sidney B; Gillespie, Mark N

    2017-06-01

    Massive transfusions are accompanied by an increased incidence of a particularly aggressive and lethal form of acute lung injury (delayed transfusion-related acute lung injury) which occurs longer than 24 hours after transfusions. In light of recent reports showing that mitochondrial (mt)DNA damage-associated molecular patterns (DAMPs) are potent proinflammatory mediators, and that their abundance in the sera of severely injured or septic patients is predictive of clinical outcomes, we explored the idea that mtDNA DAMPs are present in transfusion products and are associated with the occurrence of delayed transfusion-related acute lung injury. We prospectively enrolled fourteen consecutive severely injured patients that received greater than three units of blood transfusion products and determined if the total amount of mtDNA DAMPs delivered during transfusion correlated with serum mtDNA DAMPs measured after the last transfusion, and whether the quantity of mtDNA DAMPs in the serum-predicted development of acute respiratory distress syndrome (ARDS). We found detectable levels of mtDNA DAMPs in packed red blood cells (3 ± 0.4 ng/mL), fresh frozen plasma (213.7 ± 65 ng/mL), and platelets (94.8 ± 69.2), with the latter two transfusion products containing significant amounts of mtDNA fragments. There was a linear relationship between the mtDNA DAMPs given during transfusion and the serum concentration of mtDNA fragments (R = 0.0.74, p DAMPs in serum measured at 24 hours after transfusion predicted the occurrence of ARDS (9.9 ± 1.4 vs. 3.3 ± 0.9, p DAMPs administered during transfusion may be a determinant of serum mtDNA DAMP levels, and that serum levels of mtDNA DAMPs after multiple transfusions may predict the development of ARDS. Collectively, these findings support the idea that mtDNA DAMPs in transfusion products significantly contribute to the incidence of ARDS after massive transfusions. Prognostic study, level II; therapeutic study, level II.

  14. Severe acute respiratory syndrome-associated coronavirus vaccines formulated with delta inulin adjuvants provide enhanced protection while ameliorating lung eosinophilic immunopathology.

    Science.gov (United States)

    Honda-Okubo, Yoshikazu; Barnard, Dale; Ong, Chun Hao; Peng, Bi-Hung; Tseng, Chien-Te Kent; Petrovsky, Nikolai

    2015-03-01

    Although the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) epidemic was controlled by nonvaccine measures, coronaviruses remain a major threat to human health. The design of optimal coronavirus vaccines therefore remains a priority. Such vaccines present major challenges: coronavirus immunity often wanes rapidly, individuals needing to be protected include the elderly, and vaccines may exacerbate rather than prevent coronavirus lung immunopathology. To address these issues, we compared in a murine model a range of recombinant spike protein or inactivated whole-virus vaccine candidates alone or adjuvanted with either alum, CpG, or Advax, a new delta inulin-based polysaccharide adjuvant. While all vaccines protected against lethal infection, addition of adjuvant significantly increased serum neutralizing-antibody titers and reduced lung virus titers on day 3 postchallenge. Whereas unadjuvanted or alum-formulated vaccines were associated with significantly increased lung eosinophilic immunopathology on day 6 postchallenge, this was not seen in mice immunized with vaccines formulated with delta inulin adjuvant. Protection against eosinophilic immunopathology by vaccines containing delta inulin adjuvants correlated better with enhanced T-cell gamma interferon (IFN-γ) recall responses rather than reduced interleukin-4 (IL-4) responses, suggesting that immunopathology predominantly reflects an inadequate vaccine-induced Th1 response. This study highlights the critical importance for development of effective and safe coronavirus vaccines of selection of adjuvants based on the ability to induce durable IFN-γ responses. Coronaviruses such as SARS-CoV and Middle East respiratory syndrome-associated coronavirus (MERS-CoV) cause high case fatality rates and remain major human public health threats, creating a need for effective vaccines. While coronavirus antigens that induce protective neutralizing antibodies have been identified, coronavirus vaccines

  15. [Positive end-expiratory pressure and tidal volume titration after recruitment maneuver in a canine model of acute respiratory distress syndrome].

    Science.gov (United States)

    Zhan, Qing-Yuan; Wang, Chen; Sun, Bing; Pang, Bao-sen

    2005-11-01

    To investigate the mechanisms of alveolar derecruitment and titration of positive end-expiratory pressure (PEEP) and tidal volume (V(T)) after recruitment maneuver (RM) in acute respiratory distress syndrome (ARDS). Eighteen dogs with oleic acid induced ARDS were ventilated with volume controlled ventilation [VCV, PEEP 16 cm H2O, V(T) 10 ml/kg, respiratory rate (RR) 30 breaths/min] and the steady state in this mode was defined as baseline (0 min). All animals accepted RM by using pressure controlled ventilation [PEEP 35 cm H2O and peak inspiratory pressure (PIP) 50 cm H2O for 1 min] and then randomly assigned into three groups and ventilated by VCV for 4 h: low V(T) and moderate PEEP group (LVMP group, V(T) 10 ml/kg, PEEP 16 cm H2O, RR 30 breaths/min), low V(T) and low PEEP group (LVLP group, V(T) 10 ml/kg, PEEP 10 cm H2O, RR 30 breaths/min) and moderate V(T) and low PEEP group (MVLP group, V(T) 15 ml/kg, PEEP 10 cm H2O, RR 20 breaths/min). Oxygenation, lung mechanics, hemodynamics and lung injury score were measured. (1) The average lower inflection pressure (LIP) was identified as (16.0 +/- 2.1) cm H2O. (2) PaO(2) in the LVMP group [(371 +/- 64) mm Hg at 30 min and (365 +/- 51) mm Hg at 60 min] was higher than that in the LVLP and the MVLP group [(243 +/- 112), (242 +/- 97) mm Hg at 30 min and (240 +/- 108), (232 +/- 87) mm Hg at 60 min, respectively; all P experiment. Better ventilation profiles were observed in the MVLP group. (3) Compared with baseline, marked cardiac compromise with higher airway plateau pressure (Pplat) and lower static respiratory compliance (Cst) were found in the LVMP group, while improvement was observed in other two groups. Cst in the MVLP group was slightly higher than that in the LVLP group. (4) No significant differences of lung injury were found from bronchoalveolar lavage fluid (BALF) analysis. Higher PEEP close to LIP maybe useful in preventing alveolar recollapse and improving oxygenation, but harmful to hemodynamics and may

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Acute Coronary Syndrome

    Science.gov (United States)

    ... heart is accumulating irreversible damage. So time is myocardium – myocardium being the heart muscle itself,” Bolger said. At ... angina? This content was last reviewed July 2015. Heart Attack • Home • About Heart Attacks Acute Coronary Syndrome (ACS) ...

  18. Submersion and acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2014-01-01

    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.

  19. The neurology of acutely failing respiratory mechanics.

    Science.gov (United States)

    Wijdicks, Eelco F M

    2017-04-01

    Forces involved in breathing-which effectively pull in air-are the diaphragmatic, intercostal, spine, and neck muscles. Equally important is the bulbar musculature maintaining the architecture of a patent airway conduit and abdominal wall and internal intercostal muscles providing cough. Acute injury along a neural trajectory from brainstem to muscle will impair the coordinated interaction between these muscle groups. Acutely failing respiratory mechanics can be caused by central and peripheral lesions. In central lesions, the key lesion is in the nucleus ambiguus innervating the dilator muscles of the soft palate, pharynx, and larynx, but abnormal respiratory mechanics rarely coincide with abnormalities of the respiratory pattern generator. In peripheral lesions, diaphragmatic weakness is a main element, but in many neuromuscular disorders mechanical upper airway obstruction from oropharyngeal weakness contributes equally to an increased respiratory load. The neurology of breathing involves changes in respiratory drive, rhythm, mechanics, and dynamics. This review focuses on the fundamentals of abnormal respiratory mechanics in acute neurologic conditions, bedside judgment, interpretation of additional laboratory tests, and initial stabilization, with practical solutions provided. Many of these respiratory signs are relevant to neurologists, who in acute situations may see these patients first. Ann Neurol 2017;81:485-494. © 2017 American Neurological Association.

  20. Immunoglobulin M-enriched intravenous polyclonal immunoglobulins reduce bacteremia following Klebsiella pneumoniae infection in an acute respiratory distress syndrome rat model

    NARCIS (Netherlands)

    Lachmann, R. A.; van Kaam, A. H. L. C.; Haitsma, J. J.; Verbrugge, S. J. C.; Delreu, F.; Lachmann, B.

    2004-01-01

    Mechanical ventilation is known to induce bacterial translocation from the lung into the systemic circulation. This study determined the effect of immunoglobulin M (IgM)-enriched polyclonal immunoglobulins on bacteremia due to ventilation-induced translocation in an acute respiratory distress

  1. Prospective evaluation for respiratory pathogens in children with sickle cell disease and acute respiratory illness.

    Science.gov (United States)

    Srinivasan, Ashok; Wang, Winfred C; Gaur, Aditya; Smith, Teresa; Gu, Zhengming; Kang, Guolian; Leung, Wing; Hayden, Randall T

    2014-03-01

    Human rhinovirus (HRV), human coronavirus (hCoV), human bocavirus (hBoV), and human metapneumovirus (hMPV) infections in children with sickle cell disease have not been well studied. Nasopharyngeal wash specimens were prospectively collected from 60 children with sickle cell disease and acute respiratory illness, over a 1-year period. Samples were tested with multiplexed-PCR, using an automated system for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis. Clinical characteristics and distribution of respiratory viruses in patients with and without acute chest syndrome (ACS) were evaluated. A respiratory virus was detected in 47 (78%) patients. Nine (15%) patients had ACS; a respiratory virus was detected in all of them. The demographic characteristics of patients with and without ACS were similar. HRV was the most common virus, detected in 29 of 47 (62%) patients. Logistic regression showed no association between ACS and detection of HRV, hCoV, hBoV, hMPV, and other respiratory pathogens. Co-infection with at least one additional respiratory virus was seen in 14 (30%) infected patients, and was not significantly higher in patients with ACS (P = 0.10). Co-infections with more than two respiratory viruses were seen in seven patients, all in patients without ACS. Bacterial pathogens were not detected. HRV was the most common virus detected in children with sickle cell disease and acute respiratory illness, and was not associated with increased morbidity. Larger prospective studies with asymptomatic controls are needed to study the association of these emerging respiratory viruses with ACS in children with sickle cell disease. © 2013 Wiley Periodicals, Inc.

  2. Acute Respiratory Distress Syndrome Complicated by Amiodarone Induced Pulmonary Fibrosis: Don���t Let Your Guard Down

    OpenAIRE

    Singh, Vipin Kumar; Maheshwari, Vijeta

    2017-01-01

    Amiodarone is an antiarrhythmic agent which is commonly used to treat both supraventricular and ventricular arrhythmias. This iodine containing compound has been associated with several adverse events like it tends to accumulate in several organs. Among those, the most serious is Amiodarone Pulmonary Toxicity (APT). While the incidence of this complication has decreased with the use of lower doses of amiodarone but it can occur with any dose. Pulmonary complications usually present as an acut...

  3. Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency.

    Science.gov (United States)

    Xing, Xue-Zhong; Gao, Yong; Wang, Hai-Jun; Yang, Quan-Hui; Huang, Chu-Lin; Qu, Shi-Ning; Zhang, Hao; Wang, Hao; Xiao, Qing-Ling; Sun, Ke-Lin

    2013-01-01

    This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency. The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed. The data of 321 patients with no acute respiratory insufficiency as controls were also collected. Clinical variables of the first 24 hours after admission to intensive care unit were collected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO2/FiO2 ratio. Duration of mechanical ventilation, length of intensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated. The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases (P=0.001), surgery-related infection (P=0.004), hypo-volemic shock (Prespiratory insufficiency. Compared with the patients without acute respiratory insufficiency, the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay (Prespiratory insufficiency (P=0.029, RR: 8.522, 95%CI: 1.243-58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insufficiency had a shortened one-year survival rate (78.7% vs. 97.1%, Prespiratory insufficiency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse short-term outcome and a decreased one

  4. Soluble Forms and Ligands of the Receptor for Advanced Glycation End-Products in Patients with Acute Respiratory Distress Syndrome: An Observational Prospective Study.

    Science.gov (United States)

    Jabaudon, Matthieu; Blondonnet, Raiko; Roszyk, Laurence; Pereira, Bruno; Guérin, Renaud; Perbet, Sébastien; Cayot, Sophie; Bouvier, Damien; Blanchon, Loic; Sapin, Vincent; Constantin, Jean-Michel

    2015-01-01

    The main soluble form of the receptor for advanced glycation end-products (sRAGE) is elevated during acute respiratory distress syndrome (ARDS). However other RAGE isoforms and multiple ligands have been poorly reported in the clinical setting, and their respective contribution to RAGE activation during ARDS remains unclear. Our goal was therefore to describe main RAGE isoforms and ligands levels during ARDS. 30 ARDS patients and 30 mechanically ventilated controls were prospectively included in this monocenter observational study. Arterial, superior vena cava and alveolar fluid levels of sRAGE, endogenous-secretory RAGE (esRAGE), high mobility group box-1 protein (HMGB1), S100A12 and advanced glycation end-products (AGEs) were measured in duplicate ELISA on day 0, day 3 and day 6. In patients with ARDS, baseline lung morphology was assessed with computed tomography. ARDS patients had higher arterial, central venous and alveolar levels of sRAGE, HMGB1 and S100A12, but lower levels of esRAGE and AGEs, than controls. Baseline arterial sRAGE, HMGB1 and S100A12 were correlated with nonfocal ARDS (AUC 0.79, 0.65 and 0.63, respectively). Baseline arterial sRAGE, esRAGE, S100A12 and AGEs were associated with severity as assessed by PaO2/FiO2. This is the first kinetics study of levels of RAGE main isoforms and ligands during ARDS. Elevated sRAGE, HMGB1 and S100A12, with decreased esRAGE and AGEs, were found to distinguish patients with ARDS from those without. Our findings should prompt future studies aimed at elucidating RAGE/HMGB1/S100A12 axis involvement in ARDS. clinicaltrials.gov Identifier: NCT01270295.

  5. Extracorporeal membrane oxygenation (ECMO) in adults with acute respiratory distress syndrome (ARDS): A 6-year experience and case-control study.

    Science.gov (United States)

    Muñoz, Javier; Santa-Teresa, Patricia; Tomey, María Jesus; Visedo, Lourdes Carmen; Keough, Elena; Barrios, Juan Camilo; Sabell, Santiago; Morales, Antonio

    To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults. a) Descriptive study of 15 cases treated since the program approval from 2010 to 2016. b) Case-control study matching the 15 ECMO cases with the 52 severe ARDS treated between 2005 and 2011 in which alternative rescue treatments (prone ventilation, tracheal gas insufflation (TGI) and/or the administration of inhaled nitric oxide (iNO)) were used. ECMO experience: Mortality 47% (7/15). Four patients died due to complications directly related to ECMO therapy. ICU stay 46.6 ± 45 days (range 4-138). Hospital stay 72.4 ± 98 days (range 4-320). Case-control: The mortality in the control group was 77% (44/52). The ECMO group practically doubled the mean days of ICU and hospital stay (p ECMO treatment. The following were also independent predictors of mortality: age (OR 1.05, 95% CI 1-11), SOFA score (OR 1.34, 95% CI 1.04-1.7), and the need for renal replacement therapy (OR 1.3, 95% CI 1.04-1.7). Economic analysis: The hospital cost per patient in the ECMO group doubled compared to that of the control group (USD 77,099 vs USD 37,660). However, the cost per survivor was reduced by 4% (USD 144,560 vs USD 150,640, respectively). Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term survivors.

    Science.gov (United States)

    Kamdar, Biren B; Sepulveda, Kristin A; Chong, Alexandra; Lord, Robert K; Dinglas, Victor D; Mendez-Tellez, Pedro A; Shanholtz, Carl; Colantuoni, Elizabeth; von Wachter, Till M; Pronovost, Peter J; Needham, Dale M

    2017-09-16

    Delayed return to work is common after acute respiratory distress syndrome (ARDS), but has undergone little detailed evaluation. We examined factors associated with the timing of return to work after ARDS, along with lost earnings and shifts in healthcare coverage. Five-year, multisite prospective, longitudinal cohort study of 138 2-year ARDS survivors hospitalised between 2004 and 2007. Employment and healthcare coverage were collected via structured interview. Predictors of time to return to work were evaluated using Fine and Grey regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data. Sixty-seven (49%) of the 138 2-year survivors were employed prior to ARDS. Among 64 5-year survivors, 20 (31%) never returned to work across 5-year follow-up. Predictors of delayed return to work (HR (95% CI)) included baseline Charlson Comorbidity Index (0.77 (0.59 to 0.99) per point; p=0.04), mechanical ventilation duration (0.67 (0.55 to 0.82) per day up to 5 days; plost earnings, with average (SD) losses ranging from US$38 354 (21,533) to US$43 510 (25,753) per person per year. Jobless, non-retired survivors experienced a 33% decrease in private health insurance and concomitant 37% rise in government-funded coverage. Across 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Effect of ulinastatin combined with CRRT therapy on the endothelial oxidative damage and inflammatory injury in patients with acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Jie Li

    2017-04-01

    Full Text Available Objective: To study the effect of ulinastatin combined with CRRT therapy on the endothelial oxidative damage and inflammatory injury in patients with acute respiratory distress syndrome (ARDS. Methods: A total of 60 patients with ARDS who were treated in our hospital between April 2011 and April 2016 were collected and divided into the control group (n=29 who received pure CRRT therapy and the combined treatment group (n=31 who received ulinastatin combined with CRRT therapy after the therapy and related laboratory examination were reviewed. Before treatment and after 5d of treatment, enzyme-linked immunosorbent assay (ELISA was used to detect the levels of endothelial function indexes and inflammation indexes in serum and exhaled breath condensate; RIA method was used to detect the levels of oxidative stress indexes in serum and exhaled breath condensate. Results: Before treatment, the differences in the endothelial function, oxidative stress and inflammation indexes in serum and exhaled breath condensate were not statistically significant between two groups of patients. After treatment, endothelial function index NO levels in serum and exhaled breath condensate of observation group were higher than those of control group while ET-1 levels were lower than those of control group; oxidative stress indexes CAT and SOD levels in serum and exhaled breath condensate of observation group were higher than those of control group while MAO levels were lower than those of control group; inflammation indexes PCT, IL-1β and HMGB1 levels in serum and exhaled breath condensate of observation group were lower than those of control group. Conclusion: Ulinastatin combined with CRRT therapy can improve the endothelial function and reduce the oxidative stress and inflammatory injury in patients with ARDS.

  8. Soluble Forms and Ligands of the Receptor for Advanced Glycation End-Products in Patients with Acute Respiratory Distress Syndrome: An Observational Prospective Study.

    Directory of Open Access Journals (Sweden)

    Matthieu Jabaudon

    Full Text Available The main soluble form of the receptor for advanced glycation end-products (sRAGE is elevated during acute respiratory distress syndrome (ARDS. However other RAGE isoforms and multiple ligands have been poorly reported in the clinical setting, and their respective contribution to RAGE activation during ARDS remains unclear. Our goal was therefore to describe main RAGE isoforms and ligands levels during ARDS.30 ARDS patients and 30 mechanically ventilated controls were prospectively included in this monocenter observational study. Arterial, superior vena cava and alveolar fluid levels of sRAGE, endogenous-secretory RAGE (esRAGE, high mobility group box-1 protein (HMGB1, S100A12 and advanced glycation end-products (AGEs were measured in duplicate ELISA on day 0, day 3 and day 6. In patients with ARDS, baseline lung morphology was assessed with computed tomography.ARDS patients had higher arterial, central venous and alveolar levels of sRAGE, HMGB1 and S100A12, but lower levels of esRAGE and AGEs, than controls. Baseline arterial sRAGE, HMGB1 and S100A12 were correlated with nonfocal ARDS (AUC 0.79, 0.65 and 0.63, respectively. Baseline arterial sRAGE, esRAGE, S100A12 and AGEs were associated with severity as assessed by PaO2/FiO2.This is the first kinetics study of levels of RAGE main isoforms and ligands during ARDS. Elevated sRAGE, HMGB1 and S100A12, with decreased esRAGE and AGEs, were found to distinguish patients with ARDS from those without. Our findings should prompt future studies aimed at elucidating RAGE/HMGB1/S100A12 axis involvement in ARDS.clinicaltrials.gov Identifier: NCT01270295.

  9. Differences in the deflation limb of the pressure-volume curves in acute respiratory distress syndrome from pulmonary and extrapulmonary origin.

    Science.gov (United States)

    Albaiceta, Guillermo M; Taboada, Francisco; Parra, Diego; Blanco, Armando; Escudero, Dolores; Otero, Jesús

    2003-11-01

    To assess the differences in the deflation pressure-volume (PV) curves between acute respiratory distress syndrome from pulmonary (ARDSp) and extrapulmonary (ARDSe) origin. . Prospective study. Twenty-bed intensive care unit in an university hospital. Ten patients within the first 24 h from meeting ARDS criteria, classified as ARDSp or ARDSe in a clinical basis. A deflation PV curve was recorded by means of decreasing steps of continuous positive airway pressure (CPAP) from 35 to 0 cmH(2)O. The simultaneous recording of pressure at the airway opening (Pao), esophageal pressure (Pes) and volumes (V) allows us to trace the Pao-V, Pes-V and transpulmonary pressure (Ptp)-V curves. These data were fitted to a sigmoid model and ARDSp and ARDSe groups were compared. ARDSp has lower lung compliance and higher chest wall compliance than ARDSe (35.9+/-11.3 vs. 77.2+/-50.6 and 199.6+/-44.4 vs. 125.5+/-16.5 ml/cmH(2)O, respectively, Pcurve in ARDSp is shifted down and right with respect to ARDSe. The Ptp-V curve shows a similar displacement. The Pes-V curve in the ARDSp group is, however, shifted to the left. When relative values (percentage to the maximum volume achieved at 35 cmH(2)O) are considered, these differences persist, but, in the Ptp-V curves, are only significant in the low-pressure range. Differences between ARDSp and ARDSe PV curves are present all along the pressure axis and are related to differences not only in the Pes-V curve, but also in the Ptp-V curve.

  10. Clinical features and radiological findings of adenovirus pneumonia associated with progression to acute respiratory distress syndrome: A single center study in 19 adult patients

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Min Jae; Chong, Semin [Dept. of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of); Chung, Myung Jin; Lee, Kyung Soo; KIm, Tae Jung; Kim, Tae Sung; Han, Jung Ho [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-11-15

    To describe radiologic findings of adenovirus pneumonia and to understand clinico-radiological features associated with progression to acute respiratory distress syndrome (ARDS) in patients with adenovirus pneumonia. This study included 19 patients diagnosed with adenovirus pneumonia at a tertiary referral center, in the period between March 2003 and April 2015. Clinical findings were reviewed, and two radiologists assessed imaging findings by consensus. Chi-square, Fisher's exact, and Student's t tests were used for comparing patients with and without subsequent development of ARDS. Of 19 patients, nine were immunocompromised, and 10 were immunocompetent. Twelve patients (63%) progressed to ARDS, six of whom (32%) eventually died from the disease. The average time for progression to ARDS from symptom onset was 9.6 days. Initial chest radiographic findings were normal (n = 2), focal opacity (n = 9), or multifocal or diffuse opacity (n = 8). Computed tomography (CT) findings included bilateral (n = 17) or unilateral (n = 2) ground-glass opacity with consolidation (n = 14) or pleural effusion (n = 11). Patients having subsequent ARDS had a higher probability of pleural effusion and a higher total CT extent compared with the non-ARDS group (p = 0.010 and 0.007, respectively). However, there were no significant differences in clinical variables such as patient age and premorbid condition. Adenovirus pneumonia demonstrates high rates of ARDS and mortality, regardless of patient age and premorbid conditions, in the tertiary care setting. Large disease extent and presence of pleural effusion on CT are factors suggestive of progression to ARDS.

  11. Detrimental ELAVL-1/HuR-dependent GSK3β mRNA stabilization impairs resolution in acute respiratory distress syndrome.

    Directory of Open Access Journals (Sweden)

    Olivia Hoffman

    Full Text Available A hallmark of acute respiratory distress syndrome (ARDS is accumulation of protein-rich edema in the distal airspaces and its removal is critical for patient survival. Previous studies have shown a detrimental role of Glycogen Synthase Kinase (GSK 3β during ARDS via inhibition of alveolar epithelial protein transport. We hypothesized that post-transcriptional regulation of GSK3β could play a functional role in ARDS resolution. To address this hypothesis, we performed an in silico analysis to identify regulatory genes whose expression correlation to GSK3β messenger RNA utilizing two lung cancer cell line array datasets. Among potential regulatory partners of GSK3β, these studies identified the RNA-binding protein ELAVL-1/HuR (Embryonic Lethal, Abnormal Vision, Drosophila-Like as a central component in a likely GSK3β signaling network. ELAVL-1/HuR is a RNA-binding protein that selectively binds to AU-rich elements of mRNA and enhances its stability thereby increasing target gene expression. Subsequent studies with siRNA suppression of ELAVL-1/HuR demonstrated deceased GSK3β mRNA and protein expression and improved clearance of FITC-albumin in A549 cells. Conversely, stabilization of ELAVL-1/HuR with the proteasome inhibitor MG-132 resulted in induction of GSK3β at mRNA and protein level and attenuated FITC-albumin clearance. Utilizing ventilator-induced lung injury or intra-tracheal installation of hydrochloric acid to induce ARDS in mice, we observed increased mRNA and protein expression of ELAVL-1/HuR and GSK3β. Together, our findings indicate a previously unknown interaction between GSK3β and ELAV-1 during ARDS, and suggest the inhibition of the ELAV-1- GSK3β pathways as a novel ARDS treatment approach.

  12. Accuracy and precision of end-expiratory lung-volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome.

    Science.gov (United States)

    Dellamonica, Jean; Lerolle, Nicolas; Sargentini, Cyril; Beduneau, Gaetan; Di Marco, Fabiano; Mercat, Alain; Richard, Jean-Christophe M; Diehl, Jean-Luc; Mancebo, Jordi; Rouby, Jean-Jacques; Lu, Qin; Bernardin, Gilles; Brochard, Laurent

    2011-01-01

    End-expiratory lung volume (EELV) is decreased in acute respiratory distress syndrome (ARDS), and bedside EELV measurement may help to set positive end-expiratory pressure (PEEP). Nitrogen washout/washin for EELV measurement is available at the bedside, but assessments of accuracy and precision in real-life conditions are scant. Our purpose was to (a) assess EELV measurement precision in ARDS patients at two PEEP levels (three pairs of measurements), and (b) compare the changes (Δ) induced by PEEP for total EELV with the PEEP-induced changes in lung volume above functional residual capacity measured with passive spirometry (ΔPEEP-volume). The minimal predicted increase in lung volume was calculated from compliance at low PEEP and ΔPEEP to ensure the validity of lung-volume changes. Thirty-four patients with ARDS were prospectively included in five university-hospital intensive care units. ΔEELV and ΔPEEP volumes were compared between 6 and 15 cm H2O of PEEP. After exclusion of three patients, variability of the nitrogen technique was less than 4%, and the largest difference between measurements was 81 ± 64 ml. ΔEELV and ΔPEEP-volume were only weakly correlated (r2 = 0.47); 95% confidence interval limits, -414 to 608 ml). In four patients with the highest PEEP (≥ 16 cm H2O), ΔEELV was lower than the minimal predicted increase in lung volume, suggesting flawed measurements, possibly due to leaks. Excluding those from the analysis markedly strengthened the correlation between ΔEELV and ΔPEEP volume (r2 = 0.80). In most patients, the EELV technique has good reproducibility and accuracy, even at high PEEP. At high pressures, its accuracy may be limited in case of leaks. The minimal predicted increase in lung volume may help to check for accuracy.

  13. Crystal Structure of a Monomeric Form of Severe Acute Respiratory Syndrome Coronavirus Endonuclease Nsp15 Suggests a Role for Hexamerization As An Allosteric Switch

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, J.S.; Saikatendu, K.S.; Subramanian, V.; Neuman, B.W.; Buchmeier, M.J.; Stevens, R.C.; Kuhn, P.; /Scripps Res. Inst.

    2007-07-09

    Mature nonstructural protein-15 (nsp15) from the severe acute respiratory syndrome coronavirus (SARS-CoV) contains a novel uridylate-specific Mn{sup 2+}-dependent endoribonuclease (NendoU). Structure studies of the full-length form of the obligate hexameric enzyme from two CoVs, SARS-CoV and murine hepatitis virus, and its monomeric homologue, XendoU from Xenopus laevis, combined with mutagenesis studies have implicated several residues in enzymatic activity and the N-terminal domain as the major determinant of hexamerization. However, the tight link between hexamerization and enzyme activity in NendoUs has remained an enigma. Here, we report the structure of a trimmed, monomeric form of SARS-CoV nsp15 (residues 28 to 335) determined to a resolution of 2.9 Angstroms. The catalytic loop (residues 234 to 249) with its two reactive histidines (His 234 and His 249) is dramatically flipped by {approx}120 degrees into the active site cleft. Furthermore, the catalytic nucleophile Lys 289 points in a diametrically opposite direction, a consequence of an outward displacement of the supporting loop (residues 276 to 295). In the full-length hexameric forms, these two loops are packed against each other and are stabilized by intimate intersubunit interactions. Our results support the hypothesis that absence of an adjacent monomer due to deletion of the hexamerization domain is the most likely cause for disruption of the active site, offering a structural basis for why only the hexameric form of this enzyme is active.

  14. Endogenous expression pattern of resolvin D1 in a rat model of self-resolution of lipopolysaccharide-induced acute respiratory distress syndrome and inflammation.

    Science.gov (United States)

    Sun, Wei; Wang, Zai-ping; Gui, Ping; Xia, Weiyi; Xia, Zhengyuan; Zhang, Xing-cai; Deng, Qing-zhu; Xuan, Wei; Marie, Christelle; Wang, Lin-lin; Wu, Qing-ping; Wang, Tingting; Lin, Yun

    2014-11-01

    Resolvin D1 (RvD1), an endogenous lipid mediator derived from docosahexaenoic acid, has been reported to promote a biphasic activity in anti-inflammatory response and regulate inflammatory resolution. The present study aimed to determine the endogenous expression pattern of RvD1 in a rat model of self-resolution of lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) and inflammation. The ARDS model was induced by administrating LPS (2mg/kg) via tracheotomy in 138 male Sprague-Dawley rats. At specified time points, lung injury and inflammation were respectively assessed by lung histology and analysis of bronchoalveolar lavage fluid and cytokine levels. The expression of endogenous RvD1 was detected by high performance liquid chromatography and tandem mass spectrometry. The results showed that histological lung injury peaked between 6h (LPS6h) and day 3, followed by recovery over 4-10 days after LPS administration. Lung tissue polymorph nuclear cell (PMN) was significantly increased at LPS6h, and peaked between 6h to day 2. The levels of interleukin (IL)-6 and IL-10 were significantly increased at LPS6h and remained higher over day 10 as compared to baseline. Intriguingly, the endogenous RvD1 expression was decreased gradually during the first 3 days, followed by almost completely recovery over days 9-10. The finding indicated that endogenous RvD1 underwent a decrease in expression followed by gradual increase that was basically coincident with the lung injury recovery in a rat model of self-resolution LPS-induced ARDS and inflammation. Our results may help define the optimal therapeutic window for endogenous RvD1 to prevent or treat LPS-induced ARDS and inflammation. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    Science.gov (United States)

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research in the rapidly growing field of molecular biology. The story of SARS illustrates vividly some NOS features advocated in the school science curriculum, including the tentative nature of scientific knowledge, theory-laden observation and interpretation, multiplicity of approaches adopted in scientific inquiry, the inter-relationship between science and technology, and the nexus of science, politics, social and cultural practices. The story also provided some insights into a number of NOS features less emphasised in the school curriculum—for example, the need to combine and coordinate expertise in a number of scientific fields, the intense competition between research groups (suspended during the SARS crisis), the significance of affective issues relating to intellectual honesty and the courage to challenge authority, the pressure of funding issues on the conduct of research and the ‘peace of mind’ of researchers, These less emphasised elements provided empirical evidence that NOS knowledge, like scientific knowledge itself, changes over time. They reflected the need for teachers and curriculum planners to revisit and reconsider whether the features of NOS currently included in the school science curriculum are fully reflective of the practice of science in the 21st century. In this paper, we also report on how we made use of extracts from the news reports and documentaries on SARS, together with episodes from the scientists’ interviews, to develop a multimedia instructional package for explicitly teaching the prominent features of NOS and scientific inquiry identified in the SARS research.

  16. 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

    Directory of Open Access Journals (Sweden)

    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.

  17. The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition.

    Science.gov (United States)

    Cartotto, Robert; Li, Zeyu; Hanna, Steven; Spano, Stefania; Wood, Donna; Chung, Karen; Camacho, Fernando

    2016-11-01

    The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted

  18. Acute respiratory infections among returning Hajj pilgrims-Jordan, 2014.

    Science.gov (United States)

    Al-Abdallat, Mohammad Mousa; Rha, Brian; Alqasrawi, Sultan; Payne, Daniel C; Iblan, Ibrahim; Binder, Alison M; Haddadin, Aktham; Nsour, Mohannad Al; Alsanouri, Tarek; Mofleh, Jawad; Whitaker, Brett; Lindstrom, Stephen L; Tong, Suxiang; Ali, Sami Sheikh; Dahl, Rebecca Moritz; Berman, LaShondra; Zhang, Jing; Erdman, Dean D; Gerber, Susan I

    2017-04-01

    The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) has prompted enhanced surveillance for respiratory infections among pilgrims returning from the Hajj, one of the largest annual mass gatherings in the world. To describe the epidemiology and etiologies of respiratory illnesses among pilgrims returning to Jordan after the 2014 Hajj. Surveillance for respiratory illness among pilgrims returning to Jordan after the 2014 Hajj was conducted at sentinel health care facilities using epidemiologic surveys and molecular diagnostic testing of upper respiratory specimens for multiple respiratory pathogens, including MERS-CoV. Among the 125 subjects, 58% tested positive for at least one virus; 47% tested positive for rhino/enterovirus. No cases of MERS-CoV were detected. The majority of pilgrims returning to Jordan from the 2014 Hajj with respiratory illness were determined to have a viral etiology, but none were due to MERS-CoV. A greater understanding of the epidemiology of acute respiratory infections among returning travelers to other countries after Hajj should help optimize surveillance systems and inform public health response practices. Published by Elsevier B.V.

  19. Porcine Reproductive and Respiratory Syndrome Virus (PRRSV)

    DEFF Research Database (Denmark)

    Kvisgaard, Lise Kirstine

    This PhD thesis presents the diversity of Porcine Reproductive and Respiratory Syndrome viruses (PRRSV) circulating in the Danish pig population. PRRS is a disease in pigs caused by the PRRS virus resulting in reproductive failures in sows and gilts and respiratory diseases in pigs . Due to genetic...

  20. Human herpesviruses respiratory infections in patients with acute respiratory distress (ARDS).

    Science.gov (United States)

    Bonizzoli, Manuela; Arvia, Rosaria; di Valvasone, Simona; Liotta, Francesco; Zakrzewska, Krystyna; Azzi, Alberta; Peris, Adriano

    2016-08-01

    Acute respiratory distress syndrome (ARDS) is today a leading cause of hospitalization in intensive care unit (ICU). ARDS and pneumonia are closely related to critically ill patients; however, the etiologic agent is not always identified. The presence of human herpes simplex virus 1, human cytomegalovirus and Epstein-Barr virus in respiratory samples of critically ill patients is increasingly reported even without canonical immunosuppression. The main aim of this study was to better understand the significance of herpesviruses finding in lower respiratory tract of ARDS patients hospitalized in ICU. The presence of this group of herpesviruses, in addition to the research of influenza viruses and other common respiratory viruses, was investigated in respiratory samples from 54 patients hospitalized in ICU, without a known microbiological causative agent. Moreover, the immunophenotype of each patient was analyzed. Herpesviruses DNA presence in the lower respiratory tract seemed not attributable to an impaired immunophenotype, whereas a significant correlation was observed between herpesviruses positivity and influenza virus infection. A higher ICU mortality was significantly related to the presence of herpesvirus infection in the lower respiratory tract as well as to impaired immunophenotype, as patients with poor outcome showed severe lymphopenia, affecting in particular T (CD3+) cells, since the first days of ICU hospitalization. In conclusion, these results indicate that herpesviruses lower respiratory tract infection, which occurs more frequently following influenza virus infection, can be a negative prognostic marker. An independent risk factor for ICU patients with ARDS is an impaired immunophenotype.

  1. Acute compartment syndrome.

    Science.gov (United States)

    Via, Alessio Giai; Oliva, Francesco; Spoliti, Marco; Maffulli, Nicola

    2015-01-01

    acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure - ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves. acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS.

  2. Acute compartment syndrome

    Science.gov (United States)

    Via, Alessio Giai; Oliva, Francesco; Spoliti, Marco; Maffulli, Nicola

    2015-01-01

    Summary Background: acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure – ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves. Conclusion: acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS. PMID:25878982

  3. O manejo da síndrome do desconforto respiratório agudo Management of the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Alexandre Tellechea Rotta

    2003-11-01

    Full Text Available OBJETIVO: Revisar as atuais estratégias de suporte e de tratamento da síndrome do desconforto respiratório agudo (SDRA. FONTE DOS DADOS: Dados próprios de nosso laboratório de pesquisa e bibliografia relacionada às áreas de SDRA e lesão pulmonar aguda, pesquisados através do Medline. SÍNTESE DOS DADOS: Apesar de avanços no entendimento da sua patogênese, a SDRA ainda resulta em significativa morbidade e mortalidade. A ventilação mecânica é a principal modalidade terapêutica na SDRA, sendo atualmente considerada não mais apenas uma medida de suporte, mas sim uma terapia capaz de alterar o curso da patologia. Novas estratégias ventilatórias, como a ventilação oscilatória de alta freqüência (VOAF, têm-se mostrado promissoras. Neste texto, revisamos o conhecimento atual no manejo da SDRA, incluindo ventilação mecânica convencional e não convencional, uso de surfactante, óxido nítrico, moduladores do processo inflamatório, oxigenação extracorpórea e posição prona. CONCLUSÕES: A última década foi marcada por avanços significativos, como o conceito de ventilação mecânica protetora na SDRA. O benefício da aplicação de estratégias alternativas, como a VOAF, assim como do uso do surfactante exógeno e moduladores de inflamação continuam sendo alvo de estudo.OBJECTIVE: To review the current support and treatment strategies of the Acute Respiratory Distress Syndrome (ARDS DATA SOURCES: Original data from our research laboratory and from representative scientific articles on ARDS and acute lung Injury searched through Medline. SUMMARY OF THE FINDINGS: Despite advances in the understanding of the pathogenesis of ARDS, this syndrome still results in significant morbidity and mortality. Mechanical ventilation, the main therapeutic modality for ARDS, is no longer considered simply a support modality, but a therapy capable of influencing the course of the disease. New ventilation strategies, such as high

  4. Environmental determinants of acute respiratory symptoms and ...

    African Journals Online (AJOL)

    Environmental determinants of acute respiratory symptoms and diarrhoea in young coloured children living in urban and peri-urban areas of South Africa. ... access to essential environmental health services in urban areas and improvements in the educational status of women are urgently needed if childhood infections are ...

  5. Environmental determinants of acute respiratory symptoms and ...

    African Journals Online (AJOL)

    1991-04-20

    Apr 20, 1991 ... acute respiratory symptoms in South African coloured child- ren. A multistage ... epidemiological assessment of the effects of urban environments .... Flush inside. 908. 74,7. Flush outside. 207. 17,0. Communal flush. 23. 1,9. Own bucket system. 60. 4,9. Communal bucket system. 7. 0,6. Pit latrine. 6. 0,5.

  6. Meditation or Exercise May Help Acute Respiratory Infections

    Science.gov (United States)

    ... R S T U V W X Y Z Meditation or Exercise May Help Acute Respiratory Infections, Study ... According to a recent study, exercising or practicing meditation may be effective in reducing acute respiratory infections. ...

  7. Noninvasive ventilation for acute respiratory failure.

    Science.gov (United States)

    Jasmer, R M; Matthay, M A

    2000-01-01

    Noninvasive ventilation refers to any form of ventilatory support applied without the use of an endotracheal tube. It offers the potential to provide primary treatment for acute respiratory failure while avoiding complications associated with mechanical ventilation with endotracheal intubation. Noninvasive ventilation has been most commonly studied in hypercapnic respiratory failure. A review of randomized, controlled studies shows mixed results and methodologic limitations affect the interpretation of current evidence. Patient selection is clearly the most important issue in considering noninvasive ventilation for acute respiratory failure. Unfortunately, patients who benefit from noninvasive ventilation represent only a minority of the total group with any one disease, and thus it is difficult to make broad conclusions concerning applicability of this treatment modality. Future studies are needed to focus on determining the specific patient populations who will benefit the most, evaluating the optimal ventilatory mode and mask for providing noninvasive ventilation, and clarifying its impact on clinical outcomes.

  8. [Acute aortic syndrome].

    Science.gov (United States)

    Nienaber, Christoph A

    2016-06-01

    Acute aortic syndrome is the common denominator for acute events to the aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure). © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    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

  10. Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study.

    Science.gov (United States)

    Zhang, Ruyang; Wang, Zhaoxi; Tejera, Paula; Frank, Angela J; Wei, Yongyue; Su, Li; Zhu, Zhaozhong; Guo, Yichen; Chen, Feng; Bajwa, Ednan K; Thompson, B Taylor; Christiani, David C

    2017-03-01

    To evaluate the association between acute respiratory distress syndrome (ARDS) onset time and prognosis. Patients with moderate to severe ARDS (N = 876) were randomly assigned into derivation (N = 520) and validation (N = 356) datasets. Both 28-day and 60-day survival times after ARDS onset were analyzed. A data-driven cutoff point between early- and late-onset ARDS was determined on the basis of mortality risk effects of onset times. We estimated the hazard ratio (HR) and odds ratio (OR) of late-onset ARDS using a multivariate Cox proportional hazards model of survival time and a multivariate logistic regression model of mortality rate, respectively. Late-onset ARDS, defined as onset over 48 h after intensive care unit (ICU) admission (N = 273, 31%), was associated with shorter 28-day survival time: HR = 2.24, 95% CI 1.48-3.39, P = 1.24 × 10-4 (derivation); HR = 2.16, 95% CI 1.33-3.51, P = 1.95 × 10-3 (validation); and HR = 2.00, 95% CI 1.47-2.72, P = 1.10 × 10-5 (combined dataset). Late-onset ARDS was also associated with shorter 60-day survival time: HR = 1.70, 95% CI 1.16-2.48, P = 6.62 × 10-3 (derivation); HR = 1.78, 95% CI 1.15-2.75, P = 9.80 × 10-3 (validation); and HR = 1.59, 95% CI 1.20-2.10, P = 1.22 × 10-3 (combined dataset). Meanwhile, late-onset ARDS was associated with higher 28-day mortality rate (OR = 1.46, 95% CI 1.04-2.06, P = 0.0305) and 60-day mortality rate (OR = 1.44, 95% CI 1.03-2.02, P = 0.0313). Late-onset moderate to severe ARDS patients had both shorter survival time and higher mortality rate in 28-day and 60-day observations.

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

    Directory of Open Access Journals (Sweden)

    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

  12. PREVENTION OF ACUTE RESPIRATORY INFECTIONS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    O.V. Karneeva

    2009-01-01

    Full Text Available The issue of inflammatory diseases of the upper airways and eardrum remains relevant and associated both with high prevalence of this pathology and likelihood of developing complications. Inflammation of nasal cavity’s mucosal lining causes discomfort, while chronic dysfunction of nasal breathing significantly reduces the patient’s quality of life. Difficulty in nasal breathing of newborns and infants results in quite severe complications. Nearly 70% of acute respiratory infections cases in children are complicated with acute inflammation of eardrum, 90% of children under 3 years once develop secretory otitis media, 50% of them have several cases of eardrum inflammation.Key words: acute respiratory infections, otitis, treatment, children.