Acute Distress Syndrome Research Articles

Invasive Mechanical Ventilation in Traumatic Brain Injured Patients with Acute Respiratory Failure.

Patients with severe traumatic brain injury (TBI) need to be admitted to intensive care (ICU) because they require invasive mechanical ventilation (IMV) due to reduced consciousness resulting in loss of protective airway reflexes, reduced ability to cough and altered breathing control. In addition, these patients can be complicated by pneumonia and acute distress syndrome (ARDS). IMV allows these patients to be sedated, decreasing intracranial pressure and ensuring an adequate oxygen delivery and tight control of arterial carbon dioxide tension. However, IMV can also cause dangerous effects on the brain due to its interaction with intrathoracic and intracranial compartments. Moreover, when TBI is complicated by ARDS, the setting of mechanical ventilation can be very difficult as ventilator goals are often different and in conflict with each other. Consequently, close brain and respiratory monitoring is essential to reduce morbidity and mortality in mechanically ventilated patients with severe TBI and ARDS. Recently, recommendations for the setting of mechanical ventilation in patients with acute brain injury (ABI) were issued by the European Society of Intensive Care Medicine (ESICM). However, there is insufficient evidence regarding ventilation strategies for patients with ARDS associated with ABI. The purpose of this paper is to analyze in detail respiratory strategies and targets in patients with TBI associated with ARDS.

Features of Damage to Vital Organs Due to SARS-CoV-2 Infection

SARS-CoV-2 infection continues to be relevant for healthcare systems because it is widespread and characterized by systemic lesions . Complications of the disease primarily affect the respiratory , cardiovascular and urinary systems . In severe cases , secondary infection may join and acute distress syndrome may develop . The most formidable complication , with a high frequency leading to the death of patients , is multiple organ failure . Undoubtedly , the presence of concomitant pathology in the patient has a negative impact on the course of COVID-19 and affects the prognosis of the disease , which requires special attention in clinical practice for their detection and rapid response in order to optimize therapy . The spectrum of complications is very wide . From the cardiovascular system , these are myocarditis , acute myocardial infarction , thromboembolic events . Acute kidney injury and / or worsening of the course of chronic kidney disease also often develops . This review examines several issues related to the defeat of vital organs , various clinical variants of the course of the disease . Particular attention is paid to the damage of the kidneys and cardiovascular system , as the most vulnerable systems for the SARS-CoV-2 virus .

A glance on severe acute respiratory syndrome coronavirus 2 (SARS COV-2): A brief review

“coronavirus disease 2019” is a highly contagious and infectious illness and cause globally acute upper respiratory systemic disease at latest 2019, major causing agent is “coronavirus-2” descent; also called “SARS COV-2”. A “coronavirus” have a lower mortality in parallel with others, (SA.RS..-CoV and ME.RS-CoV). In majority of people illness is in medium state; nevertheless, pneumonia may be develop, acute distress syndrome (AR.DS), and dysfunction in multiple organs (typically the aged and who having several other illness). many people are asymptomatic, while around 20% have moderate-to-severe illness. In current topic, can summarize the virologic basic of “coronavirus”, which includes clinical features, ligand usage, mutations, epidemiology, pathogenesis, and highlighting its significant differences from previously known coronaviruses.

COVID‐19 Pandemic: Management and Challenges

Background: Coronavirus Disease 2019 (COVID-19) is an ongoing pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2). The outbreak was first identified in Wuhan, China, in December 2019. Objectives: This review gives a bird’s-eye view of the COVID-19 pandemic and its various effects on human society. Since knowledge about this virus is rapidly evolving, readers are urged to update themselves regularly. Methods: In this review, our searching was performed on international databases of Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) from October 2019 to June 2020. Results: Most patients infected with COVID‑19 have mild symptoms. Approximately 15% of patients have severe pneumonia, and about 5% acute distress syndrome or organ failure. In the absence of definitive treatment and vaccines, the most effective measure is to prevent infection, particularly in those at high risk of taking the severe form of the disease with adverse outcomes. Pharmacotherapy is essentially supportive; the role of antiviral agents is yet to be established. The commonest drugs used in treating this viral disease are tocilizumab, remdesivir, favipiravir, and camostat mesilate. Also, drugs related to malaria, AIDS, and Ebola, such as hydroxychloroquine, are widely used. Based on physical examinations alone, it is impossible to comment with certainty in mild cases of the disease. Accordingly, a wide range of methods is used for diagnosing and treating the disease. Various variables in reducing the severity of the epidemic and the effects of the virus require special management at the national, regional, and global levels. Conclusion: This review summarizes the latest findings in safety, management, and public services related to the COVID-19 virus epidemic.

First case of low-dose umbilical cord blood therapy for pediatric acute respiratory distress syndrome induced by Pneumocystis carinii pneumonia

ObjectiveThis study aimed to present the case of a boy with acute distress syndrome (ARDS) treated with low-dose umbilical cord blood (UCB) therapy and explore the underlying possible mechanism.MethodsA 7-year-old boy with severe Pneumocystis carinii pneumonia and severe ARDS was treated with allogeneic UCB as salvage therapy.ResultsThe patient did not improve after being treated with lung protective ventilation, pulmonary surfactant replacement, and extracorporeal membrane oxygenation (ECMO) for 30 days. However, his disease reversed 5 days after allogeneic UCB infusion, and he weaned from ECMO after 7 days of infusion. Bioinformatics confirmed that his Toll-like receptor (TLR) was abnormal before UCB infusion. However, after the infusion, his immune system was activated and repaired, and the TLR4/MyD88/NF-κB signaling pathway was recovered.ConclusionAllogenic UCB could treat ARDS by repairing the TLR4/MyD88/NF-κB signaling pathway, thereby achieving stability of the immune system.

ROLE OF ACE2 GLYCOSYLATION AND RHO KINASE INHIBITION IN THE INFECTIOUS/THERAPEUTIC PROCESS OF COVID-19. INSIGHTS FROM GITELMAN'S AND BARTTER'S SYNDROMES PATIENTS

Objective: ACE2 in addition to be the counterregulatory enzyme in RAS system, is the entry point of SARS-CoV-2. Several studies have reported its protective role in SARS-CoV-2-induced Acute Distress Syndrome (ARDS) and a relationship between Rho kinase (ROCK), ARDS and increased ACE2 levels induced by ROCK inhibitors. Cells’ ACE2 expression is in two different immunoreactive forms, glycosylated and unglycosylated, but only the glycosylated is associated with viral binding. ACE2-glycosylation is driven by the acidic pH of intracellular endosomes/lysosomes/Golgi vesicles and this represents the rational to the prophylactic/therapeutic use of antimalarial drugs as hydroxychloroquine/chloroquine, weak bases that increase the pH of vesicles, which leads to the production of unglycosylated ACE2 and therefore reduction/inhibition of viral binding. Gitelman's and Bartter's syndrome patients (GS/BS) (rare genetic tubulopathies) have activated RAS, high Ang II yet normotension/hypotension, metabolic alkalosis, increased and related ACE2 and its product Ang 1–7 levels, reduced ROCK activity therefore may provide information on the protective role of increased ACE2 levels and ROCK inhibition. This study has assessesed the impact of COVID-19 on GS/BS Design and method: We performed a telephone survey on more than 100 GS/BS from the hotspots of COVID-19 pandemic in Northern Italy (Veneto, Lombardia, Emilia Romagna). COVID-19 prevalence in the general population was obtained from Civil Protection's official data and the estimated prevalence from published data. 95% CI values processed with Clopper-Pearson method using R-software Results: None of GS/BS reported infection/symptoms of COVID-19, which was statistically not significant vs the prevalence of COVID-19 in the general population in the Italian hotspots due to the low prevalence of GS/ BS (rare diseases) (95% CI 0.0 -3.0% vs 0.65%, 95% CI 0.6–0.7%). It becomes significant vs the estimated prevalence in the general population in the hotspot regions (8.7%, 95% CI 8.7–8.8%, (C2), p = 0.004) Conclusions: GS/BS might serve as a human model of increased ACE2 for ex-vivo mechanistic investigation on viral binding; provide additional evidence on the absence of high ACE2 levels-increased risk of COVID-19; demonstrate that suspension of treatments with ACE inhibitors/ARBs, which increase ACE2 expression, to reduce the risk of infection is not rationale.

Some pathomorphological peculiarities of acute distress-syndrome in case of the large intestine cancer, complicated by acute prevalent peritonitis

Some pathomorphological peculiarities of acute distress-syndrome in case of the large intestine cancer, complicated by acute prevalent peritonitis

Extracorporeal Membrane Oxygenation (ECMO) treatment and physiotherapy of the patient with Acute Distress Syndrome (ARDS)

Extracorporeal Membrane Oxygenation (ECMO) treatment and physiotherapy of the patient with Acute Distress Syndrome (ARDS)

Pulmonary expansion and disobstruction maneuver with a closed system in patients with acute lung injury and acute distress syndrome, and its effect on gas exchange

Respiratory physiotherapy is ever more utilized for the treatment of critical patients. However, it is known that there are few studies on the effect on gas exchange in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and physiotherapy techniques. The purpose of this study was to assess the effect of a pulmonary expansion and disobstruction maneuver with a closed system on the gas exchange of patients with ALI and ARDS.

Extended operations after induction therapy for stage IIIb (T4) non-small cell lung cancer

Twenty-three patients with stage IIIb (T4) non-small cell lung cancer received induction chemotherapy (median, 2 cycles) with (n = 12) or without (n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved the carina (n = 8) or lateral trachéal wall (n = 1), 11 were located centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3), or both (n = 2), three were apical tumors involving T4 structures, and six were associated with historically diseased mediastinal nodes. Five complete and 18 partial responses were observed after induction treatment. Resection of all residual tumor at the primary site and involved vestiges was possible in 21 patients (91%); in two apical tumors, tumor was left behind. Nine right tracheal sleeve and 11 intrapericardial pneumonectomies and three resections of apical rumors were performed; 11 patients (48%) had radical mediastinal lymph node dissection. Complete sterilization of the primary tumor was observed in 3 patients (13%). Mean operating time was 209.3 ± 86.8 minutes, and mean blood loss was 896.9 ± 1031 mL. Major postoperative complications occurred in 6 patients (26%), including hemothorax requiring drainage (n = 1) or reoperation (n = 1), acute distress syndrome (n = 2), and bronchopleural fistula (n = 2), and their incidence was significantly higher ( p = 0.003) among patients receiving induction chemoradiation than among those receiving chemotherapy alone (42 versus 9%). Early (<1 month) postt oerative mortality was 8.6% (n = 2). With a median follow-up of 25 months (range, 12 to more than 39 months), the projected 3-year overall survival was 54%. Further follow-up will define whether this aggressive approach should become standard care for selected IIIb (T4) non-small cell lung cancer patients.