Acute Respiratory Stress Research Articles

Relationship Between SpO2/FiO2 Ratio to Community Acquired Pneumonia Patient Outcomes at Kolonel Abunjani Bangko General Hospital

Background: Acute lower respiratory tract infection causes high morbidity and mortality, which can be found in the form of pneumonia. Community acquired pneumonia (CAP) severe pneumonia can lead to acute respiratory distress. To diagnose acute respiratory disorders, namely Acute Lung Injury (ALI) and Acute Respiratory Stress Syndrome (ARDS), the ratio PaO2/FiO2 is used. This requires invasive action by taking an arterial blood sample, which is expensive and not available in all health facilities. An alternative is pulse oximetry, which measures the SpO2/FiO2 ratio and is available in health facilities. It is inexpensive and non-invasive. This study aims to determine the relationship between SpO2 and FiO2 with the outcome of community pneumonia patients at Kolonel Abunjani Bangko Hospital. Method: The study design was a retrospective descriptive cross-sectional design. The research subjects were a total sampling of medical record data from inpatients with community acquired pneumonia for the period January-December 2022. The study variables included gender, age, SpO2/FiO2 ratio, and outcomes of pneumonia patients. Univariate and bivariate statistical tests were used to analyze the data. Results: In this study, there were 43 subjects who met the inclusion criteria. The distribution of inpatient community acquired pneumonia patients, especially in the gender was mostly male (67.4%), the highest age was 56–65 years and >65 years (both 37.2%), the median SpO2 was 94% (36-99%), the median SpO2/FiO2 ratio was 447 (171-471%), the highest outcomes were alive patients (36 patients). The ratio of SpO2/FiO2 >316 was the majority (33 patients). Based on the relationship between the SpO2/FiO2 ratio and the outcome of CAP with alive outcome was a SpO2/FiO2 ratio >236 was more numerous than SpO2/FiO2 ratio <236 with value of P=0.0005. Conclusion: There is a significant relationship between the SpO2/FiO2 ratio and the outcome of community acquired pneumonia patients at Kolonel Abundjani Hospital Bangko.

Inhaled nitric oxide as rescue therapy in severe ARDS cases due to COVID-19 pneumonia: a single center experience.

Inhaled NO (iNO) has been recommended as rescue therapy in acute respiratory stress syndrome (ARDS) cases. In this study, we aimed to demonstrate the efficacy of iNO as a rescue therapy in patients with severe ARDS due to COVID-19. This retrospective study included patients with ARDS due to COVID-19 who were treated with iNO between March 2020 and January 2022 in the intensive care unit (ICU) of Inonu University. Patients' files were reviewed retrospectively, and demographic data, APACHE II and Sequential Organ Failure Assessment (SOFA) scores, initiation day of iNO and duration of iNO treatment, length of stay in hospital/ICU, blood biochemistry values, complete blood counts, inflammatory parameters, arterial blood gas values, lactate, PaO2/FiO2 ratios, anti-inflammatory drugs and outcome were recorded. Data from 16 patients were reached. iNO was given at a dose of 20 ppm continuously. The mean duration of treatment with iNO was 3.5 days. All patients took the prone position except a single patient. While all patients received steroid therapy, four patients received anti-cytokine therapy, and five patients received intravenous immunoglobulin therapy. All patients were in severe ARDS with a mean PaO2/FiO2 ratio of 58 before iNO therapy. A significant increase in PaO2/FiO2 values was detected with the use of iNO (p<0.05). While three patients (19%) were discharged from the ICU, thirteen patients died. In our study, it was determined that iNO applied as a rescue treatment in patients with severe ARDS improved oxygenation. Although the effect of iNO on survival was low, it may be interpreted as clinically significant considering the severity of the general clinical condition of the patients.

Platelet activation and ferroptosis mediated NETosis drives heme induced pulmonary thrombosis

Cell-free heme (CFH) is a product of hemoglobin, myoglobin and hemoprotein degradation, which is a hallmark of pathologies associated with extensive hemolysis and tissue damage. CHF and iron collectively induce cytokine storm, lung injury, respiratory distress and infection susceptibility in the lungs suggesting their key role in the progression of lung disease pathology. We have previously demonstrated that heme-mediated reactive oxygen species (ROS) induces platelet activation and ferroptosis. However, interaction of ferroptotic platelets and neutrophils, the mechanism of action and associated complications remain unclear. In this study, we demonstrate that heme-induced P-selectin expression and Phosphatidylserine (PS) externalization in platelets via ASK-1-inflammasome axis increases platelet-neutrophil aggregates in circulation, resulting in Neutrophil extracellular traps (NET) formation in vitro and in vivo. Further, heme-induced platelet activation in mice increased platelet-neutrophil aggregates and accumulation of NETs in the lungs causing pulmonary damage. Thus, connecting CFH-mediated platelet activation to NETosis and pulmonary thrombosis. As lung infections induce acute respiratory stress, thrombosis and NETosis, we propose that heme -mediated platelet activation and ferroptosis might be crucial in such clinical manifestations. Further, considering the ability of redox modulators and ferroptosis inhibitors like FS-1, Lpx-1 and DFO to inhibit heme-induced ferroptotic platelets-mediated NETosis and pulmonary thrombosis. They could be potential adjuvant therapy to regulate respiratory distress-associated clinical complications.

Ost-COVID-19 Syndrome - case report

Background: Coronaviruses are enveloped RNA viruses that are widely distributed among humans and other mammals and birds causing respiratory, enteric, liver, and neurological diseases. At the end of December 2019, a group of patients with pneumonia of unknown etiology were registered, where a new virus called SARS-CoV-2 was later presented, and the disease it causes, COVID-19. The main clinical manifestations of this virus are fever, dry cough, dyspnea and acute respiratory stress. Many subjects have mild symptoms, such as headache, non-productive cough, fatigue, myalgia, and anosmia. The recovery time from this disease and the reasons why the sequelae it leaves vary so much between patients is still unknown. Symptoms and clinical manifestations after SARS-CoV-2 / COVID-19 infection have appeared in many survivors and are similar to those of fatigue after Severe Acute Respiratory Syndrome. The most commonly reported symptoms are fatigue, anxiety, joint pain, ongoing headache, chest pain, dementia, depression, and dyspnea. The NICE guideline defines post-COVID-19 syndrome as the set of signs and symptoms that develop during or after an infection compatible with COVID-19 that continues for more than 12 weeks and is not explained by an alternative diagnosis. Post-COVID-19 syndrome has the characteristic that its symptoms cause a disability, which is why it generates a great impact on the individual, the care, and rehabilitation units. Purpose: The objective of this report is to present a clinical case of a patient with the post-COVID-19 syndrome and its management. Materials and methods: This is a 57-year-old female patient, with a previous history that in June 2021 began with a clinical picture consisting of asthenia, adynamia, anosmia, ageusia, headache, myoarthralgia, nausea, cough chest and lumbar pain, for which the PCR test for SARS-CoV-2 was performed, which was positive, his clinical picture worsened at home, for which he consulted an emergency service in the city of Palmira, Valle del Cauca (Colombia). Subsequently, they conclude through paraclinical SARS-CoV-2 infection plus bacterial pneumonia due to Klebsiella pneumoniae, for which she is transferred to the hospitalization room and treatment with antibiotics is started, however, At the beginning of July, the patient maintained hemodynamic and ventilatory stability, without cardiovascular support, but still with minimal ventilatory support, with oximetry goals, so it was decided to start the gradual withdrawal of sedatives in favor of spontaneous modes of mechanical ventilation. On July 6, the patient tolerates extubation with the transition to non-invasive mechanical ventilation and a decision was made to transfer to hospitalization. Then, on July 15, a patient was seen in acceptable general conditions, with support even by nasal cannula, on physical examination with attenuated vesicular murmur with declining rales, for which it was decided to discharge. Results: Currently, the patient manifests 15 symptoms 4 months after her discharge from the clinic. Conclusions: The post-COVID-19 patient must have an individual and comprehensive rehabilitation, which takes into account their needs, since this syndrome varies from person to person, it must be an early rehabilitation so as not to decrease the functionality of the patient, and does not deteriorate their physical or mental health. The great challenge identified in the midst of the pandemic is that work must be done to build an improved and strengthened health system, where true integration and coordination between levels of care, primary care, and hospital care is achieved.

618 Clinical conditions and echocariographic parameters associated with mortality in COVID-19

AimsCoronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis, and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19.Methods and resultsThis is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020, were included into the study population. The association between baseline variables and the risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses. Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. The mean age was 68.9 ± 13.9 years and male sex was reported in 141 patients (62.4%). Admission in intensive care unit was required for 72 patients (31.9%); in-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < 0.001), tricuspid annular plane systolic excursion (TAPSE, P < 0.001), and ARDS (P < 0.001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs. those without ARDS (HR: 7.66; CI: 3.95–14.8), in patients with TAPSE ≤ 17 mm vs. those with TAPSE > 17 mm (HR: 5.08; CI: 3.15–8.19), and in patients with LVEF ≤ 50% vs. those with LVEF > 50% (HR: 4.06; CI: 2.50–6.59) (Figure).ConclusionsTTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF as well as reduced TAPSE may help to identify patients at higher risk of death during hospitalization. Our preliminary findings need to be confirmed in larger, prospective studies.618 Figure 1

Long Term Effect of COVID-19 on the Brain: Review

Corona viruses (CoVs) are well-covered RNA viruses that cause enteric and respiratory infections in humans and animals. Many human CoVs have recently gained global interest because of their lethal power and high contagious power. SARS-CoV-2, or COVID-19, is a pathogenic coV that first appeared in Wuhan, China.&#x0D; Corona virus Disease 2019 (COVID-19) created by SARS-CoV-2, has been declared as pandemic by the World Health Organization since March 11, 2020. The epidemic started in Wuhan and spread rapidly around the world. Corona virus is facing a major epidemic: Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS-CoV-2 is a virus closely related to SARS.&#x0D; Corona virus (COVID-19) is caused by SARS-CoV-2 VIRUS, a complex clinical disorder characterized by severe pneumonia and acute respiratory stress syndrome. Serious and neurological disorders, such as encephalitis, coma, fever, epilepsy, and Guillain-Barré syndrome, are more common in cases of COVID-19. In addition, chronic autoimmune and neurodegenerative diseases may occur in SARS-CoV-2 immunopathology and colonization of intestinal and central nervous system, as well as systemic inflammatory response during COVID-19. Parkinson's disease is a common neurodegenerative condition that causes the development of motor and non-motor symptoms.

Clinical conditions and echocardiographic parameters associated with mortality in COVID-19.

BackgroundCoronavirus disease 2019 (COVID‐19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in‐hospital mortality in COVID‐19.MethodsThis is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID‐19 from 1 March to 22 April 2020 were included into study population. The association between baseline variables and risk of in‐hospital mortality was assessed through multivariable logistic regression and competing risk analyses.ResultsOut of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID‐19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. In‐hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P < .001), tricuspid annular plane systolic excursion (TAPSE, P < .001) and ARDS (P < .001) were independently associated with in‐hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs those without ARDS (HR: 7.66; CI: 3.95‐14.8), in patients with TAPSE ≤17 mm vs those with TAPSE >17 mm (HR: 5.08; CI: 3.15‐8.19) and in patients with LVEF ≤50% vs those with LVEF >50% (HR: 4.06; CI: 2.50‐6.59).ConclusionsTTE might be a useful tool in risk stratification of patients with COVID‐19. In particular, reduced LVEF and reduced TAPSE may help to identify patients at higher risk of death during hospitalization.

COVID-19 Pandemic: Epidemiology, Etiology, Conventional and Non-Conventional Therapies.

Coronavirus disease 2019 (COVID-19), which reported in an outbreak in 2019 in Wuhan, Hubei province, China, is caused by the SARS-CoV-2 virus. The virus belongs to the beta-coronavirus class, along with the Middle East Respiratory Syndrome coronavirus and Severe Acute Respiratory Syndrome coronavirus. Interestingly, the virus binds with angiotensin-converting enzyme-2 found in host cells, through the spike (S) protein that exists on its surface. This binding causes the entry of the virus into cells of the host organism. The actual mechanism used by the COVID-19 virus to induce disease is still speculative. A total of 44,322,504 cases, a 1,173,189 death toll and 32,486,703 recovery cases have been reported in 217 countries globally as of 28 October 2020. Symptoms from the infection of the virus include chest pain, fever, fatigue, nausea, and others. Acute respiratory stress syndrome, arrhythmia, and shock are some of the chronic manifestations recorded in severe COVID-19. Transmission is majorly by individual-to-individual through coughing, sneezing, etc. The lack of knowledge regarding the mechanism of and immune response to the virus has posed a challenge in the development of a novel drug and vaccine. Currently, treatment of the disease involves the use of anti-viral medications such as lopinavir, remdesivir, and other drugs. These drugs show some efficacy in the management of COVID-19. Studies are still on-going for the development of an ideal and novel drug for treatment. In terms of natural product intervention, Traditional Chinese Medicines (TCM) have been employed to alleviate the clinical manifestation and severity of the disease and have shown some efficacy. This review presents an updated detailed overview of COVID-19 and the virus, concerning its structure, epidemiology, symptoms and transmission, immune responses, and current interventions, and highlights the potential of TCM. It is anticipated that this review will further add to the understanding of COVID-19 and the virus, hence opening new research perspectives.

Abstract CT405: Experience in using oncology drugs in patients with COVID-19

Abstract In relation to the spread of severe acute respiratory syndrome coronavirus 2 (SARS CoV2), oncologists need to face some difficult situations. First of all, safety considerations about cancer patients during this pandemia. To keep safe both patients and healthy workers is the most important rule. In our daily practice we adopted a specific policy about the conduct of our clinical managements of melanoma patients, in order to minimise the risk of any potential exposure. We are prioritizing patients, according to the kind of treatment and the stage of disease. In order to avoid any gathering condition which could increase the risk of infection for patients, we are optimizing access about adjuvant treatment, considering of high priority the higher risk patients, privileging longer infusion schedule of treatment for immunotherapy and/or selecting patients with BRAF mutation for starting target therapy. Metastatic patients have the highest priority, and nothing changed in their daily management except for preferring, when possible, the longer schedule of treatment in order to reduce the access in the hospital. The enrolment in clinical trials is on hold and the patients still in treatment inside clinical study are managed in the respect of GCPs as well as possible. Some additional issues are side effects in patients on treatment with target therapy and immunotherapy. About target therapy (especially dabrafenib and trametinib), patients who develop fever higher than 37.5 without resolving after discontinuation, should perform COVID test before to restart the treatment. Patients on treatment with immunotherapy who show pneumonitis at CT scan (even without fever), should perform COVID test before start steroids. Immuno-oncologists have an important experience in the management of immuno-related adverse events. The hyperactivation of immune system due to the immunotherapy strategies can develop some conditions which need of immuno-suppressive drugs to reduce the harmful immune reaction. Since the acute respiratory stress syndrome COVID-19 related seems to occur from an excess of cytokine production, we focused our attention on the cytokines storm which probably lead to ARDS by COVID-19 and how to prevent or treat it. We know very well the Cytokine Release Syndrome (CRS), one of the most prominent and well described toxicity from chimeric antigen receptor T cell therapy (CAR-T), as well as from some bispecific antibodies. In particular, we know the key role played by IL-6 in the pathogenesis of these kind of hyperinflammation syndromes. Considering elevated serum concentration of IL-6 and CPR in patients admitted in ICUs department, we started to use monoclonal antibodies against IL6, above all tocilizumab. In Italy we started on 19th of March a phase II study (NCT04317092) which enrolled 330 patients in 24 hours, with the ability of tocilizumab to reduce the one-month mortality rate as main endpoint. Results should be reported at the end of April. Other drugs active in reducing the CRS are at moment in clinical trial or expanded access program like JAK inhibitors, complement inhibitors, toll like receptor inhibitors and others. Citation Format: Paolo A. Ascierto. Experience in using oncology drugs in patients with COVID-19 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT405.

A saddle nose with acute respiratory failure

A 17-year-old youth came to the Emergency Department (ED) with stridor in March, 2009. Commencing 6 months prior, he had developed bilateral progressive hearing loss along with frequent vertigo. Both auricles appeared erythematous and swollen over the prior 2 months. Intermittent dyspnoea with episodic stridor and easy choking had developed. The neck soft tissue X-ray study showed a narrowing of the airway (Fig. 1). The nasal fiberscopic examination revealed bilateral vocal paralysis with oedematous swelling of the arytenoids and false vocal cords. Left external ear destruction (Fig. 2a), right ear induration (Fig. 2b) and a saddle nose deformity (Fig. 2c) were noted. Because of the acute respiratory stress and stridor, the patient was immediately treated with endotracheal intubation in the ED. Due to soft tissue swelling, the intubation could only be performed with 6.5 French endotracheal tube. A computed tomography (CT scan) of the neck showed circumferential thickening of the tracheal wall along with tracheal lumen narrowing of the subglottic trachea (Fig. 3). The patient then underwent tracheostomy, and was successfully weaned from mechanical ventilation. The biopsy of the trachea showed acute and chronic inflammatory infiltrates surrounding the elastic cartilage with foci of perichondrial erosion and chondrocyte destruction. Biopsy of the ear revealed acutely inflamed granulation tissue with patchy organising microhemorrhage. A diagnosis of relapsing polychondritis was established by the combination of clinical typical findings (McAdam’s criteria) [1], imaging studies, and biopsies of the trachea and ear. Relapsing polychondritis is a rare multisystem inflammatory process that may potentially compromise the structural and function of all of the cartilage in the body, especially the ears, nose, eyes, joints, and respiratory tract. Auricular chondritis is the most common initial presentation [2], and the prevalence of airway involvement is about

Impact of Acute Respiratory Stress on Cardiac Autonomic Control in Young Healthy Subjects Explored by Time and Frequency Domain Methods

To find the possible utility of analysis of heart rate variability in quantifying transient cardiac autonomic modulation, we assessed the impact of breath holding-induced acute respiratory stress on heart rate variability parameters and blood pressure in young healthy subjects. In ten healthy subjects aged between 22-24 years of either sex, R-R intervals and blood pressure were recorded for one minute under resting state, during breath holding and immediately after withdrawal from breath holding. Heart rate variability was quantified by time and frequency domain methods. Mean differences in values were compared separately between resting and during breath holding, during and following withdrawal from breath holding; resting and following withdrawal from breath holding employing paired 't' test. Blood pressure and standard deviation of R-R intervals (SDNN) significantly increased during breath holding and decreased following withdrawal from it. Low frequency power in normalized units (LF nu) significantly decreased, while the high frequency power in normalized units (HF nu) significantly increased with a resulting decrease of the LF/HF ratio following withdrawal from breath holding compared to during breath holding. During the recovery phase only the LF% power significantly decreased as compared with the resting state. Thus, blood pressure and SDNN appeared to better quantify the ability of the heart to meet changing situational demands. LF nu and HF nu or LF/HF ratio reflected the behavior of sympathetic and parasympathetic limbs in adapting to changing situational demand.