Respiratory Distress Research Articles

A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in three international cohorts

Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery. Data from an international, prospective cohort study were used to develop a novel prognostic risk model for pulmonary complications after elective surgery in adult patients (aged ≥18 years) across all operation and disease types. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery, which was a composite of pneumonia, acute respiratory distress syndrome, and unexpected mechanical ventilation. Model development with candidate predictor variables was done in the GlobalSurg-CovidSurg Week dataset (global; October, 2020). Two structured machine learning techniques were explored (XGBoost and the least absolute shrinkage and selection operator [LASSO]), and the model with the best performance (GSU-Pulmonary Score) underwent internal validation using bootstrap resampling. The discrimination and calibration of the score were externally validated in two further prospective cohorts: CovidSurg-Cancer (worldwide; February to August, 2020, during the COVID-19 pandemic) and RECON (UK and Australasia; January to October, 2019, before the COVID-19 pandemic). The model was deployed as an online web application. The GlobalSurg-CovidSurg Week and CovidSurg-Cancer studies were registered with ClinicalTrials.gov, NCT04509986 and NCT04384926. Prognostic models were developed from 13 candidate predictor variables in data from 86 231 patients (1158 hospitals in 114 countries). External validation included 30 492 patients from CovidSurg-Cancer (726 hospitals in 75 countries) and 6789 from RECON (150 hospitals in three countries). The overall rates of pulmonary complications were 2·0% in derivation data, and 3·9% (CovidSurg-Cancer) and 4·7% (RECON) in the validation datasets. Penalised regression using LASSO had similar discrimination to XGBoost (area under the receiver operating curve [AUROC] 0·786, 95% CI 0·774-0·798 vs 0·785, 0·772-0·797), was more explainable, and required fewer covariables. The final GSU-Pulmonary Score included ten predictor variables and showed good discrimination and calibration upon internal validation (AUROC 0·773, 95% CI 0·751-0·795; Brier score 0·020, calibration in the large [CITL] 0·034, slope 0·954). The model performance was acceptable on external validation in CovidSurg-Cancer (AUROC 0·746, 95% CI 0·733-0·760; Brier score 0·036, CITL 0·109, slope 1·056), but with some miscalibration in RECON data (AUROC 0·716, 95% CI 0·689-0·744; Brier score 0·045, CITL 1·040, slope 1·009). This novel prognostic risk score uses simple predictor variables available at the time of a decision for elective surgery that can accurately stratify patients' risk of postoperative pulmonary complications, including during SARS-CoV-2 outbreaks. It could inform surgical consent, resource allocation, and hospital-level prioritisation as elective surgery is upscaled to address global backlogs. National Institute for Health Research.

Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19

BackgroundPrevious retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less.MethodsThis study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data.ResultsOut of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52–1.74], p = 0.87 and HR 1.1 [0.77–1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively).ConclusionsThis secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP.

Anaphylaxis shock with laryngeal edema: a case report

Anaphylaxis is a serious systemic or hypersensitivity reaction that rapid in onset and affect airway, breathing, and/or circulatory problems, and that is usually associated with skin and mucosal changes. Laryngeal edema is observed in 40-50% of death cases. A 49-year-old Asian female came to emergency department with chief complaint of difficulty to breath since 30 minutes ago after took cefixime and also common cold drug (Combination of paracetamol, glyceryl guaifenesin, phenylephrine, and Chlorpheniramine maleate). She also complained difficulty to speak and feeling strangulated on her neck. She ever had an allergic reaction, when she was child after suffering fever and common cold, but didn’t remember the name of the medication. History of food allergies was denied. On physical examination revealed, dyspnea and minimal tachycardia. Present of laryngeal edema, on auscultation stridor and wheezing on both lungs. Diagnosis of anaphylactic shock was made, and immediately giving epinephrin and followed by corticosteroid and antihistamine. The signs and symptoms of anaphylaxis might differ from patient to patient and impact the skin, gastrointestinal tract, respiratory system, and heart. Anaphylaxis fatal cases rise when laryngeal edema and cardiovascular organ involvement occur. The most frequent triggers are produced by food, venom from insects, and prescription drugs. The risk of death in anaphylaxis patients is decreased with prompt treatment. It is necessary to assess and maintain breathing, circulation, and airways in addition to determining the cause. Anaphylaxis can be potentially lethal or life-threatening, thus prompt identification and appropriate treatment are necessary.

Management of the peri-intubation period in patients with pulmonary arterial hypertension and respiratory failure.

The endotracheal intubation of patients with pulmonary arterial hypertension (PAH) in respiratory distress is a highly morbid procedure that can precipitate hemodynamic collapse. Here we review our strategy for confronting this difficult clinical situation. There are no clinical trials that explore best practices in the management of patients with PAH and respiratory failure. Here we provide a practical approach to respiratory support, inopressor and pulmonary vasodilator selection, hemodynamic considerations, point-of-care ultrasound monitoring, and endotracheal intubation in patients with PAH in respiratory failure.

Electrical Impedance Tomography, Artificial Intelligence, and Variable Ventilation: Transforming Respiratory Monitoring and Treatment in Critical Care

Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strategies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: this narrative review explores the principles and applications of EIT, variable ventilation, and AI in critical care. EIT impedance sensing creates dynamic images of internal physiology, aiding the management of conditions like Acute Respiratory Distress Syndrome (ARDS). Variable ventilation mimics natural breathing variability to improve lung function and minimize ventilator-induced lung injury. AI enhances EIT through advanced image reconstruction techniques, neural networks, and digital twin technology, offering more accurate diagnostics and tailored therapeutic interventions. Conclusions: the confluence of EIT, variable ventilation, and AI represents a significant advancement in critical care, enabling a predictive, personalized approach. EIT provides real-time insights into lung function, guiding precise ventilation adjustments and therapeutic interventions. AI integration enhances EIT diagnostic capabilities, facilitating the development of personalized treatment plans. This synergy fosters interdisciplinary collaborations and sets the stage for innovative research, ultimately improving patient outcomes and advancing the future of critical care.

Effect of apigetrin in pseudo-SARS-CoV-2-induced inflammatory and pulmonary fibrosis in vitro model

SARS-CoV-2 has become a global public health problem. Acute respiratory distress syndrome (ARDS) is the leading cause of death due to the SARS-CoV-2 infection. Pulmonary fibrosis (PF) is a severe and frequently reported COVID-19 sequela. In this study, an in vitro model of ARDS and PF caused by SARS-CoV-2 was established in MH-S, THP-1, and MRC-5 cells using pseudo-SARS-CoV-2 (PSCV). Expression of proinflammatory cytokines (IL-6, IL-1β, and TNF-α) and HIF-1α was increased in PSCV-infected MH-S and THP-1 cells, ARDS model, consistent with other profiling data in SARS-CoV-2-infected patients have been reported. Hypoxia-inducible factor-1 alpha (HIF-1α) siRNA and cobalt chloride were tested using this in vitro model. HIF-1α knockdown reduces inflammation caused by PSCV infection in MH-S and THP-1 cells and lowers elevated levels of CTGF, COLA1, and α-SMA in MRC-5 cells exposed to CPMSCV. Furthermore, apigetrin, a glycoside bioactive dietary flavonoid derived from several plants, including Crataegus pinnatifida, which is reported to be a HIF-1α inhibitor, was tested in this in vitro model. Apigetrin significantly reduced the increased inflammatory cytokine (IL-6, IL-1β, and TNF-α) expression and secretion by PSCV in MH-S and THP-1 cells. Apigetrin inhibited the binding of the SARS-CoV-2 spike protein RBD to the ACE2 protein. An in vitro model of PF induced by SARS-CoV-2 was produced using a conditioned medium of THP-1 and MH-S cells that were PSCV-infected (CMPSCV) into MRC-5 cells. In a PF model, CMPSCV treatment of THP-1 and MH-S cells increased cell growth, migration, and collagen synthesis in MRC-5 cells. In contrast, apigetrin suppressed the increase in cell growth, migration, and collagen synthesis induced by CMPSCV in THP-1 and MH-S MRC-5 cells. Also, compared to control, fibrosis-related proteins (CTGF, COLA1, α-SMA, and HIF-1α) levels were over two-fold higher in CMPSV-treated MRC-5 cells. Apigetrin decreased protein levels in CMPSCV-treated MRC-5 cells. Thus, our data suggest that hypoxia-inducible factor-1 alpha (HIF-1α) might be a novel target for SARS-CoV-2 sequela therapies and apigetrin, representative of HIF-1alpha inhibitor, exerts anti-inflammatory and PF effects in PSCV-treated MH-S, THP-1, and CMPVSC-treated MRC-5 cells. These findings indicate that HIF-1α inhibition and apigetrin would have a potential value in controlling SARS-CoV-2-related diseases.

Carbon Dioxide Targets in Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

Target values for arterial carbon dioxide tension (PaCO2) in extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) are unknown. We hypothesized that lower PaCO2 values on ECMO would be associated with lighter sedation. We used data from two independent patient cohorts with ARDS spending 1,177 days (discovery cohort, 69 patients) and 516 days (validation cohort, 70 patients) on ECMO and evaluated the associations between daily PaCO2, pH, and bicarbonate (HCO3) with sedation. Median PaCO2 was 41 (interquartile range [IQR] = 37-46) mm Hg and 41 (IQR = 37-45) mm Hg in the discovery and the validation cohort, respectively. Lower PaCO2 and higher pH but not bicarbonate (HCO3) served as significant predictors for reaching a Richmond Agitation Sedation Scale (RASS) target range of -2 to +1 (lightly sedated to restless). After multivariable adjustment for mortality, tracheostomy, prone positioning, vasoactive inotropic score, Simplified Acute Physiology Score (SAPS) II or Sequential Organ Failure Assessment (SOFA) Score and day on ECMO, only PaCO2 remained significantly associated with the RASS target range (adjusted odds ratio 1.1 [95% confidence interval (CI) = 1.01-1.21], p = 0.032 and 1.29 [95% CI = 1.1-1.51], p = 0.001 per mm Hg decrease in PaCO2 for the discovery and the validation cohort, respectively). A PaCO2 ≤40 mm Hg, as determined by the concordance probability method, was associated with a significantly increased probability of a sedation level within the RASS target range in both patient cohorts (adjusted odds ratio = 2.92 [95% CI = 1.17-7.24], p = 0.021 and 6.82 [95% CI = 1.50-31.0], p = 0.013 for the discovery and the validation cohort, respectively).

The First Report on Saprolegnia parasitica and Neoparamoeba perurans Isolated from Atlantic Salmon (Salmo salar) Reared in Korea

This study is the first report of parasite and fungal disease separated from domestically reared Atlantic salmon in Korea; the characteristics of the pathogens were identified, and histopathological analysis was conducted. Fungal and parasitic diseases were detected in Atlantic salmon and were isolated as Saprolegnia parasitica and Neoparamoeba perurans based on morphological and genetic analysis. External symptoms observed in Atlantic salmon infected with S. parasitica include fin ulcers and hemorrhage, abdominal hemorrhage, and necrosis of the gills and gill covers. The histopathological analysis results showed necrosis, hemorrhaging, and inflammatory cell infiltration in the abdominal muscles, while only inflammatory cell infiltration was observed in the gill covers. The clinical symptoms observed in Atlantic salmon infected with N. perurans included excessive mucus secretion in the gills, a dense amoebic presence on the gill filaments, respiratory distress, and opening of the mouth and gill covers after death. Through histopathological analysis, we observed lesions in epithelial cells, characterized by the proliferation of epithelial cells and the fusion of secondary lamellae. Numerous lamellae were observed to be attached or fused with each other. To ensure the successful establishment of the Atlantic salmon aquaculture industry in Korea, it is essential to swiftly quarantine infected fish based on the morphological characteristics of S. parasitica and N. perurans revealed in this study, along with the external symptoms of Atlantic salmon infected with these pathogens. Developing disease control strategies based on the findings of this research is imperative.

Successful treatment of cicatricial stenosis of the main, intermediate and upper lobe bronchi of the right lung complicated by total lung atelectasis in an infant: a clinical example

BACKGROUND. The authors present a rare clinical case of stenosis of the main, intermediate and upper lobe bronchi of the right lung complicated by total lung atelectasis in an infant. They discuss issues of complex disease diagnostics, analyze X-ray and bronchological images, assess outcomes after multidisciplinary approach in the treatment of a premature baby as well as analyze data of catamnestic observation. CLINICAL CASE DESCRIPTION. Girl T., one of monochorionic diamniotic twins , was born at 27- week gestation in 2021 with weight at birth 825 grams, Apgar score 4/5. Since her birth, she had artificial lung ventilation due to her deep immaturity and developed severe respiratory distress syndrome. At the age of 19 days, total atelectasis of the right lung was diagnosed in the child as a result of stenosis formation in the main, intermediate and upper lobe bronchi which was confirmed by clinical and radiological findings. A probable etiology of acquired stenosis is consequences of prolonged intubation under insufficiently formed cartilaginous framework. Chlamydial infection, detected in the child, could also support inflammatory process in the bronchi. The child was examined with the following instruments: radiography, MSCT angiography of the thoracic cavity, bronchofibroscopy, ECHOCG. Laboratory tests: PCR of blood and sputum for herpes viruses type 1-6, mycoplasma, ureaplasma, chlamydia pneumonia; blood ELISA — antibodies to viruses of Herpesviridae type 1-6, Chlamydia trachomatis. Conservative therapy provided only temporal improvement; atelectasis was relapsing. At the age of 5 months and 20 days, the child underwent bronchoplasty with resection of damaged areas of the bronchi. Further, age-related diameter of the bronchial lumen was maintained by the staged bougienage. Catamnestic observation lasted for 3 years. Late timing of surgical intervention is explained by severe problems in a deeply premature and immature child that required immediate treatment (intraventricular hemorrhages, hydrocephalus, retinopathy, etc.). Effective surgical treatment (bronchoplasty), active growth of lung tissue at the first year of life as well as reasonable rehabilitation allowed to obtain good long-term outcomes. By the age of 1 year 2 months, normalization of right lung airiness was achieved. Currently, there is a slight reduction in right lung volume. MSCT angiography revealed a few cylindrical bronchoectases in the segmental and subsegmental bronchi of the upper and middle lobes of the right lung which do not have clinical equivalents yet. The child is under pulmonologist's observation and management. CONCLUSIONS. A multidisciplinary approach to the treatment of complicated patient's state and high compensatory capabilities of neonatal and infantile periods have promoted the restoration of normal lung aeration and functioning after long-lasting lung atelectasis

RNA N6-methyladenosine methylation in influenza A virus infection.

Influenza A virus (IAV) is a negative-sense single-stranded RNA virus that causes acute lung injury and acute respiratory distress syndrome, posing a serious threat to both animal and human health. N6-methyladenosine (m6A), a prevalent and abundant post-transcriptional methylation of RNA in eukaryotes, plays a crucial regulatory role in IAV infection by altering viral RNA and cellular transcripts to affect viral infection and the host immune response. This review focuses on the molecular mechanisms underlying m6A modification and its regulatory function in the context of IAV infection and the host immune response. This will provide a better understanding of virus-host interactions and offer insights into potential anti-IAV strategies.

Association between Gestational Age and Perinatal Outcomes in Women with Late Preterm Premature Rupture of Membranes.

The American College of Obstetricians and Gynecologists (ACOG) suggests expectant management until 34 weeks for patients with preterm premature rupture of membranes (PPROM). New data suggest extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM. A retrospective cohort study was performed using linked vital statistics and the International Classification of Diseases, Ninth Revision data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include neonatal intensive care unit (NICU) admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons. In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared with 81% at 34 weeks and 22% at 36 weeks (p < 0.001). At 32 weeks, 20% had neonatal sepsis compared with 11% at 34 weeks and 3% at 36 weeks (p < 0.001). At 32 weeks, 67% had respiratory distress syndrome compared with 44% at 34 weeks and 12% at 36 weeks (p < 0.001). In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis. · The ACOG recommends expectant management until 34 weeks for patients with PPROM.. · However, expectant management to 37 weeks might improve neonatal outcomes.. · Later gestational age at delivery was associated with decreased rates of adverse neonatal outcomes.. · Later gestational age at delivery was not associated with an increase in neonatal sepsis.. · The management of PPROM is complex and should be individualized..

Gossypiboma larynx: a rare cause of post-tracheostomy stridor—case report and review of literature

BackgroundGossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy.Case presentationA 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient’s breathing improved drastically post intervention.ConclusionGossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.

Sequential treatment with valemetostat and conventional anti‐cancer drugs for refractory aggressive adult T‐cell leukemia/lymphoma: A case report

AbstractA 79‐year‐old man presented with respiratory distress associated with a mediastinal mass and pleural effusion, and was diagnosed as having adult T‐cell leukemia/lymphoma. The patient was highly refractory to anticancer drugs and radiotherapy from the time of onset and had progressive respiratory deterioration. However, his condition became stable with the administration of valemetostat for 11 days, and subsequent low‐dose‐anticancer agents led to a rapid improvement accompanied by high fever and a surge in C‐reactive protein. In this case, the in vivo priming effect of valemetostat on tumor cells may have increased the sensitivity of these cells to conventional anti‐cancer drugs.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study.

The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Changes in BMI and the prevalence of overweight and obesity in children and adolescents (11-15 years) from Kraków (Poland) during COVID-19 pandemic.

In March 2020, the spread of the new coronavirus SARS-CoV-2, triggered a pandemic of acute respiratory distress syndrome among people. The aim of the study was to evaluate the changes in BMI and in the prevalence of overweight and obesity in children and adolescents (11-15-year-olds) from Kraków (Poland) during the COVID-19 pandemic. Two cross-sectional studies were performed in 2020 and 2022 in randomly selected elementary schools in 4 districts of Kraków. The study group was 1572 children between the ages of 11-15 years. BMI (Body Mass Index) was calculated. Participants were grouped using Cole's cut-off points. The statistical significance of differences between the groups was estimated using the two-way ANOVA and Chi2 test. An increase in the prevalence of underweight and normal weight was observed in both sexes. In girls a decrease in the prevalence of obesity was noted, while in boys, the same tendency was present in some age groups. In girls, a decrease in the prevalence of overweight and in the average BMI was noted; in boys the trend was the opposite. The observed results may be correlated with changes in body composition and restrictions resulting from the lockdown caused by the COVID-19 pandemic.

Advancements in the study of acute lung injury resulting from intestinal ischemia/reperfusion.

Intestinal ischemia/reperfusion is a prevalent pathological process that can result in intestinal dysfunction, bacterial translocation, energy metabolism disturbances, and subsequent harm to distal tissues and organs via the circulatory system. Acute lung injury frequently arises as a complication of intestinal ischemia/reperfusion, exhibiting early onset and a grim prognosis. Without appropriate preventative measures and efficacious interventions, this condition may progress to acute respiratory distress syndrome and elevate mortality rates. Nonetheless, the precise mechanisms and efficacious treatments remain elusive. This paper synthesizes recent research models and pertinent injury evaluation criteria within the realm of acute lung injury induced by intestinal ischemia/reperfusion. The objective is to investigate the roles of pathophysiological mechanisms like oxidative stress, inflammatory response, apoptosis, ferroptosis, and pyroptosis; and to assess the strengths and limitations of current therapeutic approaches for acute lung injury stemming from intestinal ischemia/reperfusion. The goal is to elucidate potential targets for enhancing recovery rates, identify suitable treatment modalities, and offer insights for translating fundamental research into clinical applications.

Effects of Obesity on Systemic Complications after Operative Pelvic Ring Fractures

Objective: To determine the effect of obesity on systemic complications after operative pelvic ring injuries. Methods: Design: Retrospective cohort study Setting: Single level 1 trauma center Patient Selection Criteria: All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015-2022 were included. Patients were grouped based on body mass index (BMI) into four categories (normal = BMI &lt;25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI &gt;40). Outcome Measures and Comparisons: Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared to those who did not in regard to demographic and clinical parameters to determine risk factors for each complication. Results: A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio (OR) of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI were also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI &gt;40). Conclusions: This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication and specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain post-operative complications during the initial trauma admission. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Steroids in acute respiratory distress syndrome: A panacea or still a puzzle?

Acute respiratory distress syndrome (ARDS) is a unique entity marked by various etiologies and heterogenous pathophysiologies. There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support. Among several pharmacotherapies which have been examined in the treatment of ARDS, corticosteroids, in particular, have demonstrated potential for improving the resolution of ARDS. Nevertheless, it is imperative to consider the potential adverse effects of hyperglycemia, susceptibility to hospital-acquired infections, and the development of intensive care unit acquired weakness when administering corticosteroids. Thus far, a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS. Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS. This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.

Driving pressure decoded: Precision strategies in adult respiratory distress syndrome management

Mechanical ventilation (MV) is an important strategy for improving the survival of patients with respiratory failure. However, MV is associated with aggravation of lung injury, with ventilator-induced lung injury (VILI) becoming a major concern. Thus, ventilation protection strategies have been developed to minimize complications from MV, with the goal of relieving excessive breathing workload, improving gas exchange, and minimizing VILI. By opting for lower tidal volumes, clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli, which can contribute to lung injury. Additionally, other factors play a role in optimizing lung protection during MV, including adequate positive end-expiratory pressure levels, to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.

Medical management of idiopathic chylothorax in a crossbreed cat with octreotide and rutin use: A case report

BThis case report describes the diagnosis and treatment of idiopathic chylothorax in a 5-year-old female crossbreed cat who presented with respiratory distress, tachypnea, cyanosis, exercise intolerance and weight loss over a short period of time. Based on the clinical examination, blood results, radiological and echocardiographic findings, the patient was diagnosed with chylous effusion. Chylothorax was considered idiopathic because there was no underlying trauma or disease etiology. Effusion drainage was performed by thoracocentesis to reduce respiratory stress. After thoracocentesis, followed by using medical octreotide- a somatostatin analogue (Sandostatin™, 0.1 mg/ml ampoule, Novartis, USA) and rutin - a flavone benzo-γ-pyrone plant fruit extracted from the Brazilian plant Fava D'anta (Dimorphandra mollis) (Rutin - Plant-Based Bioflavonoid, 500 mg tablet, Solgar™, USA), were administered in addition to supportive treatment. Rutin and ocreotide have been used successfully in humans, dogs and cats to the treatment of pleural effusions as presented various studies. It is hoped that these drugs may also be useful for decreasing pleural effusion in cats with chylothorax. In this represented case; partial resolution of pleural effusion was observed after octreotide usage and complete resolution of pleural effusion was observed after rutin (plant-based bioflavonoid) usage. No recurrence was observed during 7 months of regular follow-up.It was determined that the use of octreotide and rutin after thoracocentesis gave successful results in the medical management of idiopathic chylothorax in cats.