Acute Respiratory Distress Syndrome Complications Research Articles

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.

Clinical presentation of maternal death with COVID-19 in rural tertiary care center: A retrospective-descriptive Study

Background: Maternal with to COVID-19 is a new maternal emergency issue leading to maternal morbidity and mortality. In Indonesia, the number of cases of maternal mortality with COVID-19 began to increase. This study aims to determine the characteristic of maternal deaths due to COVID-19 in a tertiary care center in Indonesia.Method: This observational-retrospective study descriptively analyzed 15 maternal deaths due to COVID-19 admitted to the Department of Obstetrics and Gynaecology at the tertiary care teaching hospital from March to December 2020. We included suspect, probable, and confirmed COVID-19 in the samples. Therefore, the total sampling was recorded and analyzed descriptively by Microsoft Excel.Results: There are fifteen maternal deaths from 429 maternal cases with COVID-19 in our hospital. The majority ages were in the age group 19-35 years (73.33%); body mass index (BMI) 25-29.9 (33.33%); five days average length of stay; one comorbidity (53.33%); and multiple comorbidities (20.00%). The case fatality rate (CFR) of maternal death due to COVID-19 is 3.49% were profiled out this study. The most cause of death was acute respiratory distress syndrome (ARDS) (53.33%).Conclusions: Most common characteristics of the object of this study were the age between 19-35 years, comorbidity, obesity, upper respiratory tract symptoms, elevated D-dimer, and the complication of ARDS, which are the risk factors of the deaths.

Mechanisms of Pulmonary Hypertension in Acute Respiratory Distress Syndrome (ARDS).

Background: Acute respiratory distress syndrome (ARDS) is a severe and often fatal disease. The causes that lead to ARDS are multiple and include inhalation of salt water, smoke particles, or as a result of damage caused by respiratory viruses. ARDS can also arise due to systemic complications such as blood transfusions, sepsis, or pancreatitis. Unfortunately, despite a high mortality rate of 40%, there are limited treatment options available for ARDS outside of last resort options such as mechanical ventilation and extracorporeal support strategies.Aim of review: A complication of ARDS is the development of pulmonary hypertension (PH); however, the mechanisms that lead to PH in ARDS are not fully understood. In this review, we summarize the known mechanisms that promote PH in ARDS.Key scientific concepts of review: (1) Provide an overview of acute respiratory distress syndrome; (2) delineate the mechanisms that contribute to the development of PH in ARDS; (3) address the implications of PH in the setting of coronavirus disease 2019 (COVID-19).

Comorbidities as Risk Factors for Mortality in COVID-19 Acute Respiratory Distress Syndrome Adult Patients: A Single-Center Retrospective Study

Background: Geriatric, obesity, and chronic disease are classified as risk factors for adverse outcomes of coronavirus disease 2019 (COVID-19). Studies regarding the importance of these comorbidities in COVID-19 with severe complications such as acute respiratory distress syndrome (ARDS) are scarce. This study aims to analyze age, obesity, and chronic disease comorbidities as risk factors for 28-days mortality in COVID-19 patients with ARDS. Methods: A retrospective, single-center study was conducted in Dr. Soetomo General Hospital, Surabaya, Indonesia between July-October 2020. We included all adult inpatients (≥18 years old) of confirmed COVID-19 with ARDS. Demographic, comorbidities, initial PaO2/FiO2 ratio, time of discharge or death were obtained from medical records and compared the ARDS severity between survivors and non-survivors. The univariate and multivariate logistic regression methods were used to identify risk factors associated with in-hospital death. Result: Among 102 patients of COVID-19 with ARDS, the median age is 52 years. Most of them are within 50 – 59 age categories. The median hospital length of stay (LOS) for survivor is 22 (15.7 – 26) days and 9 (4.25 – 14.4) days for non-survivor. The 28-days mortality rate is 48 (47.1%) patients. Age > 65 years old (HR= 2.7, 95% CI 1.39 – 5.44, p value= 0.004), obesity (HR= 2.2, 95% CI 1.16 – 4.51, p value= 0.016), and chronic hypertension (HR= 1.98, 95% CI 1.11 – 3.52, p value= 0.02) are the independent risk factors for 28-days mortality in COVID-19 with ARDS. Conclusion: Geriatric, obesity, and chronic hypertension comorbidities are the risk factors for mortality of COVID-19 with ARDS complications.

Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets.

The 1918 influenza killed approximately 50 million people in a few short years, and now, the world is facing another pandemic. In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of a respiratory illness termed coronavirus disease 2019 (COVID-19) and rapidly spread to cause the worst pandemic since 1918. Recent clinical reports highlight an atypical presentation of acute respiratory distress syndrome (ARDS) in COVID-19 patients characterized by severe hypoxemia, an imbalance of the renin–angiotensin system, an increase in thrombogenic processes, and a cytokine release storm. These processes not only exacerbate lung injury but can also promote pulmonary vascular remodeling and vasoconstriction, which are hallmarks of pulmonary hypertension (PH). PH is a complication of ARDS that has received little attention; thus, we hypothesize that PH in COVID-19-induced ARDS represents an important target for disease amelioration. The mechanisms that can promote PH following SARS-CoV-2 infection are described. In this review article, we outline emerging mechanisms of pulmonary vascular dysfunction and outline potential treatment options that have been clinically tested.

Acute kidney injury due to multiple Hymenoptera stings-a clinicopathological study.

BackgroundAcute kidney injury (AKI) after multiple Hymenoptera stings is well known but still a rare phenomenon.MethodsWe conducted a retrospective study of the clinicopathological spectrum of AKI due to multiple Hymenoptera stings over 13 years (July 2003–June 2016).ResultsA total of 35 patients were diagnosed with AKI due to multiple Hymenoptera stings. The mean age of the patients was 44.7 ± 17.4 years and the majority (60%) were men. Haematological and biochemical laboratory abnormalities included anaemia (97.1%), leucocytosis (54.3%), hyperkalaemia (68.6%), severe metabolic acidosis (51.4%), hepatic dysfunction (74.3%), haemolysis (91.4%) and rhabdomyolysis (62.9%). The main complications included acute respiratory distress syndrome (ARDS) and encephalopathy in four (11.4%) patients each; gastrointestinal bleeding, hypertension and panniculitis in two (5.7%) patients each and one (2.9%) patient each developed intra-abdominal bleeding, stroke and polyserositis. Twenty-nine (83%) patients required dialysis. Ten (29%) patients died. A higher white blood cell count (P = 0.05) and the complications of ARDS (P = 0.004) and encephalopathy (P = 0.004) were associated with mortality. The kidney functions normalized at 5.5 ± 2.6 weeks in patients who survived. Kidney biopsy was done in 13 patients. The predominant lesion was acute tubular necrosis (ATN) with or without pigmented granular cast in 10 (77%) patients. In four (30.8%) patients, the kidney biopsy showed severe ATN and in the other six (46.2%), the kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). In three (23%) patients the histopathological examination revealed only moderate AIN and these patients were treated with a short course of steroids.ConclusionsAKI due to multiple Hymenoptera stings is severe and is associated with high mortality. On renal histology, ATN and AIN are common.

Acute respiratory distress syndrome: A pediatric intensive care unit experience from an eastern Indian state

Background: Prevalence of acute respiratory distress syndrome (ARDS) in PICU is high with high mortality, however data from developing country with resource limited ICU are lacking in literature. Objective: To study the sociodemographic characteristics, predisposing conditions, and complications of ARDS in a tertiary care PICU and to compare the different oxygenation and ventilator parameters with survival. Methods: This prospective observational study was conducted in a PICU from a tertiary care centre. All sick children admitted to PICU over a period of 18mo who developed ARDS based on American European consensus conference committee criteria definition were enrolled. The association of survival with demographic, clinical profile, complication, different oxygenation and ventilator parameters were analysed through SPSS 24. Results: Fourty one cases of ARDS were diagnosed with an incidence of19.4 per 1000 ICU admission. Median (IQR) age at presentation was 72(42-120 mo), 30(73.1%) were males and 32(78.0%) from rural area. Sepsis 16(39.0%) and malaria 8(19.5) were the major predisposing condition, whereas shock 34(82.9%) and pneumothorax 31(75.6%) are major complication. Only 5(12%) patients survived. No significant difference in age, sex, place of residence, predisposing factors and other complications were found between survivors and non-survivors (p > 0.05). Non-survivor ARDS had more of non-pulmonary cause (p-0.006) and remained fewer days in ventilator (p-0.010). No significant difference was found in oxygenation (paO2/FiO2), respiratory mechanics and lung injury score between both groups. Conclusion: ARDS is a serious complication in children admitted to ICU with sepsis, malaria and H1N1 with high mortality. ARDS due to non pulmonary causes and ARDS complicated with shock contribute significantly to mortality. Oxygenation (PaO2/FiO2), respiratory mechanics and lung injury score are not significantly better on survivors.

Predictors of Acute Respiratory Distress Syndrome in Patients with Paraquat Intoxication

IntroductionParaquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters.Materials and MethodsIn total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed.ResultsThe overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN48-h scores (P<0.009), SOFA48-h scores (P<0.001), and time to ARDS/nadir PaO2 (P=0.008) but also suffered from lower nadir PaO2 (P<0.001), nadir AaDO2 (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA48-h scores <3 and SOFA48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS. ConclusionsThe analytical results indicate that SOFA48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.

Scrub typhus associated acute kidney injury—a study from a tertiary care hospital from western Himalayan state of India

Objective: To report the clinical profile of acute kidney injury (AKI) associated with scrub typhus. Methods: Retrospective study of hospitalized patients of acute febrile illness who were diagnosed scrub typhus and had AKI. Results: 174 (35%) patients (75.9% female), mean age (41.4 ± 15.9 years) were studied. The laboratory abnormalities were: anemia (63.2%), leukocytosis (44.3%), thrombocytopenia (61.5%), hyponatremia (35.6%), hypernatremia (2.9%), and hypokalemia (12.1%), hyperkalemia (11.5%), hypoalbuminemia (56.9%), hepatic dysfunction (70%) and metabolic acidosis (28.7%). The complications of hypotension (5.7%), septic shock (3.4%), pneumonia (10.9%), acute respiratory distress syndrome (ARDS) (11.5%), meningoencephalitis (6.9%), encephalopathy (5.2%), gastrointestinal bleed (1.3%), myocarditis (3.4%), disseminated intravascular coagulation (2.9%) and multi organ failure (MOF) (10.3%) developed during course of hospitalization in these patients. Twenty-five (14.4%) patients required intensive care support (ICU) support and seven (4%) patients were dialyzed. 146 (83.9%) patients survived. Twenty-eight (16.1%) patients died. There was a significant difference in the age, various hematological & biochemical abnormalities, complications and need for ICU support in the non-survival group as compared the survival group. Conclusion: This study shows that AKI in scrub typhus is common and a severe disease. Age, a shorter hospital stay, severities of leukocytosis, thrombocytopenia, azotemia, hypoalbuminemia, hepatic dysfunction and the complications of ARDS, encephalopathy, MOF and need for ICU support are the factors associated with mortality.

Nosocomial pneumonia during acute respiratory distress syndrome

The Acute Respiratory Distress Syndrome (ARDS) shares with nosocomial pneumonia aetiological, physiopathological and diagnostic properties. This report will focus on the importance of nosocomial pneumonia as a complication of ARDS and review data on prevalence, incidence and the impact of nosocomial pneumonia on outcome in patients with ARDS. Prevention strategies are imperative to protect ARDS patients for nosocomial pneumonia. The prevalence of nosocomial pneumonia seems to be at least 8%. The incidence varies largely with the study design but an estimate that every second patient with ARDS will suffer at least one episode of pneumonia during the course of mechanical ventilation, seems to reflect clinical experience and data. However, given the high incidence of nosocomial pneumonia during the course of ARDS and the impact of adequate antibiotic therapy on survival, microbiological surveillance seems to be appropriate even in the clinical routine.

Nosocomial pneumonia during acute respiratory distress syndrome

The Acute Respiratory Distress Syndrome (ARDS) shares with nosocomial pneumonia aetiological, physiopathological and diagnostic properties. This report will focus on the importance of nosocomial pneumonia as a complication of ARDS and review data on prevalence, incidence and the impact of nosocomial pneumonia on outcome in patients with ARDS. Prevention strategies are imperative to protect ARDS patients for nosocomial pneumonia. The prevalence of nosocomial pneumonia seems to be at least 8%. The incidence varies largely with the study design but an estimate that every second patient with ARDS will suffer at least one episode of pneumonia during the course of mechanical ventilation, seems to reflect clinical experience and data. However, given the high incidence of nosocomial pneumonia during the course of ARDS and the impact of adequate antibiotic therapy on survival, microbiological surveillance seems to be appropriate even in the clinical routine.