Incidence Of Acute Respiratory Distress Syndrome Research Articles

High-Frequency Oscillatory Ventilation for Cardiac Surgery Children With Severe Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) in children after open heart surgery, although uncommon, can be a significant source of morbidity. Because high-frequency oscillatory ventilation (HFOV) had been used successfully with pediatric patients who had no congenital heart defects, this therapy was used in our unit. This report aims to describe a single-center experience with HFOV in the management of ARDS after open heart surgery with respect to mortality. This retrospective clinical study was conducted in a pediatric intensive care unit. From October 2008 to August 2012, 64 of 10,843 patients with refractory ARDS who underwent corrective surgery at our institution were ventilated with HFOV. Patients with significant uncorrected residual lesions were not included. No interventions were performed. The patients were followed up until hospital discharge. The main outcome measure was survival to hospital discharge. Severe ARDS was defined as acute-onset pulmonary failure with bilateral pulmonary infiltrates and an oxygenation index (OI) higher than 13 despite maximal ventilator settings. The indication for HFOV was acute severe ARDS unresponsive to optimal conventional treatment. The variables recorded and subjected to multivariate analysis were patient demographics, underlying disease, clinical data, and ventilator parameters and their association with hospital mortality. Nearly 10,843 patients underwent surgery during the study period, and the ARDS incidence rate was 0.76 % (83/10,843), with 64 patients (77 %, 64/83) receiving HFOV. No significant changes in systemic or central venous pressure were associated with initiation and maintenance of HFOV. The complications during HFOV included pneumothorax for 22 patients. The overall in-hospital mortality rate was 39 % (25/64). Multiple regression analyses indicated that pulmonary hypertension and recurrent respiratory tract infections (RRTIs) before surgery were independent predictors of in-hospital mortality. The findings show that HFOV is an effective and safe method for ventilating severe ARDS patients after corrective cardiac surgery. Pulmonary hypertension and RRTIs before surgery were risk factors for in-hospital mortality.

Anesthesiology and the Acute Respiratory Distress Syndrome

Anesthesiology and the Acute Respiratory Distress Syndrome

Early fluid resuscitation with hydroxyethyl starch 130/0.4 (6%) in severe burn injury: a randomized, controlled, double-blind clinical trial

IntroductionThere are limited data on the efficacy of early fluid resuscitation with third-generation hydroxyethyl starch (HES 130) in burn injury. Adverse effects of HES on survival and organ function have been reported.MethodsIn this randomized, controlled, double-blind trial, 48 patients with severe burn injury were assigned to receive either lactated Ringer’s solution plus 6% HES 130/0.4 in a ratio of 2:1 or lactated Ringer’s solution with no colloid supplement for the first 72 hours. Primary outcome parameter was the group difference of administered total fluid from intensive care unit (ICU) admission up to day 3. Secondary outcomes included kidney and lung injury and failure, length of stay, and mortality.ResultsThree-day totals of administered resuscitation fluid (medians) were 21,190 mL in the lactated Ringer’s group and 19,535 mL in the HES group (HES: −1,213 mL; P = 0.39). Creatinine levels from day 1 to 3 (HES: +0.4 μmol/L; 95% confidence interval (CI) −18.7 to 19.5; P = 0.97) and urinary outputs from day 1 to 3 (HES: −58 mL; 95% CI −400 to 283; P = 0.90) were not different. Six patients in each group developed acute respiratory distress syndrome (ARDS) (risk ratio 0.96; 95% CI 0.35 to 2.64; P = 0.95). Length of ICU stay (HES vs. lactated Ringer’s: 28 vs. 24 days; P = 0.80) and length of hospital stay (31 vs. 29 days; P = 0.57) were similar. Twenty-eight-day mortality was 4 patients in each group (risk ratio 0.96; 95% CI 0.27 to 4.45; P = 0.95), and in-hospital mortality was 8 in the HES group vs. 5 patients in the lactated Ringer’s group (hazard ratio 1.86; 95% CI 0.56 to 6.19; P = 0.31).ConclusionsThere was no evidence that early fluid resuscitation with balanced HES 130/0.4 (6%) in addition to lactated Ringer’s solution would lead to a volume-sparing effect in severe burn injury. Together with the findings that early renal function, incidence of ARDS, length of stay, and mortality were not negatively influenced by HES in this setting, balanced HES 130/0.4 (6%) plus lactated Ringer’s solution could not be considered superior to lactated Ringer’s solution alone.Trial registrationClinicalTrials.gov NCT01012648

Effects of different resuscitation fluid on severe acute pancreatitis

To compare effects of different resuscitation fluid on microcirculation, inflammation, intestinal barrier and clinical results in severe acute pancreatitis (SAP). One hundred and twenty patients with SAP were enrolled at the Pancreatic Disease Institute between January 2007 and March 2010. The patients were randomly treated with normal saline (NS group), combination of normal saline and hydroxyethyl starch (HES) (SH group), combination of normal saline, hydroxyethyl starch and glutamine (SHG group) in resuscitation. The ratio of normal saline to HES in the SH and SHG groups was 3:1. The glutamine (20% glutamine dipeptide, 100 mL/d) was supplemented into the resuscitation liquid in the SHG group. Complications and outcomes including respiratory and abdominal infection, sepsis, abdominal hemorrhage, intra-abdominal hypertension, abdominal compartment syndrome (ACS), renal failure, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), operation intervention, length of intensive care unit stay, length of hospital stay, and mortality at 60 d were compared. Moreover, blood oxygen saturation (SpO2), gastric intramucosal pH value (pHi), intra-abdominal pressure (IAP), inflammation cytokines, urine lactulose/mannitol (L/M) ratio, and serum endotoxin were investigated to evaluate the inflammatory reaction and gut barrier. Compared to the NS group, patients in the SH and SHG groups accessed the endpoint more quickly (3.9 ± 0.23 d and 4.1 ± 0.21 d vs 5.8 ± 0.25 d, P < 0.05) with less fluid volume (67.26 ± 28.53 mL/kg/d, 61.79 ± 27.61 mL/kg per day vs 85.23 ± 21.27 mL/kg per day, P < 0.05). Compared to the NS group, incidence of renal dysfunction, ARDS, MODS and ACS in the SH and SHG groups was obviously lower. Furthermore, incidence of respiratory and abdominal infection was significantly decreased in the SH and SHG groups, while no significant difference in sepsis was seen. Moreover, less operation time was needed in the SH and SHG group than the NS group, but the difference was not significant. The mortality did not differ significantly among these groups. Blood SpO2 and gastric mucosal pHi in the SH and SHG groups increased more quickly than in the NS group, while IAP was significantly decreased in the SH and SHG group. Moreover, the serum tumor necrosis factor-α, interleukin-8 and C-reactive protein levels in the SH and SHG groups were obviously lower than in the NS group at each time point. Furthermore, urine L/M ratio and serum endotoxin were significantly lower in the SH group and further decreased in the SHG group. Results indicated that combination of normal saline, HES and glutamine are more efficient in resuscitation of SAP by relieving inflammation and sustaining the intestinal barrier.

Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years

The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years. Analysis of all patients in Iceland who fulfilled the consensus criteria for ARDS in 1988-2010. Demographic variables, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and ventilation parameters were collected from hospital charts. The age-standardised incidence of ARDS during the study period was 7.2 cases per 100,000 person-years and was increased by 0.2 cases per year (P < 0.001). The most common causes of ARDS were pneumonia (29%) and sepsis (29%). The use of pressure-controlled ventilation became almost dominant from 1993. The peak inspiratory pressure (PIP) has significantly decreased (-0.5 cmH(2) O/year), but the peak end-expiratory pressure (PEEP) has increased (0.1 cmH(2) O/year) during the study period. The hospital mortality decreased by 1% per year (P = 0.03) during the study period, from 50% in 1988-1992 to 33% in 2006-2010. A multivariable logistic regression model revealed that higher age and APACHE II score increased the odds of hospital mortality, while a higher calendar year of diagnosis reduced the odds of mortality. This was unchanged when dominant respiratory treatment, PIP and PEEP were added to the model. The 10-year survival of ARDS survivors was 68% compared with 90% survival of a reference population (P < 0.001). The incidence of ARDS has almost doubled, but hospital mortality has decreased during the 23 years of observation. The 10-year survival of ARDS survivors is poor compared with the reference population.

34

Introduction: Post-traumatic Acute Respiratory Distress Syndrome (ARDS) has historically been associated with high rates of morbidity and mortality. The incidence of post-traumatic ARDS is decreasing. Hypothesis: We hypothesize that, despite improvements in care, the associated morbidity and mortality have not declined. This study was undertaken to determine trends in the incidence of post-traumatic ARDS and its associated morbidity and mortality over the last decade. Methods: This retrospective cohort study assessed all trauma patients admitted to the Surgical Intensive Care Unit (SICU) at a Level I academic trauma center from 2001 – 2010. Patients requiring mechanical ventilation were screened for the development of ARDS. Demographics, injury data, fluid and blood component use, ventilator parameters, and outcomes were identified from the SICU, blood bank, and trauma databases. Results: A total of 3954 patients met study inclusion criteria, and 319 (8.1%) developed ARDS. The incidence of ARDS declined in a linear fashion (R2 = 0.76) from 14% in 2001 to 1.9% in 2010. Traditional risk factors including peak inspiratory pressures (PIP), blood component transfusion and positive fluid balance continue to be associated with the development of ARDS. Mean PIP, units of blood, and 48-hour fluid balance declined throughout the study period. After adjusting for age, injury severity, initial hemodynamics, blood component transfusions, fluid balance, and ventilator parameters, the development of ARDS continues to be associated with a 2.7 fold greater risk of death (95% CI 1.8, 4.2), decreased ventilator free days (p < 0.01), and increased length of ICU stay (p<0.01). Overall mortality each year remained stable at 29 – 33% throughout the decade. Conclusions: Though once relatively common after severe trauma, the incidence of ARDS has declined dramatically over the last decade. The cause of this decline is multifactorial, however despite improvements in care, the mortality associated with the development of ARDS remains high. Continued efforts to prevent the development of ARDS have lead to a near disappearance of this highly morbid complication.

Pediatric Acute Lung Injury Epidemiology and Natural History Study

The incidence and outcome of the acute respiratory distress syndrome in children are not well-known, especially under current ventilatory practices. The goal of this study was to determine the incidence, etiology, and outcome of acute respiratory distress syndrome in the pediatric population in the setting of lung protective ventilation. A 1-yr, prospective, multicenter, observational study in 12 geographical areas of Spain (serving a population of 3.77 million ≤ 15 yrs of age) covered by 21 pediatric intensive care units. All consecutive pediatric patients receiving invasive mechanical ventilation and meeting American-European Consensus Criteria for acute respiratory distress syndrome. None. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected. A total of 146 mechanically ventilated patients fulfilled the acute respiratory distress syndrome definition, representing a incidence of 3.9/100,000 population ≤ 15 yrs of age/yr. Pneumonia and sepsis were the most common causes of acute respiratory distress syndrome. At the time of meeting acute respiratory distress syndrome criteria, mean PaO2/FIO2 was 99 mm Hg ± 41 mm Hg, mean tidal volume was 7.6 mL/kg ± 1.8 mL/kg predicted body weight, mean plateau pressure was 27 cm H2O ± 6 cm H2O, and mean positive end-expiratory pressure was 8.9 cm ± 2.9 cm H2O. Overall pediatric intensive care unit and hospital mortality were 26% (95% confidence interval 19.6-33.7) and 27.4% (95% confidence interval 20.8-35.1), respectively. At 24 hrs, after the assessment of oxygenation under standard ventilatory settings, 118 (80.8%) patients continued to meet acute respiratory distress syndrome criteria (PaO2/FIO2 104 mm Hg ± 36 mm Hg; pediatric intensive care units mortality 30.5%), whereas 28 patients (19.2%) had a PaO2/FIO2 >200 mm Hg (pediatric intensive care units mortality 7.1%) (p = .014). This is the largest study to estimate prospectively the pediatric population-based acute respiratory distress syndrome incidence and the first incidence study performed during the routine application of lung protective ventilation in children. Our findings support a lower acute respiratory distress syndrome incidence and mortality than those reported for adults. PaO2/FIO2 ratios at acute respiratory distress syndrome onset and at 24 hrs after onset were helpful in defining groups at greater risk of dying (clinical trials registered with http://www.clinicaltrials.gov; NCT 01142544).

59 The Pediatric Alien Study: Incidence and Outcome of the Acute Respiratory Distress Syndrome in Children

IntroductionThe incidence and outcome of the acute respiratory distress syndrome (ARDS) in children is not well known, especially under current ventilatory practices. The goal of this study was to determine...

Breath Biomarkers and the Acute Respiratory Distress Syndrome

Because pharmacologic treatment of patients with the established Acute Respiratory Distress Syndrome (ARDS) has not been successful, the emphasis on discovering biomarkers that predict ARDS development in at-risk individuals is being rekindled so that ways of preventing ARDS can be advanced and tested. However, the low incidence of ARDS in at-risk individuals, the variable time between becoming at risk and developing ARDS, and the varying incidence of ARDS following different predisposing conditions makes finding clinically-useful ARDS predicting biomarkers challenging. Ideally, biomarkers reflecting ARDS development will be obtainable non-invasively and repeatedly and provide sensitive, specific, accurate and real time results. Biomarkers will also likely need to mirror key events in the pathogenesis of ARDS and meaningfully reflect the effect of therapies on ARDS development. At the moment, analysis of potential biomarkers in breath samples offers an intriguing way of addressing these objectives. A number of ARDS implicated molecules (e.g. hydrogen peroxide, nitric oxide, lipid peroxidation byproducts, cytokeratins) are measurable in breath or breath condensates from ARDS patients. Moreover, powerful new approaches (e.g. proton transfer reaction mass spectrometry, carbon nanotubes analyses using aptamer based multiplexed proteomic technology and cavity-enhanced frequency comb spectroscopy) are emerging that may provide biomarkers that could generate insight regarding the responsible mechanisms for ARDS, monitor ARDS development, enable testing of new ARDS interventions, and guide treating and preventing ARDS.

Trauma center designation and the decreasing incidence of post-traumatic acute respiratory distress syndrome: A potential guidepost for quality improvement

Background The incidence of post-traumatic acute respiratory distress syndrome (ARDS) is decreasing. We hypothesized that disparities exist in the overall incidence and incidence of ARDS over time across different types of trauma centers. Methods The National Trauma Databank version 7.0 was queried for patients admitted to designated trauma centers (I–III) and ventilated at least 48 hours. Level I university admissions (group 1) were compared with level I community and level II/III center admissions (group 2). Results There were 43,664 patients with an incidence of ARDS of 5.2% (2,260) overall, 4.1% (1,062/25,937) in group 1, and 6.8% (1,198/17,727) in group 2 ( P < .001). The incidence decreased significantly in group 1 in contrast to group 2 yearly. The incidence in level I community centers was marked (608/5,180 [11.7%]) and increased significantly over time. On logistic regression, admission to a level I university center (.646 [.590–.707],<.001) was independently associated with ARDS. Conclusions Admission to a level I center may not necessarily confer similar results reflecting potential variation in management between centers that presumably provide similar service. These investigations may have significance to quality improvement.

The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation

While our understanding of the pathogenesis and management of acute respiratory distress syndrome (ARDS) has improved over the past decade, estimates of its incidence have been controversial. The goal of this study was to examine ARDS incidence and outcome under current lung protective ventilatory support practices before and after the diagnosis of ARDS. This was a 1-year prospective, multicenter, observational study in 13 geographical areas of Spain (serving a population of 3.55 million at least 18years of age) between November 2008 and October 2009. Subjects comprised all consecutive patients meeting American-European Consensus Criteria for ARDS. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected. A total of 255 mechanically ventilated patients fulfilled the ARDS definition, representing an incidence of 7.2/100,000population/year. Pneumonia and sepsis were the most common causes of ARDS. At the time of meeting ARDS criteria, mean PaO(2)/FiO(2) was 114±40mmHg, mean tidal volume was 7.2±1.1ml/kg predicted body weight, mean plateau pressure was 26±5cmH(2)O, and mean positive end-expiratory pressure (PEEP) was 9.3±2.4cmH(2)O. Overall ARDS intensive care unit (ICU) and hospital mortality was 42.7% (95%CI 37.7-47.8) and 47.8% (95%CI 42.8-53.0), respectively. This is the first study to prospectively estimate the ARDS incidence during the routine application of lung protective ventilation. Our findings support previous estimates in Europe and are an order of magnitude lower than those reported in the USA and Australia. Despite use of lung protective ventilation, overall ICU and hospital mortality of ARDS patients is still higher than 40%.

The Value of Pulmonary Contusion Volume Measurement With Three-Dimensional Computed Tomography in Predicting Acute Respiratory Distress Syndrome Development

This study reports the value of accurate pulmonary contusion (PC) volume measurement with 3-dimensional computed tomography (CT) in predicting acute respiratory distress syndrome (ARDS) development. The study enrolled all patients who were diagnosed with PC on admission by CT and had a chest Abbreviated Injury Score (AIS) exceeding 2 between January 1, 2010, and October 31, 2010. PC volume was measured from 3-dimensional reconstructions of admission chest CTs and expressed as a percentage of total lung volume. Admission data were prospectively collected. The independent predictor of ARDS development was established. The accuracy and value of the predictors were analyzed, and the influence of PC volume percentage on clinical outcomes was demonstrated. The average PC volume percentage was 21.86% ± 13.90% (range, 5.6% to 61.0%), which was inconsistently correlated with the admission partial pressure of oxygen/fraction of inspired oxygen ratio (R(2) = 0.083). ARDS was diagnosed in 26 patients (43.3%) and pneumonia in 21 (35.0%). The admission partial pressure of oxygen/fraction of inspired oxygen ratio (p = 0.003) and PC volume percentage (p = 0.01) were independent predictive factors of ARDS development. Patients with a PC volume percentage exceeding the best cutoff of 21.5% were defined as the severe PC group. The partial pressure of oxygen/fraction of inspired oxygen ratio, the needed maximal positive end-expiratory pressure level, and ARDS incidence between the severe group and the general group was significantly different (p <.05). Pulmonary contusion volume measured using 3-dimensional CT is feasible in emergency departments and helpful to identify patients at high-risk for ARDS.

Pediatric acute respiratory distress syndrome

There is a lack of epidemiological data related to acute respiratory distress syndrome (ARDS) among pediatric patients. The aim of this study was to determine the incidence, comorbidity and outcome in patients with ARDS treated in tertiary level pediatric intensive care unit (PICU). This retrospective cohort study included patients aged 1 month to 18 years treated at PICU during a five-year period (June 2004 to July 2009) that fulfilled all criteria for the diagnosis of ARDS according to the 1994 North American- European Consensus Conference on ARDS criteria. The incidence of ARDS among critically ill children older than 1 month was 5.7 cases per 1.000 patient-years. ARDS usually developed in a clinical framework of sepsis and severe lower respiratory tract infections. ARDS has a high share in mortality of PICU patients aged 1 month to 18 years, with a mortality rate of 25%, accounting for 10.71% of the total number of deaths in this age group. In patients with ARDS, fatal outcome is almost 6 times more frequent comparing to other life-threatened patients.

Predicting Mortality in Patients with Acute Lung Injury

Predicting Mortality in Patients with Acute Lung Injury

Relationships between Vascular Leakage Factor and Pulmonary Dysfunction in Dengue Hemorrhagic Fever

Background: Mortality in Dengue patients hospitalized in Dr. Kariadi Hospital, Semarang is very high. The most common cause of death were bleeding and Multiple Organ Dysfunction including pulmonary dysfunction that manifest as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). The previous study have shown the incidence of ARDS in DSS but the incidence of pulmonary dysfunction in dengue hemorrhagic fever is unknown.Design and Methods: An analytical observational study was performed in Non DSS and DSS patients. Researsh subjects were patients, aged 3-14 years old, with DHF according to WHO criteria 1999 hospitalized in the pediatric ward and Pediatric Intensive Care Unit (PICU) Dr. Kariadi Hospital Semarang from February 2003 until August 2005.Result: Forty patients were included for analysis consisting of 20 Non DSS and 20 DSS. Mann-Whitney analysis showed a significant differences in the incidence pulmonary dysfunction between Non DSS and DSS patient (p &lt; 0,05). Kendall’s Tau_b analysis showed a relationship between PEI value and pulmonary dysfunction, the low total protein plasma level with pulmonary dysfunction and the low albumin plasma level with pulmonary dysfunction with r = 0.552; 0.540; 0.353 respectively, (p= 0.01).Conclusion: The study showed that pulmonary dysfunction occured more frequent in DSS than Non DSS. There were relationships between vascular leakage factors (PEI, total protein level, albumin level) with incidence of pulmonary dysfunction in DHF patients (Sains Medika, 3(1):1-15).

Relationships between Vascular Leakage Factor and Pulmonary Dysfunction in Dengue Hemorrhagic Fever

Background: Mortality in Dengue patients hospitalized in Dr. Kariadi Hospital, Semarang is very high. The most common cause of death were bleeding and Multiple Organ Dysfunction including pulmonary dysfunction that manifest as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). The previous study have shown the incidence of ARDS in DSS but the incidence of pulmonary dysfunction in dengue hemorrhagic fever is unknown.Design and Methods: An analytical observational study was performed in Non DSS and DSS patients. Researsh subjects were patients, aged 3-14 years old, with DHF according to WHO criteria 1999 hospitalized in the pediatric ward and Pediatric Intensive Care Unit (PICU) Dr. Kariadi Hospital Semarang from February 2003 until August 2005.Result: Forty patients were included for analysis consisting of 20 Non DSS and 20 DSS. Mann-Whitney analysis showed a significant differences in the incidence pulmonary dysfunction between Non DSS and DSS patient (p &lt; 0,05). Kendall’s Tau_b analysis showed a relationship between PEI value and pulmonary dysfunction, the low total protein plasma level with pulmonary dysfunction and the low albumin plasma level with pulmonary dysfunction with r = 0.552; 0.540; 0.353 respectively, (p= 0.01).Conclusion: The study showed that pulmonary dysfunction occured more frequent in DSS than Non DSS. There were relationships between vascular leakage factors (PEI, total protein level, albumin level) with incidence of pulmonary dysfunction in DHF patients (Sains Medika, 3(1):1-15).

Leptin in Fibroproliferative Acute Respiratory Distress Syndrome

Leptin in Fibroproliferative Acute Respiratory Distress Syndrome

Effect of penehyclidine hydrochloride on patients with acute lung injury and its mechanisms

Objective To assess the effects of penehyclidine hydrochloride on patients with acute lung injury (ALI), to observe the expression of Toll-like receptor 4 (TLR4) on the peripheral monocytes of ALI patients and changes of inflammatory & anti-inflammatory cytokines and to investigate the mechanism of TLR4 in ALI. Methods Forty-five patients with ALI were randomly divided into penehyclidine hydrochloride treatment group (P group, n=21) and conventional treatment group (control group, C group, n=24). Patients in both groups received conventional treatment, including active treatment of the primary disease, respiratory support, nutritional support and fluid management therapy, while those in P group were given penehyclidine hydrochloride (1 mg, im, q. 12 h) in addition. The TLR4 expression of 20 healthy volunteers were detected. The clinical effect, average length of stay in ICU and hospital, values of PaO 2 and PaO 2/FiO 2, expression of TLR4 on the surface of peripheral blood mononuclear cells and some serum cytokines were evaluated for 48 h. Results The general conditions of the two groups were improved gradually and PaO 2 increased progressively. Compared with 0 h, PaO 2 and PaO 2/FiO 2 at 6, 12, 24 and 48 h after treatment were significantly increased ( P<0.05). The improvement in P group was obviously greater than that in C group ( P<0.05). The average length of hospitalization showed no difference between the two groups, but penehyclidine hydrochloride significantly decreased the average length of stay in ICU ( t =3.485, P<0.01). The expression of TLR4 in two groups were both obviously higher than that of healthy volunteers ( P<0.01). It decreased significantly at 24 h ( t =2.032, P<0.05) and 48 h ( t=3.620, P <0.01) and was lower in P group than in C group. The patients who showed a higher level of TLR4 expression in early stage had a worse prognosis and most of them developed acute respiratory distress syndrome (ARDS). The incidence of ARDS was 23.8% in P group and 29.17% in C group at 24 h. U ntill 48 h, there were other two patients developing ARDS in control group. Serum IL-1, IL-8 and TNF-α expressions reduced after 24 h in both groups. The reduction in P group was more obvious than that in C group ( P<0.05). IL-13 increased gradually from 0 h to 24 h, and decreased slightly at 48 h, which showed no difference between two groups ( t=1.028, P >0.05). Conclusions Penehyclidine hydrochloride improves the arterial oxygen pressure, down-regulates the expression of TLR4 and restrains the inflammatory cytokines in the downstream of TLR4 signaling pathway. It prevents the development of ALI and can be considered as an important drug in ALI treatment.

Perioperative risk analysis for acute respiratory distress syndrome after elective oesophagectomy

Acute respiratory distress syndrome (ARDS) is a major contributor to respiratory morbidity and mortality after oesophagectomy. Several pre-, intra- and post-operative factors are thought to predispose to its development in the post-oesophagectomy period. The aim of this study was to determine factors predisposing to ARDS in the post-oesophagectomy period. A total of 112 patients who underwent elective oesophagectomy for oesophageal cancer (gastro-oesophageal adenocarcinoma and high-grade dysplasia, 93; oesophageal squamous cell carcinoma, 16; oesophageal oat cell tumour, 1; oesophageal anaplastic carcinoma, 1; oesophageal colloid carcinoma, 1) between 1 January 2003 and 31 December 2006 formed the study group in this retrospective study. The pre-, intra and post-operative data for these patients (male : female = 89:23, mean age 60.8 years) were collected from an oesophagectomy database and hospital medical records. The incidence of ARDS was 13%. The in-hospital mortality among ARDS cases was 20% and 1-year mortality was 40%. Various factors such as preoperative chronic respiratory disease (P-value = 0.000, odds ratio = 17.76), smoking pack-years (P-value = 0.045, odds ratio = 1.02), abnormal preoperative forced expiratory volume in 1 s (P-value = 0.009, odds ratio = 7.97), high percentage of oxygen in inspired air (P-value = 0.041, odds ratio = 1.24) and use of perioperative inotropes (P-value = 0.021, odds ratio = 4.26) were associated with ARDS. Preoperative physiological status as indicated by a preoperative history of chronic respiratory disease and preoperative pulmonary function influenced the post-operative outcome in our patients. The use of perioperative inotropes suggests perioperative cardiorespiratory instability, and could also predispose to the development of ARDS in the post-operative period.

Race/Ethnicity and Acute Respiratory Distress Syndrome: A National Trauma Data Bank Study

BackgroundA study in the general population has shown a higher acute respiratory distress syndrome (ARDS) mortality among blacks. We studied whether black blunt-trauma patients experience different ARDS incidence, ARDS-associ-ated mortality, or ARDS case fatality rates. MethodsNational Trauma Data Bank (NTDB) extracts of blunt-trauma patients with Injury Severity Score (ISS) greater than 16 and length of stay greater than 3 days were used for this study. ARDS incidence, ARDS-associated mortality, and ARDS case fatality rates were calculated for Caucasians, blacks, and Hispanics, and compared using χ2. In order to adjust for con-founders (age, gender, comorbidities, hypotension, and injury severity) multiple logistic regression models were built for the 3 outcomes. Odd ratios (ORs) and 95% confidence intervals (CIs) were calculated. A p < .05 was used for all statistics. ResultsAmong the 96 350 patients studied, ARDS incidence, ARDS-associated mortality, and ARDS case fatality rates were 0.92%, 0.18%, and 19.1%, respectively. Differences among racial/ethnic groups were found between blacks and Caucasians for ARDS incidence (0.70% vs 0.93%) and between Hispanic and Caucasians for ARDS-associated mortality (0.27% vs 0.17%). Multiple logistic regression models adjusting for confounders, using Caucasian race/ethnicity as a reference, revealed a protective effect of black race/ethnicity for ARDS incidence (OR, 0.73; 95% CI, 0.580.91). Hispanics, but not blacks, experienced higher odds of adjusted ARDS-associated mortality (OR, 1.76; 95% CI, 1.152.62) and ARDS case fatality (OR, 1.92; 95% CI, 1.17-3.09). ConclusionsBlack race/ethnicity is not associated with ARDS mortality among blunt-trauma patients. Black race/ ethnicity seems to have a protective effect in relation to ARDS incidence. Hispanic ethnicity was associated with a higher mortality and case fatality rates for ARDS.