Mechanical Ventilation Treatment Research Articles

Early Detection of Legionella pneumophila and Aspergillus by mNGS in a Critically Ill Patient With Legionella Pneumonia After Extracorporeal Membrane Oxygenation Treatment: Case Report and Literature Review.

Legionella pneumophila can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing Legionella pneumonia remains still challenging. Metagenomic next-generation sequencing (mNGS) technology has increased the rate of detection of Legionella. This study describes a patient who rapidly progressed to severe ARDS during the early stage of infection and was treated with extracorporeal membrane oxygenation (ECMO). Although his bronchoalveolar lavage fluid (BALF) was negative for infection and his serum was negative for anti-Legionella antibody, mNGS of his BALF and blood showed only the presence of Legionella pneumophila (blood mNGS reads 229, BALF reads 656). After antibiotic treatment and weaning from ECMO, however, he developed a secondary Aspergillus and Klebsiella pneumoniae infection as shown by mNGS. Mechanical ventilation and antibiotic treatment were effective. A search of PubMed showed few reports of secondary Aspergillus infections after Legionella infection. Severe pneumonia caused by any type of pathogenic bacteria may be followed by Aspergillus infection, sometimes during extremely early stages of infection. Patients with severe pneumonia caused by Legionella infection should undergo early screening for secondary infections using methods such as mNGS, enabling early and precise treatment, thereby simplifying the use of antibiotics and improving patient prognosis.

Energy requirements of long-term ventilated COVID-19 patients with resolved SARS-CoV-2 infection.

Background & aimsCoronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can rapidly progress into acute respiratory distress syndrome accompanied by multi-organ failure requiring invasive mechanical ventilation and critical care treatment. Nutritional therapy is a fundamental pillar in the management of hospitalized patients. It is broadly acknowledged that overfeeding and underfeeding of intensive care unit (ICU) patients are associated with increased morbidity and mortality. This study aimed to assess the energy demands of long-term ventilated COVID-19 patients using indirect calorimetry and to evaluate the applicability of established predictive equations to estimate their energy expenditure.MethodsWe performed a retrospective, single-center study in 26 mechanically ventilated COVID-19 patients with resolved SARS-CoV-2 infection in three independent intensive care units. Resting energy expenditure (REE) was evaluated by repetitive indirect calorimetry (IC) measurements. Simultaneously the performance of 12 predictive equations was examined. Patient's clinical data were retrieved from electronic medical charts. Bland-Altman plots were used to assess agreement between measured and calculated REE.ResultsMean mREE was 1687 kcal/day and 20.0 kcal relative to actual body weight (ABW) per day (kcal/kg/day). Longitudinal mean mREE did not change significantly over time, although mREE values had a high dispersion (SD of mREE ±487). Obese individuals were found to have significantly increased mREE, but lower energy expenditure relative to their body mass. Calculated REE showed poor agreement with mREE ranging from 33 to 54%.ConclusionResolution of SARS-CoV-2 infection confirmed by negative PCR leads to stabilization of energy demands at an average 20 kcal/kg in ventilated critically ill patients. Due to high variations in mREE and low agreement with calculated energy expenditure IC remains the gold standard for the guidance of nutritional therapy.

COVID-19 Infection During Pregnancy and Associated Perinatal Health Outcomes: A National Cohort Study of US Pregnancies

Background: Emerging evidence suggests that COVID-19 infection is more severe in pregnant individuals and may be associated with increased risk of adverse perinatal health outcomes. However, few large-scale, community-based comparative epidemiological studies have evaluated pregnancy outcomes following COVID-19 infection.Methods: We conducted a national cohort study using de-identified administrative claims and electronic health record data from the OptumLabs® Data Warehouse. Every pregnancy with a last menstrual period before 30 April 2020 and date of pregnancy end after 11 March 2020 was included. We identified maternal infections using ICD-10-CM diagnostic code of U07.1 or a positive laboratory testing record for SARS-CoV-2. We compared the risk of adverse pregnancy outcomes using Cox proportional hazard models treating COVID-19 infection as a time-varying exposure, which were adjusted for baseline covariates.Findings: Of the 78,283 pregnancies identified, 2,655 (3·4%) had a documented COVID-19 infection. Infection was more prevalent among Black and Hispanic pregnant individuals and those with pre-existing medical conditions; 3·4% of COVID-19 cases required admission to intensive care, invasive mechanical ventilation or ECMO treatment. COVID-19 during pregnancy was associated with higher risk of medical termination (adjusted hazard ratio [aHR] 2·60; 95% CI 1·17, 5·78), cesarean section (aHR 1·99; 95% CI 1·71, 2·31), clinician-initiated preterm birth (2·88; 95% CI 1·93, 4·30), spontaneous preterm birth (aHR 1·79; 95% CI 1·37, 2·34), and fetal growth restriction (aHR 2·04; 95% CI 1·72, 2·43). Similar associations were observed by trimester of COVID-19 infection.Interpretation: Data from this US pregnancy cohort show increased risk of adverse pregnancy outcomes associated with prenatal COVID-19 infection during any trimester of pregnancy. Prevention of COVID-19 through vaccination, social distancing and other measures could prevent COVID-19-associated adverse pregnancy outcomes. Funding Information: Access to study data was financially supported by OptumLabs® and University of California Los Angeles. The WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Because this study involved analysis of pre-existing, de-identified data, it was considered exempt from Institutional Review Board approval.

Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients.

To further elucidate the origin of early ICU-acquired hypernatraemia. In this retrospective single-centre study, polytrauma patients requiring ICU treatment were analysed. Forty-eight (47.5%) of 101 included polytrauma patients developed hypernatraemia within the first 7 days on ICU. They were more severely ill as described by higher SAPS III, ISS, daily SOFA scores and initial norepinephrine requirements as well as longer requirements of mechanical ventilation and ICU treatment in general. The development of hypernatraemia was neither attributable to fluid- or sodium-balances nor renal impairment. Although lower in the hypernatraemic group from day 4 onwards, median creatinine clearances were sufficiently high throughout the observation period. However, in the hypernatraemic group, urine sodium and chloride concentrations prior to the evolvement of hypernatraemia (56 (27-87) mmol/l and 39 (23-77) mmol/l) were significantly decreased when compared to i) the time after developing hypernatraemia (94 (58-134) mmol/l and 78 (36-115) mmol/l; p < 0.001) and ii) the non-hypernatraemic group in general (101 (66-143) mmol/l and 75 (47-109) mmol/l; p < 0.001). Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients.

Protective effect of combination of anakinra and MCC950 against acute lung injury is achieved through suppression of the NF-κB-mediated-MAPK and NLRP3-caspase pathways

BackgroundIt has been uncovered that the interleukin-1 receptor antagonist anakinra and the NLRP3 inflammasome blocker MCC950 can alleviate acute lung injury (ALI). However, the specific mechanism underlying these effects remains unknown. Thus, we sought to investigate the effects of anakinra and MCC950 in ALI as well as the molecular mechanisms. MethodsWe treated C57BL/6 mice with aerosols of anakinra and/or MCC950 along with lipopolysaccharide (LPS), followed by mechanical ventilation (MV) treatment after 1.5 h of inhalation of aforementioned compounds. Lung injury was assessed by determining the level of inflammatory factors in the alveolar lavage fluid and monitoring blood oxygen saturation. We confirmed our findings of regulation of the ALI model through the nuclear factor-κB (NF-κB)/mitogen-activated protein kinase (MAPK)/nucleotide binding domain and leucine-rich repeat (NLR) pyrin domain containing 3 (NLRP3)-caspase pathway in further studies with RelA−/− mice. ResultsCombined treatment of anakinra and MCC950 presented the best therapeutic effect on LPS and MV-induced ALI than did treatment with anakinra or MCC950 alone. Combined therapy with anakinra and MCC950 suppressed MAPK and NLRP3-caspase via inhibition of the NF-κB pathway to improve ALI, but the therapeutic pathway was revoked by knockout of NF-κB. ConclusionTaken together, combined treatment of anakinra and MCC950 was effective in alleviating ALI in the mouse model, highlighting a new insight into ALI treatment.

Comparison of ETCO2 Value and Blood Gas PCO2 Value of Patients Receiving Non-invasive Mechanical Ventilation Treatment in Emergency Department.

Capnography is the non-invasive measurement and graphic representation of the partial pressure of CO2 in expiration. Although there are many studies in the literature comparing the partial pressure of carbon dioxide (pCO2) and end-tidal CO2 (ETCO2) values in patients who underwent IMV (invasive mechanical ventilation), there are no studies showing their interchangeable applicability in patients who received NIMV (non-IMV). We aimed to evaluate whether the use of ETCO2 in the treatment process can replace pCO2 use in patients scheduled for NIMV treatment in the emergency department. Patients who applied to the emergency department with respiratory distress between March 2019 and January 2020, who were diagnosed with acute cardiogenic edema or acute chronic obstructive pulmonary disease (COPD) exacerbation, and who needed NIMV were included in the study. General characteristics of the patients and the pCO2 and ETCO2 values were measured in the blood gas 1 h after the NIMV application was started. 64.2% (99 patients) of the patients included in the study were male, and 35.8% (55 patients) were female. The mean age of the patients included in the study was 69.1 ± 12.2 years. The mean pCO2 values ​​were measured as 52.6 ± 13.2. The mean of ETCO2 values ​​measured simultaneously was 33.6 ± 10.1. There was a significant difference between the controlled pCO2 values ​​and ETCO2 values ​​at the first hour of NIMV treatment (Z: − 10.640, p < 0.001). The ETCO2 level was found to be different in our patients who received NIMV treatment, which could not be used instead of the pCO2 level.

Low diaphragm muscle mass predicts adverse outcome in patients hospitalized for COVID-19 pneumonia: an exploratory pilot study.

The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. We prospectively enrolled 77 patients with laboratory-confirmed COVID-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow-up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P<0.10 were entered into a multivariate logistic regression model. Cumulative probability for lack of adverse outcomes in patients with or without low baseline diaphragm muscle mass was calculated with the Kaplan-Meier product-limit estimator. The main findings of this study are that: 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs. 2.2 mm, P=0.001); and 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (ß=-708; OR=0.492; P=0.018). Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO<inf>2</inf>/FiO<inf>2</inf>, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.

Factors associated with hospitalization, invasive mechanical ventilation treatment and death among all confirmed COVID-19 cases in Norway: Prospective cohort study.

Aims: For everyone with a positive test for SARS-CoV-2 in Norway, we studied whether age, sex, comorbidity, continent of birth and nursing home residency were risk factors for hospitalization, invasive mechanical ventilation treatment and death. Methods: Data for everyone who had tested positive for SARS-CoV-2 in Norway by end of June 2020 (N = 8569) were linked at the individual level to hospitalization, receipt of invasive mechanical ventilation treatment and death measured to end of July 2020. Underlying comorbidity was proxied by hospital-based in- or outpatient treatment during the two months before the SARS-CoV-2 test. Multivariable generalized linear models were used to assess risk ratios (RRs). Results: Risk of hospitalization was particularly high for elderly (for those aged 90 and above: RR 9.5; 95% confidence interval (CI) 7.1-12.7; comparison group aged below 50), Norwegian residents born in Asia, Africa or Latin-America (RR 2.1; 95% CI 1.9-2.4; comparison group born in Norway), patients with underlying comorbidity (RR 1.6; 95% CI 1.4-1.8) and men (RR 1.3; 95% CI 1.2-1.5). Men and residents born in Africa, Asia and Latin-America were also at higher risk of receiving ventilation treatment and dying, but the mortality risk was especially high for the elderly (for those aged 90 and above: RR 607.9; 95% CI 145.5-2540.1; comparison group aged below 50) and residents in nursing homes (RR 4.2; 95% CI 3.1-5.7). Conclusions: High age was the most important predictor of severe disease and death if infected with SARS-CoV-2, and nursing home residents were at particularly high risk of death.

A novel ratio of CD8+:B-cells as a prognostic marker of coronavirus disease 2019 patient progression and outcome

Infection with SARS-COV-2 may result in severe pneumonia potentially leading to mechanical ventilation and intensive care treatment. The aim of the present study was to analyze the immune responses in critically ill coronavirus 2019 (COVID-19) patients requiring mechanical ventilation and assess their potential use as markers of clinical progression and outcome. Confirmed COVID-19 patients were grouped into those requiring mechanical ventilation (intubated) and non-intubated. Immune phenotyping was performed and cytokine levels were determined. A novel ratio of CD8+:B cells was significantly lower in intubated versus non-intubated (p = 0.015) and intubated non-survivors (NSV) versus survivors (SV) (p = 0.015). The same ratio correlated with outcome, CRP, IL-6 levels and neutrophil count. Receiving operating curve (ROC) analysis for prediction of requirement of mechanical ventilation by the CD8+:B cells ratio revealed an AUC of 0.747 and a p = 0.007. The ratio of CD8+:B cells may serve as a useful prognostic marker for disease severity and outcome.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Coronavirus diseases 2019 and kidney injury: a brief review based on current evidence.

Correlation Between CRP Il-6 Level, Severity and Mortality in Patients with Covid-19 Infection in Indonesia

Background: IL-6 plays an important role in the occurrence of cytokine storm and is the major inducer of C-reactive protein (CRP) gene expression in the liver. This study aims to analyze CRP and IL-6 levels as markers of severity and mortality in COVID-19 patients. Methods: 50 subjects met the inclusion and exclusion criteria; the study was conducted using a retrospective observational cohort design and analyzed using Spearman-Rho and Mann Whitney test. Results: There is relationship between CRP and the severity of COVID-19 with p value &lt; 0.001 and r value 0.604. The severity of IL-6 and COVID-19 was also associated with a p-value of 0.017 and an R-value of 0.337. CRP was also associated with mortality with a p value of 0.004, where the baseline SOFA score was p &lt; 0.001 and the r value was 0.551. IL-6 was associated with symptom onset with a p-value of 0.027 and an R-value of 0.314. Meanwhile, CRP and IL-6 were associated with mechanical ventilation treatment with p-values ​​of 0.013 and 0.027, respectively. CRP also has a strong correlation with IL-6 levels with p value &lt; 0.001 and r value 0.557. Conclusion: Examination of CRP and IL-6 was associated with severity, complications and mortality in COVID-19 patients, except that IL-6 was not associated with mortality because it is influenced by the patient’s comorbid disease.

Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax.

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.

Network Data Acquisition and Monitoring System for Intensive Care Mechanical Ventilation Treatment

The rise of model-based and machine learning methods have created increasingly realistic opportunities to implement personalized, patient-specific mechanical ventilation (MV) in the ICU. These methods require monitoring of real-time patient ventilation waveform data (VWD) during MV treatment. However, there are relatively few non-invasive and/or non-proprietary systems to monitor and record patient-specific lung condition in real-time. In this paper, we present a CARE network data acquisition and monitoring system (CARENet) to automate data collection and to remotely monitor patient-specific lung condition and ventilation parameters. The automated system acquires VWD from a mechanical ventilator using a data acquisition device (DAQ), stores data in network-attached storage (NAS), and processes VWDs via a data management platform (DMP) web application. The web application enables real-time and retrospective model-based monitoring and analysis of clinical MV data. In particular, CARENet provides detailed breath-by-breath patient-specific respiratory mechanics, as well as the overall trends assessing changes in patient condition. Validation testing with a retrospective data set illustrated how breath-to-breath and time-varying patient-ventilator interaction during MV can be monitored, and, in turn, can be used to guide MV treatment. The network data acquisition system design presented is low-cost, open, and enables continuous, automated, scalable, real-time collection and analysis of waveform data, to help improve decision making, care, and outcomes in MV.

PINK1/Parkin-mediated mitophagy in mechanical ventilation-induced diaphragmatic dysfunction.

Background:Mechanical ventilation (MV) often leads to ventilation-induced diaphragm dysfunction (VIDD). Although the development of this disorder had been linked to oxidative stress, mitochondrial energy deficiency, autophagy activation, and apoptosis in the diaphragm, it remains unclear whether the activation of mitophagy can induce VIDD. With our research, our endeavor is to uncover whether PTEN-induced putative kinase 1 (PINK1)/Parkin-mediated mitophagy affects the MV-caused diaphragmatic dysfunctionMethods:Sprague-Dawley rats were subjected to MV treatment for 6 h (MV-6h), 12 h (MV-12h), or 24 h (MV-24h). Post MV, the diaphragm muscle compound action potential (CMAP) and cross-sectional areas (CSAs) of the diaphragm of these rats were measured. The levels of proteins of interest were examined to assess muscle health, mitochondrial dynamics, and mitophagy in the diaphragm. The co-localization of PINK1 with the mitochondrial protein marker tom20 was examined, as well as transmission electron microscopy analysis to detect changes in diaphragm mitochondrial ultrastructure.Results:MV-12h and MV-24h treatments resulted in a decrease in CSA of diaphragm and CMAP amplitude. In addition, the expressions of F-box (MFAbx), muscle-specific ring finger 1 (MURF1), PINK1, and p62 were elevated in rats treated with MV for 12 h and 24 h, while mfn2 expression was reduced. Rats following MV-24h treatment displayed an increase in mitochondrial dynamic protein (Drp1) and Parkin expression and microtubule-associated protein 1 light chain 3/1 (LC3II/I) ratio. Moreover, decreased SOD and GSH activity and membrane potential were observed after MV-12h and MV-24h treatment, while H2O2 activity increased after MV-24h treatment. In addition, a strong co-localization between PINK1 and tom20 was identified.Conclusion:These results reveal that MV leads to various changes in mitochondrial dynamics and significantly increases the mitophagy levels, which subsequently cause the variation in diaphragmatic function and muscle atrophy, indicating that mitophagy could be one of the possible mechanisms by which MV induces diaphragmatic dysfunction. The reviews of this paper are available via the supplemental material section.

Albumin Supplementation Dampens Hypercoagulability in COVID-19: A Preliminary Report

Coronavirus disease 2019 (COVID-19) is characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) needing mechanical ventilation and intensive care unit (ICU) treatment. In addition to lung disease, clinical features of SARS-CoV-2 include myocardial damage and ischemia-related vascular disease, which are associated with a hypercoagulable state (e.g., high D-dimer levels) predisposing to thrombotic-related complications and eventually death.[1] [2] [3] Serum albumin levels <3.5 g/dL are detectable in SARS-CoV-2 patients and associated with death[4] and elevated D-dimer and thrombotic events,[5] which is in accordance with previous studies reporting an association between serum albumin <3.5 g/dL and risk of venous and arterial thrombosis.[6] Thus, we tested the hypothesis that albumin supplementation could dampen hypercoagulability in SARS-CoV-2 with serum albumin <3.5 g/dL.

Lung Ultrasound as a Monitoring Tool

Lung ultrasound has proven to be useful in detecting pneumothorax, interstitial syndrome, and lung consolidation. It is easily applied at the bedside, in real-time, and free of radiation hazards. Recently, the use of lung ultrasound has moved from a diagnostic tool to a monitoring tool for lung aeration quantification. This article reviewed the use of lung ultrasound in monitoring acute pulmonary edema, acute respiratory distress syndrome, and pneumonia, and how it could be used to monitor changes during the application of mechanical ventilation or other treatments for respiratory failure.

Influence of perinatal complications on the development of a sample of 36-month-old premature infants

ObjectiveThe lack of clear results in previous studies for this context makes us consider an exploratory study. The objective of this research is to examine the influence of certain perinatal factors on the development of premature infants over their first 36 months of life. MethodThe sample consisted of 59 preterm infants born between 25 and 34 weeks of gestational age in an NICU of a third-level hospital. At 36 months of age, the Bayley-III Infant Development Scale (Spanish adaptation) and a clinical history were collected. ResultsThe average scores on the Bayley-III Infant Development Scale were generally within the normal range, but significantly lower than normal for Fine Motor Function, Gross Motor Function, and Expressive Language. These differences remained when considering the degree of prematurity, gender, and perinatal complications. Infants who received mechanical ventilation, oxygen therapy or corticosteroid treatment due to bronchopulmonary dysplasia showed the greatest discrepancies from normal levels. ConclusionOur results support prior studies that show that a combination of perinatal risk factors constitutes the largest determinant for developmental issues at 36 months of age. This information establishes the need for a priority follow-up in this population beyond 24 months of corrected age.

Five novel clinical phenotypes for critically ill patients with mechanical ventilation in intensive care units: a retrospective and multi database study

BackgroundAlthough protective mechanical ventilation (MV) has been used in a variety of applications, lung injury may occur in both patients with and without acute respiratory distress syndrome (ARDS). The purpose of this study is to use machine learning to identify clinical phenotypes for critically ill patients with MV in intensive care units (ICUs).MethodsA retrospective cohort study was conducted with 5013 patients who had undergone MV and treatment in the Department of Critical Care Medicine, Peking Union Medical College Hospital. Statistical and machine learning methods were used. All the data used in this study, including demographics, vital signs, circulation parameters and mechanical ventilator parameters, etc., were automatically extracted from the electronic health record (EHR) system. An external database, Medical Information Mart for Intensive Care III (MIMIC III), was used for validation.ResultsPhenotypes were derived from a total of 4009 patients who underwent MV using a latent profile analysis of 22 variables. The associations between the phenotypes and disease severity and clinical outcomes were assessed. Another 1004 patients in the database were enrolled for validation. Of the five derived phenotypes, phenotype I was the most common subgroup (n = 2174; 54.2%) and was mostly composed of the postoperative population. Phenotype II (n = 480; 12.0%) led to the most severe conditions. Phenotype III (n = 241; 6.01%) was associated with high positive end-expiratory pressure (PEEP) and low mean airway pressure. Phenotype IV (n = 368; 9.18%) was associated with high driving pressure, and younger patients comprised a large proportion of the phenotype V group (n = 746; 18.6%). In addition, we found that the mortality rate of Phenotype IV was significantly higher than that of the other phenotypes. In this subgroup, the number of patients in the sequential organ failure assessment (SOFA) score segment (9,22] was 198, the number of deaths was 88, and the mortality rate was higher than 44%. However, the cumulative 28-day mortality of Phenotypes IV and II, which were 101 of 368 (27.4%) and 87 of 480 (18.1%) unique patients, respectively, was significantly higher than those of the other phenotypes. There were consistent phenotype distributions and differences in biomarker patterns by phenotype in the validation cohort, and external verification with MIMIC III further generated supportive results.ConclusionsFive clinical phenotypes were correlated with different disease severities and clinical outcomes, which suggested that these phenotypes may help in understanding heterogeneity in MV treatment effects.

Predictors of perioperative morbidity and mortality in adult living donor liver transplantations: report of results of a tertiary hospital

BackgroundThe aim of this study was to investigate the risk factors effective in perioperative morbidity and mortality in 161 living donor liver transplantations (LDLT).ResultsThe most common indication for living donor transplantation was cryptogenic cirrhosis. The most common complication was biliary problems in 62.16% cases. Sepsis was the most common cause of in 52%. Patients in whom sepsis was observed, significantly prolonged stay under mechanical ventilation and prolonged ICU stay were detected. In patient group in whom mortality was observed, higher amounts of erythrocytes, fresh frozen plasma (FFP), and platelets were transfused, and patients remained longer under mechanical ventilation treatment, and in the ICU.ConclusionPerioperative morbidity and mortality was found to be significantly related with higher amounts of erythrocytes and FFP transfusions and longer operative and warm ischemia times. Sepsis was found to be the most common cause of mortality.

Total alveolar lavage with oxygen fine bubble dispersion directly improves lipopolysaccharide-induced acute respiratory distress syndrome of rats

Severe respiratory disorder induced by pulmonary inflammation is one of the causes of acute respiratory distress syndrome, which still has high mortality. It is crucial to remove causative substances and inflammatory mediators early in order to inhibit the progression of pulmonary inflammation. Total alveolar lavage (TAL) may avert the inflammatory response by eliminating causative substances in certain inflammatory lung diseases. We developed an efficient TAL system and examined the efficacy of short-term TAL treatment performed for acute lung injury models of rats. In the first experiment with a severe lung injury model, 15 rats were divided into 3 groups: sham group, mechanical gas ventilation (MGV) treatment group, and TAL treatment group. The treatments were conducted for 5 min, 20 min after the provocation of inflammation. Two days after treatment, the TAL and MGV treatment groups exhibited significant differences in blood oxygen levels, mean arterial pressure, weight-loss ratio, and inflammatory cytokine levels in the lungs. In contrast, almost no differences were observed between the TAL treatment and sham groups. In the second experiment with a lethal lung injury model, the TAL treatment dramatically improved the survival rate of the rats compared to the MGV treatment groups (p = 0.0079). Histopathological analysis confirmed pronounced differences in neutrophil accumulation and thickening of the interstitial membrane between the TAL and MGV treatment groups in both experiments. These results indicate that as little as 5 min of TAL treatment can protect rats from acute lung injury by removing causative substances from the lungs.