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Acute Distress Syndrome

C Roberto Simons-Linares, Sunguk Jang, Madhusudan Sanaka, Amit Bhatt, Rocio Lopez, John Vargo, Tyler Stevens, Prabhleen Chahal
The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only.Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes...
February 2019: Medicine (Baltimore)
Manpreet K Virk, Justin C Hotz, Wendy Wong, Robinder G Khemani, Christopher J L Newth, Patrick A Ross
Objective: To determine if increasing positive end expiratory pressure (PEEP) leads to a change in cardiac index in children with Pediatric Acute Respiratory Distress Syndrome ranging from mild to severe. Design: Prospective interventional study. Setting: Multidisciplinary Pediatric Intensive Care Unit in a University teaching hospital. Patients: Fifteen intubated children (5 females, 10 males) with a median age of 72 months (IQR 11, 132) and a median weight of 19.3 kg (IQR 7.5, 53.6) with a severity of Pediatric Acute Respiratory Distress Syndrome that ranged from mild to severe with a median lung injury score of 2...
2019: Frontiers in Pediatrics
Tingting Xie, Qiaoyi Xu, Hanxi Wan, Shunpeng Xing, Chen Shang, Yuan Gao, Zhengyu He
Pulmonary fibrosis is a major cause of death in patients with acute respiratory distress syndrome (ARDS). Our previous study revealed that lipopolysaccharide (LPS) challenge could lead to mouse lung fibroblast proliferation. Additionally, inhibition of autophagy in lung fibroblasts was also reported to be crucial during the process of pulmonary fibrosis. However, the correlation between proliferation and inhibition of autophagy of lung fibroblasts and the underlying mechanism remain unknown. In this study, we report that autophagy was inhibited in mouse lung fibroblasts after LPS challenge, and was accompanied by activation of the PI3K-Akt-mTOR signaling pathway...
February 13, 2019: Laboratory Investigation; a Journal of Technical Methods and Pathology
Yue Zhou, Pengfei Li, Andrew J Goodwin, James A Cook, Perry V Halushka, Eugene Chang, Basilia Zingarelli, Hongkuan Fan
BACKGROUND: The acute respiratory distress syndrome (ARDS) is characterized by disruption of the alveolar-capillary barrier resulting in accumulation of proteinaceous edema and increased inflammatory cells in the alveolar space. We previously found that endothelial progenitor cell (EPC) exosomes prevent endothelial dysfunction and lung injury in sepsis in part due to their encapsulation of miRNA-126. However, the effects of EPC exosomes in acute lung injury (ALI) remain unknown. METHODS: To determine if EPC exosomes would have beneficial effects in ALI, intratracheal administration of lipopolysaccharide (LPS) was used to induce ALI in mice...
February 13, 2019: Critical Care: the Official Journal of the Critical Care Forum
Catia Cillóniz, Cristina Dominedò, Antonello Nicolini, Antoni Torres
Worldwide, there is growing concern about the burden of pneumonia. Severe community-acquired pneumonia (CAP) is frequently complicated by pulmonary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syndrome, and acute cardiac events, resulting in significantly increased intensive care admission rates and mortality rates. Streptococcus pneumoniae (Pneumococcus) remains the most common causative pathogen in CAP. However, several bacteria and respiratory viruses are responsible, and approximately 6% of cases are due to the so-called PES ( Pseudomonas aeruginosa , extended-spectrum β-lactamase Enterobacteriaceae , and methicillin-resistant Staphylococcus aureus ) pathogens...
February 12, 2019: Microorganisms
Yunbo Ke, Pratap Karki, Chenou Zhang, Yue Li, Trang Nguyen, Konstantin G Birukov, Anna A Birukova
Mechanical ventilation remains an imperative treatment for the patients with acute respiratory distress syndrome, but can also exacerbate lung injury. We have previously described a key role of RhoA GTPase in high cyclic stretch (CS)-induced endothelial (EC) barrier dysfunction. However, cellular mechanotransduction complexes remain to be characterized. This study tested a hypothesis that recovery of vascular EC barrier after pathologic mechanical stress may be accelerated by cell exposure to physiologic CS levels and involves Rap1-dependent rearrangement of endothelial cell junctions...
February 13, 2019: Molecular Biology of the Cell
Yishan Wang, Huijuan Wang, Chunfang Zhang, Chao Zhang, Huqin Yang, Ruiyue Gao, Zhaohui Tong
BACKGROUND: With the development of new techniques to easily obtain lower respiratory tract specimens, bronchoalveolar lavage fluid and other lung fluids are gaining importance in pulmonary disease diagnosis. We aimed to review and summarize lung fluid biomarkers associated with acute respiratory distress syndrome diagnosis and mortality. METHODS: After searching PubMed, Embase, Web of Science, and the Cochrane Library for articles published prior to January 11, 2018, we performed a meta-analysis on biomarkers for acute respiratory distress syndrome diagnosis in at-risk patients and those related to disease mortality...
February 12, 2019: Critical Care: the Official Journal of the Critical Care Forum
Yurong Yan, Kexin Lu, Ting Ye, Zongwang Zhang
Acute lung injury (ALI) and the more severe acute respiratory distress syndrome are common and complex inflammatory lung diseases. MicroRNAs (miRs) have emerged as novel gene regulatory molecules, serving a crucial role in a variety of complex diseases, including ALI. In the present study, the anti‑inflammatory action of miR‑223 on inflammation in ALI was demonstrated and the possible mechanism was further examined. In lipopolysaccharide‑induced ALI, the expression of miR‑223 was reduced compared with that in the control normal group...
January 23, 2019: International Journal of Molecular Medicine
Anup Das, Luigi Camporota, Jonathan G Hardman, Declan G Bates
BACKGROUND: Recent analyses of patient data in acute respiratory distress syndrome (ARDS) showed that a lower ventilator driving pressure was associated with reduced relative risk of mortality. These findings await full validation in prospective clinical trials. METHODS: To investigate the association between driving pressures and ventilator induced lung injury (VILI), we calibrated a high fidelity computational simulator of cardiopulmonary pathophysiology against a clinical dataset, capturing the responses to changes in mechanical ventilation of 25 adult ARDS patients...
February 11, 2019: Respiratory Research
Tetsuro Kamo, Sadatomo Tasaka, Takeshi Suzuki, Takanori Asakura, Shoji Suzuki, Kazuma Yagi, Ho Namkoong, Makoto Ishii, Hiroshi Morisaki, Tomoko Betsuyaku
BACKGROUND: In the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients. METHODS: In this study, we examined the associations between the Berlin definition criteria and prognosis and clinical parameters, including high-resolution computed tomography (HRCT) scores of fibroproliferative changes of the lungs...
February 11, 2019: BMC Pulmonary Medicine
Samuel M Galvagno, Nirav G Shah, Christopher R Cornachione, Kristopher B Deatrick, Michael A Mazzeffi, Jay Menaker
INTRODUCTION: Diffuse alveolar damage is the histologic hallmark for the acute phase of acute respiratory distress syndrome and can occasionally present as diffuse alveolar hemorrhage. CASE REPORT: We report a patient with diffuse alveolar hemorrhage and acute respiratory distress syndrome requiring veno-venous extracorporeal life support for 210 days, who was successfully treated for a period of 130 consecutive days without intravenous anticoagulation. DISCUSSION: Although there are a few brief reports detailing long extracorporeal life support runs, the literature is largely devoid of data regarding long-term extracorporeal life support without full systemic anticoagulation...
February 11, 2019: Perfusion
Renee D Stapleton, Benjamin T Suratt, Margaret J Neff, Mark M Wurfel, Lorraine B Ware, John T Ruzinski, Ellen Caldwell, Teal S Hallstrand, Polly E Parsons
PURPOSE: Bronchoalveolar fluid (BALF) and plasma biomarkers are often endpoints in early phase randomized trials (RCTs) in acute respiratory distress syndrome (ARDS). With ARDS mortality decreasing, we analyzed baseline biomarkers in samples from contemporary ARDS patients participating in a prior RCT and compared these to historical controls. MATERIALS AND METHODS: Ninety ARDS adult patients enrolled in the parent trial. BALF and blood were collected at baseline, day 4 ± 1, and day 8 ± 1...
February 12, 2019: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
Shu-Chen Kung, Yi-Li Hung, Wan-Ling Chen, Ching-Min Wang, Hui-Chun Chang, Wei-Lun Liu
Since the clinical benefit of lung recruitment maneuvers (LRMs) is still conflicting, we performed this prospective, randomized, controlled study to investigate whether LRMs should be used in the routine management of acute respiratory distress syndrome (ARDS). This trial was conducted in four intensive care units (ICUs) to compare application of a modified stepwise LRMs with solely lung-protective ventilation in patients with moderate to severe ARDS within 72 h from the onset. The primary outcome was 28-day mortality, and the secondary outcomes were ventilator-free days and ICU-free days...
February 10, 2019: Journal of Clinical Medicine
Jessica Selter, Timothy Wen, Katherine L Palmerola, Alexander M Friedman, Zev Williams, Eric J Forman
BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening clinical condition. OBJECTIVE: The objective of this study was to evaluate risk factors for life-threatening complications for patients with severe OHSS in a United States nationwide sample. MATERIALS AND METHODS: OHSS admissions from 2002-2011 from the Nationwide Inpatient Sample (NIS) were included in this study. The association between patient and hospital factors and life-threatening complications (deep vein thrombosis/pulmonary embolism [DVT/PE], acute respiratory distress syndrome [ARDS], acute renal failure [ARF], intubation), non-routine discharge (discharge to skilled nursing facility, transfer hospital), prolonged length of stay (LOS), and total hospital charges were analyzed...
February 8, 2019: American Journal of Obstetrics and Gynecology
John W Kreit
Volume capnography provides a non-invasive, continuous display of the fractional concentration or partial pressure of carbon dioxide versus exhaled volume. Derived measurements and calculations are influenced by changes in both ventilation and perfusion and are therefore useful for assessing both respiratory and cardiovascular function. This article provides an evidence-based review of several potential uses of volume capnography in the ICU: 1) monitoring the effectiveness of ventilation by using end-tidal PCO2 as a surrogate for arterial PCO2; 2) assessing volume-responsiveness; 3) measuring cardiac output; 4) determining prognosis in patients with the acute respiratory distress syndrome; 5) optimizing alveolar recruitment; and 6) excluding pulmonary embolism...
February 11, 2019: Annals of the American Thoracic Society
Nandakishore Bompelli, Rakesh Reddy C, Santosh Modani, Anirudda Deshpande
We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly...
February 9, 2019: BMJ Case Reports
Sahereh Mirzaei, Alana Steffen, Karen Vuckovic, Catherine Ryan, Ulf Bronas, Jessica Zegre-Hemsey, Holli A DeVon
INTRODUCTION: More than 5.5 million patients present to emergency departments in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in emergency departments. Our aim was to describe the quality of symptoms (chest discomfort/description of pain, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in emergency departments. METHODS: The sample consisted of 1,064 patients presenting to emergency departments with symptoms that triggered cardiac workups...
February 7, 2019: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Lan Meng, Xin Zhao, Hongxia Zhang
<strong>BACKGROUND</strong> Acute respiratory distress syndrome (ARDS), which is characterized by severe hypoxemia (PaO2/FIO2 ≤300 mmHg), is usually companied by uncontrolled inflammation, oxidative injury, and the damage to the alveolar-capillary barrier. Severe ARDS is usually companied with acute lung injury that worsen the patients' condition. HIPK1 is a modulator of homeodomain-containing transcription factors and regulates multiple cellular biological process associated with inflammation and anti-stress responses...
January 29, 2019: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
William Bain, Tolani Olonisakin, Minting Yu, Yanyan Qu, Mei Hulver, Zeyu Xiong, Huihua Li, Joseph Pilewski, Rama K Mallampalli, Mehdi Nouraie, Anuradha Ray, Prabir Ray, Zhenyu Cheng, Robert M Q Shanks, Claudette St Croix, Roy L Silverstein, Janet S Lee
Thrombocytopenia is associated with worse outcomes in patients with acute respiratory distress syndrome, which is most commonly caused by infection and marked by alveolar-capillary barrier disruption. However, the mechanisms by which platelets protect the lung alveolar-capillary barrier during infectious injury remain unclear. We found that natively thrombocytopenic Mpl -/- mice deficient in the thrombopoietin receptor sustain severe lung injury marked by alveolar barrier disruption and hemorrhagic pneumonia with early mortality following acute intrapulmonary Pseudomonas aeruginosa (PA) infection; barrier disruption was attenuated by platelet reconstitution...
February 12, 2019: Blood Advances
Danqiong Wang, Guozheng Zhang, Weiwen Zhang, Jian Luo, Lihua Zhu, Jianhua Hu
RATIONALE: Because of the lack of an antidote or effective treatment, patients with severe acute diquat and glyphosate poisoning always died within a few hours. Extracorporeal membrane pulmonary oxygenation (ECMO), as an artificial heart-lung supporting system, can be applied to support lung that is expected to recover from reversible pathological damage. However, to our knowledge, the application of ECMO for patients with diquat and glyphosate poisoning has not been reported. PATIENT CONCERNS: A 40-year-old man ingested in 100 ml of diquat (20 g/100 ml) and 400 ml glyphosate (41 g/100 ml) was admitted to the intensive care unit (ICU), immediately complicated by the development of ventricular fibrillation, respiratory failure, renal failure, and multi-organ failure...
February 2019: Medicine (Baltimore)
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