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Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.
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Objective To investigate the effect and mechanisms of radix salviae miliorrhizae (RSM)on acute lung injury (ALI)caused by inhalation of high concentration rocket liquid propellant unsymmetrical dimethylhydrazine (UDMH)and dinitrogen tetroxide (N_2O_4). Methods Forty-two rats were divided into three groups:the control group,the inhalation group and the inhalation plus treatment group (RSM group).The latter two groups were inhaled with UDMH 0.98 g/m3 for ten minutes and N_2O_4 0.19 g/m3 for ten minutes.After the inhalation,the rats in RSM group were treated with 9 g?kg -1 RSM intravenously immediately,and were injected into peritoneal cavity with RSM at a dose of 3 g?kg -1 at the 3 hours after the first injection.The rats in other group were treated with equivalent saline.All rats were killed after the observation for six hours.Lung wet to dry ratio (W/D),LDH and total protein in bronchoalveolar lavage fluid (BALF),the activities of superoxide dismutase (SOD)and glutathione peroxidase (GSH-Px)in lung tissue,and the malondialdehyde (MDA)of plasma were measured.Histopathology was observed.Results The lung W/D ratio,LDH and total protein in BALF,MDA of plasma were increased in the inhalation group,while the activities of SOD and GSH-Px in lung tissue were decreased.The histopathology of the inhalation groups rats showed that exudation within alveolar space and interstitial thicken of septa was prominent.In the RSM group,above index were improved,and the degree of lung injury in histopathology was relieved.The lung W/D were related to the activities of SOD and GSH-Px in lung tissue,correlation coefficient were-0.661(P
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1.2 ng/ml on the third day as a threshold,the sensitivity,and specificity in predicting the prognosis of VAP were 81.0%,and 87.5%,respectively. CONCLUSIONS The results suggested that serum PCT be important for the diagnosis of VAP.PCT concentration over 1.2 ng/ml as a threshold is more sensitive and specific to distinguishing different outcomes.And the sensitivity and specificity of PCT are better than that of IL-6,IL-8.
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@#ObjectiveTo investigate the change of the level of testosterone and CD4+/CD8+ T cell in long-term mechanical ventilation patients with chronic obstructive pulmonary disease (COPD) and their correlation.MethodsThe level of testosterone, count of CD4+ and CD8+ T cell were measured in 42 COPD patients accepted long-term mechanical ventilation and other 34 stable COPD patients. The ratio of CD4+/CD8+ was calculated.The correlation between testosterone and CD4+/CD8+ was analyzed.ResultsCompared with the stabel COPD, there were significantly differences in the level of testosterone and the ratio of CD4+/CD8+ in long-term mechanical ventilation COPD group(P<0.05), but there was not relationship between them.ConclusionThe level of testosterone and the ratio of CD4+/CD8+ were significantly decreased in COPD patients with long-term mechanical ventilation. There is no correlation between the level of testosterone and the ratio of CD4+/CD8+.
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Objective To explore the strategies of prevention and treatment of MRSA infection in ICU patients. Methods The clinical data of 6 patients with MRSA infection occurring at the same time in ICU were reviewed retrospectively. Results Vancomycin was given in 4 cases, 250mg twice daily, and teicoplanin was given in one case, 400mg once daily. MRSA cultures were negative in 5 cases after antibiotic treatment. Conclusions MRSA infection occurs frequently in ICU patients, and it spreads readily. Antibiotic treatment, isolation and bacteriological monitoring are very important measures for control of MRSA infection in ICU patients. [HS(1*2/3]
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Objective To screen the influencing factors related to prolonged mechanical ventilation (PMV). Methods Series of parameters of 154 elderly patients with pneumonia or COPD exacerbation were collected before using ventilator, after weaning of ventilator or at the 21st day of ventilating, respectively. Results By single factor analysis, PMV related to not only age, lying on bed, white blood cell, neutrophil, P (A-a)O 2, BUN, Cr, upper digestive tract bleeding, heart rate(HR), and blood pressure(BP) before using ventilator, but also related to heart function and consciousness after ventilator weaning or ventilating for 21 days. By multiple factor analysis, age, P (A-a) O 2 , heart function when ventilating for 21 days were related to PMV. Age≥82.0, P (A-a)O 2 ≥95.0 mm Hg, heart function≥grade 3 were high risk factors of PMV. Furthermore, it was found that the accuracy rate for meeting with those three parameters among 8 elderly patients with PMV was 87.5%. Conclusions Age, P (A-a)O 2 and heart function when ventilating for 21 days might be the independent factors of PMV.
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AIM: To investigate neutrophil(PMN) apoptosis in bronchoalveolar lavage fluid(BALF) in the course of acute lung injury(ALI). METHODS: A rat model of ALI was established by the "two-hit" method,acid instillation and subsequent lipopolysaccharide challenge. At different time,PMN from the BALF and normal peripheral blood were incubated in BALF from normal rats or rats with ALI.PMN apoptosis was determined by flow cytometric analysis of annexin V binding, and interleukin-1?(IL-1?) mRNA was measured in PMN by PCR. RESULTS: Incubated with BALF from ALI ,PMN apoptosis was delayed with elevated expression of IL-1?, and there was a significant negative correlation between the percentage of apoptotic PMN and IL-1? level. CONCLUSION: Neutrophil apoptosis is delayed during ALI, which might have relevance to elevated expression of IL-1?.
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Objective To explore the sensitization effect of insulin to chemotherapy as a metabolic promoter on human lung adenocarcinoma cells A549.Methods The sensitivity of human adenocarcinoma cells A549 to DDP was observed by MTT methods,and IC30 values of the cells were calculated.The optimal concentration of insulin to promoting A549 cells' growth was determined by MTT assay.The A549 cells were pretreated with insulin of various concentrations for different time period,and then the cell sensitivity to DDP was evaluated with MTT assay.Flow cytometry was used to study the cell cycle distribution of the A549 cells treated with insulin.Results The IC30 value of DDP was about 36.87?g/ml.It was found that the cell growth was significantly promoted with pretreatment of insulin at the concentration of 4~16mU/ml for 8~16 hours.Insulin enhanced the inhibitory effect of DDP(36.87?g/ml)on cell proliferation when human lung adenocarcinoma cells A549 were treated with insulin(2.0~16.0mU/ml;8~16h)as indicated by MTT assay(P
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Objective To study the expression of phosphoinositide 3 kinase (PI3-K) and its relationship with lung cell apoptosis in rats with acute lung injury induced by oleic acid. Methods 60 healthy male SD rats were divided into 5 groups randomly, with 12 rats for each group. 0.25ml/kg oleic was injected into the tail vein in 4 oleic groups in which the rats were respectively sacrificed after 1h, 2h, 4h, 6h and 24h by exsanguination. In the control group 0.25ml/kg of saline was injected intravenously and sacrificed 2h later. Arterial blood gas, left lung wet/dry ratio, lung index, protein content of BALF, and pulmonary permeability index (PPI) were determined. Fas-L expression of lung tissue was determined by immunohistochemical method and protein expression of PI3-K was determined by Western blot and immunohistochemical method. Results PaO_2 was lowered, and left lung wet/dry ratio, lung index, and protein content of BALF and PPI were increased obviously after oleic acid injection. Fas-L and PI3-K in bronchus epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells were highly expressed in the lung of ALI rats, and peak value of PI3-K appeared earlier than Fas-L. Conclusion Fas-L related apoptosis of bronchial epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells participated in the pathogenesis of earlier period of ALI through PI3-K transduction pathway.
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Objective To investigate heat shock protein 70 (HSP70) and nuclear factor-?appa B(NF-?B)expression in the lung after mechanical ventilation with PEEP(positive end expiratory pressure)in a rabbit model of ventilator-induced lung injury (VILI). Methods Thirty healthy adult white rabbits were randomly divided into three groups. After anesthesia and tracheostomy were installed, rabbits received ventilation with different tidal volumes for 4 hrs. In PEEP group, rabbits received ventilation withVT=40ml/kg, PEEP=3cmH_2O; group, rabbits received ventilation with VT=40ml/kg, PEEP=0cmH_2O; and NVC group, with normal ventilation with VT=10ml/kg. The different modalities of ventilation were maintained for 4 hours. After 4 hours, rabbits were killed by exsanguination. Lung histopathology was examined and compared among three groups. Expression of HSP70 and NF-?B were determined by using Western-blot technique. Results There were marked pathological changes in the lung tissue in group ZEEP, but pathological changes were relatively milder in group PEEP. After injurious ventilation for 4 hours, there was a significantly higher expression of HSP70 and NF-?B in group ZEEP, while that of NF-?B was negatively correlated with HSP70 levels. There was a significant lower expression of NF-?B in the lung of group PEEP. Conclusion We postulate that HSP70 expression protects the lung against ventilator-induced lung injury by down-regulating expression of NF-?B in the lung. Mechanical ventilation with PEEP can protect the lung against ventilator-induced lung injury through down-regulation of NF-?B in the lung.
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Objective In the present study we examined the roles of three proinflammatory cytokines, i.e. tumor necrosis factor-?(TNF-?), interleukin 1?(IL-1?), and IL-8 in the early phase of APTE, and analyze the impact of these cytokines on the systemic circulation. Methods APTE was induced in 7 anesthetized dogs by injecting the thrombus of own blood into the right jugular vein. Seven animals receiving only warm sterile saline served as controls. Arterial serum samples were collected regularly (0h, 0.5h, 1h, 2h, 4h, 6h) and cytokine levels could be measured by radio-immunity assay. Results Introduction of clots into the pulmonary circulation caused significant increase in the mean pulmonary arterial pressure(from 99.1?5.7 to 66.8?15.3mmHg, P
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Objective On the basis of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), to establish and appraise a new prognostic evaluation system for elder patients with respiratory failure undergoing mechanical ventilation in order to predict hospital mortality in the respiratory intensive care unit. Methods Two hundred and thirty-eight senile patients with respiratory failure having had mechanical ventilation during their hospitalization were retrospectively analyzed. Patients were randomly divided into 2 groups: model group (n=138) and validation group (n=100). Data of model group were analyzed by monofactorial and multifactorial regression analysis to screen the risk factors. Risk factors were given numerical values according to different grades, and complementary scoring system was then established. APACHE Ⅱ system was combined with complementary scoring system with Logistic multiple regression to form SRFMV system, a special evaluation system for the senile patients with respiratory failure undergoing mechanical ventilation. One hundred patients from validation group were evaluated by both SRFMV system and APACHE Ⅱ system, and the results were then compared to assess the validity and reliability of SRFMV system. Oxygenation index, positive end expiratory pressure (PEEP), tidal volume, phlegm quantity and character, and pulmonary auscultation were selected to serve as standard for complementary scoring system. Mortality equation was set up with logistic multiple regression analysis. Results The predication sensitivity and specificity evaluated by SRFMV system in validation group (0.878 and 0.821, respectively) outstripped that evaluated by APACHE Ⅱsystem (0.818 and 0.771, respectively); the area under ROC curve in SRFMV system and the X2 value in Lemesshow-Hosmer statistic (0.911 and 13.77, respectively) also outstripped that in APACHE Ⅱsystem (0.860 and 11.808, respectively). Conclusions SRFMV system is of better sensitivity and specificity, in which the prediction of mortality is closely consistent with the reality. SRFMV system can be applied to obtain valid predictions of relevant outcomes in senile patients with respiratory failure underwent mechanical ventilation.
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Objective The effects of dexamethasone on cell signal transaction system ERK and PI3-K were studied in acute lung injury (ALI) rat in order to provide a theoretical basis for clinical treatment. Methods 36 healthy male SD rats were randomly divided into 3 groups, 12 rats for each group: injured group, dexamethasone treated group and control group. 0.25ml/kg oleic acid was injected via caudal venous into each animal in the former two groups to form ALI models. Then, for dexamethasone treated group, each animal received 1.0mg/kg of dexamethasone 15 min after oleic acid injection; the same amount of saline was given to the animals in injured group, and the animals in control group were injected the same amount of saline at the last two times. All animals were killed by common carotid artery bleeding 2 hours after the last injection. The indexes of PaO2, wet/dry weight of left lung, pulmonary permeability and lung pathology were investigated. The expression of PI3-K, ERK and P-ERK were determined by Western blot and immunohistochemical method. Results PaO2 declined in the animals of injured group, while left lung wet/dry ratio and pulmonary permeability increased obviously, and pulmonary edema and transparent film were observed in injured lung pathology. Compared to injured group, those indexes were improved in dexamethasone treated group. PI3-K, ERK and P-ERK were highly expressed in bronchus epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells of the animals in injured group, the expression of PI3-K, ERK and P-ERK were reduced in dexamethasone group, but the expression in the both groups were still higher than that in control group. Conclusions The higher expression of PI3-K and ERK were involved in the regulation of earlier period of ALI, and dexamethasone may improve ALI by repressing the high expression of PI3-K and ERK.
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Objective To assess the efficacy and safety of non invasive positive pressure ventilation (NPPV) in the treatment of cor pulmonale with acute exacerbation after multiple endotracheal intubation mechanical ventilation. Methods Thirty three patients with acute exacerbation of cor pulmonale, male 31, female 2, aged 81 4?4 7 years old, having undergone endotracheal intubation varying from 2 to 5 times, were treated with NPPV by Bi level positive airway pressure (BiPAP) mode. Results Among all patients, twenty of them (60 6%) could tolerate NPPV with significant improvement in pH(7 23?0 05 vs 7 39?0 04),PaCO 2 (9 98?2 27kPa vs 7 56?1 67kPa), PaO 2 (6 69?2 01kPa vs 10 92?2 33kPa), respectively ( P