The correlation between coagulation function and prognosis in patients with acute respiratory distress syndrome caused by extrapulmonary sepsis or pulmonary infection / 中华内科杂志

Objective:To explore the difference of coagulation function and its correlation with prognosis in patients with acute respiratory distress syndrome (ARDS) caused by extrapulmonary sepsis and pulmonary infection.Methods:ARDS patients caused by extrapulmonary sepsis and pulmonary infection admitted to the ICU were retrospectively analyzed at the First Affiliated Hospital of China Medical University from July 2017 to June 2019. The clinical characteristics were collected including sequential organ failure assessment (SOFA), coagulation parameters [prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-Dimer (D-D), fibrinogen degradation product (FDP), antithrombin Ⅲ(AT-Ⅲ), platelet (PLT)], duration of mechanical ventilation, length of stay (LOS) in ICU and 28-day mortality. According to the risk factors, the patients were divided into extrapulmonary sepsis group and pulmonary infection group. The correlation analysis between coagulation parameters and the prognosis of ARDS patients were analyzed by multivariate logistic regression analysis.Results:A total of 268 ARDS patients were screened and 28 cases were excluded. Finally, 240 ARDS patients were enrolled, including 145 caused by extrapulmonary sepsis and 95 by pulmonary infection. PT, INR and APTT in the extrapulmonary sepsis group were significantly higher than those in pulmonary infection group ( P<0.05). AT-Ⅲ level was lower than that in pulmonary infection group ( P<0.05). Ninty-three patients survived at 28 days in the non-pulmonary sepsis group, the mortality rate was 35.9% (52/145). PT, INR, APTT in patients who died at 28 days were significantly higher than those of the patients who survived ( P<0.05), while AT-Ⅲ level was lower than those of the patients who survived ( P<0.05). 49 patients survived at 28 days in the pulmonary infection group, the mortality rate was 48.4% (46/95). There was no significant difference in the coagulation parameters between two groups. Multivariate logistic regression analysis showed that SOFA score without PLT( OR=1.210,95% CI 1.067-1.372, P=0.003) and INR ( OR=2.408,95% CI 1.007-5.760, P=0.048) were independent risk factors for 28-day mortality in extrapulmonary sepsis group. Coagulation parameters are not independent risk factors for 28-day mortality in ARDS patients related to pulmonary infection. Conclusion:There are significant differences in coagulation function between ARDS patients caused by extrapulmonary sepsis or pulmonary infection. INR is an independent risk factor for 28-day mortality in extrapulmonary sepsis group.

Oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo devido à pneumonia por influenza A (H1N1) pdm09. Experiência em um único centro durante a temporada de 2013-2014 / Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

RESUMO Objetivo: Descrever os desfechos de pacientes com síndrome do desconforto respiratório agudo associada à influenza subtipo H1N1 grave tratados com oxigenação por membrana extracorpórea. Métodos: Trata-se de revisão retrospectiva de uma coorte de pacientes oriunda de um único centro, constituída por adultos com síndrome do desconforto respiratório agudo relacionada com influenza subtipo H1N1 e tratados com oxigenação venovenosa por membrana extracorpórea durante a temporada de inverno no hemisfério norte de 2013/2014. Resultados: Dez pacientes receberam oxigenação venovenosa por membrana extracorpórea para tratamento de influenza subtipo H1N1 entre janeiro de 2013 e março de 2014. Sete deles foram transferidos para nosso centro visando à utilização de oxigenação por membrana extracorpórea dentro de um período de 72 horas após o início da ventilação mecânica. A idade mediana foi de 40 anos, sendo 30% dos pacientes do sexo feminino. O valor mediano da proporção entre pressão parcial de oxigênio e fração inspirada de oxigênio foi de 62,5, sendo o escore RESP mediano de 6. Três pacientes receberam inalação de óxido nítrico e quatro utilizaram posição prona como tratamento de resgate antes de ser iniciada a oxigenação por membrana extracorpórea. A duração mediana da ventilação mecânica foi de 22 dias (variação de 14 - 32). O tempo mediano de permanência na unidade de terapia intensiva foi de 27 dias (variação de 14 - 39). O tempo mediano de permanência no hospital foi de 29,1 dias (variação de 16,0 - 46,9). Ocorreram complicações não importantes de sangramento em seis dos dez pacientes. Oito dos dez pacientes sobreviveram até a alta hospitalar. Conclusão: Os sobreviventes eram relativamente jovens e tiveram alta com boas condições funcionais, o que salienta os anos de vida ajustados pela qualidade que foram salvos. Nossa experiência demonstra que mesmo um programa ainda relativamente novo de oxigenação por membrana extracorpórea pode desempenhar um papel importante, e proporcionar resultados excelentes para os pacientes mais graves.

ABSTRACT Objective: This report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy. Methods: This retrospective review analyzed a single-center cohort of adult patients with H1N1-related acute respiratory distress syndrome who were managed with veno-venous extracorporeal membrane oxygenation during the winter of 2013/2014. Results: A total of 10 patients received veno-venous extracorporeal membrane oxygenation for H1N1 influenza between January 2013 and March 2014. Seven patients were transferred to our center for extracorporeal membrane oxygenation consideration (all within 72 hours of initiating mechanical ventilation). The median patient age was forty years, and 30% were female. The median arterial oxygen partial pressure to fraction of inspired oxygen ratio was 62.5, and the median RESP score was 6. Three patients received inhaled nitric oxide, and four patients were proned as rescue therapy before extracorporeal membrane oxygenation was initiated. The median duration of mechanical ventilation was twenty-two days (range, 14 - 32). The median length of stay in the intensive care unit was twenty-seven days (range, 14 - 39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9). Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten patients survived to hospital discharge. Conclusion: The survivors were relatively young and discharged with good functional status (i.e., enhancing quality-adjusted life-years-saved). Our experience shows that even a relatively new extracorporeal membrane oxygenation program can play an important role in that capacity and provide excellent outcomes for the sickest patients.

Decúbito prono en pacientes con síndrome de distrés respiratorio agudo / Prone position in patients with acute respiratory distress syndrome

RESUMEN El síndrome de distrés respiratorio agudo ocupa gran atención en la unidad de cuidados intensivos. A pesar del amplio conocimiento alcanzado sobre la fisiopatología de éste síndrome, el enfoque en la unidad de cuidados intensivos consiste, en gran parte, en un tratamiento de soporte vital y en evitar los efectos secundarios de las terapéuticas invasivas. Si bien, durante los últimos 20 años, se generaron grandes avances en ventilación mecánica con un impacto importante sobre la mortalidad, ésta continúa siendo elevada. Una característica de los pacientes con síndrome de distrés respiratorio agudo, sobre todo los más severos, es la presencia de hipoxemia refractaria debido a la existencia de shunt, pudiendo requerir tratamientos adicionales a la ventilación mecánica, entre ellos la ventilación mecánica en decúbito prono. Este método, recomendado para mejorar la oxigenación por primera vez en 1974, puede ser implementado fácilmente en cualquier unidad de cuidados intensivos con personal entrenado. El decúbito prono tiene un sustento bibliográfico sumamente robusto. Varios ensayos clínicos randomizados han demostrado el efecto del decúbito prono sobre la oxigenación en pacientes con síndrome de distrés respiratorio agudo medida a través de la relación PaO2/FiO2 e incluso su impacto en el aumento de la sobrevida de estos pacientes. Los integrantes del Comité de Kinesiología Intensivista de la Sociedad Argentina de Terapia Intensiva realizaron una revisión narrativa con el objetivo de exponer la evidencia disponible en relación a la implementación del decúbito prono, los cambios producidos en el sistema respiratorio por la aplicación de la maniobra y su impacto sobre la mortalidad. Por último, se sugerirán lineamientos para la toma de decisiones.

ABSTRACT Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position. This method, first recommended to improve oxygenation in 1974, can be easily implemented in any intensive care unit with trained personnel. Prone position has extremely robust bibliographic support. Various randomized clinical studies have demonstrated the effect of prone decubitus on the oxygenation of patients with acute respiratory distress syndrome measured in terms of the PaO2/FiO2 ratio, including its effects on increasing patient survival. The members of the Respiratory Therapists Committee of the Sociedad Argentina de Terapia Intensiva performed a narrative review with the objective of discovering the available evidence related to the implementation of prone position, changes produced in the respiratory system due to the application of this maneuver, and its impact on mortality. Finally, guidelines are suggested for decision-making.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome / 대한구급학회지

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome / 결핵및호흡기질환

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome / 대한중환자의학회지

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Prognostic factors of acute respiratory distress syndrome of children / 中国医师进修杂志

ObjectiveTo analyse the prognostic factors of acute respiratory distress syndrome (ARDS) of children by comparing mortality in ARDS. MethodARDS type ,treatment process if there were multiple organ dysfunction syndrome (MODS), and whether family members actively cooperated with the treatment factors in 38 children with ARDS were analyzed. ResultsARDS of the original mortality of sepsis was the highest[ 66.67％ ( 14/21 )]; treatment process combined with MODS in 8 cases, 6 died, the mortality up to 75.00％ (6/8), significantly higher than combined without MODS [40.00％ (12/30)],there was significant difference (P ＜ 0.05); family members actively cooperated with the treatment could reduce mortality of children (P ＜0.05); PaO2 and PaO2/FiO2 value:pulmonary-exterior type was lower than pulmonary-interior type, combined with MODS was lower than combined without MODS, family members actively cooperated with the treatment was lower than family members inactively cooperated with the treatment (P ＜ 0.05 );PaCO2 value:pulmonary- exterior type was lower than pulmonary-interior type, family members actively cooperated with the treatment was lower than family members inactively cooperated with the treatment (P ＜ 0.05 ) ; pH: pulmonary-exterior type was higher than pulmonary-interior type, combined with MODS was higher than combined without MODS, family members actively cooperated with the treatment was higher than family members inactively cooperated with the treatment (P ＜0.05);the critical illness score in family members with a positive attitude was higher than that in family members with a negative attitude (P ＜ 0.05).ConclusionThe primary disease of sepsis, associated with MODS, the family members with a negative attitude toward the treatment affect the prognosis of children with ARDS.

Soporte nutricional en enfermedad pulmonar: una revisión sistemática / Parenteral nutrition in chronic obstructive pulmonary disease / Suporte nutricional em enfermidade pulmonar: uma revisão sistemática

Introducción: los pacientes con enfermedad pulmonar aguda (Síndrome de Dificultad Respiratoria Aguda -SDRA/ Lesión Pulmona Aguda-LPA) o crónica(Enfermedad Pulmonar Obstructiva Crónica- EPOC), presentan una importante alteración de su estado nutricional. La pérdida de peso tiene un efecto negativo en el curso clínico de estos pacientes. Las causas incluyen un disbalance energético, un incremento en las citoquinas, hipoxia y uso de glucocorticoides. El soporte nutricional está usualmente indicado como terapéutica o como apoyo en eltratamiento. Métodos: ésta es una revisión sistemática de literatura que consultó 1.026 números y seleccionó 87 artículos por su calidad y pertinencia.Resultados: se han propuesto diversas fórmulas de Nutrición Enteral (NE) yparenteral (NP) para contrarrestar los efectos adversos relacionados con elincremento en las demandas de ventilación mecánica de los pacientes alimentados con fórmulas estándar con altos contenidos de carbohidratos. Sin embargo, el uso de fórmulas especiales en pacientes con enfermedad pulmonar sigue siendo objeto de controversia.Conclusión: esta revisión sistemática tuvo como propósito mostrar los principales factores asociados con la malnutrición en las enfermedades pulmonares y examinar objetivamente el uso de las fórmulas de nutrición enteral y parenteral en enfermedad pulmonar aguda y crónica. Incluye los estudios que evalúan la eficacia de estas fórmulas y aporta recomendaciones básicas para su uso en enfermedades pulmonares específicas.

Introduction: the potential for altered nutritional status in critically ill patients with either acute (Acute Respiratory Distress Syndrome-ARDS/Acute Lung Injury-ALI) or chronic pulmonary disease (Chronic Obstructive Pulmonary Disease) is significant. Weight loss in patients with chronic obstructive pulmonary disease has a negative effect on the clinical course of the patient. Causes of weight loss in this population are known to include effects of an energy imbalance, increased cytokines, hypoxia, and glucocorticoid use. Nutritional support is often indicated as a treatment modality. Methods: we searched 1026 articles and was selected 87 articles. Results: several enteral and parenteral formulas (EN-PN) have been suggested to help counteract the possible adverse respiratory effects associated with a standard formula with higher carbohydrates content to reduce ventilator demand of the patients. However, the use of these specialized enteral formulas in individuals with pulmonary disease remains controversial. Conclusion: the purposes of this systematic review was to synthesize the factors associated with malnutrition in pulmonary diseases and to evaluate the rationale for use of modified parenteral and enteral formulas in both chronic and acute pulmonary disease. This paper includes the available studies evaluating the efficacy of these formulas, and provides overall recommendations for the use of specialized formulas in individuals with pulmonary disease.

Introdução: os pacientes com enfermidade pulmonar aguda (Síndrome de Dificuldade Respiratória Aguda -SDRA/ Lesão Pulmonar Aguda -LPA) ou crônica (Enfermidade Pulmonar Obstrutiva Crônica- EPOC), apresentam uma importante alteração de seu estado nutricional. A perda de peso tem um efeito negativo no curso clínico destes pacientes. As causas incluem um desequilíbrio energético, um incremento nas citoquimicas, hipoxia e uso de glucocorticoides. O suporte nutricional está usualmente indicado como terapêutico ou como apoio no tratamento. Métodos: este é uma revisão sistemática da literatura que consultou 1026 números e selecionou 87 artigos por sua qualidade e pertinência. Resultados: têm-se proposto diversas fórmulas de Nutrição Enteral (NE) e parenteral (NP) para contra restar os resultados adversos relacionados ao incremento nas demandas de ventilação mecânica dos pacientes alimentados com fórmulas uniformes com altos conteúdos de carboidratos. Mas o uso de fórmulas especiais em pacientes com doenças pulmonar segue sendo objeto de controvérsia. Conclusão: esta revisão sistemática teve como propósito mostrar os principais fatores associados à má nutrição nas enfermidades pulmonares e examinar objetivamente o uso das fórmulas de nutrição enteral e parenteral em enfermidades pulmonares agudas e crônicas. Inclui estudos que avaliam a eficácia destas fórmulas e traz recomendações básicas para seu uso em enfermidades pulmonares específicas.

Clinical Meaning of Early Oxygenation Improvement in Severe Acute Respiratory Distress Syndrome under Prolonged Prone Positioning

BACKGROUND/AIMS: Ventilating patients with acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve arterial oxygenation, but prolonged prone positioning frequently requires continuous deep sedation, which may be harmful to patients. We evaluated the meaning of early gas exchange in patients with severe ARDS under prolonged (> or = 12 hours) prone positioning. METHODS: We retrospectively studied 96 patients (mean age, 60.1 +/- 15.6 years; 75% men) with severe ARDS (PaO2/FiO2 or = 20 mmHg and decreases in PaCO2 of > or = 1 mmHg, respectively, 8 to 12 hours after first placement in the prone position. RESULTS: The mean duration of prone positioning was 78.5 +/- 61.2 hours, and the 28-day mortality rate after MICU admission was 56.3%. No significant difference in clinical characteristics was observed between PaO2 and PaCO2 responders and non-responders. The PaO2 responders after prone positioning showed an improved 28-day outcome, compared with non-responders by Kaplan-Meier survival estimates (p < 0.05 by the log-rank test), but the PaCO2 responders did not. CONCLUSIONS: Our results suggest that the early oxygenation improvement after prone positioning might be associated with an improved 28-day outcome and may be an indicator to maintain prolonged prone positioning in patients with severe ARDS.

Acute Respiratory Failure Treated with Veno-venous Extracorporeal Membrane Oxygenation / 결핵및호흡기질환

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. METHODS: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a PaO2/FiO2 ratio <100 mm Hg on FiO2 of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. EBS(R), Bio-pump(R), and Centrifugal Rotaflow pump(R) were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. RESULTS: Five of the 7 patients were male and the mean age was 46.3+/-18.3. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was 17.3+/-13.7 days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. CONCLUSION: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.

Clinical Analysis of 32 Children with Measles Complicated with Severe Pneumonia and Acute Respiratory Distress Syndrome / 实用儿科临床杂志

Objective To explore the clinical characteristics and the remedial measurement of measles complicated with severe pneumonia and the acute respiratory distress syndrome(ARDS) in children.Methods From Jan 2004 to Jul 2007,clinical data of 32 cases with measles complicated with severe pneumonia and ARDS in PICU of Chongqing Children's Hospital were retrospective analyzed.In addition,the ratio of partial pressure of oxygen in arterial blood fractional concentration of oxygen in inspired gas[pa(O2)/FiO2] between the death group and survival group,the mortality rates between the hormone therapy group and control group were performed.Results Sixteen cases were cured and 16 cases were died,with the mortality rate 50%.The ratio of pa(O2) /FiO2 before mechanical ventilation in death group was lower than that in the survival group [(11.93?1.67) kPa,(21.77?1.16) kPa,respectively,P0.05).Conclusions ARDS is a severe complication in children with measles pneumonia and associated with a high mortality,which requires early diagnosis and intervention to improve survival rate and prognosis.The ratio of pa(O2)/FiO2 may provide reference to evaluation for severity and prognosis of ARDS.

Therapy of Acute Lymphoblastic Leukemia Complicating Acute Respiratory Distress Syndrome in Children / 实用儿科临床杂志

Objective To approach therapy of acute lymphoblastic leukemia(ALL) complicating acute respiratory distress syndrome (ARDS) in children.Methods The therapy of seven children diagnosed as ALL complicating ARDS was analyzed, who were treated by anti-infection, methyllprednisolone, ambroxol and constant positive airway pressure (CPAP) assisted ventilation.Results Six cases were recovery and one was death. The cure rate was 85.7%. Conclusion The cure rate is high, when employing combined therapy to treat ALL complicating ARDS.

Effect of radix paeoniae rubra on expression of heme oxygenase and inducible nitric oxide synthesis in lipopolysaccharide-induced acute lung injury in rats / 中华创伤杂志

Objective To investigate the effect of radix paeoniae rubra (RPR) on expression of heme oxygenase (HO-1) and inducible nitric oxide synthase (iNOS) in lipopolysaccharide (LPS)-induced acute lung injury (ALI) and explore its protective mechanism. Methods Forty Wistar rats were randomly and equally divided into five groups, ie, control group, LPS group, RPR treatment group, RPR prevention group and Hemin group. Arterial blood was drawn for blood gas analysis. Models of endotoxin-induced ALI were used to observe the protein content, the ratio of neutrophiles in bronchoalveolar lavage fluid (BALF), the malondialdehyde (MDA) content in lung and the activities of serum NO. Expression of HO-1 and iNOS in rat lung tissue was detected by immunohistochemistry and morphometry computer image analysis. The histological change of lung were observed under light microscope. Results Compared with control group, expression of HO-1 and iNOS was markedly increased (P

A Practical Protocol for Titrating "Optimal" PEEP in Acute Lung Injury: Recruitment Maneuver and PEEP Decrement

This study was conducted to evaluate the effectiveness and safety of a practical protocol for titrating positive end-expiratory pressure (PEEP) involving recruitment maneuver (RM) and decremental PEEP. Seventeen consecutive patients with acute lung injury who underwent PEEP titration were included in the analysis. After baseline ventilation, RM (continuous positive airway pressure, 35 cm H2O for 45 sec) was performed and PEEP was increased to 20 cmH2O or the highest PEEP guaranteeing the minimal tidal volume of 5 mL/kg. Then PEEP was decreased every 20 min in 2 cmH2O decrements. The "optimal" PEEP was defined as the lowest PEEP attainable without causing a significant drop (>10%) in PaO2. The "optimal PEEP" was 14.5 +/- 3.8 cmH2O. PaO2 /FI O2 ratio was 154.8 +/- 63.3 mmHg at baseline and improved to 290.0 +/- 96.4 mmHg at highest PEEP and 302.7 +/- 94.2 mmHg at "optimal PEEP", both significantly higher than baseline (p<0.05). Static compliance was significantly higher at "optimal" PEEP (27.2 +/- 10.4 mL/ cmH2O) compared to highest PEEP (22.3 +/- 7.7 mL/cmH2O) (p<0.05). Three patients experienced transient hypotension and one patient experienced atrial premature contractions. No patient had gross barotrauma. PEEP titration protocol involving RM and PEEP decrement was effective in improving oxygenation and was generally welltolerated.

The effect of two modes of mechanical ventilation on cardiopulmonary function in pigs with or without acute lung injury: a comparison of pressure regulated biphasic positive airway pressure ventilation and airway pressure release ventilation / 解放军医学杂志

Objective To compare the effect of pressure regulated biphasic positive airway pressure ventilation(BiPAP) and airway pressure release ventilation(APRV) on cardiopulmonary function of pigs with or without acute lung injury. Methods after anaesthesia, 18 healthy pigs were given BiPAP or APRV ventilation through tracheotomy. Inspiration pressure and expiration pressure in BiPAP equal to APRV. Inspiration time and expiration time is 1.5/2.5s in BiPAP and 4.0/2.0s, 4.5/1.5s, 5.0/1.0s, 5.5/0.5s in APRV respectively. Respiration dynamics, hemodynamics, blood gases and oxygen metabolize scales were measured during two mechanical ventilatory modalities pigs acquired from Swam-gans catheter in internal jugular vein and from catheter in femoral artery. Then oleic-induced acute lung injury model was made, modalities pigs were distributed to BiPAP group (n=9) and APRV group (n=8) randomly. Forenamed scales were repeat measured. Results BiPAP has not difference with APRV on respiration dynamics, hemodynamics, blood gases and oxygen metabolize during normal condition, BiPAP has higher cardiac output (CO) and lower oxygen extraction ratio (O2ER) compare with APRV in ALI pigs. If expiration time is short to 0.5s in APRV, it would represent intrinsic peak end-expiratory (PEEPi), heart rate (HR), mean pulmonary arterial pressure (MPAP) and systemic vascular resistance (SVR) increased and CO decreased. Conclusion Both BiPAP and APRV are beneficial in ALI, but BiPAP has fewer side-effect compared with APRV in early ALI.

Significance of Endothelin-1 and Interleukin - 8 Levels in Tracheal Aspirates of Children with Acute Respiratory Distress Syndrome / 实用儿科临床杂志

Objective To investigate the role of endothelin - 1( ET-1) and interleukin-8( IL-8) in tracheal aspirates (TA) in children with acute respiratory distress syndrome(ARDS). Methods The levels of ET- 1 and IL - 8 in TA of 13 patients with ARDS and 11 controls were assayed by enzyme - linked immunosorbent assay. Lung injury score was applied to all patients. Results The levels of ET-1 and 1L-8 in TA were significantly higher in ARDS than those in controls (P

Renal function damage induced by acute lung injury in aging rats / 中国病理生理杂志

AIM:To investigate whether renal function damage could be induced by acute lung injury(ALI)in aging rats. METHODS: 40 Wistar male rats were used for reproducing aging animal model. Aging rats were randomly divided into aging control; ALI group (Lipopolysaccharide, LPS, 5 mg/kg body weight, iv) and LPS group (same dosage LPS, intraventricle of left heart injection). The samples (blood, lung and kidney ) were collected at 2 or 6 hours after LPS or normal saline administration. RESULTS:Compared with aging control, in ALI group, creatinine (Cr) and urea nitrogen (BUN) contents in blood were increased significantly (all P