Lowering pulmonary artery pressure in a patient with severe acute respiratory failure

A case of pulmonary arterial hypertension on the basis of ARDS is presented. The cyclooxygenase inhibitor Ibuprofen is used to lower pulmonary arterial pressure, resulting in an improvement in the right ventricular function.     

Tracheal and alveolar gas composition during low-frequency positive pressure ventilation with extracorporeal CO2-removal (LFPPV-ECCO2R)

Tracheal and alveolar gas composition was studied by mass spectrometry in a patient with severe ARDS treated by low frequency positive pressure ventilation/extracorporeal CO₂-removal (LFPPV-ECCO₂R). Measured alveolar gas concentrations were compared with values derived from standard respiratory equations. As a result we found that during LFPPV-ECCO₂R with a constant endotracheal O₂-flow, alveolar gas composition cannot be predicted reliably from standard equations. The reasons for this finding are discussed. We conclude that monitoring of alveolar gas composition by mass spectrometry is of great value during LFPPV-ECCO₂R if P_AO₂, P_(A-a)O₂ and Q_va/Q_t are to be determined correctly.     

Zinc chloride smoke inhalation: a rare cause of severe acute respiratory distress syndrome

Zinc chloride smoke inhalation is a rare cause of slowly progressive and often fatal acute respiratory distress syndrome (ARDS). The conventional treatment includes intravenous N-acetylcysteine, L-3, 4-dehydroproline, methylene blue, and respiratory support according to the lung protective strategy. This report presents the cases of three patients with serious zinc chloride inhalation and ARDS, the last of whom survived after prolonged intensive care, videothoracoscopic excision of emphysema bullae, and recurrent chemical pleurodesis. Received: 3 March 1999 Final revision received: 6 July 1999 Accepted: 27 October 1999     

Experimental studies on the adult respiratory distress syndrome: effects of induced DIC; granulocytes and elastase in mini pigs

The potential role of granulocyte proteinases on experimentally induced ARDS was evaluated. In order to investigate the acute effects on lung function, elastase (330 U kg-1h-1) or thrombin (75-150 U kg-1 h-1) was continuously infused into anaesthetized and mechanically ventilated mini pigs. Both elastase as well as thrombin induced a progressive respiratory failure with prompt increase in pulmonary vascular resistance, and decrease of cardiac output, further a pulmonary leukostasis, and a disturbance of blood coagulation leading to hypocoagulability. High proteolytic activity selectively in the lung indicates a possible role of proteinases released from sequestered polymorphonuclear neutrophils. Similar results following elastase infusion were however obtained in leukopenic animals pretreated with a single dose of dimethylmyleran (5 mg kg-1) which depleted the granulocytes totally. These results offer the possibility that elastase itself may cause respiratory failure and lung tissue damage. On the other hand the digestion pattern of phosphorylase kinase by lung tissue homogenates of thrombin- or elastase-infused mini pigs clearly indicates that elastase is only one of several mediators which may cause experimentally induced ARDS even in the absence of granulocytes.     

胸部外伤318例救治体会

目的：了解胸部外伤的特点,探讨处理胸部外伤的流程和策略。方法：统计分析318例胸部外伤患者的抢救和治疗情况。结论：及时正确诊断伤情是关键,胸腔闭式引流术是治疗血气胸简单有效的救治措施。及时准确的手术治疗是降低死亡率的保障,ARDS和休克的治疗可参照指南进行。     

连续性血液净化对急性呼吸窘迫综合征患者的疗效分析

目的:探讨对ARDS(急性呼吸窘迫综合征)患者应用CBP(连续性血液净化)进行治疗的临床效果。方法:回顾我院2008年10月～2010年12月,我科收治的60例ARDS患者临床资料,随机分为治疗组与对照组,每组患者30例。两组患者在入院后均建立了人工气道,并以呼吸机进行控制/辅助呼吸,对对照组30例患者进行常规治疗,对治疗组30例患者在对照组基础上应用CBP进行治疗,对两组APACHEⅡ评分与血气分析以及TNF-α和IL-1β其变化进行对比。结果:治疗组的APACHEⅡ评分与血气分析较对照组明显改善(P<0.05),同时TNF-α与IL-1β的表达也较对照组明显降低(P<0.05)。结论:对ARDS(急性呼吸窘迫综合征)患者应用CBP(连续性血液净化)进行治疗,不但能将其体内的TNF-α与IL-1β有效的清除,而且有利于改善其呼吸功能,效果确切,应予合理推广。     

The prognostic value of the SOFA score in patients with COVID-19: A retrospective,observational study

Coronavirus disease 2019 (COVID-19) can lead to serious illness and death, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients.We retrospectively included all patients ≥18 years old who were diagnosed with COVID-19 in the laboratory continuously admitted to Jingzhou Central Hospital from January 16, 2020 to March 23, 2020. The demographic, clinical manifestations, complications, laboratory results, and clinical outcomes of patients infected with the severe acute respiratory syndrome coronavirus-2 were collected and analyzed. Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan–Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated.A total of 117 patients with confirmed diagnoses of COVID-19 were retrospectively analyzed, of which 108 patients were discharged and 9 patients died. The median age of the patients was 50.0 years old (interquartile range [IQR], 35.5–62.0). 63 patients had comorbidities, of which hypertension (27.4%) was the most frequent comorbidities, followed by diabetes (8.5%), stroke (4.3%), coronary heart disease (3.4%), and chronic liver disease (3.4%). The most common symptoms upon admission were fever (82.9%) and dry cough (70.1%). Regression analysis showed that high SOFA scores, advanced age, and hypertension were associated with severe COVID-19. The median SOFA score of all patients was 2 (IQR, 1–3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 (3 [IQR, 2–4] vs 1 [IQR, 0–1]; P < .001). The SOFA score can better identify severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044–11.245; P < .001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 (cutoff value = 2; AUC = 0.908 [95% CI: 0.857–0.960]; sensitivity: 85.20%; specificity: 80.40%) and the risk of death in COVID-19 patients (cutoff value = 5; AUC = 0.995 [95% CI: 0.985–1.000]; sensitivity: 100.00%; specificity: 95.40%). Regarding the 60-day mortality rates of patients in the 2 groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score < 5).The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.     

一例体外循环心内直视术后并发ARDS的护理

体外循环心内直视手术后急性呼吸窘迫综合征（Acute respiratory distress syndrome,ARDS）是术后严重的肺部并发症,尽管其发生率仅为0．4％-1．7％,但死亡率高达15％-68．4％,严重影响心脏手术的预后。我科于2007年7月成功救治1例体外循环心内直视术后并发ARDS的病人。现将护理体会介绍如下：     

小儿法洛四联症根治术后急性呼吸窘迫综合征危险因素分析

目的 探讨法洛四联症(tetralogy of Fallot,TOF)术后出现急性呼吸窘迫综合(acute respiratory distress syndrome,ARDS)的危险因素,为预防及治疗提供依据.方法 329例TOF根治患儿,分为未发生ARDS组(Ⅰ组,304例)和发生ARDS组(Ⅱ组25例).全组ABDS发生率为7.6%.以年龄、性别、体重、Nakata指数等作为观察变量,进行统计学分析.结果 Ⅱ组死亡3例,病死率为12%.单因素分析显示.Ⅱ组与Ⅰ组比较,年龄低,Nakata指数小[(165±43)mm2/m2 vs.(201±32)mm2/m2],体外循环时间长[(150±258)min vB.(108±38)min],跨环补片比例多(88%vs69.7%),主动脉/肺动脉比值(AO/PA)大.均有显著性差异.Logistic回归显示,年龄<4个月、Nakat指数<140mm2/m2、体外循环时间>150min、AO/PA>2.5是TOF术后ARDS的危险因素.结论 TOF根治术后ARDS的主要危险因素是低龄、Nakata指数小、体外循环时间长、肺动脉发育差.     

RETRACTED ARTICLE: Coexpression of HSP47 Gene and Type I and Type III Collagen Genes in LPS-Induced Pulmonary Fibrosis in Rats

Diffuse alveolar damage is the histopathologic hallmark of acute respiratory distress syndrome (ARDS). A significant proportion of ARDS survivors have residual pulmonary fibrosis and compromised pulmonary function. On the other hand, heat shock protein 47 (HSP47) is a collagen-binding stress protein that is assumed to act as a collagen-specific molecular chaperone during the biosynthesis and secretion of procollagen in living cells. The synthesis of HSP47 has been reported to correlate with that of collagen in several cell lines. We examined the expression of HSP47 mRNA and protein during the progression of lipopolysaccharide (LPS)-induced ARDS in rat lung. Male Wistar rats were randomly divided into two groups: a control group with instillation of 0.9% NaCl solution alone, and a LPS group with instillation of LPS dissolved in 0.9% NaCl solution (10 mg/kg). Histologic changes thereafter appeared in the LPS-treated rats. Northern blot analysis revealed the expression of HSP47 mRNA to be markedly induced during the progression of lung damage in parallel with type I and type III collagen mRNA. These results suggest that the upregulation of HSP47 and collagen may play an important role in the fibrotic process of LPS-induced ARDS lung.