[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilato...[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilator-associated pneumonia,pressure ulcers,delirium)in ARDS patients,thus contributing evidence for the clinical application of early-stage phased rehabilitation training.[Methods]The China National Knowledge Infrastructure(CNKI),Wanfang,and other databases were searched.Literature screening,data extraction,and systematic analysis of the included studies were performed using Revman software.[Results]Thirteen randomized controlled trials involving a total of 860 patients were included in this review.The results of the meta-analysis showed that compared to the traditional rehabilitation training group,the early-stage phased rehabilitation training group demonstrated a significant increase in the oxygenation index of ARDS patients[SMD=1.18,95%CI(1.01,1.35),P<0.01],with statistically significant differences.Furthermore,there were significant reductions in ICU length of stay[SMD=-0.70,95%CI(-0.90,-0.50),P<0.01],duration of mechanical ventilation[SMD=-1.15,95%CI(-1.36,-0.94),P<0.01],and occurrence of complications[OR=0.16,95%CI(0.10,0.26),P<0.01],all of which were statistically significant.[Conclusions]Early-stage phased pulmonary rehabilitation training for ARDS patients effectively improves the oxygenation index,shortens ICU length of stay and duration of mechanical ventilation,and reduces complications.These findings support the clinical application and promotion of early-stage phased rehabilitation training.展开更多
Objective To study endothelial damage by observing changes of circulating endothelial cells (CECs) in blood, coagula-tion and fibrinolysis index in patients with acute respiratory distress syndrome. Methods CECs were ...Objective To study endothelial damage by observing changes of circulating endothelial cells (CECs) in blood, coagula-tion and fibrinolysis index in patients with acute respiratory distress syndrome. Methods CECs were separated by isopycnic centrifugation method in 14 patients with acute lung injury (ALI), 7 patients with acute respiratory distress syndrome (ARDS), 10 intensive care unit (ICU) controls, and 15 healthy controls. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), fibrin degradation products (FDP), and D-dimer were examined simultaneously. Acute physiology and chronic health evaluation (APACHE)Ⅱand lung injury score (LIS) were recorded to evaluate severity of illness and lung injury. Results (1) The number of CECs in ALI (10.4 ±2.3) and ARDS groups (16.1 ±2.7) was higher than that in the healthy (1.9 ±0.5) (P< 0.01). In both ALI and ARDS, the number of CECs correlated with APACHEⅡ(r=0.55, P< 0.05 and r=0.62, P< 0.05, respectively)and LIS (r=0.60, P< 0.05 and r=0.53, P< 0.05, respectively). CEC number was negatively correlated with PaO 2 in ALI and ARDS (r=-0.49, P< 0.05 and r=-0.64, P< 0.05, respectively). (2) The level of FDP and D-dimer were higher in ALI and ARDS patients than that in ICU and healthy control groups (P< 0.05). The level of FG in ARDS group was significantly higher than in the ICU and healthy control groups (P< 0.05). But in ALI group, the level of FG was significantly higher than only healthy control group (P< 0.05). Conclusions Endothelial cell damage occurs in ARDS patients, which may play a major role in the pathophysiology of ARDS. Changes of endothelial cell activation and damage markers, such as CECs, plasma coagulation and fibrinolysis index, to some extent reflect severity of illness and lung injury in ARDS.展开更多
A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms...A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms of anaphylaxis or interestingly, the treatment itself;adrenaline, majority of the latter being related to administration of supra-therapeutic doses. According to our clinical experience, the possibility of ARDS should be considered in <span>patients who develop unexplainable hypoxaemia following anaphylactic</span><span> shock. </span><span>This case report discusses the pathophysiology of ARDS both in anaphylaxis and following epinephrine treatment and key aspects of management of ARDS with </span><span>a </span><span>main focus on the role of high flow oxygen, diuretics and anxiolytics. </span><span>T</span><span>he </span><span>importance of avoiding drug administration errors is also highlighted.</span>展开更多
To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome （ARDS） and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 gro...To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome （ARDS） and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 groups： group Ⅰ （saline control group）, group Ⅱ （LPS intravenous ＂single-hit＂ group）, group Ⅲ （LPS intratracheal ＂single-hit＂ group） and Group IV （LPS ＂two-hit＂ group）. Rats were intravenously injected or intratracheally instilled with a large dose of LPS （10 mg/kg in 0.5 mL） to simulate a single attack of ARDS, or intraperitoneally injected with a small dose of LPS （1 mg/kg） followed by tracheal instillation with median dose of LPS （5 mg/kg） to establish a ＂two-hit＂ model. Rats in each group were monitored by arterial blood gas analysis and visual inspection for three consecutive days. Arterial blood gas values, lung wet/dry weight ratio and pathological pulmonary changes were analyzed to determine the effects of each ALI/ARDS model. Concentrations of TNF-α, IL-1 and IL-10 in the bronchoalveolar lavage fluid （BALF） and blood plasma were meastired by using enzyme-linked immunosorbent assays （ELISA）. Our resulsts showed that single LPS-stimulation, whether through intravenous injection or tracheal instillation, could only induce ALl and temporary hypoxemia in rats. A two-hit LPS stimulation induces prolonged hypoxemia and specific pulmonary injury in rats, and is therefore a more ideal approximation of ARDS in the animal model. The pathogenesis of LPS two-hit-induced ARDS is associated with an uncontrolled systemic inflammatory response and inflammatory injury. It is concluded that the rat ARDS model produced by our LPS two-hit method is more stable and reliable than previous models, and closer to the diagnostic criteria of ARDS, and better mimics the pathological process of ARDS.展开更多
Acute lung injury(ALI)and acute respiratory distress syndrome(ARDS)are common life-threatening lung diseases associated with acute and severe inflammation.Both have high mortality rates,and despite decades of research...Acute lung injury(ALI)and acute respiratory distress syndrome(ARDS)are common life-threatening lung diseases associated with acute and severe inflammation.Both have high mortality rates,and despite decades of research on clinical ALI/ARDS,there are no effective therapeutic strategies.Disruption of alveolar-capillary barrier integrity or activation of inflammatory responses leads to lung inflammation and injury.Recently,studies on the role of extracellular vesicles(EVs)in regulating normal and pathophysiologic cell activities,including inflammation and injury responses,have attracted attention.Injured and dysfunctional cells often secrete EVs into serum or bronchoalveolar lavage fluid with altered cargoes,which can be used to diagnose and predict the development of ALI/ARDS.EVs secreted by mesenchymal stem cells can also attenuate inflammatory reactions associated with cell dysfunction and injury to preserve or restore cell function,and thereby promote cell proliferation and tissue regeneration.This review focuses on the roles of EVs in the pathogenesis of pulmonary inflammation,particularly ALI/ARDS.展开更多
Venovenous extracorporeal membrane oxygenation(VV-ECMO)is an established rescue therapy in the management of refractory acute respiratory distress syndrome(ARDS).Although ECMO played an important role in previous resp...Venovenous extracorporeal membrane oxygenation(VV-ECMO)is an established rescue therapy in the management of refractory acute respiratory distress syndrome(ARDS).Although ECMO played an important role in previous respiratory viral epidemics,concerns about the benefits and usefulness of this technique were raised during the coronavirus disease 2019(COVID-19)pandemic.Indeed,the mortality rate initially reported in small case series from China was concerning and exceeded 90%.A few months later,the critical care community published the findings from several observational cohorts on the use of extracorporeal membrane oxygenation(ECMO)in COVID-19-related ARDS.Contrary to the preliminary results,data from the first surge supported the use of ECMO in experienced centers because the mortality rate was comparable to those from the ECMO to Rescue Lung Injury in Severe ARDS(EOLIA)trial or other large prospective studies.However,the mortality rate of the population with severe disease evolved during the pandemic,in conjunction with changes in the management of the disease and the occurrence of new variants.The results from subsequent studies confirmed that the outcomes mainly depend on strict patient selection and center expertise.In comparison with non-COVID-related ARDS,the duration of ECMO for COVID-related ARDS was longer and increased over time.Clinicians and decision-makers must integrate this finding in the ECMO decision-making process to plan their ICU capacity and resource allocation.This narrative review summarizes the current evidence and specific considerations for ECMO use in COVID-19-associated ARDS.展开更多
文摘[Objectives]To systematically evaluate the effects of early-stage phased rehabilitation training on the oxygenation index,ICU length of stay,duration of mechanical ventilation,and occurrence of complications(ventilator-associated pneumonia,pressure ulcers,delirium)in ARDS patients,thus contributing evidence for the clinical application of early-stage phased rehabilitation training.[Methods]The China National Knowledge Infrastructure(CNKI),Wanfang,and other databases were searched.Literature screening,data extraction,and systematic analysis of the included studies were performed using Revman software.[Results]Thirteen randomized controlled trials involving a total of 860 patients were included in this review.The results of the meta-analysis showed that compared to the traditional rehabilitation training group,the early-stage phased rehabilitation training group demonstrated a significant increase in the oxygenation index of ARDS patients[SMD=1.18,95%CI(1.01,1.35),P<0.01],with statistically significant differences.Furthermore,there were significant reductions in ICU length of stay[SMD=-0.70,95%CI(-0.90,-0.50),P<0.01],duration of mechanical ventilation[SMD=-1.15,95%CI(-1.36,-0.94),P<0.01],and occurrence of complications[OR=0.16,95%CI(0.10,0.26),P<0.01],all of which were statistically significant.[Conclusions]Early-stage phased pulmonary rehabilitation training for ARDS patients effectively improves the oxygenation index,shortens ICU length of stay and duration of mechanical ventilation,and reduces complications.These findings support the clinical application and promotion of early-stage phased rehabilitation training.
文摘Objective To study endothelial damage by observing changes of circulating endothelial cells (CECs) in blood, coagula-tion and fibrinolysis index in patients with acute respiratory distress syndrome. Methods CECs were separated by isopycnic centrifugation method in 14 patients with acute lung injury (ALI), 7 patients with acute respiratory distress syndrome (ARDS), 10 intensive care unit (ICU) controls, and 15 healthy controls. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), fibrin degradation products (FDP), and D-dimer were examined simultaneously. Acute physiology and chronic health evaluation (APACHE)Ⅱand lung injury score (LIS) were recorded to evaluate severity of illness and lung injury. Results (1) The number of CECs in ALI (10.4 ±2.3) and ARDS groups (16.1 ±2.7) was higher than that in the healthy (1.9 ±0.5) (P< 0.01). In both ALI and ARDS, the number of CECs correlated with APACHEⅡ(r=0.55, P< 0.05 and r=0.62, P< 0.05, respectively)and LIS (r=0.60, P< 0.05 and r=0.53, P< 0.05, respectively). CEC number was negatively correlated with PaO 2 in ALI and ARDS (r=-0.49, P< 0.05 and r=-0.64, P< 0.05, respectively). (2) The level of FDP and D-dimer were higher in ALI and ARDS patients than that in ICU and healthy control groups (P< 0.05). The level of FG in ARDS group was significantly higher than in the ICU and healthy control groups (P< 0.05). But in ALI group, the level of FG was significantly higher than only healthy control group (P< 0.05). Conclusions Endothelial cell damage occurs in ARDS patients, which may play a major role in the pathophysiology of ARDS. Changes of endothelial cell activation and damage markers, such as CECs, plasma coagulation and fibrinolysis index, to some extent reflect severity of illness and lung injury in ARDS.
文摘A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms of anaphylaxis or interestingly, the treatment itself;adrenaline, majority of the latter being related to administration of supra-therapeutic doses. According to our clinical experience, the possibility of ARDS should be considered in <span>patients who develop unexplainable hypoxaemia following anaphylactic</span><span> shock. </span><span>This case report discusses the pathophysiology of ARDS both in anaphylaxis and following epinephrine treatment and key aspects of management of ARDS with </span><span>a </span><span>main focus on the role of high flow oxygen, diuretics and anxiolytics. </span><span>T</span><span>he </span><span>importance of avoiding drug administration errors is also highlighted.</span>
基金supported by a grant from the Shanghai Education Committee(No.2005-81)
文摘To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome （ARDS） and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 groups： group Ⅰ （saline control group）, group Ⅱ （LPS intravenous ＂single-hit＂ group）, group Ⅲ （LPS intratracheal ＂single-hit＂ group） and Group IV （LPS ＂two-hit＂ group）. Rats were intravenously injected or intratracheally instilled with a large dose of LPS （10 mg/kg in 0.5 mL） to simulate a single attack of ARDS, or intraperitoneally injected with a small dose of LPS （1 mg/kg） followed by tracheal instillation with median dose of LPS （5 mg/kg） to establish a ＂two-hit＂ model. Rats in each group were monitored by arterial blood gas analysis and visual inspection for three consecutive days. Arterial blood gas values, lung wet/dry weight ratio and pathological pulmonary changes were analyzed to determine the effects of each ALI/ARDS model. Concentrations of TNF-α, IL-1 and IL-10 in the bronchoalveolar lavage fluid （BALF） and blood plasma were meastired by using enzyme-linked immunosorbent assays （ELISA）. Our resulsts showed that single LPS-stimulation, whether through intravenous injection or tracheal instillation, could only induce ALl and temporary hypoxemia in rats. A two-hit LPS stimulation induces prolonged hypoxemia and specific pulmonary injury in rats, and is therefore a more ideal approximation of ARDS in the animal model. The pathogenesis of LPS two-hit-induced ARDS is associated with an uncontrolled systemic inflammatory response and inflammatory injury. It is concluded that the rat ARDS model produced by our LPS two-hit method is more stable and reliable than previous models, and closer to the diagnostic criteria of ARDS, and better mimics the pathological process of ARDS.
基金This work was supported by the Weatherhead Endowment Fund
文摘Acute lung injury(ALI)and acute respiratory distress syndrome(ARDS)are common life-threatening lung diseases associated with acute and severe inflammation.Both have high mortality rates,and despite decades of research on clinical ALI/ARDS,there are no effective therapeutic strategies.Disruption of alveolar-capillary barrier integrity or activation of inflammatory responses leads to lung inflammation and injury.Recently,studies on the role of extracellular vesicles(EVs)in regulating normal and pathophysiologic cell activities,including inflammation and injury responses,have attracted attention.Injured and dysfunctional cells often secrete EVs into serum or bronchoalveolar lavage fluid with altered cargoes,which can be used to diagnose and predict the development of ALI/ARDS.EVs secreted by mesenchymal stem cells can also attenuate inflammatory reactions associated with cell dysfunction and injury to preserve or restore cell function,and thereby promote cell proliferation and tissue regeneration.This review focuses on the roles of EVs in the pathogenesis of pulmonary inflammation,particularly ALI/ARDS.
文摘Venovenous extracorporeal membrane oxygenation(VV-ECMO)is an established rescue therapy in the management of refractory acute respiratory distress syndrome(ARDS).Although ECMO played an important role in previous respiratory viral epidemics,concerns about the benefits and usefulness of this technique were raised during the coronavirus disease 2019(COVID-19)pandemic.Indeed,the mortality rate initially reported in small case series from China was concerning and exceeded 90%.A few months later,the critical care community published the findings from several observational cohorts on the use of extracorporeal membrane oxygenation(ECMO)in COVID-19-related ARDS.Contrary to the preliminary results,data from the first surge supported the use of ECMO in experienced centers because the mortality rate was comparable to those from the ECMO to Rescue Lung Injury in Severe ARDS(EOLIA)trial or other large prospective studies.However,the mortality rate of the population with severe disease evolved during the pandemic,in conjunction with changes in the management of the disease and the occurrence of new variants.The results from subsequent studies confirmed that the outcomes mainly depend on strict patient selection and center expertise.In comparison with non-COVID-related ARDS,the duration of ECMO for COVID-related ARDS was longer and increased over time.Clinicians and decision-makers must integrate this finding in the ECMO decision-making process to plan their ICU capacity and resource allocation.This narrative review summarizes the current evidence and specific considerations for ECMO use in COVID-19-associated ARDS.
