[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
BACKGROUND In the early stage of acute pancreatitis(AP),a large number of cytokines induced by local pancreatic inflammation seriously damage the intestinal barrier function,and intestinal bacteria and endotoxins ente...BACKGROUND In the early stage of acute pancreatitis(AP),a large number of cytokines induced by local pancreatic inflammation seriously damage the intestinal barrier function,and intestinal bacteria and endotoxins enter the blood,causing inflammatory storm,resulting in multiple organ failure,infectious complications,and other disorders,eventually leading to death.Intestinal failure occurs early in the course of AP,accelerating its development.As an alternative method to detect small intestinal bacterial overgrowth,the hydrogen breath test is safe,noninvasive,and convenient,reflecting the number of intestinal bacteria in AP indirectly.This study aimed to investigate the changes in intestinal bacteria measured using the hydrogen breath test in the early stage of AP to clarify the relationship between intestinal bacteria and acute lung injury(ALI)/acute respiratory distress syndrome(ARDS).Early clinical intervention and maintenance of intestinal barrier function would be highly beneficial in controlling the development of severe acute pancreatitis(SAP).AIM To analyze the relationship between intestinal bacteria change and ALI/ARDS in the early stage of SAP.METHODS A total of 149 patients with AP admitted to the intensive care unit of the Digestive Department,Xuanwu Hospital,Capital Medical University from 2016 to 2019 were finally enrolled,following compliance with the inclusion and exclusion criteria.The results of the hydrogen breath test within 1 wk of admission were collected,and the hydrogen production rates at admission,72 h,and 96 h were calculated.The higher the hydrogen production rates the more bacteria in the small intestine.First,according to the improved Marshall scoring system in the 2012 Atlanta Consensus on New Standards for Classification of Acute Pancreatitis,66 patients with a PaO2/FiO2 score≤1 were included in the mild AP(MAP)group,18 patients with a PaO2/FiO2 score≥2 and duration<48 h were included in the moderately SAP(MSAP)group,and 65 patients with a PaO2/FiO2 score≥2 and duration>48 h were included in the SAP group,to analyze the correlation between intestinal bacterial overgrowth and organ failure in AP.Second,ALI(PaO2/FiO2=2)and ARDS(PaO2/FiO2>2)were defined according to the simplified diagnostic criteria proposed by the 1994 European Union Conference.The MSAP group was divided into two groups according to the PaO2/FiO2 score:15 patients with PaO2/FiO2 score=2 were included in group A,and three patients with score>2 were included in group B.Similarly,the SAP group was divided into two groups:28 patients with score=2 were included in group C,and 37 patients with score>2 were included in group D,to analyze the correlation between intestinal bacterial overgrowth and ALI/ARDS in AP.RESULTS A total of 149 patients were included:66 patients in the MAP group,of whom 53 patients were male(80.3%)and 13 patients were female(19.7%);18 patients in the MSAP group,of whom 13 patients were male(72.2%)and 5 patients were female(27.8%);65 patients in the SAP group,of whom 48 patients were male(73.8%)and 17 patients were female(26.2%).There was no significant difference in interleukin-6 and procalcitonin among the MAP,MSAP,and SAP groups(P=0.445 and P=0.399,respectively).There was no significant difference in the growth of intestinal bacteria among the MAP,MSAP,and SAP groups(P=0.649).There was no significant difference in the growth of small intestinal bacteria between group A and group B(P=0.353).There was a significant difference in the growth of small intestinal bacteria between group C and group D(P=0.038).CONCLUSION Intestinal bacterial overgrowth in the early stage of SAP is correlated with ARDS.展开更多
In this editorial we comment on the article published in the recent issue of the World Journal of Gastroenterology[2022;28(19):2123-2136].We pay attention to how to construct a simpler and more reliable new clinical p...In this editorial we comment on the article published in the recent issue of the World Journal of Gastroenterology[2022;28(19):2123-2136].We pay attention to how to construct a simpler and more reliable new clinical predictive model to early identify patients at high risk of acute respiratory distress syndrome(ARDS)associated with severe acute pancreatitis(SAP),and to early predict the severity of organ failure from chest computed tomography(CT)findings in SAP patients.As we all know,SAP has a sudden onset,is a rapidly changing condition,and can be complicated with ARDS and even multiple organ dysfunction syndrome,and its mortality rate has remained high.At present,there are many clinical scoring systems for AP,including the bedside index for severity in AP,acute physiology and chronic health evaluation II,systemic inflammatory response syndrome,Japanese severe score,quick sepsis-related organ failure assessment,etc.However,some of these scoring systems are complex and require multiple and difficult clinical parameters for risk stratification.Although the aforementioned biomarkers are readily available,their ability to predict ARDS varies.Accordingly,it is extremely necessary to establish a simple and valuable novel model to predict the development of ARDS in AP.In addition,the extra-pancreatic manifestations of AP patients often involve the chest,among which pleural effusion and pulmonary consolidation are the more common complications.Therefore,by measuring the semi-quantitative indexes of chest CT in AP patients,such as the amount of pleural effusion and the number of lobes involved as pulmonary consolidation,it has important reference value for the early diagnosis of SAP complicated with ARDS and is expected to provide a basis for the early treatment of ARDS.展开更多
BACKGROUND There have been few reports on the risk factors for acute respiratory distress syndrome(ARDS)in coronavirus disease 2019(COVID-19),and there were obvious differences regarding the incidence of ADRS between ...BACKGROUND There have been few reports on the risk factors for acute respiratory distress syndrome(ARDS)in coronavirus disease 2019(COVID-19),and there were obvious differences regarding the incidence of ADRS between Wuhan and outside Wuhan in China.AIM To investigate the risk factors associated with ARDS in COVID-19,and compare the characteristics of ARDS between Wuhan and outside Wuhan in China.METHODS Patients were enrolled from two medical centers in Hunan Province.A total of 197 patients with confirmed COVID-19,who had either been discharged or had died by March 15,2020,were included in this study.We retrospectively collected the patients’clinical data,and the factors associated with ARDS were compared by theχ²test,Fisher’s exact test,and Mann-Whitney U test.Significant variables were chosen for the univariate and multivariate logistic regression analyses.In addition,literature in the PubMed database was reviewed,and the characteristics of ARDS,mortality,and biomarkers of COVID-19 severity were compared between Wuhan and outside Wuhan in China.RESULTS Compared with the non-ARDS group,patients in the ARDS group were significantly older,had more coexisting diseases,dyspnea,higher D-dimer,lactate dehydrogenase(LDH),and C-reactive protein.In univariate logistic analysis,risk factors associated with the development of ARDS included older age[odds ratio(OR)=1.04),coexisting diseases(OR=3.94),dyspnea(OR=17.82),dry/moist rales(OR=9.06),consolidative/mixed opacities(OR=2.93),lymphocytes(OR=0.68 for high lymphocytes compared to low lymphocytes),D-dimer(OR=1.41),albumin(OR=0.69 for high albumin compared to low albumin),alanine aminotransferase(OR=1.03),aspartate aminotransferase(OR=1.02),LDH(OR=1.02),C-reactive protein(OR=1.04)and procalcitonin(OR=17.01).In logistic multivariate analysis,dyspnea(adjusted OR=27.10),dry/moist rales(adjusted OR=9.46),and higher LDH(adjusted OR=1.02)were independent risk factors.The literature review showed that patients in Wuhan had a higher incidence of ARDS,higher mortality rate,and higher levels of biomarkers associated with COVID-19 severity than those outside Wuhan in China.CONCLUSION Dyspnea,dry/moist rales and higher LDH are independent risk factors for ARDS in COVID-19.The incidence of ARDS in Wuhan seems to be overestimated compared with outside Wuhan in China.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
Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients wi...Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University from June 2016 to December 2018 were randomly divided into SAP with ARDS sepsis group(sepsis group)and SAP.In the ARDS non-sepsis group(non-sepsis group),20 patients were treated according to the guidelines for the diagnosis and treatment of acute pancreatitis in China in 2013.They were given regular fasting,gastrointestinal decompression,fluid resuscitation,acid suppression,and growth.On the basis of the inhibition of water,electrolytes,acid-base balance,add rhubarb 3 g/kg,water 200 mL,filter the slag juice to 37~38℃for retention enema for more than 15min,2 times a day For a total of 7 days.The inflammatory markers WBC,PCT,heart rate,respiratory rate,oxygenation index(PaO2/FiO2),pancreatic severity score(BISAP),and IL-33 and various cytokine changes were recorded in the two groups.Results:On the first day of admission,the patients in the sepsis group had more severe inflammation index(WBC:14.23±2.95,PCT:3.62±2.04,heart rate:104.02±8.89,respiration:26.81±2.44),and the oxygenation index was more.Poor(PaO2/FiO2:164.08±21.05),IL-33(46.32±7.82)and higher cytokine expression(TNF-α:266.78±72.89,IL-1:53.47±10.52,IL-6:1824.68±598.53,IL-8:160.42±50.34),the difference was statistically significant compared with the non-sepsis group,P<0.01.After the treatment of rhubarb enema,the above indicators were significantly decreased in both groups,and admission.The difference was statistically significant on the first day,P<0.01.However,on the seventh day after treatment,the sepsis patients hadΔIL-33(41.63±7.86)and cytokines(ΔTNF-α:258.90±72.18,ΔIL-1:47.87±11.85,ΔIL-6:1775.57±598.31,ΔIL-8:143.12±51.98),oxygenation index(162.01±43.23)improved better than non-sepsis group,P<0.01,and the rate of invasive ventilation was not statistically significant.P>0.05.Conclusion:SAP combined with sepsis leads to the use of rhubarb enema in patients with ARDS to significantly improve the concentration of IL-33 as a"target"factor and reduce the proinflammatory factors TNF-α,IL-1,IL-6 and IL-8.Level,improve the patient's oxygenation,has clinical application value.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.
基金Beijing Municipal Education Commission Science and Technology Plan General Project,No.KM201310025015.
文摘BACKGROUND In the early stage of acute pancreatitis(AP),a large number of cytokines induced by local pancreatic inflammation seriously damage the intestinal barrier function,and intestinal bacteria and endotoxins enter the blood,causing inflammatory storm,resulting in multiple organ failure,infectious complications,and other disorders,eventually leading to death.Intestinal failure occurs early in the course of AP,accelerating its development.As an alternative method to detect small intestinal bacterial overgrowth,the hydrogen breath test is safe,noninvasive,and convenient,reflecting the number of intestinal bacteria in AP indirectly.This study aimed to investigate the changes in intestinal bacteria measured using the hydrogen breath test in the early stage of AP to clarify the relationship between intestinal bacteria and acute lung injury(ALI)/acute respiratory distress syndrome(ARDS).Early clinical intervention and maintenance of intestinal barrier function would be highly beneficial in controlling the development of severe acute pancreatitis(SAP).AIM To analyze the relationship between intestinal bacteria change and ALI/ARDS in the early stage of SAP.METHODS A total of 149 patients with AP admitted to the intensive care unit of the Digestive Department,Xuanwu Hospital,Capital Medical University from 2016 to 2019 were finally enrolled,following compliance with the inclusion and exclusion criteria.The results of the hydrogen breath test within 1 wk of admission were collected,and the hydrogen production rates at admission,72 h,and 96 h were calculated.The higher the hydrogen production rates the more bacteria in the small intestine.First,according to the improved Marshall scoring system in the 2012 Atlanta Consensus on New Standards for Classification of Acute Pancreatitis,66 patients with a PaO2/FiO2 score≤1 were included in the mild AP(MAP)group,18 patients with a PaO2/FiO2 score≥2 and duration<48 h were included in the moderately SAP(MSAP)group,and 65 patients with a PaO2/FiO2 score≥2 and duration>48 h were included in the SAP group,to analyze the correlation between intestinal bacterial overgrowth and organ failure in AP.Second,ALI(PaO2/FiO2=2)and ARDS(PaO2/FiO2>2)were defined according to the simplified diagnostic criteria proposed by the 1994 European Union Conference.The MSAP group was divided into two groups according to the PaO2/FiO2 score:15 patients with PaO2/FiO2 score=2 were included in group A,and three patients with score>2 were included in group B.Similarly,the SAP group was divided into two groups:28 patients with score=2 were included in group C,and 37 patients with score>2 were included in group D,to analyze the correlation between intestinal bacterial overgrowth and ALI/ARDS in AP.RESULTS A total of 149 patients were included:66 patients in the MAP group,of whom 53 patients were male(80.3%)and 13 patients were female(19.7%);18 patients in the MSAP group,of whom 13 patients were male(72.2%)and 5 patients were female(27.8%);65 patients in the SAP group,of whom 48 patients were male(73.8%)and 17 patients were female(26.2%).There was no significant difference in interleukin-6 and procalcitonin among the MAP,MSAP,and SAP groups(P=0.445 and P=0.399,respectively).There was no significant difference in the growth of intestinal bacteria among the MAP,MSAP,and SAP groups(P=0.649).There was no significant difference in the growth of small intestinal bacteria between group A and group B(P=0.353).There was a significant difference in the growth of small intestinal bacteria between group C and group D(P=0.038).CONCLUSION Intestinal bacterial overgrowth in the early stage of SAP is correlated with ARDS.
基金Supported by the Nanchong City College Cooperative Research Project,No.19SXHZ0282Medical Imaging Key Laboratory of Sichuan Province,No MIKLSP202008.
文摘In this editorial we comment on the article published in the recent issue of the World Journal of Gastroenterology[2022;28(19):2123-2136].We pay attention to how to construct a simpler and more reliable new clinical predictive model to early identify patients at high risk of acute respiratory distress syndrome(ARDS)associated with severe acute pancreatitis(SAP),and to early predict the severity of organ failure from chest computed tomography(CT)findings in SAP patients.As we all know,SAP has a sudden onset,is a rapidly changing condition,and can be complicated with ARDS and even multiple organ dysfunction syndrome,and its mortality rate has remained high.At present,there are many clinical scoring systems for AP,including the bedside index for severity in AP,acute physiology and chronic health evaluation II,systemic inflammatory response syndrome,Japanese severe score,quick sepsis-related organ failure assessment,etc.However,some of these scoring systems are complex and require multiple and difficult clinical parameters for risk stratification.Although the aforementioned biomarkers are readily available,their ability to predict ARDS varies.Accordingly,it is extremely necessary to establish a simple and valuable novel model to predict the development of ARDS in AP.In addition,the extra-pancreatic manifestations of AP patients often involve the chest,among which pleural effusion and pulmonary consolidation are the more common complications.Therefore,by measuring the semi-quantitative indexes of chest CT in AP patients,such as the amount of pleural effusion and the number of lobes involved as pulmonary consolidation,it has important reference value for the early diagnosis of SAP complicated with ARDS and is expected to provide a basis for the early treatment of ARDS.
基金The Natural Science Foundation of Hunan Province,No.2019JJ40435.
文摘BACKGROUND There have been few reports on the risk factors for acute respiratory distress syndrome(ARDS)in coronavirus disease 2019(COVID-19),and there were obvious differences regarding the incidence of ADRS between Wuhan and outside Wuhan in China.AIM To investigate the risk factors associated with ARDS in COVID-19,and compare the characteristics of ARDS between Wuhan and outside Wuhan in China.METHODS Patients were enrolled from two medical centers in Hunan Province.A total of 197 patients with confirmed COVID-19,who had either been discharged or had died by March 15,2020,were included in this study.We retrospectively collected the patients’clinical data,and the factors associated with ARDS were compared by theχ²test,Fisher’s exact test,and Mann-Whitney U test.Significant variables were chosen for the univariate and multivariate logistic regression analyses.In addition,literature in the PubMed database was reviewed,and the characteristics of ARDS,mortality,and biomarkers of COVID-19 severity were compared between Wuhan and outside Wuhan in China.RESULTS Compared with the non-ARDS group,patients in the ARDS group were significantly older,had more coexisting diseases,dyspnea,higher D-dimer,lactate dehydrogenase(LDH),and C-reactive protein.In univariate logistic analysis,risk factors associated with the development of ARDS included older age[odds ratio(OR)=1.04),coexisting diseases(OR=3.94),dyspnea(OR=17.82),dry/moist rales(OR=9.06),consolidative/mixed opacities(OR=2.93),lymphocytes(OR=0.68 for high lymphocytes compared to low lymphocytes),D-dimer(OR=1.41),albumin(OR=0.69 for high albumin compared to low albumin),alanine aminotransferase(OR=1.03),aspartate aminotransferase(OR=1.02),LDH(OR=1.02),C-reactive protein(OR=1.04)and procalcitonin(OR=17.01).In logistic multivariate analysis,dyspnea(adjusted OR=27.10),dry/moist rales(adjusted OR=9.46),and higher LDH(adjusted OR=1.02)were independent risk factors.The literature review showed that patients in Wuhan had a higher incidence of ARDS,higher mortality rate,and higher levels of biomarkers associated with COVID-19 severity than those outside Wuhan in China.CONCLUSION Dyspnea,dry/moist rales and higher LDH are independent risk factors for ARDS in COVID-19.The incidence of ARDS in Wuhan seems to be overestimated compared with outside Wuhan in China.
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Chongqing Municipal Health and Family Planning Commission Chinese Medicine Science and Technology Project(No.ZY201702071)Chongqing Municipal Health and Family Planning Commission Medical Research Project(No.2018MSXM097)。
文摘Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University from June 2016 to December 2018 were randomly divided into SAP with ARDS sepsis group(sepsis group)and SAP.In the ARDS non-sepsis group(non-sepsis group),20 patients were treated according to the guidelines for the diagnosis and treatment of acute pancreatitis in China in 2013.They were given regular fasting,gastrointestinal decompression,fluid resuscitation,acid suppression,and growth.On the basis of the inhibition of water,electrolytes,acid-base balance,add rhubarb 3 g/kg,water 200 mL,filter the slag juice to 37~38℃for retention enema for more than 15min,2 times a day For a total of 7 days.The inflammatory markers WBC,PCT,heart rate,respiratory rate,oxygenation index(PaO2/FiO2),pancreatic severity score(BISAP),and IL-33 and various cytokine changes were recorded in the two groups.Results:On the first day of admission,the patients in the sepsis group had more severe inflammation index(WBC:14.23±2.95,PCT:3.62±2.04,heart rate:104.02±8.89,respiration:26.81±2.44),and the oxygenation index was more.Poor(PaO2/FiO2:164.08±21.05),IL-33(46.32±7.82)and higher cytokine expression(TNF-α:266.78±72.89,IL-1:53.47±10.52,IL-6:1824.68±598.53,IL-8:160.42±50.34),the difference was statistically significant compared with the non-sepsis group,P<0.01.After the treatment of rhubarb enema,the above indicators were significantly decreased in both groups,and admission.The difference was statistically significant on the first day,P<0.01.However,on the seventh day after treatment,the sepsis patients hadΔIL-33(41.63±7.86)and cytokines(ΔTNF-α:258.90±72.18,ΔIL-1:47.87±11.85,ΔIL-6:1775.57±598.31,ΔIL-8:143.12±51.98),oxygenation index(162.01±43.23)improved better than non-sepsis group,P<0.01,and the rate of invasive ventilation was not statistically significant.P>0.05.Conclusion:SAP combined with sepsis leads to the use of rhubarb enema in patients with ARDS to significantly improve the concentration of IL-33 as a"target"factor and reduce the proinflammatory factors TNF-α,IL-1,IL-6 and IL-8.Level,improve the patient's oxygenation,has clinical application value.
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.
