Objective To explore the effects of lateral position ventilation on lung volume and oxygenation in patients with acute respiratory distress syndrome ( ARDS) . Methods Fourteen patients with ARDS were enrolled. Supine position, lateral position and supine position were successively adopted and continued for one hour respectively. End-expiratory lung volume ( EELV) was measured at the end of each epoch. Effects of different position on gas exchange, lung mechanics and hemodynamics were monitored.Results EELV was increased from ( 1109 ±321) mL to ( 1376 ±381) mL after lateral ventilation ( P lt;0. 05) , and decreased to ( 1143 ±376) mL after the second supine ventilation ( P lt;0. 05) . Compared with initial supine ventilation, there was no significant difference in EELV after the second supine ventilation( P gt;0. 05) . PaO2 /FiO2 was increased from ( 154. 3 ±35. 0) mm Hg to ( 189. 9 ±60. 1) mm Hg after lateral ventilation ( P lt;0. 05) , and increased to ( 209. 2 ±75. 4) mm Hg after the second supine ventilation ( P lt; 0. 05) . Compared with initial supine ventilation, PaO2 /FiO2 was increased greatly after the secondsupine ventilation ( P lt; 0. 01) . There was no significant difference in PaCO2 , lung mechanics and hemodynamics after changing different position. Conclusion Lateral position ventilation can increase EELV and improve oxygenation in patients with ARDS.
With the growth of offshore activities, the incidence rates of seawater drowning (SWD) induced acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) increase significantly higher than before. Pulmonary interstitial edema, alveolar septum fracture, red blood cells, and inflammatory cells infiltration can be seen under light microscope in the pathologic changes of lungs. The major clinical manifestations are continual hyoxemia and acidosis, which lead to a severe condition, a high death rate, and a poor treatment effect. Bone marrow mesenchymal stem cells are capable of self-renewal, multilineage differentiation and injured lung-homing, which are induced to differentiate into alveolar epithelial cells and pulmonary vascular endothelial cells for tissues repairing. This may be a new way to treat SWD-ALI and SW-ARDS.
Objective To investigate the value of serum angiopoietin like protein 4 (ANGPTL-4), growth differentiation factor 15 (GDF-15) and fibroblast growth factor 21 (FGF-21) in evaluating the condition and predicting the prognosis of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of 147 patients with ARDS admitted in our hospital from January 2019 to December 2021 were collected. The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the ARDS patients on the day of admission were detected. According to the oxygenation index(OI), the ARDS patients were divided into a mild group with 38 cases (200 mm Hg <OI≤300 mm Hg), a moderate group with 63 cases (100 mm Hg <OI≤200 mm Hg) and a severe group with 46 cases (OI≤100 mm Hg). According to the survival within 28 days after entering the intensive care unit, the ARDS patients were divided into a survival group with 90 cases and a death group with 57 cases. Multivariate logistic regression analysis was used to analyze the risk factors of death in the patients with ARDS. Receiver operator characteristic curve were drawn to analyze the value of serum ANGPTL-4, GDF-15 and FGF-21 levels in predicting the prognosis of ARDS patients. Pearson correlation was used to analyze the correlation between serum ANGPTL-4, GDF-15 and FGF-21 levels. Results The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the death group were significantly higher than those in the survival group (all P<0.001). The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the severe group were significantly higher than those in the mild group and the moderate group (all P<0.001). Multivariate logistic regression analysis showed that the levels of OI (OR=2.416, 95%CI 1.615 - 5.470), APACHEⅡ score (OR=2.795, 95%CI 1.973 - 6.874), SOFA score (OR=1.692, 95%CI 1.170 - 3.105), ANGPTL-4 (OR=1.951, 95%CI 1.360 - 4.208), GDF-15 (OR=2.583, 95%CI 1.804 - 6.195) and FGF-21 (OR=3.116, 95%CI 2.513 - 9.307) were the risk factors of death in patients with ARDS (P<0.05). The area under the ROC curve of combination of ANGPTL-4, GDF-15 and FGF-21 was the highest (0.953, 95%CI 0.892 - 0.998) for prediction the death of ARDS patients, with a sensitivity of 98.0% and specificity of 87.3%. Correlation analysis showed that serum ANGPTL-4 level was positively correlated with GDF-15 and FGF-21 in the ARDS patients (P<0.001). Conclusions The elevated levels of serum ANGPTL-4, GDF-15 and FGF-21 are related to the severity and death of ARDS patients. The combined detection of serum ANGPTL-4, GDF-15 and FGF-21 is helpful to predict the prognosis of ARDS patients.
ObjectiveTo investigate the clinical characteristics and prognostic factors of severe viral pneumonia induced moderate to severe acute respiratory distress syndrome (ARDS). MethodsTwenty patients with severe viral pneumonia induced moderate to severe ARDS admitted in the Respiratory Intensive Care Unit(RICU) in Xiangya Hospital of Central South University from January 2011 to April 2014 were included in the study.The clinical characteristics and prognostic factors were analyzed retrospectively by analysis of variance(ANOVA). ResultsFive patients developed secondary bacterial infections,while three patients developed secondary fungal infections,among which 2 patients developed both bacterial and fungal infections.Fourteen patients died during hospitalization. ANOVA revealed that gender,body temperature,respiratory frequency,pulse frequency,white blood cell count (WBC),hemoglobin(Hb),platelet(Plt),prothrombin time (PT),albumin(Alb),blood urea nitrogen(BUN),serum creatinine(Scr),total bilirubin(TBIL),serum sodium,serum potassium,erythrocyte sedimentation rate (ESR),C-reactive protein(CRP),procalcitionin(PCT),pH,PaCO2,PaO2 and FiO2 were not significantly different between the dead patients and the alive patients (P>0.05).Whereas the age,length of hospital stay,duration of mechanical ventilation,oxygenation index,and the severity of ARDS were significantly different between the dead patients and the alive patients (P<0.05). ConclusionAge,oxygenation index and severity of ARDS can influence the prognosis of patients with severe viral pneumonia induced moderate to severe ARDS.
Objective To explore clinical significance of interleukin-8 (IL-8), clarada protein 16 (CC16), and intercellular adhesion molecule-1 (ICAM-1) in exhaled breath condensate (EBC) and serum samples collected from patients with acute respiratory distress syndrome (ARDS). Methods A total of 45 ARDS patients were assigned into a mild ARDS group (n=20), a moderate ARDS group (n=15) and a severe ARDS group (n=10) based on the Berlin definition. During the same study period, 45 healthy subjects were recruited as control. Serum and EBC levels of IL-8, CC16 and ICAM-1 were detected on the first and fifth day of admission. Results Compared with the control group, serum and EBC IL-8, CC16 and ICAM-1 were significantly higher in the ARDS groups (P<0.05). Serum and EBC IL-8 levels increased with the severity of ARDS, whereas no significant difference was detected between the three groups (P>0.05). Compared with the mild group and the moderate group, serum and EBC CC16 levels were significantly higher in the severe ARDS group. At the first day after admission, serum ICAM-1 was higher in the severe and moderate ARDS groups than that in the mild ARDS group (P<0.05). Meanwhile, EBC ICAM-1 was significantly different between the three groups (P<0.05). At the fifth day after admission, different EBC ICAM-1 was identified between the severe ARDS group and the other two groups (P<0.05). Regardless of ARDS severity, there were no significant differences in serum and EBC IL-8 and CC16 levels at the first and fifth days after admission (P>0.05). However, serum and EBC ICAM-1 at the first and fifth days showed significant difference (except in the mild ARDS group) (P<0.05). The levels of ICAM-1 in serum and EBC of death group were significantly higher than those of survival group (P<0.05). Conclusion Serum and EBC IL-8, CC16 and ICAM-1 are of significance in diagnosis and prognosis evaluation of ARDS.
Objective To investigate the serumlevel of endothelin-1 ( ET-1) in patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) and its clinical significance. Methods Thirty-one ALI/ARDS patients received mechanical ventilation in ICUand 25 normal subjects were recruited in the study. The patients who died in two weeks fell in death group, and the patients who did not died in two weeks fell in survival group. The serum level of ET-1 measured by EIA method were compared between thepatients with different severity of lung injury [ evaluated by American-European Consensus Conference on ARDS ( AECC) criteria and lung injury score( LIS) ] , and between the patients with different prognosis ( death or survival ) . The correlation was analyzed between the level of ET-1 and clinical parameters.Results The ET-1 level was higher in the ALI/ARDS patients than that in the control subjects [ ( 6. 18 ±4. 48) ng/L vs. ( 2. 68 ±1. 34) ng/L, P lt;0. 05] . There was no significant difference in the patients with different severity [ ALI vs. ARDS, ( 5. 43 ±4. 39) ng/L vs. ( 7. 01 ±4. 51) ng/L, P gt; 0. 05; LIS≤2. 5 vs.LISgt;2. 5, ( 5. 93 ±5. 21) ng/L vs. ( 6. 68 ±2. 76) ng/L, P gt; 0. 05] . The ET-1 level in the death group continued to increase, and higher than that in the survival group on the 5th day [ ( 7. 96 ±3. 30) ng/L vs.( 4. 36 ±3. 29) ng/L, P lt; 0. 05] . The ET-1 level was positively correlated with SIRS, SAPSⅡ and APACHEⅡ ( r = 0. 359, 0. 369 and 0. 426, respectively, P lt; 0. 05 ) , and negatively correlated with PaO2 /FiO2 and AaDO2 ( r = - 0. 286 and - 0. 300, respectively, P lt;0. 05) . Conclusion The measurementof serum ET-1 can help to evaluate the severity and prognosis of ALI/ARDS patients.
Acute respiratory distress syndrome is a clinical syndrome caused by many reasons, which is characterized by intractable hypoxemia. Its etiology is complex and its mortality is high. Lung biopsy techniques can give accurate histopathological diagnosis to such patients to guide treatment and improve prognosis. At present, lung biopsy techniques include surgical lung biopsy, transbronchial lung cryobiopsy, transbronchial lung biopsy and percutaneous lung biopsy. The diagnostic rate of surgical lung biopsy is high, but it is traumatic and difficult to implement. The diagnostic rate of transbronchial cryobiopsy is relatively high, and the complications are acceptable. Transbronchial lung biopsy is minimally invasive but the diagnostic rate is low. The diagnostic rate of percutaneous lung biopsy is relatively high, and the complications are relatively few. For patients with acute respiratory distress syndrome who need lung biopsy, it is very important to choose different surgical procedures according to their effectiveness, safety and applicability.
ObjectivesTo investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).MethodsPatients with ARDS who received PPV treatment in the this hospital were enrolled from January 1, 2017 to December 31, 2017. The changes in heart rate, respiratory mechanics and blood gas index before and after PPV in patients, the inhaled oxygen concentration (FiO2), oxygenation index (PaO2/FiO2), pressure sore and other related complications were observed and compared in patients before and after PPV.ResultsA total of 28 patients with ARDS were registered, including 21 males and 7 females. Fourteen patients were complicated with chronic obstructive pulmonary disease (COPD) and 20 were dead in 28 days. After PPV, the peak pressure and plateau pressure decreased significantly, PaO2 and SaO2 increased significantly, system compliance improved considerably but PaCO2 did not change. There was no significant difference in the changes of heart reat, respiratory rate, minute volume, tidal volume and positive end-expiratory pressure between before and after PPV. FiO2 decreased significantly, PaO2/FiO2 increased significantly, and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 post-PPV in comparison to day 1 post-PPV. A total of 13 unplanned extubation occurred during the entire PPV procedure, 9 of them were gastric tube slipping, 2 were urethral catheter slipping, 1 was tracheal tube slipping, and 1 was deep venous catheter slipping. There were 17 cases of artificial airway obstruction, 7 cases of hypotension, 3 cases of arrhythmia, and 4 cases of keratitis. In the subgroup analysis, the age of the patients complicated with COPD was significantly higher, but there was no difference in additional baseline data and the survival rate.ConclusionPPV can significantly improve the patient's respiratory status, especially oxygenation and respiratory mechanics, but PPV can increase the incidence of complications such as pressure sore, and PPV does not improve the prognosis.
Objective To investigate the effect of microRNA-22-3p (miR-22-3p) on the inflammation of human pulmonary microvascular endothelial cells (HPMEC) induced by lipopolysaccharide (LPS) by regulating the HMGB1/NLRP3 pathway. Methods miRNA microarray was taken from peripheral blood of patients with acute respiratory distress syndrome (ARDS) caused by abdominal infection and healthy controls for analysis, and the target miRNA was selected. miRNA mimics, inhibitor and their negative controls were transfected in HPMECs which were stimulated with LPS. Real time fluorescent quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to detect the mRNA and protein levels of high mobility group box-1 protein (HMGB1) and nucleotide binding oligomerization segment like receptor family 3 (NLRP3). RT-qPCR and enzyme linked immunosorbent assay were used to detect the levels of inflammatory factors in the cells and supernatant. Results miRNA microarray showed that miR-22-3p was down-regulated in the plasma of patients with ARDS. Compared with the negative control group, after miR-22-3p over-expression, the protein and mRNA levels of HMGB1 and NLRP3 decreased significantly. Similarly, the level of cleaved-caspase-1 decreased significantly. At the same time, interleukin (IL)-6, IL-8 and IL-1β mRNA level in cytoplasm and supernatant were down-regulated by miR-22-3p mimics. After transfected with miR-22-3p inhibitor, the expression levels of HMGB1, NLRP3, caspase-1 protein and inflammatory factors were significantly up-regulated. Conclusion miR-22-3p is significantly downregulated in peripheral blood of ARDS patients caused by abdominal infection, which can inhibit the expression of HMGB1 and NLRP3 and its downstream inflammatory response in HPMECs.
ObjectiveTo explore the value of procalcitonin-to-albumin (PAR) in patients with acute respiratory distress syndrome (ARDS).MethodsA retrospective study was carried on patients diagnosed with ARDS from December 2016 to March 2018. The receiver-operating characteristics (ROC) curve was used to identify the cutoff value of PAR. The association of PAR and 28-day mortality was evaluated using univariate and multivariable Cox regression.ResultsIn the final analysis, there were a total of 255 patients included. Of whom 164 (64.3%) was male, 91 (35.7%) was female and the mean age was 52.1±14.5 years old. The 28-day mortality of all the patients was 32.9% (n=84). ROC curve revealed that the cutoff value of PAR was 0.039 (specificity: 0.714, sensitivity: 0.702) and area under the curve was 0.793 (95%CI: 0.735 - 0.850, P<0.001). The following variables were considered for multivariable adjustment: age, body mass index, pneumonia, aspiration, sepsis, surgery, PaO2/FiO2, red blood cell counts and PAR (P<0.01 in univariate analysis). After multivariable analysis, only age (HR: 1.033, 95%CI: 1.009 - 1.059, P=0.008), PaO2/FiO2 (HR: 0.992, 95%CI: 0.985 - 1.000, P=0.044) and PAR (HR: 4.899, 95%CI: 2.148 - 11.174, P<0.001) remained independently associated with 28-day mortality (P<0.05).ConclusionHigh PAR predicts a poor outcome in ARDS patients, therefore it appears to be a prognostic biomarker of outcomes in patients with ARDS.