Rapid assay for plasma soluble E-selectin predicts the development of acute respiratory distress syndrome in patients with systemic inflammatory response syndrome

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to COVID-19, but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19. Methods: All adult patients who were placed on ECMO for ARDS due to COVID -19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not. Results: 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing between survivors and non-survivors, older age was associated with hospital mortality (p=0.02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n=7), bacteremia during ECMO (20%, n=4),coinfection with bacterial pneumonia (15%, n=3), cannula site bleeding (15%, n=3), stroke (10%, n=2), gastrointestinal bleeding (10%, n=2), and liver failure (5%, n=1). The complications associated with patient mortality were culture positive septic shock (p=0.01), culture-negative systemic inflammatory response syndrome (p=0.01), and renal failure (p=0.01). The causes of death were septic shock (44%, n=4), culture-negative systemic inflammatory response syndrome (44%, n=4), and stroke (11%, n=1). Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving survival.

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Chemokines in acute respiratory distress syndrome

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00405.2003 ◽

2005 ◽

Vol 288 (1) ◽

pp. L3-L15 ◽

Cited By ~ 180

Author(s):

Padmam Puneet ◽

Shabbir Moochhala ◽

Madhav Bhatia

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Inflammatory Response ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Chemokine Receptors ◽

Distress Syndrome ◽

Inflammatory Diseases ◽

Systemic Inflammatory Response ◽

Major Surgery ◽

Inflammatory Disorders

A characteristic feature of all inflammatory disorders is the excessive recruitment of leukocytes to the site of inflammation. The loss of control in trafficking these cells contributes to inflammatory diseases. Leukocyte recruitment is a well-orchestrated process that includes several protein families including the large cytokine subfamily of chemotactic cytokines, the chemokines. Chemokines and their receptors are involved in the pathogenesis of several diseases. Acute lung injury that clinically manifests as acute respiratory distress syndrome (ARDS) is caused by an uncontrolled systemic inflammatory response resulting from clinical events including major surgery, trauma, multiple transfusions, severe burns, pancreatitis, and sepsis. Systemic inflammatory response syndrome involves activation of alveolar macrophages and sequestered neutrophils in the lung. The clinical hallmarks of ARDS are severe hypoxemia, diffuse bilateral pulmonary infiltrates, and normal intracardiac filling pressures. The magnitude and duration of the inflammatory process may ultimately determine the outcome in patients with ARDS. Recent evidence shows that activated leukocytes and chemokines play a key role in the pathogenesis of ARDS. The expanding number of antagonists of chemokine receptors for inflammatory disorders may hold promise for new medicines to combat ARDS.

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The systemic inflammatory response syndrome and the adult respiratory distress syndrome

Current Opinion in Anaesthesiology ◽

10.1097/00001503-199312000-00016 ◽

1993 ◽

Vol 6 (6) ◽

pp. 981-992 ◽

Cited By ~ 1

Author(s):

Andrew T. Costarino

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Adult Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Systemic Inflammatory Response

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ARDS and Massive Pulmonary Embolism: The Combined Use of Extracorporeal Membrane Oxygenation (ECMO) with Thrombolytics

Case Reports in Critical Care ◽

10.1155/2020/1032629 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Brett Dickens ◽

Casey Bryant ◽

John Gaillard ◽

Nathaniel Westphal

Keyword(s):

Pulmonary Embolism ◽

Acute Respiratory Distress Syndrome ◽

Inflammatory Response ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Massive Pulmonary Embolism ◽

Systemic Inflammatory Response ◽

Combined Use

Pancreatitis causes a systemic inflammatory response that can lead to acute respiratory distress syndrome (ARDS). We present a case of severe ARDS complicated by a pulmonary embolism (PE) in a 39-year-old female that developed rapidly progressive pancreatitis secondary to hypertriglyceridemia.

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