scholarly journals Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jan Matthias Kruse ◽  
Daniel Zickler ◽  
Willie M. Lüdemann ◽  
Sophie K. Piper ◽  
Inka Gotthardt ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Tertiary Care ◽  
Injury Patterns ◽  
Prothrombotic State ◽  
Icu Admission ◽  
Artery Branch ◽  
Observation Period

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25–17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35–58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.

scholarly journals A Cohort Study on Lung Cavitations in Severely Ill COVID-19 Patients – Evidence for a Thromboembolic Pathogenesis.

2021 ◽  
Author(s):  
Jan M. Kruse ◽  
Daniel Zickler ◽  
Willie M Lüdemann ◽  
Sophie K Piper ◽  
Inka Gotthardt ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Tertiary Care ◽  
Injury Patterns ◽  
Prothrombotic State ◽  
Icu Admission ◽  
Artery Branch ◽  
Observation Period

Abstract Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19.Methods: Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany.Results: We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11 5 (6 25-17 75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions.Conclusion: Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.

scholarly journals Nanomedicine for Treatment of Acute Lung Injury and Acute Respiratory Distress Syndrome

2017 ◽  
Vol 2 (2) ◽  
pp. 1-12 ◽  
Author(s):  
Ruxana T. Sadikot ◽  
Arun V. Kolanjiyil ◽  
Clement Kleinstreuer ◽  
Israel Rubinstein
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Distress Syndrome ◽  
Mode Of Delivery ◽  
Heterogenous Group

Acute lung injury and acute respiratory distress syndrome (ARDS) represent a heterogenous group of lung disease in critically ill patients that continues to have high mortality. Despite the increased understanding of the molecular pathogenesis of ARDS, specific targeted treatments for ARDS have yet to be developed. ARDS represents an unmet medical need with an urgency to develop effective pharmacotherapies. Multiple promising targets have been identified that could lead to the development of potential therapies for ARDS; however, they have been limited because of difficulty with the mode of delivery, especially in critically ill patients. Nanobiotechnology is the basis of innovative techniques to deliver drugs targeted to the site of inflamed organs, such as the lungs. Nanoscale drug delivery systems have the ability to improve the pharmacokinetics and pharmacodynamics of agents, allowing an increase in the biodistribution of therapeutic agents to target organs and resulting in improved efficacy with reduction in drug toxicity. Although attractive, delivering nanomedicine to lungs can be challenging as it requires sophisticated systems. Here we review the potential of novel nanomedicine approaches that may prove to be therapeutically beneficial for the treatment of this devastating condition.

Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients*

2004 ◽  
Vol 32 (2) ◽  
pp. 327-331 ◽  
Author(s):  
Miriam M. Treggiari ◽  
Leonard D. Hudson ◽  
Diane P. Martin ◽  
Noel S. Weiss ◽  
Ellen Caldwell ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Trauma Patients

scholarly journals Radiotherapy as a Cure for Covid-19 Pneumonia: Is this a Possibility?

2020 ◽  
Vol 5 (S1) ◽  
pp. 157-159
Author(s):  
Partha Pratim Medhi ◽  
Shashank Bansal ◽  
Faridha Jane Momin ◽  
Ghritashee Bora
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Low Dose ◽  
Distress Syndrome ◽  
Febrile Illness ◽  
Lung Pathology ◽  
Inflammatory Cascade ◽  
Low Dose Radiotherapy

The ongoing pandemic of COVID-19 caused by the Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2) has affected the healthcare system worldwide to a great extent. Millions of people have succumbed to the disease which might vary from mild febrile illness to severe Acute Lung Injury ultimately resulting in ARDS (Acute Respiratory Distress Syndrome). The mechanism of lung pathology due to SARS CoV-2 infection though unclear, is thought to be due to an imbalance in the inflammatory cascade; leading to a condition called Chemokine Release Syndrome. Low dose Radiotherapy which was historically used to treat Pneumonia, can serve as an approach for this subset of patients; by virtue of its anti-inflammatory response. Thus, in the present time, where a perfect cure is yet to derived all possible interventions should be looked upon with a ray of hope. 

scholarly journals Longitudinal assessment of IFN-I activity and immune profile in critically ill COVID-19 patients with acute respiratory distress syndrome

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Fabienne Venet ◽  
◽  
Martin Cour ◽  
Thomas Rimmelé ◽  
Sebastien Viel ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Distress Syndrome ◽  
Type I ◽  
Immune Profile ◽  
Icu Admission ◽  
Over Time

Abstract Background Since the onset of the pandemic, only few studies focused on longitudinal immune monitoring in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) whereas their hospital stay may last for several weeks. Consequently, the question of whether immune parameters may drive or associate with delayed unfavorable outcome in these critically ill patients remains unsolved. Methods We present a dynamic description of immuno-inflammatory derangements in 64 critically ill COVID-19 patients including plasma IFNα2 levels and IFN-stimulated genes (ISG) score measurements. Results ARDS patients presented with persistently decreased lymphocyte count and mHLA-DR expression and increased cytokine levels. Type-I IFN response was initially induced with elevation of IFNα2 levels and ISG score followed by a rapid decrease over time. Survivors and non-survivors presented with apparent common immune responses over the first 3 weeks after ICU admission mixing gradual return to normal values of cellular markers and progressive decrease of cytokines levels including IFNα2. Only plasma TNF-α presented with a slow increase over time and higher values in non-survivors compared with survivors. This paralleled with an extremely high occurrence of secondary infections in COVID-19 patients with ARDS. Conclusions Occurrence of ARDS in response to SARS-CoV2 infection appears to be strongly associated with the intensity of immune alterations upon ICU admission of COVID-19 patients. In these critically ill patients, immune profile presents with similarities with the delayed step of immunosuppression described in bacterial sepsis.

scholarly journals SARS-CoV-2 RNAemia with higher nasopharyngeal viral load is strongly associated with severity and mortality in patients with COVID-19

2020 ◽  
Author(s):  
Hitoshi Kawasuji ◽  
Yoshitomo Morinaga ◽  
Hideki Tani ◽  
Yoshihiro Yoshida ◽  
Yusuke Taekgoshi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Care Hospital ◽  
Oxygen Supplementation ◽  
Cross Sectional ◽  
Icu Admission ◽  
Viral Loads

AbstractObjectiveThis study aimed to determine the frequency of SARS-CoV-2 RNA in serum and its association with the clinical severity of COVID-19.MethodsAn analytical cross-sectional study was performed in a single tertiary care hospital and included consecutive patients with confirmed COVID-19. The prevalence of SARS-CoV-2 RNAemia and the strength of its association with clinical severity variables, including required oxygen supplementation, ICU admission, invasive mechanical ventilation, and in-hospital mortality, were examined.ResultsFifty-six patients were included in the study. The median age was 54.5 years, and individuals with RNAemia were older than those without detectable SARS-CoV-2 RNA in serum (78 vs. 50 years; P = .0013). RNAemia was detected in 19.6% of patients (11/56) and in 1.0% (1/25), 50.0% (6/12), and 100.0% (4/4) of moderate, severe, and critically ill cases, respectively. Patients with RNAemia required more frequent oxygen supplementation (90.0% vs. 13.3%; P < .0001) and ICU admission (81.8% vs. 6.7%; P < .0001) and required invasive mechanical ventilation (27.3% vs. 0.0%; P < .0001). Among patients with RNAemia, the median viral loads of NP swabs that were collected around the same time as the serum were significantly higher in critically ill cases (5.4 Log10 copies/μL [IQR: 4.2–6.3]) than in moderate–severe cases (2.6 Log10 copies/μL [1.1–4.5]; P =.030) and were significantly higher in nonsurvivor cases (6.2 Log10 copies/μL [IQR: 6.0–6.5]) than in survivor cases (3.9 Log10 copies/μL [1.6–4.6]; P =.045).ConclusionsThis study demonstrated a relatively high proportion of SARS-CoV-2 RNAemia and an association between RNAemia and clinical severity. Moreover, among the patients with RNAemia, the viral loads of NP swabs were correlated with severity and mortality, thus suggesting the potential utility of combining serum testing with NP tests as a prognostic indicator for COVID-19 with a higher quality than each separate test.

First reported case of Weissella confusa abundance in the lung microbiota of a critically ill trauma patient with acute respiratory distress syndrome - caution warranted in the use of the Weissella genus as a probiotic

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Joint Infection ◽  
Starter Cultures ◽  
Trauma Patients ◽  
Virulence Determinants ◽  
Prosthetic Joint

Weissella strains are currently being used for biotechnological and probiotic purposes [1]. While, Weissella hellenica found in flounder intestine had probiotic effects [2], certain species from this genus are opportunistic pathogens in humans. Apart from being implicated in disease in farmed rainbow trout [3], Weissella has been found to cause the following disease in humans.1. endocarditis [4,5]2. bacteraemia [6]3. prosthetic joint infection [7]Whole genome sequences ‘find several virulence determinants such as collagen adhesins, aggregation sub- stances, mucus-binding proteins, and hemolysins in some species’, as well as antibiotic resistance-encoding genes [8]. Caution is warranted in selecting of Weissella strains as starter cultures or probiotics, if at all, since the other option, Lactobacillus, are rarely involved in human disease.Here, the analysis of the lung microbiota in critically ill trauma patients suffering from acute respiratory distress syndrome [9] shows (Accid:ERR1992912) shows complete colonization of Weissella (Fig 1). While, the study mentions ‘significant enrichment of potential pathogens including Streptococcus, Fusobacterium, Prevotella, Haemophilus and Treponema’, there is no reference to the Weissella genus. The percentages of Weissella strains are :confusa=81, soli=7 ,hellenica=5 ,diestrammenae=2. I believe this is the first reported case of Weissella causing ARDS in humans.

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