Acute respiratory distress syndrome: a life threatening associated complication of SARS-CoV-2 infection inducing COVID-19

Respiratory Distress ◽

Diabetic Ketoacidosis ◽

Distress Syndrome ◽

Early Recognition ◽

Ecmo Support ◽

List Type ◽

Life Threatening ◽

Life Threatening Complication

Summary Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management. Learning points ARDS is a very rare but life-threatening complication in DKA. The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA. The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition. Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes. DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.

Rationale for the Use of Radiation-Activated Mesenchymal Stromal/Stem Cells in Acute Respiratory Distress Syndrome

Cells ◽

10.3390/cells9092015 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2015 ◽

Cited By ~ 3

Author(s):

Isabel Tovar ◽

Rosa Guerrero ◽

Jesús J. López-Peñalver ◽

José Expósito ◽

José Mariano Ruiz de Almodóvar

Keyword(s):

Stem Cells ◽

Respiratory Distress ◽

Distress Syndrome ◽

Human Umbilical Cord ◽

Annexin A1 ◽

Significant Difference ◽

Life Threatening ◽

Stromal Stem Cells

We have previously shown that the combination of radiotherapy with human umbilical-cord-derived mesenchymal stromal/stem cells (MSCs) cell therapy significantly reduces the size of the xenotumors in mice, both in the directly irradiated tumor and in the distant nonirradiated tumor or its metastasis. We have also shown that exosomes secreted from MSCs preirradiated with 2 Gy are quantitatively, functionally and qualitatively different from the exosomes secreted from nonirradiated mesenchymal cells, and also that proteins, exosomes and microvesicles secreted by MSCs suffer a significant change when the cells are activated or nonactivated, with the amount of protein present in the exosomes of the preirradiated cells being 1.5 times greater compared to those from nonirradiated cells. This finding correlates with a dramatic increase in the antitumor activity of the radiotherapy when is combined with MSCs or with preirradiated mesenchymal stromal/stem cells (MSCs*). After the proteomic analysis of the load of the exosomes released from both irradiated and nonirradiated cells, we conclude that annexin A1 is the most important and significant difference between the exosomes released by the cells in either status. Knowing the role of annexin A1 in the control of hypoxia and inflammation that is characteristic of acute respiratory-distress syndrome (ARDS), we designed a hypothetical therapeutic strategy, based on the transplantation of mesenchymal stromal/stem cells stimulated with radiation, to alleviate the symptoms of patients who, due to pneumonia caused by SARS-CoV-2, require to be admitted to an intensive care unit for patients with life-threatening conditions. With this hypothesis, we seek to improve the patients’ respiratory capacity and increase the expectations of their cure.

Rituximab Twice Weekly for Refractory Thrombotic Thrombocytopenic Purpura in a Critically Ill Patient with Acute Respiratory Distress Syndrome

Case Reports in Oncology ◽

10.1159/000505236 ◽

2020 ◽

Vol 13 (1) ◽

pp. 153-157

Author(s):

Bahjat Azrieh ◽

Arwa Alsaud ◽

Khaldun Obeidat ◽

Amr Ashour ◽

Seham Elebbi ◽

...

Keyword(s):

Respiratory Distress ◽

Thrombotic Thrombocytopenic Purpura ◽

Distress Syndrome ◽

Standard Of Care ◽

Critically Ill Patient ◽

Microangiopathic Hemolytic Anemia ◽

Thrombocytopenic Purpura ◽

Thrombotic thrombocytopenic purpura (TTP) is a rare, serious, life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and hypercoagulability. The etiology is a deficiency of ADAMTS13 which is usually caused by acquired antibodies. Plasma exchange and steroids is the standard of care in the treatment of TTP. However, there are refractory cases of TTP which require further management. Rituximab appears to be a safe and effective therapy for refractory and relapsing TTP. Here we report a challenging case of TTP that responded to treatment with rituximab twice weekly. According to our knowledge, rituximab twice weekly has never been used for TTP before.

Customization of an Open-Lung Ventilation Strategy to Treat a Case of Life-Threatening Acute Respiratory Distress Syndrome

Respiratory Care ◽

10.4187/respcare.00867 ◽

2011 ◽

Vol 56 (4) ◽

pp. 514-519 ◽

Cited By ~ 1

Author(s):

D. A. Grooms ◽

S. H. Sibole ◽

J. R. Tomlinson ◽

P. E. Marik ◽

R. L. Chatburn

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Lung Ventilation ◽

Ventilation Strategy ◽

Open Lung ◽

Ketorolac may control more than pain

Clinical Science ◽

10.1042/cs20030275 ◽

2003 ◽

Vol 105 (5) ◽

pp. 549-550 ◽

Cited By ~ 1

Author(s):

Frank ISIK

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Inhalation Injury ◽

Clinical Science ◽

Inflammatory Cascade ◽

Life-threatening acute respiratory distress syndrome (ARDS) complicates the recovery of patients with burn and inhalation injury. The study by Enkhbaatar and co-workers in this issue of Clinical Science suggests that reducing the early and robust inflammatory cascade may provide patients with protection from developing cardiopulmonary compromise seen early after burn and inhalation injury.

Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature

Anesthesiology Research and Practice ◽

10.1155/2010/586425 ◽

2010 ◽

Vol 2010 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Thorsten Brenner ◽

Johann Motsch ◽

Jens Werner ◽

Lars Grenacher ◽

Eike Martin ◽

...

Keyword(s):

Liver Resection ◽

Respiratory Distress ◽

Surgical Procedure ◽

Distress Syndrome ◽

Rapid Onset ◽

Pulmonary Complications ◽

Life Threatening ◽

Metastatic Liver

Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.

Acute respiratory distress syndrome in paediatric scrub typhus

Tropical Doctor ◽

10.1177/00494755211029146 ◽

2021 ◽

pp. 004947552110291

Author(s):

Sathish K Loganathan ◽

Amol Jaybhaye ◽

Nabaneeta Dash ◽

Anu Punnen ◽

Urmi Ghosh ◽

...

Keyword(s):

Retrospective Study ◽

Respiratory Distress ◽

Associated Factors ◽

Distress Syndrome ◽

Scrub Typhus ◽

Severe Thrombocytopenia ◽

Life Threatening ◽

Life Threatening Complication

Acute respiratory distress syndrome is a life-threatening complication of scrub typhus; we sought to describe its mortality and associated factors, namely eschar, hepatomegaly and severe thrombocytopenia, in a retrospective study in India of 65 children.

Acute respiratory distress syndrome: An update and review

Journal of Translational Internal Medicine ◽

10.1515/jtim-2016-0012 ◽

2018 ◽

Vol 6 (2) ◽

pp. 74-77 ◽

Cited By ~ 14

Author(s):

Gautam Rawal ◽

Sankalp Yadav ◽

Raj Kumar

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Rescue Therapy ◽

Severe Hypoxemia ◽

Low Tidal Volume ◽

The Past ◽

Threatening Condition ◽

Abstract Acute respiratory distress syndrome (ARDS) is a life threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure and was first recognized in 1960s.Since its first description, it has undergone intensive research in the past few decades to understand its pathogenesis and therapies. Despite this, the recommended therapies to decrease mortality in ARDS remain limited and include low-tidal volume mechanical ventilation, prone ventilation and recently, the ECMO rescue therapy in extreme cases. This review article will summarize the key features of ARDS with a brief overview of the therapeutic options in the management of ARDS.

Acute Respiratory Distress Syndrome as an Organ Phenotype of Vascular Microthrombotic Disease: Based on Hemostatic Theory and Endothelial Molecular Pathogenesis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619887437 ◽

2019 ◽

Vol 25 ◽

pp. 107602961988743 ◽

Cited By ~ 31

Author(s):

Jae C. Chang

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Regulatory Protein ◽

Membrane Attack Complex ◽

Best Supportive Care ◽

Molecular Pathogenesis ◽

Circulatory Disorder ◽

Acute respiratory distress syndrome (ARDS) is a life-threatening noncardiogenic circulatory disorder of the lungs associated with critical illnesses such as sepsis, trauma, and immune and collagen vascular disease. Its mortality rate is marginally improved with the best supportive care. The demise occurs due to progressive pulmonary hypoxia and multi-organ dysfunction syndrome (MODS) with severe inflammation. Complement activation is a part of immune response against pathogen or insult in which membrane attack complex (MAC) is formed and eliminates microbes. If complement regulatory protein such as endothelial CD59 is underexpressed, MAC may also cause pulmonary vascular injury to the innocent bystander endothelial cell of host and provokes endotheliopathy that causes inflammation and pulmonary vascular microthrombosis, leading to ARDS. Its pathogenesis is based on a novel “two-path unifying theory” of hemostasis and “two-activation theory of the endothelium” promoting molecular pathogenesis. Endotheliopathy activates two independent molecular pathways: inflammatory and microthrombotic. The former triggers the release inflammatory cytokines and the latter promotes exocytosis of unusually large von Willebrand factor multimers (ULVWF) and platelet activation. Inflammatory pathway initiates inflammation, but microthrombotic pathway more seriously produces “microthrombi strings” composed of platelet-ULVWF complexes, which become anchored on the injured endothelial cells, and causes disseminated intravascular microthrombosis (DIT). DIT is a hemostatic disease due to lone activation of ULVWF path without activated tissue factor path. It leads to endotheliopathy-associated vascular microthrombotic disease (EA-VMTD), which orchestrates consumptive thrombocytopenia, microangiopathic hemolytic anemia, and MODS. Thrombotic thrombocytopenic purpura (TTP)-like syndrome is the hematologic phenotype of EA-VMTD. ARDS is one of organ phenotypes among MODS associated with TTP-like syndrome. The most effective treatment of ARDS can be achieved by counteracting the activated microthrombotic pathway based on two novel hemostatic theories.

Veno-venous extracorporeal membrane oxygenation for COVID-19-associated pediatric acute respiratory distress syndrome

Perfusion ◽

10.1177/0267659120939757 ◽

2020 ◽

Vol 35 (6) ◽

pp. 550-553

Author(s):

Deirdre Lewis ◽

Grace Fisler ◽

James Schneider ◽

Todd Sweberg ◽

Kristina Murphy ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress ◽

Distress Syndrome ◽

Intensive Therapy ◽

Respiratory Pathogen ◽

Medical Systems ◽

Membrane Oxygenation ◽

Background: The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) coronavirus has emerged as a highly contagious respiratory pathogen causing severe acute lung injury. Extracorporeal membrane oxygenation is a standard tool for the management of life-threatening acute respiratory distress syndrome, but the use of this resource-intensive therapy has come into question due to strained medical systems and limited proven treatments for COVID-19. Case summary: A 16-year-old female with obesity presented with fever, myalgias, cough, and tachypnea and was diagnosed with COVID-19. She progressed to severe pediatric acute respiratory distress syndrome requiring intubation on hospital day 4 and cannulation to veno-venous extracorporeal membrane oxygenation on hospital day 6. The patient received remdesivir, steroids, and anakinra. The patient was successfully decannulated on hospital day 12 and was discharged home on hospital day 21. Conclusion: We report the use of veno-venous extracorporeal membrane oxygenation as a bridge to lung recovery in a pediatric patient with severe pediatric acute respiratory distress syndrome due to COVID-19.