A Device for Improving Oxygenation in Patients With Acute Respiratory Distress Syndrome

2018 ◽  
Author(s):  
Alex Gordon ◽  
Kevin Ai Xin Jue Luo ◽  
Rami Saab ◽  
Doreen Engelberts ◽  
Brian Kavanagh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Blood Oxygenation ◽  
Abdominal Pressure ◽  
Healthy Humans ◽  
Sensor Module ◽  
Lower Lung ◽  
Fraction Of Inspired Oxygen

In this paper we present a device for improving blood oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). ARDS is caused by lung-related illness or injury, and can occur in mechanically ventilated ICU patients due to volutrauma or barotrauma. In ARDS, the lower lung is closed resulting in impaired gas exchange, and the upper lung is easily overstretched resulting in injury. The application of continuous negative abdominal pressure (CNAP) assists in opening the lower lung by pulling the diaphragm towards the abdomen. The device, consisting of a rigid arch, a compliant patient interface, and a pressure sensor module, allows for the application of CNAP to a patient suffering from ARDS. An initial pig trial using the prototype device showed significant improvement in the ratio of oxygen in the blood to the fraction of inspired oxygen, PaO2/FiO2, after five minutes of −5 cmH2O pressure application. Furthermore, preliminary testing on healthy humans indicated the device was comfortable, easy to apply, and formed a consistent airtight seal. Future prototypes will focus on ease of application, rigidity, and adjustability.

scholarly journals Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome

Blood ◽  
2020 ◽  
Vol 136 (10) ◽  
pp. 1169-1179 ◽  
Author(s):  
Elizabeth A. Middleton ◽  
Xue-Yan He ◽  
Frederik Denorme ◽  
Robert A. Campbell ◽  
David Ng ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ex Vivo ◽  
Neutrophil Extracellular Traps ◽  
Dna Complexes ◽  
Platelet Factor ◽  
Extracellular Traps ◽  
Fraction Of Inspired Oxygen

Abstract COVID-19 affects millions of patients worldwide, with clinical presentation ranging from isolated thrombosis to acute respiratory distress syndrome (ARDS) requiring ventilator support. Neutrophil extracellular traps (NETs) originate from decondensed chromatin released to immobilize pathogens, and they can trigger immunothrombosis. We studied the connection between NETs and COVID-19 severity and progression. We conducted a prospective cohort study of COVID-19 patients (n = 33) and age- and sex-matched controls (n = 17). We measured plasma myeloperoxidase (MPO)-DNA complexes (NETs), platelet factor 4, RANTES, and selected cytokines. Three COVID-19 lung autopsies were examined for NETs and platelet involvement. We assessed NET formation ex vivo in COVID-19 neutrophils and in healthy neutrophils incubated with COVID-19 plasma. We also tested the ability of neonatal NET-inhibitory factor (nNIF) to block NET formation induced by COVID-19 plasma. Plasma MPO-DNA complexes increased in COVID-19, with intubation (P < .0001) and death (P < .0005) as outcome. Illness severity correlated directly with plasma MPO-DNA complexes (P = .0360), whereas Pao2/fraction of inspired oxygen correlated inversely (P = .0340). Soluble and cellular factors triggering NETs were significantly increased in COVID-19, and pulmonary autopsies confirmed NET-containing microthrombi with neutrophil-platelet infiltration. Finally, COVID-19 neutrophils ex vivo displayed excessive NETs at baseline, and COVID-19 plasma triggered NET formation, which was blocked by nNIF. Thus, NETs triggering immunothrombosis may, in part, explain the prothrombotic clinical presentations in COVID-19, and NETs may represent targets for therapeutic intervention.

scholarly journals Biomarkers of acute respiratory distress syndrome in adults hospitalised for severe SARS-CoV-2 infection in Tenerife Island, Spain

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Juan Marco Figueira Gonçalves ◽  
José María Hernández Pérez ◽  
Marco Acosta Sorensen ◽  
Aurelio Luis Wangüemert Pérez ◽  
Elena Martín Ruiz de la Rosa ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Significant Negative Correlation ◽  
Protein Levels ◽  
Reactive Protein ◽  
Infected Adult ◽  
Tenerife Island ◽  
Fraction Of Inspired Oxygen

Abstract Objective The dramatic spread of SARS-CoV-2 infections calls for reliable, inexpensive tools to quickly identify patients with a poor prognosis. In this study, acute respiratory distress syndrome (ARDS) was assessed within 72 h after admission of each of 153 consecutive, SARS-CoV-2 infected, adult patients to either of two hospitals in Tenerife, Spain, using suitable routine laboratory tests for lymphocyte counts, as well as ferritin, lactate dehydrogenase (LDH), and C-reactive protein levels. Results were correlated with the patients’ respiratory function, defined through their pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) ratio. Results Within 72 h from admission, criteria matched ARDS (SpO2/FiO2 < 235) in 13.1% of cases. We found a significant, negative correlation between SpO2/FiO2 ratios and d-dimer, ferritin, and LDH levels (− 0.31, − 0.32, and − 0.41; p = 0.004, 0.004, and < 0.0001, respectively). In patients with ARDS, the mean LDH was 373 U/L (CI95%: 300.6–445.3), but only 298 U/L (CI95%: 274.7–323.1) when they did not develop the syndrome (p = 0.015). None of the additionally evaluated biomarkers correlated with the SpO2/FiO2 ratios. Serum LDH levels in patients hospitalised for COVID-19 correlate with ARDS, as defined by their SpO2/FiO2 ratio, and might help to predict said complication.

scholarly journals Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome

2019 ◽  
Vol 130 (2) ◽  
pp. 263-283 ◽  
Author(s):  
Tài Pham ◽  
Ary Serpa Neto ◽  
Paolo Pelosi ◽  
John Gerard Laffey ◽  
Candelaria De Haro ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Peak Inspiratory Pressure ◽  
Primary Objective ◽  
Oxygen Fraction ◽  
Large Observational Study ◽  
Fraction Of Inspired Oxygen ◽  
Alveolar Oxygen

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

scholarly journals Insight into erythrocyte phospholipid molecular flux in healthy humans and in patients with acute respiratory distress syndrome

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0221595 ◽  
Author(s):  
Ahilanandan Dushianthan ◽  
Rebecca Cusack ◽  
Grielof Koster ◽  
Michael P. W. Grocott ◽  
Anthony D. Postle
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Healthy Humans ◽  
Molecular Flux ◽  
Insight Into

Colchicine Reduces Lung Injury in Experimental Acute Respiratory Distress Syndrome

2020 ◽  
Author(s):  
Jocelyn Dupuis ◽  
Martin G. Sirois ◽  
Eric Rhéaume ◽  
Quang T. Nguyen ◽  
Marie-Élaine Clavet-Lanthier ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Low Cost ◽  
Clinical Development ◽  
Blood Oxygenation ◽  
Lung Edema ◽  
Pre Treatment

Abstract The acute respiratory distress syndrome (ARDS) is characterized by intense dysregulated inflammation leading to lung injury and respiratory failure. We studied the effects of colchicine pre-treatment on oleic acid-induced ARDS in rats. Colchicine reduced histological lung injury by 61%, reduced lung edema, and markedly improved blood oxygenation by increasing PaO2/FiO2 from 66 ± 13 mmHg (mean ± SEM) to 246 ± 45 mmHg. Lung neutrophil recruitment was reduced by colchicine with evidence for reduced neutrophils activation, as assessed by flow cytometry. This study strongly supports the clinical development of colchicine, a widely available low-cost drug, for the prevention of ARDS in conditions causing acute lung injury.

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