Airway Inflammation Induced by Mechanical Ventilation Through Multiscale Modeling

2012 ◽  
Author(s):  
Ramana M. Pidaparti ◽  
Kevin R. Ward
Keyword(s):  
Mechanical Ventilation ◽  
Multiscale Modeling ◽  
Inflammatory Responses ◽  
Healing Process ◽  
Multiple Organ ◽  
The Body ◽  
Multiple Organ Dysfunction ◽  
Over Expression ◽  
Biomechanical Forces ◽  
External Stimuli

Inflammation has been recognized as a major integral component for most of the acute and chronic diseases. Inflammation can be initiated within the body as an innate process or by external factors such as infections and trauma. Inflammation is a complex and dynamic process, and involves nonlinearity and stochasticity. Without the inflammation, the harmful stimuli cannot be removed and the healing process cannot occur. However, an over-expression or under-expression of inflammatory responses can lead to severe consequences, such as Multiple Organ Dysfunction Syndrome (MODS), which is characterized by sequential organ failure. Acute lung injury (ALI) is typically one of the first manifestation of MODS. It can be triggered by external stimuli such as pathogens or from inflammatory mediators produced from various other processes ranging from other damaged organs or to blood transfusions to even the biomechanical forces of mechanical ventilation itself.

scholarly journals Coronavirus Disease 2019 in a Hemodialysis Patient

2020 ◽  
Vol 49 (6) ◽  
pp. 761-764 ◽  
Author(s):  
Hai Yuan ◽  
E. Guo ◽  
Zhao Gao ◽  
Fengqi Hu ◽  
Li Lu
Keyword(s):  
Mechanical Ventilation ◽  
Polymerase Chain Reaction ◽  
Hemodialysis Patient ◽  
Multiple Organ ◽  
Lung Imaging ◽  
Maintenance Hemodialysis ◽  
Multiple Organ Dysfunction ◽  
Chain Reaction ◽  
Pharyngeal Swab ◽  
Polymerase Chain

There has been a global outbreak of the coronavirus disease 2019 (COVID-19) since December 2019. Here, we describe the case of a 49-year-old male undergoing maintenance hemodialysis (HD) who got infected with COVID-19 and our experience in performing HD for him. The patient’s symptoms and lung imaging changes were atypical. However, his lymphocyte range decreased upon admission and the polymerase chain reaction of the pharyngeal swab for the ­COVID-19 nucleic acid was positive. The patient developed respiratory failure and required mechanical ventilation 8 days after admission. In the end, he died from multiple organ dysfunction syndrome. The difficulties in diagnosis, infection control, and treatment of COVID-19 in maintenance HD patients are discussed in this report.

scholarly journals Effect of Pentoxifylline on Organ Dysfunction and Mortality in Severe Sepsis

2020 ◽  
Vol 14 (1) ◽  
pp. 14-21
Author(s):  
Hanaa A. Elgendy ◽  
Haytham M. Ibrahim ◽  
Bahaa Eldeen E. Hasan ◽  
Amr Sobhy A. Elkawe
Keyword(s):  
Mechanical Ventilation ◽  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Organ Dysfunction ◽  
Length Of Hospital Stay ◽  
Total Sample ◽  
Developed Countries ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Secondary Outcomes

Background: Sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high-income countries is rising with a mortality rate of 40% and 90% of the worldwide deaths from pneumonia, meningitis or other infections occur in less developed countries. This study was performed to evaluate the therapeutic efficacy of pentoxifylline as an adjuvant therapy in septic patients and its effect on multiple organ dysfunction and mortality in septic patients. Methods: This randomized, double-blinded prospective study was conducted from October 2017 to November 2018, which included a total sample size of 52 cases of septic patients. Organ dysfunction was used as a primary outcome with proposed large effect size ((0.8) and alfa =0.05 and power=0.80, so, 26 cases were needed in each group). Secondary outcomes were inflammatory markers C-Reactive Protein (CRP) and pro-calcitonin, duration of hospital stay, need for hemodialysis, need for vasopressor & inotropes, need for mechanical ventilation and 28 days survival. Results: Fifty-two patients with sepsis were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, chest disorders were the main cause of sepsis in both groups. There were no statistically significant differences between both groups in terms of Sequential Organ Failure Assessment (SOFA) score, lactate level, CRP level and pro-calcitonin level. As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (p =0.707), need for hemodialysis (p =0.541), need for vasopressor & inotropes (p =0.249), need for mechanical ventilation (p =0.703), and 28 days survival (p =0.5). Conclusion: We concluded that pentoxifylline as an adjuvant therapy in septic patients had no significant influence on multiple organ dysfunction and mortality.

scholarly journals Early Diagnosis and Prognostic Value of Acute Kidney Injury in Critically Ill Patients

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 506
Author(s):  
Diana Dobilienė ◽  
Jūratė Masalskienė ◽  
Šarūnas Rudaitis ◽  
Astra Vitkauskienė ◽  
Jurgita Pečiulytė ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Critically Ill ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Organ Systems ◽  
Patient Groups ◽  
The Mean

Background and objectives: In hospitalized children, acute kidney injury (AKI) remains to be a frequent and serious condition, associated with increased patient mortality and morbidity. Identifying early biomarkers of AKI and patient groups at the risk of developing AKI is of crucial importance in current clinical practice. Specific human protein urinary neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin 18 (uIL-18) levels have been reported to peak specifically at the early stages of AKI before a rise in serum creatinine (sCr). Therefore, the aim of our study was to determine changes in uNGAL and uIL-18 levels among critically ill children and to identify the patient groups at the highest risk of developing AKI. Materials and methods: This single-center prospective observational study included 107 critically ill children aged from 1 month to 18 years, who were treated in the Pediatric Intensive Care Unit (PICU) of Lithuanian University of Health Sciences Hospital Kauno Klinikos from 1 December 2013, to 30 November 2016. The patients were divided into two groups: those who did not develop AKI (Group 1) and those who developed AKI (Group 2). Results: A total of 68 (63.6%) boys and 39 (36.4%) girls were enrolled in the study. The mean age of the patients was 101.30 ± 75.90 months. The mean length of stay in PICU and hospital was 7.91 ± 11.07 and 31.29 ± 39.09 days, respectively. A total of 32 (29.9%) children developed AKI. Of them, 29 (90.6%) cases of AKI were documented within the first three days from admission to hospital. In all cases, AKI was caused by diseases of non-renal origin. There was a significant association between the uNGAL level and AKI between Groups 1 and 2 both on day 1 (p = 0.04) and day 3 (p = 0.018). Differences in uNGAL normalized to creatinine in the urine (uCr) (uNGAL/uCr) between the groups on days 1 and 3 were also statistically significant (p = 0.007 and p = 0.015, respectively). uNGAL was found to be a good prognostic marker. No significant associations between uIL-18 or Uil-18/uCr and development of AKI were found. However, the uIL-18 level of >69.24 pg/mL during the first 24 h was associated with an eightfold greater risk of AKI progression (OR = 8.33, 95% CI = 1.39–49.87, p = 0.023). The AUC for uIL-18 was 73.4% with a sensitivity of 62.59% and a specificity of 83.3%. Age of <20 months, Pediatric Index of Mortality 2 (PIM2) score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of three and more organ systems, PICU length of stay more than three days, and length of mechanical ventilation of >five days were associated with a greater risk of developing AKI. Conclusions: Significant risk factors for AKI were age of <20 months, PIM2 score of >2.5% on admission to the PICU, multiple organ dysfunction syndrome with dysfunction of 3 and more organ systems, PICU length of stay of more than three days, and length of mechanical ventilation of > five days. uNGAL was identified as a good prognostic marker of AKI. On admission to PICU, uNGAL should be measured within the first three days in patients at the risk of developing AKI. The uIL-18 level on the first day was found to be as a biomarker predicting the progression of AKI.

scholarly journals Anticoagulation Therapy Using Unfractionated Heparin at a Therapeutic Dose for Coronavirus Disease 2019 Patients With Severe Pneumonia: A Retrospective Historical Control Study

2020 ◽  
Author(s):  
Wataru Takayama ◽  
Akira Endo ◽  
Yasuhiro Otomo
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Unfractionated Heparin ◽  
Therapeutic Dose ◽  
Dose Group ◽  
Anticoagulation Therapy ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Prophylactic Dose ◽  
Control Study

Abstract Introduction: Patients with severe coronavirus disease 2019 (COVID-19) pneumonia often have the complications of coagulopathy and thrombotic phenomena, which lead to high mortality. Whether administering systematic anticoagulant therapy is beneficial remains unclear. We report our experience using systemic anticoagulation with unfractionated heparin to treat severe COVID-19.Methods: We conducted a retrospective historical control study of severe COVID-19 patients requiring mechanical ventilation who received prophylactic-dose anticoagulation (April 1–May 20) or therapeutic-dose anticoagulation (May 21–August 20) in the intensive care unit (ICU) of the tertiary emergency critical care medical center in Japan. The primary endpoints were in-hospital mortality and anticoagulation therapy-related adverse events. The secondary endpoints included the administration of veno-venous extracorporeal membrane oxygenation (ECMO), ventilator-free days (VFD), ICU-free days, and the development of multiple organ dysfunction syndrome.Results: Twenty-one patients were in the prophylactic-dose group and 26 patients were in the therapeutic-dose group. Background characteristics between the groups were not significantly different, although the therapeutic-dose group had a lower in-hospital mortality rate [0 (0.0%) patients vs. 4 (19.0%) patients; p = 0.063] and significantly longer ICU-free days (median [interquartile range (IQR)]: 15 days [13-18] vs. 5 days [0-13]; p = 0.014). Hemorrhagic events did not occur during the study period. Compared to the prophylactic-dose group, the therapeutic-dose group tended to have a longer VFD, were not treated with ECMO, and did not experience multiple organ dysfunction syndrome; however, the difference was not statistically significant.Conclusions: Therapeutic-dose anticoagulation may be beneficial for patients with severe COVID-19 pneumonia requiring mechanical ventilation.

scholarly journals Increased complement activation 3 to 6 h after trauma is a predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome: a prospective observational study

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Ingrid Nygren Rognes ◽  
Søren Erik Pischke ◽  
William Ottestad ◽  
Jo Røislien ◽  
Jens Petter Berg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Complement Activation ◽  
Prolonged Mechanical Ventilation ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Multiple Organ Dysfunction ◽  
Concentration Curves

Abstract Background Complement activation is a central mechanism in systemic inflammation and remote organ dysfunction following major trauma. Data on temporal changes of complement activation early after injury is largely missing. We aimed to describe in detail the kinetics of complement activation in individual trauma patients from admission to 10 days after injury, and the association with trauma characteristics and outcome. Methods In a prospective cohort of 136 trauma patients, plasma samples obtained with high time resolution (admission, 2, 4, 6, 8 h, and thereafter daily) were assessed for terminal complement complex (TCC). We studied individual TCC concentration curves and calculated a summary measure to obtain the accumulated TCC response 3 to 6 h after injury (TCC-AUC3–6). Correlation analyses and multivariable linear regression analyses were used to explore associations between individual patients’ admission TCC, TCC-AUC3–6, daily TCC during the intensive care unit stay, trauma characteristics, and predefined outcome measures. Results TCC concentration curves showed great variability in temporal shapes between individuals. However, the highest values were generally seen within the first 6 h after injury, before they subsided and remained elevated throughout the intensive care unit stay. Both admission TCC and TCC-AUC3–6 correlated positively with New Injury Severity Score (Spearman’s rho, p-value 0.31, 0.0003 and 0.21, 0.02) and negatively with admission Base Excess (− 0.21, 0.02 and − 0.30, 0.001). Multivariable analyses confirmed that deranged physiology was an important predictor of complement activation. For patients without major head injury, admission TCC and TCC-AUC3–6 were negatively associated with ventilator-free days. TCC-AUC3–6 outperformed admission TCC as a predictor of Sequential Organ Failure Assessment score at day 0 and 4. Conclusions Complement activation 3 to 6 h after injury was a better predictor of prolonged mechanical ventilation and multiple organ dysfunction syndrome than admission TCC. Our data suggest that the greatest surge of complement activation is found within the first 6 h after injury, and we argue that this time period should be in focus in the design of future experimental studies and clinical trials using complement inhibitors.

scholarly journals Successful Treatment of Streptococcal Toxic Shock Syndrome with Both Diffuse Peritonitis and Necrotizing Fasciitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Shuichi Sato ◽  
Masahiro Ito ◽  
Tsuyoshi Sakai ◽  
Anri Kaneta ◽  
Fumie Sato
Keyword(s):  
Mechanical Ventilation ◽  
Necrotizing Fasciitis ◽  
Toxic Shock Syndrome ◽  
Multiple Organ ◽  
Streptococcal Toxic Shock Syndrome ◽  
Diffuse Peritonitis ◽  
Multiple Organ Dysfunction ◽  
Toxic Shock ◽  
Life Threatening ◽  
Uncommon Case

Streptococcal toxic shock syndrome (STSS) is a life-threatening disease caused by infection of beta-hemolytic streptococci. Here, we report an uncommon case of STSS with both diffuse peritonitis and necrotizing fasciitis and summarize previous cases. The patient was diagnosed with STSS due to an infection of the soft tissue of the lower extremity after surgery for diffuse peritonitis. The general condition had rapidly deteriorated with multiple organ dysfunction. Immediate intensive care, including mechanical ventilation, hemodiafiltration, and repeated debridement, is indispensable for a favorable outcome.

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