scholarly journals Early Leukapheresis Depletion in an Ex-Premature with Severe Acute Respiratory Distress Syndrome Due to Bordetella Pertussis and Coronavirus Infection

2020 ◽  
Vol 49 (6) ◽  
pp. 758-760
Author(s):  
Emanuele Rossetti ◽  
Linda Appierto ◽  
Antonella Meschini ◽  
Giovanna Leone ◽  
Stefania Lazzaro ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Bordetella Pertussis ◽  
Distress Syndrome ◽  
Recent Literature ◽  
Pediatric Intensive Care ◽  
Pertussis Infection ◽  
Cardiopulmonary Complications ◽  
Coronavirus Infection

We describe a 2 weeks corrected gestational age infant admitted in pediatric intensive care unit (PICU) for severe acute respiratory distress syndrome (ARDS) associated to <i>Bordetella pertussis</i> and Coronavirus infection. He developed leukocytosis as soon as ARDS required intubation and aggressive mechanical ventilation: hence he underwent 3 early therapeutic leukapheresis treatments in order to avoid the worsening of related cardiopulmonary complications, according to recent literature on pertussis infection in infants. The infant was discharged from PICU healthy.

Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Monika Janagill ◽  
Puneet Aulakh Pooni ◽  
Siddharth Bhargava ◽  
Shibba Takkar Chhabra
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Inclusion Criteria ◽  
Northern India ◽  
Pulmonary Vasodilator ◽  
Pulmonary Arterial

AbstractAcute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Cardiologist performed a detailed echocardiogram to determine pulmonary arterial pressure (PAP). Patients with persistent hypoxemia were started on oral sildenafil. The majority (77%) patients had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO2/FiO2 ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.

scholarly journals SARS-CoV-2 Triggering Severe Acute Respiratory Distress Syndrome and Secondary Hemophagocytic Lymphohistiocytosis in a 3-Year-Old Child With Down Syndrome

2020 ◽  
Author(s):  
Sarah Kim-Hellmuth ◽  
Matthias Hermann ◽  
Julia Eilenberger ◽  
Julia Ley-Zaporozhan ◽  
Marcus Fischer ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Intravenous Immunoglobulin ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Down Syndrome Patient ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Down syndrome (DS) predisposes to severe immunologic reaction secondary to infectious triggers. Here, we report a pediatric DS patient with coronavirus disease 2019 (COVID-19) who developed a hyperinflammatory syndrome, severe acute respiratory distress syndrome, and secondary hemophagocytic lymphohistiocytosis requiring pediatric intensive care unit admission and treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19 and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated complications warrant systematic clinical and scientific studies. We report a pediatric Down syndrome patient with coronavirus disease 2019 (COVID-19) who developed secondary hemophagocytic lymphohistiocytosis requiring treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19-associated complications warrant systematic clinical and scientific studies.

scholarly journals The Role of Macrophages in the Pathogenesis of SARS-CoV-2-Associated Acute Respiratory Distress Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Kosyreva ◽  
Dzhuliia Dzhalilova ◽  
Anastasia Lokhonina ◽  
Polina Vishnyakova ◽  
Timur Fatkhudinov
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Macrophage Activation ◽  
Distress Syndrome ◽  
Innate And Adaptive Immunity ◽  
Cell Therapies ◽  
Coronavirus Infection ◽  
Inflammatory Phenotypes

Macrophages are cells that mediate both innate and adaptive immunity reactions, playing a major role in both physiological and pathological processes. Systemic SARS-CoV-2-associated complications include acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation syndrome, edema, and pneumonia. These are predominantly effects of massive macrophage activation that collectively can be defined as macrophage activation syndrome. In this review we focus on the role of macrophages in COVID-19, as pathogenesis of the new coronavirus infection, especially in cases complicated by ARDS, largely depends on macrophage phenotypes and functionalities. We describe participation of monocytes, monocyte-derived and resident lung macrophages in SARS-CoV-2-associated ARDS and discuss possible utility of cell therapies for its treatment, notably the use of reprogrammed macrophages with stable pro- or anti-inflammatory phenotypes.

scholarly journals COVID-19 Pneumomediastinum: Possible Role of Transesophageal Echo in Bedside Percutaneous Bicaval Double-Lumen ECMO Cannulation in Children. A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Andrea Moscatelli ◽  
Stefano Pezzato ◽  
Silvia Buratti ◽  
Elisabetta Lampugnani ◽  
Alberto Di Mascio ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Double Lumen ◽  
Membrane Oxygenation ◽  
Air Leak Syndrome

COVID-19 is generally uneventful in children. Only 8% of severe acute respiratory distress syndrome corona virus 2 pediatric patients require intensive care; of these, 1% may need extracorporeal membrane oxygenation. Preexisting medical conditions are an independent risk factor for pediatric intensive care unit admission. We describe the case of an 11-year-old girl with adenosine deaminase 2 deficiency who presented severe COVID-19 acute respiratory distress syndrome, complicated by a massive air leak syndrome. The respiratory failure, refractory to conventional support, required veno-venous extracorporeal membrane oxygenation. To prevent viral diffusion, bicaval double-lumen cannulation was performed percutaneously at the bedside under exclusive echo guidance. Because of pneumomediastinum, pneumothorax, and subcutaneous emphysema, ultrasound visualization of the heart was possible only with transesophageal echo. To our knowledge, this is the first description of a transesophageal echo guided bedside percutaneous bicaval double-lumen extracorporeal membrane oxygenation cannulation in a pediatric patient. Pitfalls of the technique are highlighted.

scholarly journals Evaluation of Inhaled Nitric Oxide Use in Patients with Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Gülhan Atakul ◽  
Gökhan Ceylan ◽  
Ferhat Sarı ◽  
Özlem Saraç Sandal ◽  
Sevgi Topal ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Oxygenation Index ◽  
Pediatric Intensive Care ◽  
Conventional Mechanical Ventilation ◽  
Inhaled Nitric Oxide

Objective: Nitric oxide therapy is not routinely used in the treatment of pediatric acute respiratory distress syndrome (PARDS), but it is recommended to be used as an adjunctive therapy in some selected cases. In our study, we aimed to discuss patients with PARDS who were treated with inhaled nitric oxide (iNO) therapy. Methods: The data of patients who were hospitalized in the pediatric intensive care unit with a diagnosis of PARDS and received iNO treatment between January 2016 and January 2018 were retrospectively analyzed. Age, gender, length of stay, mortality, number of days on mechanical ventilation, use of vasoactive drugs, mortality scores, lactate levels, OI (oxygenation index), PaO2/FiO2, methemoglobin levels, iNO administration time, echocardiographic findings and underlying primary diseases were recorded. Results: It was determined that 9 patients who were followed up with the diagnosis of PARDS were given iNO treatment. Except for one patient, they were diagnosed with pneumonia developing on the basis of chronic disease and PARDS secondary to septic shock. Five patients died while receiving iNO therapy. Seven patients were ventilated with iNO in addition to conventional mechanical ventilation methods. Two patients who died were ventilated with HFOV (high frequency oscillatory ventilation). In 3 of 9 patients, inhaled nitric oxide treatment was successful. Conclusion: Although inhaled nitric oxide treatment is a known treatment used in different diseases, the level of its effect in PARDS patients continues to be investigated. We think that this treatment can be beneficial when applied in selected patients and experienced centers.

scholarly journals Coronavirus: A Disease of the Haemoglobin? Suggested Therapeutic Approaches

2020 ◽  
Vol 10 (6-s) ◽  
pp. 1-2
Author(s):  
Moustapha Diedhiou ◽  
A. Dieye ◽  
D. Makalou ◽  
E.B. Ba ◽  
M.L. Fall ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Therapeutic Management ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Therapeutic Approaches ◽  
Vascular Thrombosis ◽  
Coronavirus Infection

The pathophysiology of the coronavirus infection is not yet fully understood. Several theories have been developed from the acute respiratory distress syndrome to antiphospholipid antibody syndrome to vascular thrombosis. It is in this context that we propose through brainstorming some proposals for the therapeutic management based on secondary haemoglobin damage by COVID-19. Keywords: coronavirus - haemoglobin - chloroquine - pathophysiology

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