A THERAPEUTIC APPROACH IN 100 CASES OF THE RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN INFANT

PEDIATRICS ◽  
1964 ◽  
Vol 33 (6) ◽  
pp. 956-964
Author(s):  
James H. Hutchison ◽  
Margaret M. Kerr ◽  
T. A. Douglas ◽  
J. A. Inall ◽  
J. C. Crosbie
Keyword(s):  
Sodium Bicarbonate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Umbilical Vein ◽  
Prognostic Significance ◽  
Supportive Therapy ◽  
Respiratory Acidosis ◽  
Mortality Rates ◽  
Trial Series

A method of treatment in 100 cases of the idiopathic respiratory distress syndrome of severe degree is described. This includes the rapid correction of metabolic acidosis with 8.4% solution of sodium bicarbonate (1 ml = 1 mEq). The sodium bicarbonate is given by periodic intravenous injections by the umbilical vein, and the dosage is controlled by frequent estimations in the blood of the pH, pCO2, plasma standard bicarbonate and base excess by means of the Astrup micro-apparatus. The total daily fluid intake by the same route is brought up to 60 ml/kg with 20% fructose solution. In view of the serious prognostic significance of severe or persisting respiratory acidosis, which cannot be relieved by sodium bicarbonate, a trial of Tris-(hydroxymethyl)-aminomethane (THAM) was made in 26 cases. In each of these very severely affected infants the pCO2 was above 70 mm Hg. The results failed to show sufficient advantage to justify the increased risks with THAM. The mortality figures in the trial series have been compared with those recorded in the same hospital in cases of comparable severity which were treated by standard methods in 1960 and 1961. The over-all mortality rates in 1960, 1961, and the trial series, including patients who also had intraventricular hemorrhage or other major complications, were 66, 64, and 46% respectively. The mortality rates in cases of the uncomplicated respiratory distress syndrome in 1960, 1961, and the trial series were 49, 44.7, and 11.5% respectively. It is considered that the improvement in the mortality figures with this type of supportive therapy is sufficiently striking to encourage its trial use in other centers.

scholarly journals Filgrastim as a Rescue Therapy for Persistent Neutropenia in a Case of Dengue Hemorrhagic Fever with Acute Respiratory Distress Syndrome and Myocarditis

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Desh Deepak ◽  
Rakesh Garg ◽  
Mridula Pawar ◽  
Neerja Banerjee ◽  
Rakesh Solanki ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Dengue Hemorrhagic Fever ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Clinical Status ◽  
Supportive Therapy ◽  
Hemorrhagic Fever ◽  
Standard Management

Pathogenesis of dengue involves suppression of immune system leading to development of characteristic presentation of haematological picture of thrombocytopenia and leucopenia. Sometimes, this suppression in immune response is responsible for deterioration in clinical status of the patient in spite of all specific and supportive therapy. Certain drugs like steroids are used for rescue therapy in conditions like sepsis. We present a novel use of filgrastim as a rescue therapy in a patient with dengue hemorrhagic fever (DHF) with acute respiratory distress syndrome (ARDS), myocarditis, and febrile neutropenia and not responding to standard management.

scholarly journals Acute Respiratory Distress Syndrome: 30 Years Later?

1999 ◽  
Vol 6 (1) ◽  
pp. 71-86 ◽  
Author(s):  
Olivier Lesur ◽  
Yves Berthiaume ◽  
Gilbert Blaise ◽  
Pierre Damas ◽  
Éric Deland ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Diffuse Alveolar Damage ◽  
Keratinocyte Growth Factor ◽  
Supportive Therapy ◽  
Alveolar Epithelium ◽  
Patient Positioning ◽  
Neutrophil Accumulation

Acute respiratory distress syndrome (ARDS) was first described about 30 years ago. Modern definitions and statements have recently been proposed to describe ARDS accurately, but none is perfect. Diffuse alveolar damage is the basic pathological pattern most commonly observed in ARDS, and the term includes permeability edema. The alveolar epithelium of the alveolar-capillary barrier is clearly a key component requiring repair, given its multipotent functional activity. Lung inflammation and neutrophil accumulation are essential markers of disease in ARDS, and a wide variety of pro- and anti-inflammatory cytokines have been described in the alveolar fluid and blood of patients. These molecules still have to prove their value as diagnostic or prognostic biomarkers of ARDS.Supportive therapy in ARDS improved in the past decade; mechanical ventilation with lung protective strategies and patient positioning are gaining interest, but the indications for corticosteroids for ARDS are still debated. Nitric oxide may have a place in the treatment of one-third of patients. Novel approaches, such as surfactant replacement and liquid ventilation, may further improve supportive therapy. Innovative interventions may be on the horizon in treatments that help to resolve or modulate common pathways of ARDS, such as inflammation (eg, granulocyte-colony stimulating factor) or epithelial repair (eg, keratinocyte growth factor).

scholarly journals Colchicine reduces lung injury in experimental acute respiratory distress syndrome

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242318
Author(s):  
Jocelyn Dupuis ◽  
Martin G. Sirois ◽  
Eric Rhéaume ◽  
Quang T. Nguyen ◽  
Marie-Élaine Clavet-Lanthier ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Oleic Acid ◽  
Respiratory Failure ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Respiratory Acidosis ◽  
Neutrophil Recruitment ◽  
Cell Surface Expression

The acute respiratory distress syndrome (ARDS) is characterized by intense dysregulated inflammation leading to acute lung injury (ALI) and respiratory failure. There are no effective pharmacologic therapies for ARDS. Colchicine is a low-cost, widely available drug, effective in the treatment of inflammatory conditions. We studied the effects of colchicine pre-treatment on oleic acid-induced ARDS in rats. Rats were treated with colchicine (1 mg/kg) or placebo for three days prior to intravenous oleic acid-induced ALI (150 mg/kg). Four hours later they were studied and compared to a sham group. Colchicine reduced the area of histological lung injury by 61%, reduced lung edema, and markedly improved oxygenation by increasing PaO2/FiO2 from 66 ± 13 mmHg (mean ± SEM) to 246 ± 45 mmHg compared to 380 ± 18 mmHg in sham animals. Colchicine also reduced PaCO2 and respiratory acidosis. Lung neutrophil recruitment, assessed by myeloperoxidase immunostaining, was greatly increased after injury from 1.16 ± 0.19% to 8.86 ± 0.66% and significantly reduced by colchicine to 5.95 ± 1.13%. Increased lung NETosis was also reduced by therapy. Circulating leukocytosis after ALI was not reduced by colchicine therapy, but neutrophils reactivity and CD4 and CD8 cell surface expression on lymphocyte populations were restored. Colchicine reduces ALI and respiratory failure in experimental ARDS in relation with reduced lung neutrophil recruitment and reduced circulating leukocyte activation. This study supports the clinical development of colchicine for the prevention of ARDS in conditions causing ALI.

scholarly journals Does Prone Positioning Decrease Mortality Rate in ARDS? A Systematic Review

2018 ◽  
Author(s):  
Joseph Sarkis
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Supportive Care ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Prone Positioning ◽  
Reduce Mortality Rate

Acute Respiratory Distress Syndrome (ARDS) is a clinical condition in which the lungs suffer severe irreversible, large-scale damage causing a grievous form of hypoxemic respiratory failure. Acute respiratory distress syndrome is one of the most evasive diagnosis confronted in the Intensive care unit (ICU) as the name, definition and diagnostic standards have adapted over the past four decades. An ARDS diagnosis is established by physiological criteria and continues to be a diagnosis of exclusion, which makes it crucial that medical professionals expand their knowledge base to effectively diagnose ARDS. Patients admitted with ARDS have high mortality rates ranging from 40 to 60 percent. High-level quality supportive care continues to be the sole option for ARDS treatment. Even with improved supportive care, however, ARDS prognosis is still poor. Extended prone positioning (PP) has been shown to increase alveolar recruitment end expiratory lung volume, thereby improving oxygenation and survival. Unfortunately, few studies have examined the association of mortality and prone positioning in ARDS. A systematic review was conducted to examine the following research question: Does prone positioning compared to supine positioning in patients with ARDS decrease mortality rates? This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP). A literature review was performed and data were collected from each study. A cross study analysis was performed and PP was found to reduce mortality rate in patients who were severely hypoxic. The reviewed studies demonstrated that incorporating early and longer periods of PP may improve mortality in ARDS patients, but further research is needed.

scholarly journals Intestinal Collinsella may mitigate infection and exacerbation of COVID-19 by producing ursodeoxycholate

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260451
Author(s):  
Masaaki Hirayama ◽  
Hiroshi Nishiwaki ◽  
Tomonari Hamaguchi ◽  
Mikako Ito ◽  
Jun Ueyama ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gut Microbiota ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Sequencing Data ◽  
Angiotensin Converting Enzyme 2 ◽  
Underlying Mechanisms ◽  
Apoptotic Effects

The mortality rates of COVID-19 vary widely across countries, but the underlying mechanisms remain unelucidated. We aimed at the elucidation of relationship between gut microbiota and the mortality rates of COVID-19 across countries. Raw sequencing data of 16S rRNA V3-V5 regions of gut microbiota in 953 healthy subjects in ten countries were obtained from the public database. We made a generalized linear model (GLM) to predict the COVID-19 mortality rates using gut microbiota. GLM revealed that low genus Collinsella predicted high COVID-19 mortality rates with a markedly low p-value. Unsupervised clustering of gut microbiota in 953 subjects yielded five enterotypes. The mortality rates were increased from enterotypes 1 to 5, whereas the abundances of Collinsella were decreased from enterotypes 1 to 5 except for enterotype 2. Collinsella produces ursodeoxycholate. Ursodeoxycholate was previously reported to inhibit binding of SARS-CoV-2 to angiotensin-converting enzyme 2; suppress pro-inflammatory cytokines like TNF-α, IL-1β, IL-2, IL-4, and IL-6; have antioxidant and anti-apoptotic effects; and increase alveolar fluid clearance in acute respiratory distress syndrome. Ursodeoxycholate produced by Collinsella may prevent COVID-19 infection and ameliorate acute respiratory distress syndrome in COVID-19 by suppressing cytokine storm syndrome.

Letter to the Editor

PEDIATRICS ◽  
1969 ◽  
Vol 43 (2) ◽  
pp. 301-302
Author(s):  
John C. Sinclair ◽  
Knud Engel ◽  
William A. Silverman
Keyword(s):  
Sodium Bicarbonate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Perinatal Care ◽  
Early Feeding ◽  
Rapid Infusion ◽  
Letter To The Editor

Like early feeding, early attempted correction of acidosis can have different meanings. Our babies (median postnatal age 5 hours) were treated as early as we could obtain the necessary observations. Some were born at other hospitals and were transported to us. Of course, we agree that, with different organization of perinatal care, earlier therapy is possible. It is the evaluation of our therapeutic efforts, however, which mainly concerns us. Dr. Aclin claims to have produced "a significant decrease in morbidity and a decrease in the occurrence of a subsequent respiratory distress syndrome" with immediate postnatal rapid infusion of sodium bicarbonate.

Adult Respiratory Distress Syndrome in Full-Term Newborns

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 1132-1132
Author(s):  
ROGER G. FAIX ◽  
MICHAEL A. DIPIETRO
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
Full Term ◽  
Persistent Pulmonary Hypertension ◽  
Term Newborns ◽  
The Difference

In Reply.— We appreciate the interest and continuing contributions of Drs Pfenninger and Tschaeppeler. We agree with their assessment that the difference in mortality rates is probably attributable to selection differences. All five of their infants would have been excluded from our series, since proven sepsis and documented persistent pulmonary hypertension were both among the criteria for exclusion. As we noted in our article, the low mortality in our series was not surprising because of such exclusions.

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