Single dose surfactant early rescue therapy in respiratory distress syndrome-experience and outcome at a tertiary care centre

Introduction: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread on an unprecedented scale from around the world, we described our experience in treating early COVID-19 cases in India. Materials and Methods: An observational study of COVID-19 patients admitted to a tertiary care centre in North India between 2 March–4 April 2020 was performed. The clinical, epidemiological, laboratory, treatment and outcome data of patients were evaluated. Results: A total of 75 patients were treated and 56 (74.66%) were men. The clinical spectrum of COVID-19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS). Fever (85.36%) was the most common symptom followed by cough (56.09%) and dyspnoea (19.51%). Findings from hemogram analysis showed that 32%, 21.33% and 18.67% of patients had lymphopaenia, eosinopenia and thrombocytopaenia, respectively. Inflammatory markers such as C-reactive protein, D-dimer, ferritin, fibrin degradation product and interleukin-6 were significantly elevated (P <0.05) in patients who required oxygen therapy than those who did not require it, suggesting the potential role such markers could play in predicting prognosis in patients. Mean hospital stay was 9.2 days and 72 (96%) patients made a complete recovery, but 3 (4%) patients demised after progressing to ARDS. Conclusion: The clinical and epidemiological spectrum of COVID-19 has jeopardised the health system in India. Without a proven therapy to combat this pandemic and with no sight of vaccines in the near future, a preventive strategy should be adopted to contain the spread of this infectious disease. Key words: Acute respiratory distress syndrome, Cytokine release syndrome, Interleukin-6, Lopinavir-ritonavir, Lymphopaenia

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Morbidity profile of infants of mothers with gestational diabetes admitted to a tertiary care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171707 ◽

2017 ◽

Vol 4 (3) ◽

pp. 960

Author(s):

Devi Meenakshi K. ◽

Narayana Babu R. ◽

Srinivasan Padmanaban

Keyword(s):

Gestational Diabetes ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Tertiary Care ◽

Birth Asphyxia ◽

Tertiary Care Centre ◽

Insulin Group ◽

Increased Risk ◽

Meal Plan

Background: Infants born to mothers with gestational diabetes are at increased risk of neonatal morbidities like birth trauma, hyperbilirubinemia, hypoglycemia, birth asphyxia etc., Maternal glycemic control has been one of the parameters that determines the occurrence of these problems.Methods: A retrospective study done by analysing the case records of babies born to mothers with gestational diabetes and admitted to the NICU of Govt Kilpauk Medical college from January 2015 to December 2015. The morbidity profile of infants born to mothers with gestational diabetes was analysed and comparison was made between the two groups namely mothers who were managed by meal plan and those who were managed by insulin.Results: About 198 babies were analysed majority were delivered by caesarean section (83%). Only 2 babies (1%) weighed more than 4000gms. The commonest morbidity observed was hyperbilirubinemia (24.2%) which was 27.7% in the insulin group as against 19% in the group on meal plan. The next common morbidity was sepsis (15.2%). This was also common in insulin group 18.5% as against 10.1% in the meal group. Others were hypoglycemia (4%), congenital heart disease (2.5 %) and respiratory distress syndrome (1.5 %).Conclusions: Babies born to mothers with gestational diabetes were found to have morbidities like hyperbilirubinemia and sepsis. Less commonly found morbidities were hypoglycemia, birth asphyxia, respiratory distress syndrome etc., Though the morbidities were more common among insulin group as compared to the group on meal plan this difference was not statistically significant.

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Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine ◽

10.1177/0885066620944042 ◽

2020 ◽

pp. 088506662094404

Author(s):

Shubhi Kaushik ◽

Sindy Villacres ◽

Ruth Eisenberg ◽

Shivanand S. Medar

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Kidney Injury ◽

Oxygenation Index ◽

Significant Difference

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio ( P = .007), need for inotropes ( P = .003), need for diuretics ( P = .004), higher oxygenation index ( P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure ( P = .008), and higher Fio 2 requirement ( P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

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Vitamin D deficiency and its effect on respiratory distress syndrome in premature infants: results from a prospective study in a tertiary care centre

African Health Sciences ◽

10.4314/ahs.v20i1.50 ◽

2020 ◽

Vol 20 (1) ◽

pp. 437-443

Author(s):

Pelin Dogan ◽

Hilal Ozkan ◽

Nilgun Koksal ◽

Onur Bagci ◽

Ipek Guney Varal

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prospective Study ◽

Premature Infants ◽

Lung Development ◽

Distress Syndrome ◽

Tertiary Care ◽

Hydroxyvitamin D ◽

Positive Effects ◽

25 Hydroxyvitamin D

Background: The positive effects of steroids on lung development are well known, and 1,25-dihydroxy vitamin D3 has been shown to exert positive effects on fetal lung development. Objective: We aimed to investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and respiratory distress syn- drome (RDS) in premature infants. Methods: Infants aged ≤32 gestational weeks who were admitted to the neonatal intensive care unit (NICU) during 1 year were enrolled in this prospective study. 25(OH)D levels were obtained at the time of admission to NICU. Patients were divided into three groups according to their 25(OH)D levels: severe (group 1), moderate (group 2), and mild (group 3) 25(OH)D deficiencies. Results: The study comprised 72 patients; of them, RDS was observed in 49 and not observed in 23 patients. The mean 25(OH)D levels were significantly lower in RDS patients (p=0.04). Multivariate analysis showed that patients with higher 25(OH)D levels can be preventive for the development of RDS (odds ratio 0.89; 95% confidence interval 0.8–0.99; p=0.04). Conclusion: Our study revealed that 25(OH)D deficiency is an independent risk factor for RDS in premature infants. However, further studies are necessary to explore the association between 25(OH)D deficiency and RDS. Keywords: 25-hydroxyvitamin D; prematurity; respiratory distress syndrome.

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Nursing Management of Prone Positioning in Patients With COVID-19

Critical Care Nurse ◽

10.4037/ccn2020222 ◽

2020 ◽

pp. e1-e9

Author(s):

Filippo Binda ◽

Federica Marelli ◽

Alessandro Galazzi ◽

Riccardo Pascuzzo ◽

Ileana Adamini ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Older Patients ◽

Distress Syndrome ◽

Rescue Therapy ◽

Prone Positioning ◽

Improvement Project

Background At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. Objectives To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. Methods A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. Results Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients. Conclusions Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

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Clinical profile and survival outcome of acute respiratory distress syndrome in a rural tertiary care hospital

Journal of Datta Meghe Institute of Medical Sciences University ◽

10.4103/jdmimsu.jdmimsu_116_19 ◽

2019 ◽

Vol 14 (3) ◽

pp. 213

Author(s):

Sourya Acharya ◽

Nakul Kadam ◽

Samarth Shukla ◽

Nitin Raisinghani ◽

Aditya Khandekar

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Survival Outcome ◽

Clinical Profile ◽

Care Hospital

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

Case Reports in Anesthesiology ◽

10.1155/2011/896783 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

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.

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