scholarly journals The Method and Results of a Treatment Targeting SARS-CoV-2-Activated Inflammasomes

2021 ◽  
Author(s):  
JONG HOON LEE ◽  
Badar Kanwar ◽  
Asif Khattak ◽  
Jenny Balentine ◽  
Chul Joong Lee ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Mortality Rates ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Treatment Targeting

Abstract A COVID-19 committee at Hunt Regional Medical Center reviewed the use of dapsone as an inflammasome competitor. The hospital then revalidated its effectiveness by reporting the findings of 44 (22 cases/22 controls) patients with acute respiratory distress syndrome (ARDS) treated with dapsone. All of 17 ARDS Onset patients who received standard COVID-19 treatment, including dapsone, did not die except one patient not taken dapsone after relapsed, whereas 8/20 patients who received standard COVID-19 treatment without dapsone died; the mortality rates were 5.9% and 40%, respectively. Dapsone treats and prevents SARS-CoV-2 ARDS. We confirmed that dapsone clinically treated the onset of ARDS by targeting SARS-CoV-2-activated inflammasomes.

An Evidence-Based Protocol for Manual Prone Positioning of Patients With ARDS

2021 ◽  
Vol 41 (6) ◽  
pp. 55-60
Author(s):  
Patrick Ryan ◽  
Cynthia Fine ◽  
Christine DeForge
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Unplanned Extubations

Background Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device. Review of Evidence A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment. Implementation An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation. Evaluation This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications. Sustainability Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods. Conclusions Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.

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.

Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in Adults

2013 ◽  
Vol 24 (2) ◽  
pp. 149-158 ◽  
Author(s):  
Kelly E. Williams
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ventilatory Support ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Traditional Management ◽  
Membrane Oxygenation

Despite advances in treatment, acute respiratory distress syndrome (ARDS) remains a common cause of respiratory failure requiring ventilatory support and is associated with significantly high rates of morbidity and mortality. To date, the only treatment shown to increase survival rate in patients with ARDS is the use of supportive mechanical ventilation using low tidal volumes. Extracorporeal membrane oxygenation (ECMO) is a therapy that has been used in severe cases of ARDS when patients fail to improve with traditional management. Recent literature shows varying mortality rates for the use of ECMO for ARDS; however, the literature suggests that transfer of patients to an ECMO center for treatment using specific criteria and indications may improve outcomes. Further research is needed regarding the timing of the initiation of ECMO, standardization of therapy, and which type of ECMO reduces morbidity and mortality rates in patients with ARDS.

scholarly journals The Use of Dornase Alfa in the Management of COVID-19-Associated Adult Respiratory Distress Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Andrew Toma ◽  
Christina Darwish ◽  
Michele Taylor ◽  
Justin Harlacher ◽  
Ribal Darwish
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Distress Syndrome ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Dornase Alfa

Objective. Currently, management of acute respiratory distress syndrome (ARDS) in COVID-19 infection with invasive mechanical ventilation results in poor prognosis and high mortality rates. Interventions to reduce ventilatory requirements or preclude their needs should be evaluated in order to improve survival rates in critically ill patients. Formation of neutrophil extracellular traps (NETs) during the innate immune response could be a contributing factor to the pulmonary pathology. This study suggests the use of dornase alfa, a recombinant DNAse I that lyses NETs, to reduce ventilatory requirements and improve oxygenation status, as well as outcomes in critically ill patients with ARDS subsequent to confirmed or highly suspected COVID-19 infection. Design. A single-institution cohort study. Setting. Intensive care unit in a tertiary medical center. Patients. Adult patients with acute respiratory distress syndrome (ARDS) admitted to the ICU with confirmed COVID-19 infection. Intervention. Treatment with aerosolized dornase alfa. Measurements and Main Results. Of 39 patients evaluated, most patients had improvement in oxygenation measured by increase in the PaO2/FiO2 ratio, reduction in ventilatory support or other supportive oxygen requirements, and partial resolution of bilateral opacities visible on CXR, as well as improved outcome. Conclusions. Administration of inhalational dornase alfa via a filtered nebulizer medication system or through an adapter in a ventilator circuit should be considered in all COVID-19-positive patients with ARDS as early in the disease course as possible.

scholarly journals The use of Ventilator Parameters in the Prediction of Development and Outcome of Acute Respiratory Distress Syndrome in Postoperative Patients

2021 ◽  
Author(s):  
Chew-Ten Kor ◽  
Kai-Huang Lin ◽  
Chen-Hsu Wang ◽  
Jui-Feng Lin ◽  
Cheng-Deng Kuo
Keyword(s):  
Esophageal Cancer ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Volume Index ◽  
Rate Pressure Product ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Abstract Background: To investigate the usefulness of ventilator parameters in the prediction of development and outcome of acute respiratory distress syndrome (ARDS) in postoperative patients with esophageal or lung cancer on admission to the surgical intensive care unit (SICU). Methods: A total of 32 post-operative patients with lung or esophageal cancer from SICU in a tertiary medical center were retrospectively analyzed. The study patients was divided into ARDS group (n = 21) and non-ARDS group (n = 11). ARDS group were the post-operative patients who developed ARDS after lung or esophageal cancer surgery. The ventilator variables were analyzed in this study. Principal component analysis (PCA) was performed to reduce the correlated ventilator variables to a small set of variables. By using the PCA selection method, top three ventilator variables with large coefficients can be considered as sensitive variables and were included in the analysis model based on the rule of 10 events per variable. Firth logistic regression with selective stepwise elimination procedure was performed to identify the most important predictors of morbidity and mortality in patients with ARDS. The ventilator parameters including rapid shallow breath index during mechanical ventilation (RSBIv), rate pressure product of ventilation (RPPv), rate pressure volume index (RPVI), mechanical work (MW), and inspiration to expiration time ratio (IER) were analyzed in this studyResults: The newly defined parameter MW/IER was the most important predictors for the development of ARDS, and both RPPv and RPVI were the significant predictors of mortality in patients with ARDS.Conclusion: Some ventilator parameters can be derived from ventilator readings and be used to predict the development and outcome of ARDS in mechanically ventilated patients on admission to the SICU, such as RPPv, RPVI and MW/IER defined in this study.

Extracorporeal life support for posttraumatic acute respiratory distress syndrome at a children’s medical center

2003 ◽  
Vol 38 (8) ◽  
pp. 1221-1226 ◽  
Author(s):  
James D Fortenberry ◽  
Andreas H Meier ◽  
Robert Pettignano ◽  
Michael Heard ◽  
C.Robert Chambliss ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Medical Center

Pulmonary tuberculosis presenting as acute respiratory distress syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. e237664
Author(s):  
Neha Chopra ◽  
Sujay Halkur Shankar ◽  
Sagnik Biswas ◽  
Animesh Ray
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Pulmonary Tuberculosis ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Mortality Rates ◽  
The Other ◽  
Pulmonary Tb ◽  
Parenchymal Disease

Pulmonary tuberculosis (TB) may present in the form of parenchymal disease or extraparenchymal disease. Patients with TB as a primary cause of respiratory failure requiring mechanical ventilation have been reported to have mortality rates ranging between 47% and 80%. However, acute respiratory distress syndrome (ARDS) as a presentation of TB is rarely reported. We describe two cases of immunocompetent women presenting with ARDS. They were initially worked up for viral aetiologies in view of the ongoing COVID-19 pandemic but were later diagnosed to have microbiologically proven parenchymal pulmonary TB. One of our patients succumbed to nosocomial pneumonia, while the other was discharged to follow-up.

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