Early Improvement of Acute Respiratory Distress Syndrome in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China (Preprint)

UNSTRUCTURED Background: This study aimed to describe the clinical features, outcomes, and acute respiratory distress syndrome (ARDS) characteristics of patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) in Chongqing, China. Methods: The epidemiology of COVID-19 in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from 2 hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and bivariate analysis was performed to identify predictors for early improvement of ARDS (eiARDS). Results: Chongqing reported a 5.3% case fatality rate of the 75 ICU patients. The median age of the ICU patients was 57 years (interquartile range, 25–75), and no bias was obtained in the sex ratio. A total of 93% of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most of the patients (55%) were supported with high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and lower length of ICU stay than those with “non-eiARDS”. Age (<55 years) was the only variable independently associated with eiARDS, with an odds ratio of 7.4. Conclusions: eiARDS was common in patients with COVID-19, and predicted a favorable clinical outcome. Age (<55 years) was an independent predictor of eiARDS, and stratification of patients with COVID-19 by age was recommended.

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Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis

JMIR Public Health and Surveillance ◽

10.2196/24843 ◽

2021 ◽

Vol 7 (3) ◽

pp. e24843

Author(s):

Zhu Zhan ◽

Xin Yang ◽

Hu Du ◽

Chuanlai Zhang ◽

Yuyan Song ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Icu Patients ◽

Early Improvement ◽

Icu Stay ◽

Arterial Blood

Background Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death. Objective This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China. Methods The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS). Results Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08). Conclusions A new subphenotype of ARDS—eiARDS—in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended.

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Early Improvement of Acute Respiratory Distress Syndrome in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China

10.1101/2020.07.15.20154047 ◽

2020 ◽

Author(s):

Zhu Zhan ◽

Xin Yang ◽

Hu Du ◽

Chuanlai Zhang ◽

Yuyan Song ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Independent Predictor ◽

Case Fatality ◽

High Flow Nasal Cannula ◽

Icu Patients ◽

Early Improvement

Acute respiratory distress syndrome (ARDS) may be the main cause of death in patients with coronavirus disease 2019 (COVID-19). Herein, we retrospect clinical features, outcomes and ARDS characteristics of 75 intensive care unit (ICU) patients with COVID-19 in Chongqing, China. We found a 5.3% case fatality rate of the ICU patients in Chongqing. 93% patients developed ARDS during the intensive care, and more than half were moderate. However, most of the patients (55%) supported with high flow nasal cannula (HFNC) oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS got an early improvement (eiARDS), and the rate is much higher than the other causes of ARDS in a previous study. Patients with eiARDS had a higher survival rate and lower length of ICU stay. The age (< 55 years) is an independent predictor for the eiARDS, and stratification of COVID-19 patients by age is recommended.

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Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Critical Care ◽

10.1186/s13054-021-03537-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Chiara Robba ◽

◽

Lorenzo Ball ◽

Denise Battaglini ◽

Danilo Cardim ◽

...

Keyword(s):

Carbon Dioxide ◽

Acute Respiratory Distress Syndrome ◽

Observational Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prospective Observational Study ◽

Distress Syndrome ◽

Cerebral Oxygenation ◽

Arterial Blood ◽

Early Effects

Abstract Background In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. Methods This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. Results Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%, p < 0.001). After PP, a significant increase was observed in PaO2 (from 62 [56–71] to 82 [76–87] mmHg, p = 0.005) and rSO2 (from 53 [52–54]% to 60 [59–64]%, p = 0.005). The use of iNO increased PaO2 (from 65 [67–73] to 72 [67–73] mmHg, p = 0.015) and rSO2 (from 53 [51–56]% to 57 [55–59]%, p = 0.007). The use of ECCO2R decreased PaO2 (from 75 [75–79] to 64 [60–70] mmHg, p = 0.009), with reduction of rSO2 values (59 [56–65]% vs. 56 [53–62]%, p = 0.002). In the whole population, a significant relationship was found between SpO2 and rSO2 (R = 0.62, p < 0.001) and between PaO2 and rSO2 (R0 0.54, p < 0.001). Conclusions Rescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs. Registration The study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).

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COVID19 Acute respiratory distress syndrome and extra-corporeal membrane oxygenation; A mere option or ultimate necessity

Perfusion ◽

10.1177/0267659120961507 ◽

2020 ◽

pp. 026765912096150

Author(s):

Taha Ahmed ◽

Talha Ahmed ◽

Hussain Karimi ◽

Leslie Tolle ◽

Muhammad Nouman Iqbal

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Potential Role ◽

Distress Syndrome ◽

Case Fatality ◽

Lung Protective Ventilation ◽

Membrane Oxygenation ◽

Exponential Increase ◽

Refractory Hypoxemia

Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.

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Acute respiratory failure and acute respiratory distress syndrome

10.1093/med/9780199687039.003.0064_update_001 ◽

2018 ◽

Author(s):

Luciano Gattinon ◽

Eleonora Carlesso

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Partial Pressure ◽

Distress Syndrome ◽

Gas Analysis ◽

Chronic Obstructive ◽

Low Oxygen ◽

Arterial Blood

Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.

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Effect of different levels of PEEP on mortality in ICU patients without acute respiratory distress syndrome: a systematic review and meta-analysis

10.37766/inplasy2021.2.0052 ◽

2021 ◽

Author(s):

Shuai Shao ◽

Hanyujie Kang ◽

Quanying Wang ◽

Zhenbei Qian ◽

Zhaohui Tong

Keyword(s):

Systematic Review ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Meta Analysis ◽

Icu Patients ◽

Different Levels

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Acute respiratory failure and acute respiratory distress syndrome

10.1093/med/9780199687039.003.0064 ◽

2015 ◽

Author(s):

Luciano Gattinon ◽

Eleonora Carlesso

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Partial Pressure ◽

Distress Syndrome ◽

Gas Analysis ◽

Chronic Obstructive ◽

Low Oxygen ◽

Arterial Blood

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Effects of PDE3 Inhibitor Olprinone on the Respiratory Parameters, Inflammation, and Apoptosis in an Experimental Model of Acute Respiratory Distress Syndrome

International Journal of Molecular Sciences ◽

10.3390/ijms21093382 ◽

2020 ◽

Vol 21 (9) ◽

pp. 3382

Author(s):

Petra Kosutova ◽

Pavol Mikolka ◽

Sona Balentova ◽

Marian Adamkov ◽

Andrea Calkovska ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Arterial Oxygen Saturation ◽

Oxygenation Index ◽

Arterial Oxygen ◽

Arterial Blood ◽

Respiratory Parameters ◽

Pde3 Inhibitor

This study aimed to investigate whether a selective phosphodiesterase-3 (PDE3) inhibitor olprinone can positively influence the inflammation, apoptosis, and respiratory parameters in animals with acute respiratory distress syndrome (ARDS) model induced by repetitive saline lung lavage. Adult rabbits were divided into 3 groups: ARDS without therapy (ARDS), ARDS treated with olprinone i.v. (1 mg/kg; ARDS/PDE3), and healthy ventilated controls (Control), and were oxygen-ventilated for the following 4 h. Dynamic lung–thorax compliance (Cdyn), mean airway pressure (MAP), arterial oxygen saturation (SaO2), alveolar-arterial gradient (AAG), ratio between partial pressure of oxygen in arterial blood to a fraction of inspired oxygen (PaO2/FiO2), oxygenation index (OI), and ventilation efficiency index (VEI) were evaluated every hour. Post mortem, inflammatory and oxidative markers (interleukin (IL)-6, IL-1β, a receptor for advanced glycation end products (RAGE), IL-10, total antioxidant capacity (TAC), 3-nitrotyrosine (3NT), and malondialdehyde (MDA) and apoptosis (apoptotic index and caspase-3) were assessed in the lung tissue. Treatment with olprinone reduced the release of inflammatory mediators and markers of oxidative damage decreased apoptosis of epithelial cells and improved respiratory parameters. The results indicate a future potential of PDE3 inhibitors also in the therapy of ARDS.

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Gadobutrol-induced acute respiratory distress syndrome rescued by intravenous immunoglobulin and extracorporeal membrane oxygenation

10.21203/rs.3.rs-378237/v1 ◽

2021 ◽

Author(s):

Yu-Chen Chen ◽

Yi-Chih Hsu ◽

Hsiang-Cheng Chen ◽

CHUN-CHI LU

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Intravenous Immunoglobulin ◽

Distress Syndrome ◽

Rapid Progression ◽

Membrane Oxygenation ◽

Arterial Blood ◽

Ige Mediated

Abstract BackgroundGadobutrol-induced life-threatening allergies, such as acute respiratory distress syndrome (ARDS), is rarely reported. The severe allergies publishing in previous literature report involves IgE and tryptase-mediated immune responses. Gadobutrol-related non-IgE-mediated allergy has not been reported.Case presentationA 39-year-old woman underwent Gadobutrol-contrast magnetic resonance imaging of both lower limbs for clinically suspected vasculitis. One hour after injection of 8 ml Gadobutrol, the patient developed dizziness without respiratory symptoms. Eight hours after the contrast injection, she exhibited vomiting, dyspnea, and rapid progression of edema. She visited the emergency room, where chest imaging showed increased infiltration in both lungs. Arterial blood gas analysis revealed hypoxemia when she was given 100% inspired oxygen. The patient was admitted to intensive care unit and received inotropic agents. Extracorporeal membrane oxygenation was applied due to the diagnosis of ARDS and persistent hypoxia after using mechanical ventilation. Systemic intravenous glucocorticoid and antihistamine were prescribed for allergic reaction. Contrast-relevant non-IgE-mediated allergy was confirmed by detailed medical record and laboratory data. An additional 2 days of intravenous immunoglobulin was prescribed. By 3 days after admission, the patient’s shock and acute respiratory distress syndrome had responded great. She was discharged 13 days after admission.ConclusionsHere, we present the first case of gadobutrol-induced non-IgE-mediated allergy complicated by ARDS. This condition was successfully rescued by dual therapy of venovenous extracorporeal membrane oxygenation and intravenous immunoglobulin without any complications.

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Clinical and pathological features of fat embolism with acute respiratory distress syndrome

Clinical Science ◽

10.1042/cs20070011 ◽

2007 ◽

Vol 113 (6) ◽

pp. 279-285 ◽

Cited By ~ 31

Author(s):

Shang Jyh Kao ◽

Diana Yu-Wung Yeh ◽

Hsing I. Chen

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Partial Pressure ◽

Alveolar Macrophages ◽

Distress Syndrome ◽

Fat Embolism ◽

Arterial Partial Pressure ◽

Arterial Blood ◽

Blood Ph

FES (fat embolism syndrome) is a clinical problem, and, although ARDS (acute respiratory distress syndrome) has been considered as a serious complication of FES, the pathogenesis of ARDS associated with FES remains unclear. In the present study, we investigated the clinical manifestations, and biochemical and pathophysiological changes, in subjects associated with FES and ARDS, to elucidate the possible mechanisms involved in this disorder. A total of eight patients with FES were studied, and arterial blood pH, PaO2 (arterial partial pressure of O2), PaCO2 (arterial partial pressure of CO2), biochemical and pathophysiological data were obtained. These subjects suffered from crash injuries and developed FES associated with ARDS, and each died within 2 h after admission. In the subjects, chest radiography revealed that the lungs were clear on admission, and pulmonary infiltration was observed within 2 h of admission. Arterial blood pH and PaO2 declined, whereas PaCO2 increased. Plasma PLA2 (phospholipase A2), nitrate/nitrite, methylguanidine, TNF-α (tumour necrosis factor-α), IL-1β (interleukin-1β) and IL-10 (interleukin-10) were significantly elevated. Pathological examinations revealed alveolar oedema and haemorrhage with multiple fat droplet depositions and fibrin thrombi. Fat droplets were also found in the arterioles and/or capillaries in the lung, kidney and brain. Immunohistochemical staining identified iNOS (inducible nitric oxide synthase) in alveolar macrophages. In conclusion, our clinical analysis suggests that PLA2, NO, free radicals and pro-inflammatory cytokines are involved in the pathogenesis of ARDS associated with FES. The major source of NO is the alveolar macrophages.

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