scholarly journals Plasma Renin Concentration in Critically Ill COVID-19 Patients

BioMed ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 94-98
Author(s):  
Gabriele Melegari ◽  
Lucia Veronesi ◽  
Jessica Maccieri ◽  
Francesco Ponzetta ◽  
Suela Osmenaj ◽  
...  
Keyword(s):  
Intensive Care ◽  
Distress Syndrome ◽  
Plasma Renin ◽  
Receptor Expression ◽  
Organ Perfusion ◽  
Angiotensin Converting Enzyme 2 ◽  
Plasma Renin Concentration ◽  
Small Cohort ◽  
Near Future ◽  
Septic Condition

Investigations of plasma renin concentration as a marker of organ perfusion in several intensive care settings have shown a significant correlation between its increase and a lack of perfusion in critical tissues, especially in septic patients. Castillo et al. proposed that activation of the non-canonical pathway of the renin–angiotensin–aldosterone system could improve cardiovascular homeostasis under COVID-19. During the first wave of COVID-19, we preliminarily enrolled a small cohort of subjects admitted to the Intensive Care Unit with a diagnosis of COVID-19 and acute respiratory distress syndrome. Their plasma renin value was measured in the first 24 h (T0), in the following 72 h (T1), and after one week (T2). In eight patients, we observed a higher plasma renin concentration—patients with difficulty weaning and in non-survivors. This is a preliminary observation. The variation of plasma renin levels in a septic condition is known, but settings such as COVID-19 infection have recently been investigated, showing a correlation with angiotensin-converting enzyme 2 receptor expression and functionality; in the near future, it will be interesting to have more data about its variation and value in COVID-19 patients.

Pronation Technique in ARDS Patients

ABOUTOPEN ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 21-23
Author(s):  
Raffaele Di Fenza ◽  
Hedwige Gay ◽  
Martina Favarato ◽  
Isabella Fontana ◽  
Roberto Fumagalli
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Distress Syndrome ◽  
Daily Practice ◽  
Volume Distribution ◽  
Intensive Care Unit Staff ◽  
Safe Technique ◽  
Fraction Of Inspired Oxygen ◽  
And Diffusion ◽  
Inspired Oxygen

In severe acute respiratory distress syndrome (ARDS), characterized by the ratio of arterial partial pressure of oxygen over fraction of inspired oxygen (P/F) less than 150 mm Hg, pronation cycles are the only intervention that showed improved survival, in combination with protective ventilation. The physiological advantages of performing pronation cycles, such as the improvement of oxygenation, better tidal volume distribution with increased involvement of dorsal regions, and easier drainage of secretions, overcome the possible complications, that is, endotracheal tube occlusion or misplacement, pressure ulcers, and brachial plexus injury. However, the incidence of complications is dramatically lower in intensive care units with expertise, adopting prone positioning in daily practice. In this video we are proposing step by step an easy and ergonomic technique to perform pronation maneuvers in patients with severe ARDS. Recent literature suggests that a high percentage of these patients are treated without undergoing pronation cycles. The main purpose of this video is to help increase the number of intensive care units worldwide commonly performing pronation cycles in patients that have indications to be pronated, in order to decrease healthcare burden and costs directly caused by ARDS. Proper intensive care unit staff training is fundamental in minimizing the risks associated with the maneuver for both patients and operators; and diffusion of a safe technique encouraging the operators is the second main purpose of this video.

Possible therapeutic interventions in COVID-19 induced ARDS by cotinine as an ACE-2 promoter and AT-1R blocker

2020 ◽  
Vol 20 ◽  
Author(s):  
Tarun Sharma ◽  
Sidharth Mehan
Keyword(s):  
Protein Binding ◽  
Plasma Protein Binding ◽  
Plasma Protein ◽  
Distress Syndrome ◽  
Therapeutic Interventions ◽  
Promising Candidate ◽  
Angiotensin Converting Enzyme 2 ◽  
Proinflammatory Effect ◽  
Pulmonary Permeability

: In these challenging times of the pandemic, as coronavirus disease 2019 (COVID-19) has taken over the planet, its complications such as acute respiratory distress syndrome (ARDS) have the potential to wipe out a large portion of our population. Whereas a serious lack of ventilators, vaccine being months away makes the condition even worse. That's why promising drug therapy is required. One of them was suggested in this article. It is the angiotensin-converting enzyme-2 (ACE-2) to which the COVID-19 virus binds and upon downregulation of which the pulmonary permeability increases and results in the filling of alveoli by proteinaceous fluids, which finally results in ARDS. ARDS can be assisted by angiotensinII type-1 receptor (AT-1R) blocker and ACE-2 upregulator. AT-1R blocker will prevent vasoconstriction, the proinflammatory effect seen otherwise upon its activation. ACE-2 upregulation will ensure less formation of angiotensin II, vasodilatory effects due to the formation of angiotensin (1-7), increased breakdown of bradykinin at lung level. Overall, decreased vasoconstriction of vessels supplying lungs and decreased vasodilation of lung tissues will ensure decreased pulmonary permeability and eventually relieve ARDS. It should also be considered that all components of the reninangiotensin-aldosterone system (RAAS) are located in the lung tissues. A drug with the least plasma protein binding is required to ensure its distribution across these lung tissues. Cotinine appears to be a promising candidate for COVID-19- induced ARDS. It acts across the board and acts as both an AT-1R blocker, ACE-2 upregulator. It also has a weak plasma protein binding that helps to spread through the lung tissues. In this review, we summarized that cotinine, along with COVID-19 virus replication blocker anti-virals, may prove to be a promising therapy for the treatment of COVID-19 induced ARDS.

scholarly journals Cardiac biomarkers in acute respiratory distress syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Dilip Jayasimhan ◽  
Simon Foster ◽  
Catherina L. Chang ◽  
Robert J. Hancox
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Cardiac Dysfunction ◽  
Distress Syndrome ◽  
Troponin I ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Risk Of Death

Abstract Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

The Estimation of Plasma Renin Concentration in the Dog

1964 ◽  
Vol 93 (1) ◽  
pp. 3C-4C ◽  
Author(s):  
J. J. Brown ◽  
D. L. Davies ◽  
A. F. Lever ◽  
J. I. S. Robertson ◽  
M. Tree
Keyword(s):  
Plasma Renin ◽  
Plasma Renin Concentration

scholarly journals Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

2021 ◽  
pp. bmjmilitary-2021-001876
Author(s):  
Thibault Martinez ◽  
K Simon ◽  
L Lely ◽  
C Nguyen Dac ◽  
M Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Selection Criteria ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Military Aircraft ◽  
Life Threatening ◽  
The Military

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

EXTRAHEPATIC AND EXTRARENAL RENIN INACTIVATION IN THE DOG

1974 ◽  
Vol 60 (2) ◽  
pp. 217-222
Author(s):  
R. FAGARD ◽  
E. FOSSION ◽  
M. CAMPFORTS ◽  
A. AMERY
Keyword(s):  
Blood Vessels ◽  
Pulmonary Circulation ◽  
Plasma Renin ◽  
Glass Container ◽  
Plasma Renin Concentration ◽  
Vascular Beds ◽  
Extrarenal Renin

SUMMARY It was demonstrated previously that renin disappears quickly from the circulation after nephrectomy in the hepatectomized dog. In the present study the plasma renin concentration (PRC) was measured in the efferent and afferent blood vessels of several vascular beds (pulmonary circulation, splanchnic region, spleen, both inferior limbs and pelvis, head) in the anhepatic and in the anhepatic and anephric dog in order to investigate extrarenal and extrahepatic renin inactivation. However, no significant arteriovenous differences in PRC could be traced. The blood of these dogs kept in vitro at 37 °C in a glass container showed no decline in PRC within 3 h of removal. Therefore no specific extrahepatic and extrarenal renin-inactivating mechanism was found which could explain the rapid disappearance of renin from the blood in vivo in the anhepatic and anephric dog.

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