Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome

Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016. Each patient was assessed for signs and symptoms, clinical features, treatment, complications and outcome of ILI and SARI. Throat or nasopharyngeal swabs were obtained from 36 patient and analyzed for the presence of Influenza virus by quantitative PCR. Patients presenting with ILI or SARI were febrile (p<0.001, one sample t-test), significantly tachypneic (p<0.001) and had critically lower oxygen saturation (p<0.001). Nasal congestion at presentation (p=0.006, chi-square test for association) and infiltrates on chest radiographs (p=0.025) were significantly associated with acute respiratory distress syndrome. Likelihood of the occurrence of ARDS was significantly increased with decrease in oxygen saturation (Odds ratio; 0.75, 95% CI; 0.46, 1.21, p=0.048) and marginally significantly increased in lower age (Odds ratio; 0.82, 95% CI; 0.58, 1.15, p=0.055) and higher white cell count (Odds ratio; 1.001, 95% CI; 0.99, 1.002, p=0.054). The presence of Influenza type A/H1N1pdm09 strains was confirmed in 7/11 patients. However no significant difference was observed in the clinical features and complications of PCR positive and negative patients. Clinical signs and symptoms of influenza-like illness or severe acute respiratory illness significantly predict the development of complications irrespective of the positivity or negativity of laboratory qPCR reports.

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Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma

Anesthesiology ◽

10.1097/aln.0b013e3181948a97 ◽

2009 ◽

Vol 110 (2) ◽

pp. 351-360 ◽

Cited By ~ 95

Author(s):

Onuma Chaiwat ◽

John D. Lang ◽

Monica S. Vavilala ◽

Jin Wang ◽

Ellen J. MacKenzie ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Distress Syndrome ◽

Red Blood Cell Transfusion ◽

Thoracic Injury ◽

National Study ◽

Trauma Patients

Background Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. Methods For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. Results A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6-10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6-10 units: adjusted odds ratio 2.5, 95% CI 1.12-5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03-1.10). Conclusions Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

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Gas Exchange of prone positioning in influenza pneumonia-related acute respiratory distress syndrome: A multicenter retrospective cohort study in Taiwan

10.21203/rs.2.186/v1 ◽

2019 ◽

Author(s):

Ko-Wei Chang ◽

Shih-Wei Lin ◽

Li-Pang Chuang ◽

Shinn-Jye Liang ◽

Kuang-Yao Yang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Odds Ratio ◽

Retrospective Cohort ◽

Distress Syndrome ◽

Prone Positioning ◽

Younger Age ◽

Influenza Pneumonia ◽

Paco2 Level

Abstract Background: Prone positioning has demonstrated decreased mortality in severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the effect of prone positioning in patients with influenza pneumonia-related severe ARDS. Methods: This retrospective study includes eight tertiary referral centers. All the patients with influenza pneumonia induced severe ARDS and receiving prone positioning were enrolled. Demographic data, laboratory data, treatment record, ventilator setting data and outcomes were collected. PaO2 responders were defined as the PaO2/FiO2 ratio increasing by ≥20% or ≥20 mm Hg, while PaCO2 responders were defined as PaCO2 decreasing by ≥1 mm Hg after prone positioning for one day. Results: Sixty-five patients receiving prone positioning were enrolled, with 37 (57%) were PaO2 responders and 33 (51%) were PaCO2 responders. Mortality rates were not significantly different between responders and non-responders. PaCO2 responder survivors had significantly shortened length of stay at the ICU (21.0 ± 13.5 vs. 31.7 ± 18.5 days, P = 0.038) and hospital (30.2 ± 16.6 vs. 43.0 ± 16.3 days, P = 0.013) than did non-responders. Multivariate analysis revealed younger age (odds ratio 0.903, 95% confidence interval 0.824-0.989; P = 0.028) and higher PaCO2 level before prone positioning (odds ratio 1.121 confidence interval 1.020-1.231; P = 0.017) were the predictors of PaCO2 responders. Conclusions: In this multicenter retrospective cohort study of influenza pneumonia patients with severe ARDS receiving prone positioning, PaCO2 responders had modestly better clinical outcomes. Younger age and higher PaCO2 level before prone positioning were the predictors of PaCO2 responders. Keywords: Prone positioning, Acute Respiratory Distress Syndrome, Influenza, Gas exchange, Outcome

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Salivary Diagnosis of COVID-19

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.5498 ◽

2022 ◽

Vol 71 (6) ◽

pp. 2254-55

Author(s):

Seema Shafiq ◽

Asim Riaz

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Severe Acute Respiratory Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Sore Throat ◽

Distress Syndrome ◽

Signs And Symptoms ◽

Fatality Rate ◽

Ongoing Research ◽

Global Pandemic

Dear Editor, It is indeed an honour for us to contribute towards the ongoing research regarding the latest contagion, Coronavirus disease (COVID-19) as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to global pandemic with variable clinical outcomes. COVID-19 positive individuals present with a variety of signs and symptoms as sore throat, cough, fever, dyspnoea, headache, myalgia, nausea, and vomiting whereas, some develop severe acute respiratory distress syndrome with a fatality rate of about 10%.1 Possible oral findings include xerostomia, hypogeusia, and chemosensory alterations. Common routes of transmission being person-to-person via direct sneeze, cough, and droplet inhalation or by contact through mucosa of eyes, nose and saliva.

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A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620957778 ◽

2020 ◽

Vol 8 ◽

pp. 232470962095777 ◽

Cited By ~ 1

Author(s):

Kartikeya Rajdev ◽

Lyndie A. Farr ◽

Muhammad Ahsan Saeed ◽

Rorak Hooten ◽

Joseph Baus ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Respiratory Illness ◽

Supplemental Oxygen ◽

Positive Pressure ◽

Membrane Oxygenation ◽

The Right

Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient’s hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized.

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A Nomogram to Predict Acute Respiratory Distress Syndrome After Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf.3809 ◽

2021 ◽

Vol 24 (3) ◽

pp. E445-E450

Author(s):

Yan Liu ◽

Man Song ◽

Lixue Huang ◽

Guangfa Zhu

Keyword(s):

Cardiac Surgery ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Odds Ratio ◽

Distress Syndrome ◽

Artery Bypass ◽

Albumin Level ◽

Internal Validation ◽

History Of

Purpose: To establish a model to predict the risk of acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: Data were collected on 132 ARDS patients, who received valvular or coronary artery bypass grafting surgery from January 2009 to December 2019. We developed the prediction model by multivariable logistic regression. Then, we used the coefficients for developing a nomogram that predicts ARDS occurrence. Internal validation was performed using resampling techniques to evaluate and optimize the model. Results: All variables fit into the model, including albumin level before surgery (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92, 0.99; P = .01), cardiopulmonary bypass time (OR: 1.01; 95% CI: 1.00, 1.02; P = .02), APACHE II after surgery (OR: 1.21; 95% CI: 1.13, 1.29; P < .001), and history of diabetes (OR: 2.31; 95% CI: 1.88, 3.87; P < .001); these were considered to build the nomogram. The score distinguished ARDS patients from non-ARDS patients with an AUC of 0.785 (95% CI: 0.740, 0.830) and was well calibrated (Hosmer–Lemeshow P = .53). Conclusions: Our developed model predicted ARDS in patients undergoing cardiac surgery and may serve as a tool for identifying patients at high risk for ARDS after cardiac surgery.

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Multiorgan Involvement in COVID-19 and Possible Therapies

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0040-1714151 ◽

2020 ◽

Vol 04 (01) ◽

pp. 20-24

Author(s):

Prachee Sathe ◽

Vijay Sundar Singh

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

World Health Organization ◽

Distress Syndrome ◽

Respiratory Illness ◽

World Health ◽

The World ◽

Novel Coronavirus ◽

Health Organization

AbstractIn late 2019, China reported cases of respiratory illness in humans, which involved a novel Coronavirus SARS-CoV-2 (also known as 2019-nCoV). The World Health Organization (WHO) termed the disease COVID-19 (i.e., Coronavirus disease 2019). Most of the morbidity and mortality from COVID-19 is largely due to acute viral pneumonitis that leads to acute respiratory distress syndrome (ARDS). This article will discuss the clinical features of the multiorgan involvement in COVID-19 as well as the management of patients who become critically ill due to COVID-19.

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Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets

International Journal of Molecular Sciences ◽

10.3390/ijms21218081 ◽

2020 ◽

Vol 21 (21) ◽

pp. 8081 ◽

Cited By ~ 2

Author(s):

Harry Karmouty-Quintana ◽

Rajarajan A. Thandavarayan ◽

Steven P. Keller ◽

Sandeep Sahay ◽

Lavannya M. Pandit ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Vascular Dysfunction ◽

Treatment Options ◽

Renin Angiotensin System ◽

Respiratory Illness ◽

1918 Influenza ◽

Novel Coronavirus

The 1918 influenza killed approximately 50 million people in a few short years, and now, the world is facing another pandemic. In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of a respiratory illness termed coronavirus disease 2019 (COVID-19) and rapidly spread to cause the worst pandemic since 1918. Recent clinical reports highlight an atypical presentation of acute respiratory distress syndrome (ARDS) in COVID-19 patients characterized by severe hypoxemia, an imbalance of the renin–angiotensin system, an increase in thrombogenic processes, and a cytokine release storm. These processes not only exacerbate lung injury but can also promote pulmonary vascular remodeling and vasoconstriction, which are hallmarks of pulmonary hypertension (PH). PH is a complication of ARDS that has received little attention; thus, we hypothesize that PH in COVID-19-induced ARDS represents an important target for disease amelioration. The mechanisms that can promote PH following SARS-CoV-2 infection are described. In this review article, we outline emerging mechanisms of pulmonary vascular dysfunction and outline potential treatment options that have been clinically tested.

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Outcomes of Post-Traumatic Acute Respiratory Distress Syndrome (ARDS) in Young Patients with and Without Extracorporeal Membrane Oxygenation (ECMO) at a Level-1 Trauma Center

10.21203/rs.3.rs-1093012/v1 ◽

2021 ◽

Author(s):

Hassan Al-Thani ◽

Ammar Al-Hassani ◽

Ayman El-Menyar ◽

Mohammad Asim ◽

Ibrahim Fawzy

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Odds Ratio ◽

Distress Syndrome ◽

Young Patients ◽

Ecmo Support ◽

Trauma Patients ◽

Post Traumatic

Abstract Background We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in young patients with and without Extracorporeal membrane oxygenation (ECMO) support. Methods A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group. Results We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation; 1:3 matching ratio). The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p=0.43 and Tarone-Ware, p=0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17-53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10-21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p=0.004). Conclusion Although ARDS is uncommon in young trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.

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Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

10.21203/rs.3.rs-363195/v1 ◽

2021 ◽

Author(s):

Hassan Al-Thani ◽

Ammar Al-Hassani ◽

Ayman El-Menyar ◽

Mohammad Asim ◽

Ibrahim Fawzy

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Brain Edema ◽

Odds Ratio ◽

Distress Syndrome ◽

Ecmo Support ◽

Trauma Patients ◽

Post Traumatic

Abstract Purpose: We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in patients with and without Extracorporeal membrane oxygenation (ECMO) support.Methods: A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group.Results: We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation. The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p=0.43 and Tarone-Ware, p=0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17-53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10-21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p=0.004).Conclusion: Although ARDS is uncommon in trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.

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Dietary intake to help prevent Covid-19 implications: The devil is in the detail

Abasyn Journal Life Sciences ◽

10.34091/ajls.4.1.3 ◽

2021 ◽

pp. 20-27

Author(s):

Sana Noreen ◽

Abdul Rehman ◽

Rabia Kanwal ◽

Saba Saleem ◽

Ayesha Sadiqa ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Immune System ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Strong Association ◽

Signs And Symptoms ◽

Metabolic Disturbances ◽

Aged People ◽

High Level

One of the most frequent antecedents of mortality in world is coronavirus that proceeds multitude metabolic disorders and is consequence of damaged lungs that is ultimately caused by contagious infection and virus called coronavirus. It effects people of every age mostly dominating in child, aged, people who have already poor immune system and lungs related disorders. It has tremendous effects on body affecting physical, emotional, cognitive and intellectual abilities as well. It leads to various clinical moderate to severe complications including acute respiratory distress syndrome (ARDS), pneumonia, coughing up blood, persistent chest pain, fever, SOB (shortness of breath), coughing up sputum, chills, sore throat, respiratory sputum production (phlegm), loss of sense and smell, headache, muscle aches, rashes and diarrhea etc. One of the most imprudent factors examined in these patients is acute respiratory distress syndrome (ARDS) as well which refers to respiratory failure, a mechanism in which body is unable to respond normally sequentially results by high level of widespread inflammation in lungs. Penurious immune system which contributes to higher rate of mortality worldwide present strong association with COVID-19. Metabolic disturbances contribute to the development and progression of respiratory distress, as well as they have serious consequences in next stages of life that can have harmful effects on health. In this review we will discuss the pathophysiology as well as the signs and symptoms of COVID-19, the morbidities related to this disease and the treatment required controlling this disorder. Keywords: Covid-19, Diet, Health Benefits.

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