Objective To review the effects of pulmonary surfactant in adult patients with acute lung injury ( ALI) /acute respiratory distress syndrome ( ARDS) . Methods Randomized controlled trials ( RCTs) were recruited from PubMed ( 1966.1-2011.3) , ISI Web of Knowledge ( all the years) and Wanfang Database ( 1982-2011) . Related published data and attached references were hand searched. All the RCTs about pulmonary surfactant for the adult patients with ALI/ARDS were included, then a meta-analysis was performed. Results Eight eligible trials were enrolled. Pooled analysis showed that treatment with pulmonary surfactant was not associated with reduction in 28 or 30-day mortality compared with the control group [ OR 1.05, 95% CI ( 0.90, 1.22 ) , P = 0.55] , neither did subgroup analysis in the pneumoia/ aspiration, sepsis, and trauma/ surgery induced ALI/ARDS patients. Three RCTs showed the oxygenation was significantly improved in adult ALI/ARDS patients receiving pulmonary surfactant compared with the control group( Plt;0.05) . Shorter mechanical ventilation days was shown in the ALI/ARDS patients receiving pulmonary surfactant in one RCT(Plt;0.05) . Conclusions Meta-analysis showed pulmonary surfactant did not reduce the 28 or 30-day mortality of adult patients with ALI/ARDS, however, improved the oxygenation. Pulmonary surfactant can be considered a therapy in ALI/ARDS.
ObjectiveTo explore whether positive end-expiratiory pressure (PEEP) guided by the esophageal balloon manometry is better than the ARDS Network standard of care recommendations during treating traumatic acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. MethodsTwelve traumatic ARDS patients selected from September 2013 to March 2015 in ICU of Xiamen No. 3 Hospital were administrated esophageal balloor catheter and underwent mechanical ventilation with PEEP adjusted according to measurements of esophageal pressure and the ARDS Network standard of care recommendations simultaneously. According to the selection method of PEEP, the patients were divided into two groups:the esophageal pressure guided group and the ARDS Network recommendations guided group (the control group). The changes of peak inspiratory pressure, esophageal pressure, transpulmonary end-expiratory pressure, transpulmonary end-inpiratory pressure, lung compliance at 0 h, 24 h, 48 h, 72 h following different PEEP treatments were observed and compared between two groups of patients. ResultsA mean PEEP in the esophageal pressure guided group of (10.98±4.36)cm H2O was significantly higher than the control group of (7.13±2.21)cm H2O (P<0.01). The transpulmonary end-expiratory pressure was significantly higher in the esophageal pressure guided group (0.71±0.62)cm H2O than the control group (-2.29±3.49) cm H2O. And all of the mean transpulmonary end-expiratory pressure remained above zero in the esophageal pressure guided group, whereas in the control group 73% patients remained negative (P<0.01). ConclusionsEsophageal pressure method adjusts PEEP for traumatic ARDS patients with mechanical ventilation through estimating pleural pressure so as to calculate transpulmonary pressure. It can identify traumatic ARDS patients who would benefit from the high PEEP, adjust PEEP individually and meet patients' need more satisfactorily.
Objective To investigate the role of angiotensin-II type 1 receptor ( AT1) antagonist in treatment of acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) . Methods Animal model of ALI/ARDS was induced by cecal ligation and perforation ( CLP) . ALI/ARDS animals received a separate intraperitoneal injection of several concentrations( 5, 10, 15, 20, 25 mg/kg) of AT1 inhibitor losartan after CLP, then the changes of lung injury and 7-day survival were measured. Results Oxygenation index and lung wet to dry weight ratio ( W/D) showed an improving trend when losartan was administered at doses of 5 to 15 mg/kg in ALI/ARDS rats, but aggravated above the dose of 15 mg/kg. Losartan ( 15 mg/kg) treatment significantly alleviated pulmonary edema after CLP operation, and decreased serumlevels of TNF-α, IL-6, andIL-1β [ TNF-α: ( 554. 1 ±62. 7 ) pg/mL vs. ( 759. 2 ±21. 5 ) pg/mL, P lt; 0. 01; IL-6: ( 1227. 3 ±130. 0) pg/mL vs. ( 2670. 4 ±174. 1) pg/mL, P lt; 0. 01; IL-1β: ( 444. 0 ±38. 6) pg/mL vs. ( 486. 6 ±61. 7)pg/mL, P lt; 0. 05] . 7-day survival rate also increased in losartan treatment group at a dose of 15 mg/kg( 6. 7% vs. 0 ) . Conclusions The AT1 inhibitor, losartan, can significantly prevent lung injury in ALI/ARDS after CLP, and improve the 7-day survival rate.
Objective To observe the level of vascular endothelium growth factor A( VEGF-A) in exhaled breath condensate ( EBC) of patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) , and investigate its clinical significance. Methods EBC of 23 patients with ALI/ARDS by mechanical ventilation in intensive care unit ( ICU) were collected with improved EcoScreen condenser. EBC of 17 normal control subjects were collected with EcoScreen condensor. The level of VEGF-A was measured by ELISA in EBC and serum. The levels of VEGF-A in EBC of patients with different grades of lung injuries were compared, and the correlation was analyzed between the level of VEGF-A and clinical indicators. Results The level of VEGF-A in EBC was lower in the patients with ALI/ARDS than that of control subjects [ ( 49. 88 ±6. 32) ng/L vs. ( 56. 50 ±6. 323) ng/L, P lt;0. 01] , the level of VEGF-A was higher in the ALI patients than that of ARDS patients [ ( 53. 56 ±5. 56) ng/L vs. ( 45. 86 ±4. 45) ng/L, P lt;0. 01] ,and higher in the survival patients than that of the died patients [ ( 51. 92 ±6. 28) ng/L vs. ( 46. 05 ± 4. 58) ng/L, P lt;0. 05] . The level of VEGF-A in EBC was negatively correlated with lung injury score and A-aDO2 /PaO2 ( r = - 0. 426 and - 0. 510, respectively, P lt;0. 05) , and positively correlated with PaO2 /FiO2 and PaO2 ( r =0. 626 and 0. 655, respectively, P lt; 0. 05) . The level of VEGF-A in serum was not different between the ALI/ARDS patients and the control subjects, between the ALI and ARDS patients, or between the survival and the died patients ( all P gt;0. 05) . The level of VEGF-A in serumhad no correlation with lung injury score, A-aDO2 /PaO2 , PaO2 /FiO2 , or PaO2 ( all P gt;0. 05) . Conclusion The changes of VEGF-A in EBC of patients with ALI/ARDSmay serve as an indicator for severity and prognosis evaluation.
Objective To investigate the risk factors for early progression in patients with acute respiratory distress syndrome (ARDS), and to provide a reference for early detection and intervention of high-risk patients with ARDS progression. Methods Data from multicenter mechanically ventilated patients with mild to moderate ARDS were retrospectively analyzed. According to the severity grade of 72 h ARDS, the patients were divided into an early progressive group and a non-progressive group. Chi-square test was used to compare the risk factors of ARDS patients and the prognosis of the two groups were analyzed by Logistic regression. Results A total of 355 patients with mild to moderate ARDS were included in invasive mechanical ventilation, of which 97 patients (27.3%) progressed after 72 hours. 78.4% were female in the progressive group and 64.0% were female in the non-progressive group. Compared with the non-progressive group, the patients with ARDS in the progressive group had shorter 28-day no mechanical ventilation, higher ICU mortality, and lower survival rate at 30 days and 60 days（P<0.05）, but there was no significant difference in the length of ICU stay between the two groups (P>0.05). Univariate and multivariate regression analysis showed that the patients with ARDS in the progressive group had lower baseline oxygenation index (OR=0.979, 95%CI 0.961 - 0.986, P<0.01), higher peak airway pressure (OR=1.068, 95%CI 1.017 - 1.121, P<0.01), higher lactate level (OR=1.224, 95%CI 1.057 - 1.417, P<0.01), higher tidal volume (OR=1.159, 95%CI 1.002 - 1.341, P<0.05), higher age (OR=1.373, 95%CI 1.051 - 1.082, P<0.01), and more male patients (OR=2.583, 95%CI 1.336 - 4.995, P<0.05). Conclusions Early progression is common in mild to moderate ARDS patients with mechanical ventilation. The progressive group has shorter duration of 28 days without mechanical ventilation, higher ICU mortality and lower 30-day and 60-day survival rate than the non-progressive group. Male, low baseline oxygenation index levels, high peak airway pressure, tidal volume, lactate levels, and higher age are risk factors for early progression in patients with mild to moderate ARDS.
Objective To investigate the value of serum angiopoietin like protein 4 (ANGPTL-4), growth differentiation factor 15 (GDF-15) and fibroblast growth factor 21 (FGF-21) in evaluating the condition and predicting the prognosis of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of 147 patients with ARDS admitted in our hospital from January 2019 to December 2021 were collected. The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the ARDS patients on the day of admission were detected. According to the oxygenation index(OI), the ARDS patients were divided into a mild group with 38 cases (200 mm Hg <OI≤300 mm Hg), a moderate group with 63 cases (100 mm Hg <OI≤200 mm Hg) and a severe group with 46 cases (OI≤100 mm Hg). According to the survival within 28 days after entering the intensive care unit, the ARDS patients were divided into a survival group with 90 cases and a death group with 57 cases. Multivariate logistic regression analysis was used to analyze the risk factors of death in the patients with ARDS. Receiver operator characteristic curve were drawn to analyze the value of serum ANGPTL-4, GDF-15 and FGF-21 levels in predicting the prognosis of ARDS patients. Pearson correlation was used to analyze the correlation between serum ANGPTL-4, GDF-15 and FGF-21 levels. Results The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the death group were significantly higher than those in the survival group (all P<0.001). The levels of serum ANGPTL-4, GDF-15 and FGF-21 in the severe group were significantly higher than those in the mild group and the moderate group (all P<0.001). Multivariate logistic regression analysis showed that the levels of OI (OR=2.416, 95%CI 1.615 - 5.470), APACHEⅡ score (OR=2.795, 95%CI 1.973 - 6.874), SOFA score (OR=1.692, 95%CI 1.170 - 3.105), ANGPTL-4 (OR=1.951, 95%CI 1.360 - 4.208), GDF-15 (OR=2.583, 95%CI 1.804 - 6.195) and FGF-21 (OR=3.116, 95%CI 2.513 - 9.307) were the risk factors of death in patients with ARDS (P<0.05). The area under the ROC curve of combination of ANGPTL-4, GDF-15 and FGF-21 was the highest (0.953, 95%CI 0.892 - 0.998) for prediction the death of ARDS patients, with a sensitivity of 98.0% and specificity of 87.3%. Correlation analysis showed that serum ANGPTL-4 level was positively correlated with GDF-15 and FGF-21 in the ARDS patients (P<0.001). Conclusions The elevated levels of serum ANGPTL-4, GDF-15 and FGF-21 are related to the severity and death of ARDS patients. The combined detection of serum ANGPTL-4, GDF-15 and FGF-21 is helpful to predict the prognosis of ARDS patients.
ObjectiveTo retrospectively compare the clinical effects of high frequency oscillatory ventilation (HFOV) and conventional ventilation (CV) on patients with acute respiratory distress syndrome (ARDS) induced by smoke inhalation injury. MethodsForty-three patients with smoke inhalation induced ARDS were admitted in the Center Hospital of Hu Ludao between October 2004 and June 2015.Among the patients, 19 cases were treated with CV (CV group) and 24 cases were treated with HFOV (HFOV group).The clinical data were collected and compared between two groups including blood gas at certain time points (6 h, 24 h, 48 h, 96 h, and 7 d) as well as complications and prognosis. ResultsThere was no significant difference in arterial blood gas between two groups before treatment (P > 0.05).After ventilation treatment, there were significant differences in arterial blood gas parameters between two groups except arterial carbon dioxide partial pressure at 48 and 96 h.And the patients in the HFOV group improved more obviously.The hospitalization time and ventilation time in the HFOV group were significantly shorter than those in the CV group (P < 0.05).No significant difference was found between two groups in the incidences of mortality, complications or 30-day survival rate (P > 0.05). ConclusionsBoth high frequency oscillatory ventilation and conventional ventilation can improve the clinical status in patients with smoke inhalation induced ARDS.These two ventilation modes do not present any difference with respect to prognosis by present evidence.
Objective To compare the clinical efficacy and safety of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in treatment of acute respiratory distress syndrome (ARDS) induced by coronavirus disease 2019 (COVID-19). Methods Sixty-eight patients with ARDS induced by COVID-19 in Wuhan Concorde Red Cross Hospital form January 25, 2020 to March 10, 2020 were included in the study. They were divided into an HFNC group (n=36) and an NIV group (n=36) according to the treatment. All patients received basic routine treatment, antiviral treatment and prevention therapy of secondary infection. The HFNC group received high-flow nasal cannula oxygen therapy, and the NIV group received NIV therapy. Then respiration and circulation parameters, comfort and tolerance, complications were compared between the two groups. Results After treatment for 3 days, 1 week, and 2 weeks in all patients with COVID-19 induced ARDS, respiratory rate (RR) was lower than that before therapy, arterial partial pressure of oxygen (PaO2), pulse oxygen saturation (SpO2), PaO2/FiO2 were higher than those before therapy (P<0.05), and therapeutic effect was time-dependent. But there was no significant difference of RR, PaO2, SpO2, PaO2/FiO2 between the HFNC group and the NIV group at different time points (P>0.05). After treatment for 2 weeks, the HFNC group patients' comfort, difficulty breathing, tolerance score were lower than the NIV group (P<0.05, P<0.01), the incidence rate of gastric distension and dry mouth etc. was lower than that in the NIV group (11.11% vs. 37.50%, P<0.05). There was no significant difference in rate of invasive mechanical ventilation or mortality between the two groups (P>0.05). Conclusions HFNC and NIV can improve respiratory and circulatory parameters of patients with COVID-19 induced ARDS. HFNC has better comfort and tolerance, and can reduce related complications.
Objective To investigate the effects of noninvasive ventilation for the treatment of acute respiratory failure secondary to severe acute respiratory syndrome ( SARS) . Methods 127 patients with complete information were collected from the database of SARS in Guangdong province, who were all consistent with the ALI/ARDS diagnostic criteria. The patients were divided into three groups depending on ventilation status, ie. a no-ventilation group, a noninvasive ventilation group, and a mechanical ventilation group. The outcome of ventilation treatmentwas followed up.Multi-factor regression analysis was conducted to analyze the relations of ventilation treatment with ARDS and mortality, and factors associated with success of noninvasive ventilation. Results As soon as the patients met the diagnostic criteria of ALI/ARDS, the patients in the noninvasive ventilation group were in more serious condition and had a higher proportion of ARDS compared with the no-ventilation group ( P lt;0. 01) . The patients in the mechanical ventilation group had a higher mortality rate ( P lt;0.01) . 6 and 7 patients in the no-ventilation group had noninvasive ventilation and invasive ventilation thereafter, respectively. 15 patients in the noninvasive group switched to invasive ventilation. Compared with the patients without ventilation ( n =45) , the patients receiving noninvasive ventilation ( n = 61) were in more serious condition and at higher risk of developing ARDS ( P lt;0. 01) , but the mortality was not different between them ( P gt; 0. 05) . The patients who continued to receive noninvasive ventilation ( n = 40) were in more serious condition, and at higher risk of developing ARDS compared with the patients without ventilation ( n = 45) ( P lt; 0. 01) . 15 patients in the noninvasive group who switched to invasive ventilation were older than those patients continuing noninvasive ventilation.Conclusions For SARS patients fulfilling the ALI/ARDS criteria, the patients underwent noninvasive ventilation are more severe, run a higher probability of developing ARDS from ALI. But earlier initiation of noninvasive ventilation has no impact on mortality. The patients who tolerate noninvasive ventilation can avoid intubation, especially for young patients. However, the time and indication of shifting from noninvasive ventilation to invasive ventilation should be emphasized.
ObjectiveTo investigate different levels of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in patients with acute respiratory distress syndrome (ARDS) complicated with intra-abdominal hypertension(IAH). MethodsThirty patients with moderate ARDS admitted in ICU between January 2012 and December 2014 were recruited in the study. They were divided into three groups according to intra-abdominal pressure (IAP),including 10 patients with normal abdominal pressure as a normal IAP group,10 patients with IAP of 12-15 mm Hg as an IAPⅠ group,and 10 patients with IAP of 16-20 mm Hg as an IAPⅡ group. The optimal level of PEEP was titrated according to the best oxygenation methods. The changes of oxygenation index (OI),respiratory mechanics and hemodynamics before and after the optimal level of PEEP were monitored and compared in all groups. The 28-day mortality and ICU stay were also compared. ResultsThe OI after titration was significantly improved compared to baseline in all groups (all P<0.01). The OI after titration in the IAPⅡ group was significantly higher than that in other two groups (all P<0.05). The static lung compliance (Cst) after titration significantly improved than baseline in all groups(all P<0.05),but no significant difference was revealed among three groups (all P>0.05). In the IAPⅡ group,the levels of PEEP,IAP,blood lactate,heart rate and airway plateau pressure after titration were significantly increased than baseline but higher than those in other two groups(all P<0.05),while the level of mean arterial pressure was significantly decreased and significantly lower than those in other two groups(all P<0.01). Meanwhile,the ICU stay was longest in the IAPⅡ group (P<0.01). There was no significant difference in 28-day mortality among three groups(all P>0.05). ConclusionsPEEP can significantly improve oxygenation in patients with ARDS complicated with IAH. The higher the IAP is,the higher the PEEP level is required. However the higher PEEP will significantly increase IAP which will cause adverse impacts on hemodynamics and can not improve the prognosis.