ObjectiveTo explore the value of procalcitonin-to-albumin (PAR) in patients with acute respiratory distress syndrome (ARDS).MethodsA retrospective study was carried on patients diagnosed with ARDS from December 2016 to March 2018. The receiver-operating characteristics (ROC) curve was used to identify the cutoff value of PAR. The association of PAR and 28-day mortality was evaluated using univariate and multivariable Cox regression.ResultsIn the final analysis, there were a total of 255 patients included. Of whom 164 (64.3%) was male, 91 (35.7%) was female and the mean age was 52.1±14.5 years old. The 28-day mortality of all the patients was 32.9% (n=84). ROC curve revealed that the cutoff value of PAR was 0.039 (specificity: 0.714, sensitivity: 0.702) and area under the curve was 0.793 (95%CI: 0.735 - 0.850, P<0.001). The following variables were considered for multivariable adjustment: age, body mass index, pneumonia, aspiration, sepsis, surgery, PaO2/FiO2, red blood cell counts and PAR (P<0.01 in univariate analysis). After multivariable analysis, only age (HR: 1.033, 95%CI: 1.009 - 1.059, P=0.008), PaO2/FiO2 (HR: 0.992, 95%CI: 0.985 - 1.000, P=0.044) and PAR (HR: 4.899, 95%CI: 2.148 - 11.174, P<0.001) remained independently associated with 28-day mortality (P<0.05).ConclusionHigh PAR predicts a poor outcome in ARDS patients, therefore it appears to be a prognostic biomarker of outcomes in patients with ARDS.
Objective To explore the value of pulmonary ultrasound in the evaluation of pulmonary edema and the guidance of pulmonary therapy in patients with acute respiratory distress syndrome (ARDS). Methods Sixty patients with ARDS admitted to the Department of Critical Medicine of Shanghai Seventh People’s Hospital were randomly divided into a lung ultrasound group and a control group, with 30 patients in each group. The gender, age and etiology of patients were collected, and the relevant data were recorded at the time of admission and on the 7th day, including Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment score (SOFA), white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), extravascular pulmonary water index, oxygenation index, and mechanical ventilation treatment time. Pulmonary ultrasound score was collected in the pulmonary ultrasound group. The 7-day improvement rate, intensive care unit (ICU) hospitalization time and 28 day mortality rate of the two groups were also collected. The value of pulmonary ultrasound in evaluating the severity, treatment process and prognosis of patients, and the correlation between pulmonary ultrasound score and extravascular pulmonary water index were studied. Results There was no significant difference in APACHEⅡ score, SOFA score, oxygenation index, extravascular pulmonary water index, WBC, CRP or PCT between the two groups before and after treatment (all P>0.05). After 7 days of treatment, the two groups improved, and the pulmonary ultrasound group improved more significantly with more shorter mechanical ventilation time, higher 7-day improvement rate, shorter ICU hospitalization time, and lower 28-day mortality rate (all P<0.05). The extravascular pulmonary water index was positively correlated with APACHEⅡ score and SOFA score, and negatively correlated with oxygenation index. The pulmonary ultrasound score was positively correlated with APACHEⅡ, and SOFA score and extravascular pulmonary water index, and negatively correlated with oxygenation index. Conclusions Pulmonary ultrasound can effectively evaluate the severity of ARDS patients, guide the individualized treatment, and predict the prognosis. It can be used as a routine monitoring method for patients with ARDS.
Objective To evaluate the effects of neuromuscular blocking agents( NMBAs) in acute respiratory distress syndrome( ARDS) . Methods Randomized controlled trials( RCTs) and non-RCTs were recruited fromPubMed( 1966. 1-2012. 3) , EMBASE( all the years) , Cochrane Library( all the years) and CNKI Database( 1979-2012) . Related published studies and attached references were hand searched. All the RCTs and non-RCTs ( including prospective and retrospective studies) about NMBAs for the patients with ARDS were included. Then a meta-analysis and statistic descriptions for RCTs( using RevMan5. 0 software) and non-RCTs were performed. Jadad and NEWCASTLE-OTTAWA QUALITY ASSESSMENT SCALE were used to assess the methodological quality of the included RCTs and non-RCTs. Results Three eligible RCTs and four non-RCTs were enrolled. The quality of the included trials was high. Pooled analysis for three RCTs showed that NMBAs significantly reduced 28-day mortality [ OR 0. 58, 95% CI( 0. 39, 0. 86) , P = 0. 007] and increased ventilator-free days within 28 days [ WMD 1. 91 d, 95% CI( 0. 28,3. 55) , P =0. 02] in ARDS compared with the control group. Conclusion The present meta-analysis indicates that NMBAs reduce the 28-day mortality and increase ventilator-free days within 28 days in ARDS.
ObjectiveTo investigate the clinical significance of levels of serum salivary Krebs von den Lungen 6 (KL-6) and matrix metalloproteinase-9 (MMP-9) in predicting the prognosis of patients with acute respiratory distress syndrome (ARDS). MethodsFrom January 2020 to December 2023, 100 ARDS patients who received treatment in our hospital were included as the study group, and 59 healthy professionals who underwent health checkup were selected as the control group. And the levels of serum KL-6 and MMP-9 were measured on the day of admission. According to the oxygenation index (OI) results, the study group was separated into mild group (38 cases), moderate group (33 cases), and severe group (29 cases); Based on 28-day intensive care unit (ICU) survival status, the study group was divided into a survival group of 69 cases and a death group of 31 cases. Enzyme-Linked Immunosorbent Assay (ELISA) method was applied to detect the levels of serum KL-6 and MMP-9. Pearson correlation was applied to analyze the correlation between serum KL-6 and MMP-9 levels and OI in the death group. Logistic regression was applied to analyze the influencing factors of prognostic mortality in ARDS patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of serum KL-6 and MMP-9 levels for prognostic mortality in ARDS patients. ResultsCompared with the control group, the levels of serum KL-6 and MMP-9 in the study group were notably increased, and the levels of serum KL-6 and MMP-9 in the severe ARDS group were notably higher than those in the moderate and mild groups. The levels of serum KL-6 and MMP-9 in the moderate group were notably higher than those in the mild group, the OI in the survival group was greatly higher than that in the death group, and the acute physiology and chronic health evaluationⅡ (APACHE II) score, KL-6, and MMP-9 in the survival group were greatly lower than those in the death group (P<0.05). Pearson analysis showed that serum KL-6 and MMP-9 levels were negatively correlated with OI (P<0.05). Logistic analysis showed that APACHE II score, KL-6, and MMP-9 were risk factors for prognostic mortality in ARDS patients (P<0.05). ROC curve showed that the AUC of serum KL-6 and MMP-9 levels in predicting prognostic mortality in ARDS patients was 0.809 and 0.816, respectively, with cutoff value of 510.44 U/ml and 317.15μg/L, respectively. The area under the ROC curve (AUC) predicted by the combination of the two was 0.935, greatly higher than that of KL-6 (Z=2.133, P=0.033) and MMP-9 (Z=2.164, P=0.030) alone. ConclusionsThe levels of serum KL-6 and MMP-9 in ARDS patients are greatly upregulated and increase with the severity of the disease. The combination of the two has certain predictive value for the prognostic mortality of ARDS patients.
Clinical scientists have paid more and more attention to the acute respiratory distress syndrome(ARDS), a severe complication after thoracotomy, for its high mortality rate. Compared with other surgical patients, patients who received thoracotomy often have a worse cardiopulmonary function and are prone to suffering from ARDS. Surgical treatment or injury, massive blood transfusion, respiratory tract infection, improper fluid replacement and ventilation are probable reasons to cause ARDS. Mechanical ventilation is an important treatment for ARDS，but ventilation with lungprotective strategies was proved to be the only therapy which can improve the prognosis of patients with ARDS. At present, thinking highly of and promoting the perioperative management, lessening surgical injury and active prevention are still very important measures to reduce the mortality after thoracotomy. This article is aimed to review the high risk factors of ARDS after thoracotomy as well as its treatment.
Acute respiratory distress syndrome following plastic operation of the abdominal wall with the purpose to reduce over-weight of the body in 3 case was reported. They all recovered following effective and appropriate treatment. The criteria for the diagnosis of ARDS were diseussed and the method of treatment was introduced and the importance of early diagnosis was emphasized.
Objective To investigate the current status and influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome (ARDS). Methods A total of 210 patients with mild to moderate ARDS admitted between December 2022 and January 2023 were investigated by general information questionnaire and self-made prone position knowledge questionnaire. The daily prone position time during hospitalization was recorded. The influencing factors of awake prone position were analyzed by univariate and multivariate linear regression. Results The 210 mild and moderate ARDS patients had an average daily prone position length of stay of (4.97±3.94)h/d, showing a low level. Multiple linear regression analysis showed that prone position knowledge score, age, waist circumference and BMI were the influencing factors of awake prone position (P<0.05). Conclusions Daily awake prone position length was at a low level in mild and moderate ARDS patients. Healthcare workers can prolong the time in the prone position by developing an individualized treatment plan for the prone position, improving the patient’s perception of the prone position, and resolving the discomfort from the prone position.
ObjectiveTo investigate the relationship between platelets changes and outcomes of acute respiratory distress syndrome (ARDS) patients.MethodsA total of 275 ARDS patients treated in Zhongshan Hospital of Fudan University were retrospectively enrolled from 2008 to 2015. Their clinical characteristics, experimental test results and disease outcomes were obtained from the archived medical records. The correlation between the decreasing of platelet within three days and the prognosis of ARDS and in each subgroup were analyzed by statistical methods, including COX analysis and Kaplan-Meier curve.ResultsThere were 233 patients validly selected through eliminating those with exclusion criteria. They were divided into a decreasing group and a non-decreasing group according to their platelet counts in three days. There was significant difference in the ontcome between the two groups with the univariate analysis, the COX analysis and Kaplan-Meier curve (all P<0.05). According to the initial platelet count and change of platelet in 3 days all the patients were categorized into 9 subgroups. The mortality among them was compared and two risk groups were defined, including a persistently low platelet group (the initial platelet count <139×109/L with an increase less than 16×109/L during the first three days after the diagnosis), and a decreased platelet group (the initial platelet count ≥139×109/L and platelet count decreased more than 30×109/L during the first three days after the diagnosis). The other subgroups made up a non-risk group. Merging two risk groups as one risk group and comparing with the non-risk group, there were significant differences in the outcome between two groups with the univariate analysis, the multiplicity COX analysis and Kaplan-Meier curve (all P<0.05), the differences of coagulation function indexes were not significant (allP>0.05). The platelet count of the risk group was also an independent risk factor for ARDS mortality in the surgery subgroup (P=0.003), the non-hypertension subgroup (P=0.018) and the pneumonia subgroup (P<0.001).ConclusionLow platelets and declining platelets are closely associated with poor prognosis in most ARDS patients, which might be applied in clinical prognosis evaluation.
ObjectiveTo assesse the association of an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene (ACE) with the risk and the mortality of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).
MethodsWe searched electronic databases through April 2014 for the terms "angiotensin-converting enzyme gene", "acute lung injury" and "acute respiratory distress syndrome", and reviewed all studies that reported the relationship of the I/D polymorphism in ACE with ALI/ARDS in adults. Eight studies met the inclusion criteria, comprising 498 ALI/ARDS patients, 3220 healthy controls and 1137 patients without ALI/ARDS. Three genetic models were used: the allele, dominant and recessive models. The meta-analysis was performed with RevMan 5.2 software.
ResultsThe ACE I/D polymorphism was not associated with susceptibility to ALI/ARDS compared with the healthy controls and the patient controls for any genetic model. The ACE I/D polymorphism was associated with the mortality risk of ALI/ARDS in Asian subjects, and OR was 2.99 (95% CI 1.87-4.76, P < 0.05), 0.36 (95% CI 0.20-0.67, P < 0.05), 4.62 (95% CI 1.71-12.45, P < 0.05) for allele I/D, genotype II/II+ID and genotype DD/II+ID, respectively.
ConclusionThere is a possible association between the ACE I/D polymorphism genotype and the mortality risk of ALI/ARDS in Asians.
ObjectiveTo summarize and analyze the clinical characteristics of patients with acute diffuse lung changes and respiratory failure.MethodsThe clinical data of patients in the Department of Critical Care Medicine, Dazhou Central Hospital between January 2016 and December 2018 were retrospectively collected, whose main clinical manifestation was acute respiratory distress syndrome with acute onset (<3 weeks) and main imaging manifestation was diffuse changes in both lungs. The clinical characteristics of patients were summarized, and the causes of the disease were explored.ResultsA total of 65 patients with acute diffuse lung changes and respiratory failure were enrolled, including 42 males (64.6%) and 23 females (35.4%). The average age was (57.1±18.4) years, the average time from onset to treatment was (7.5±5.9) d, and the average length of stay in the intensive care unit was (8.9±4.1) d. A total of 23 cases died, with a case-fatality rate of 35.4%. Among the 65 patients, there were 50 case (76.9%) of infectious diseases, including 36 cases of bacterial infections (including 4 cases of tuberculosis), 8 cases of viral infections (all were H1N1 infections), and 6 cases of fungal infections (including 1 case of pneumocystis infection); and there were 15 cases (23.1%) of non-infectious diseases, including 4 cases of acute left heart failure, 2 cases of interstitial pneumonia, 2 cases of vasculitis, 1 case of myositis dermatomyositis, 1 case of aspiration pneumonia, 1 case of acute pulmonary embolism, 1 case of acute drug lung injury, 1 case of neurogenic pulmonary edema, 1 case of drowning, and 1 case of unknown origin.ConclusionsInfectious diseases are the main cause of acute diffuse lung changes and respiratory failure, while among non-infectious diseases, acute heart failure and immune system diseases are common causes.
