Objective To evaluate the efficiency and associated factors of noninvasive positive pressure ventilation( NPPV) in the treatment of acute lung injury( ALI) and acute respiratory distress syndrome( ARDS) .Methods Twenty-eight patients who fulfilled the criteria for ALI/ARDS were enrolled in the study. The patients were randomized to receive either noninvasive positive pressure ventilation( NPPV group) or oxygen therapy through a Venturi mask( control group) . All patients were closely observed and evaluated during observation period in order to determine if the patients meet the preset intubation criteria and the associated risk factors. Results The success rate in avoiding intubation in the NPPV group was 66. 7%( 10/15) , which was significantly lower than that in the control group ( 33. 3% vs. 86. 4% , P = 0. 009) . However, there was no significant difference in the mortality between two groups( 7. 7% vs.27. 3% , P =0. 300) . The incidence rates of pulmonary bacteria infection and multiple organ damage were significantly lower in the NPPV success subgroup as compared with the NPPV failure group( 2 /10 vs. 4/5, P =0. 01;1 /10 vs. 3/5, P = 0. 03) . Correlation analysis showed that failure of NPPV was significantly associated with pulmonary bacterial infection and multiple organ damage( r=0. 58, P lt;0. 05; r =0. 53, P lt;0. 05) . Logistic stepwise regression analysis showed that pulmonary bacterial infection was an independent risk factor associated with failure of NPPV( r2 =0. 33, P =0. 024) . In the success subgroup, respiratory rate significantly decreased( 29 ±4 breaths /min vs. 33 ±5 breaths /min, P lt; 0. 05) and PaO2 /FiO2 significantly increased ( 191 ±63 mmHg vs. 147 ±55 mmHg, P lt;0. 05) at the time of 24 hours after NPPV treatment as compared with baseline. There were no significant change after NPPV treatment in heart rate, APACHEⅡ score, pH and PaCO2 ( all P gt;0. 05) . On the other hand in the failure subgroup, after 24 hours NPPV treatment, respiratory rate significantly increased( 40 ±3 breaths /min vs. 33 ±3 breaths /min, P lt;0. 05) and PaO2 /FiO2 showed a tendency to decline( 98 ±16 mmHg vs. 123 ±34 mmHg, P gt; 0. 05) . Conclusions In selected patients, NPPV is an effective and safe intervention for ALI/ARDS with improvement of pulmonary oxygenation and decrease of intubation rate. The results of current study support the use of NPPV in ALI/ARDS as the firstline choice of early intervention with mechanical ventilation.
Objective To explore the effects of lateral position ventilation on lung volume and oxygenation in patients with acute respiratory distress syndrome ( ARDS) . Methods Fourteen patients with ARDS were enrolled. Supine position, lateral position and supine position were successively adopted and continued for one hour respectively. End-expiratory lung volume ( EELV) was measured at the end of each epoch. Effects of different position on gas exchange, lung mechanics and hemodynamics were monitored.Results EELV was increased from ( 1109 ±321) mL to ( 1376 ±381) mL after lateral ventilation ( P lt;0. 05) , and decreased to ( 1143 ±376) mL after the second supine ventilation ( P lt;0. 05) . Compared with initial supine ventilation, there was no significant difference in EELV after the second supine ventilation( P gt;0. 05) . PaO2 /FiO2 was increased from ( 154. 3 ±35. 0) mm Hg to ( 189. 9 ±60. 1) mm Hg after lateral ventilation ( P lt;0. 05) , and increased to ( 209. 2 ±75. 4) mm Hg after the second supine ventilation ( P lt; 0. 05) . Compared with initial supine ventilation, PaO2 /FiO2 was increased greatly after the secondsupine ventilation ( P lt; 0. 01) . There was no significant difference in PaCO2 , lung mechanics and hemodynamics after changing different position. Conclusion Lateral position ventilation can increase EELV and improve oxygenation in patients with ARDS.
Objective To explore the effects of different humidification and heating strategies during non-invasive positive pressure ventilation( NIPPV) in patients with ALI/ARDS. Methods A total of 45 patients with ALI/ARDS were randomly divided into three groups to receive NIPPV with different humidification and heating strategies, ie. Group A ( humidification with a 370 Humidifier without heating) ,group B ( humidification with a 370 Humidifier along with a MR410 Heater) , and group C ( humidification and heating with aMR850 Humidifier, and a RT308 circuit heater) . The changes of air temperature, absolute humidity, relative humidity, sputum thickness and patient comfort were compared between the three groups. Sputum thickness was evaluated with AWSS scoring system. Results After humidification and heating, the air temperature, absolute humidity and AWSS score improved significantly in group B [ elevated from ( 23. 9 ±1. 0) ℃, (9.8 ±1. 3) mg/L and 2. 0 ±0. 7 respectively to ( 30. 3 ±1. 7) ℃, ( 31. 0 ±2. 3)mg/L and ( 3. 0 ±0. 9) respectively, P lt; 0. 001] and group C [ elevated from( 23. 8 ±1. 0) , ( 9. 8 ±1. 5)mg/L and ( 2. 1 ±0. 7) respectively to ( 34. 0 ±1. 1) ℃, ( 43.8 ±2. 5) mg /L and 3. 5 ±1. 0 respectively,P lt; 0. 001] . Air temperature and absolute humidity were significantly higher in group C than those in group B( P lt; 0. 001) . Of all the parameters, only absolute humidity showed a significant improvment in group A [ elevated from( 9. 9 ±1. 6) mg/L to ( 11. 9 ±0. 9) mg/L, P lt; 0. 001] . The degree of comfort in group C was significantly higher than that in group A and B [ 8. 0 ±1. 7 vs 5. 0 ±1. 2 and 3. 0 ±0. 4, respectively, P lt;0. 001] . In group A seven patients were switched to group C because of discomfort, four accepted NIPPV continuously, and two avoided invasive mechanical ventilation eventually. In group B three patients were switched to group C because of intolerance of too much condensed water in the breathing circuit, all of them accepted NIPPV continuously, and one avoided invasive mechanical ventilation eventually. Conclusions Compared with mere humidification or humidification with heating humidifier, humidification with heating humidifier and circuit heating during NIPPV can improve the absolute humidity, air temperature and patient comfort,meanwhile decreasing the sputumthickness of patients with ALI/ARDS.
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 investigate the serumlevel of endothelin-1 ( ET-1) in patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) and its clinical significance. Methods Thirty-one ALI/ARDS patients received mechanical ventilation in ICUand 25 normal subjects were recruited in the study. The patients who died in two weeks fell in death group, and the patients who did not died in two weeks fell in survival group. The serum level of ET-1 measured by EIA method were compared between thepatients with different severity of lung injury [ evaluated by American-European Consensus Conference on ARDS ( AECC) criteria and lung injury score( LIS) ] , and between the patients with different prognosis ( death or survival ) . The correlation was analyzed between the level of ET-1 and clinical parameters.Results The ET-1 level was higher in the ALI/ARDS patients than that in the control subjects [ ( 6. 18 ±4. 48) ng/L vs. ( 2. 68 ±1. 34) ng/L, P lt;0. 05] . There was no significant difference in the patients with different severity [ ALI vs. ARDS, ( 5. 43 ±4. 39) ng/L vs. ( 7. 01 ±4. 51) ng/L, P gt; 0. 05; LIS≤2. 5 vs.LISgt;2. 5, ( 5. 93 ±5. 21) ng/L vs. ( 6. 68 ±2. 76) ng/L, P gt; 0. 05] . The ET-1 level in the death group continued to increase, and higher than that in the survival group on the 5th day [ ( 7. 96 ±3. 30) ng/L vs.( 4. 36 ±3. 29) ng/L, P lt; 0. 05] . The ET-1 level was positively correlated with SIRS, SAPSⅡ and APACHEⅡ ( r = 0. 359, 0. 369 and 0. 426, respectively, P lt; 0. 05 ) , and negatively correlated with PaO2 /FiO2 and AaDO2 ( r = - 0. 286 and - 0. 300, respectively, P lt;0. 05) . Conclusion The measurementof serum ET-1 can help to evaluate the severity and prognosis of ALI/ARDS patients.
Acute respiratory distress syndrome (ARDS) is the most common cause of acute respiratory failure. Extensive researches have been conducted for the pathophysiology of this disease, but the mortality rate remains high. Previous studies have found that catecholamines play an important role in acute lung injury, and newly discover prompted that upregulation of phagocyte-derived catecholamines augmented the acute inflammatory response in acute lung injury which provides a new way of thinking. In the current review, we describe the mechanism of the phagocyte-derived catecholamines augmenting the acute lung injury.
Objective To investigate the predictive value of mechanical power (MP) in the weaning outcome of adaptive mechanical ventilation plus intelligent trigger (AMV+IntelliCycle, simply called AMV) mode for acute respiratory distress syndrome (ARDS) patients. Methods From November 2019 to March 2021, patients with mild to moderate ARDS who were treated with invasive mechanical ventilation in the intensive care unit of the First Affiliated Hospital of Jinzhou Medical University were divided into successful weaning group and failed weaning group according to the outcome of weaning. All patients were treated with AMV mode during the trial. The MP, oral closure pressure (P0.1), respiratory rate (RR) and tidal volume (VT) of the two groups were compared 30 min and 2 h after spontaneous breathing trial (SBT). The correlation between 30 min and 2 h MP and shallow rapid respiratory index (RSBI) was analyzed by Pearson correlation. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 30 min MP in ARDS patients with AMV mode weaning failure. Results Sixty-eight patients were included in the study, 49 of them were successfully removed and 19 of them failed. There was no statistical significance in age, gender, body mass index, oxygenation index, acute physiology and chronic health evaluation Ⅱ score, reasons for mechanical ventilation (respiratory failure, sepsis, intracranial lesions, and others) between the two groups (all P>0.05). The MP, P0.1 and RR at SBT 30 min and 2 h of the successful weaning group was lower than those of the failed weaning group (all P<0.05), but the VT of the successful weaning group was higher than the failed weaning group (all P<0.05). There was a significant relation between the MP at SBT 30 min and 2 h and RSBI (r value was 0.640 and 0.702 respectively, both P<0.05). The area under ROC curve of MP was 0.674, 95% confidence interval was 0.531 - 0.817, P value was 0.027, sensitivity was 71.73%, specificity was 91.49%, positive predictive value was 0.789, negative predictive value was 0.878, optimal cutoff value was 16.500. The results showed that 30 min MP had a good predictive value for the failure of weaning in AMV mode in ARDS patients. Conclusion MP can be used as an accurate index to predict the outcome of weaning in ARDS patients with AMV mode.
Objective To explore the clinical application value of electrical impedance tomography (EIT) individualized adjustment of positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). Methods The ARDS patients requiring mechanical ventilation who admitted between April 2019 and March 2022 were recruited in the study. They were randomly divided into 3 groups with 12 cases in each group. Optimal PEEP was set using ARDSnet method (a control group), lung ultrasound scoring method (LUS group) and EIT adjustment method (EIT group). The changes of hemodynamics, blood gas analysis, respiratory mechanics, extravascular lung water index and other indicators of the patients were recorded at each time point. Results There was no significant difference in PEEP between the EIT group and the LUS group, but PEEP in both the EIT group and the LUS group was significantly higher than the control group (P<0.05). After 12 hours of treatment, the dynamic lung compliance of the control group did not change significantly, while the dynamic lung compliance ventilation of the LUS group and the EIT group was significantly improved for 12 hours, and the improvement in the EIT group was significantly better than that in the control group (P<0.05). After treatment, the oxygenation index in the three groups was significantly increased, and the oxygenation index in the EIT group was significantly higher than that in the control group (P<0.05). There was no significant difference in hemodynamics between the three groups before and after treatment (P>0.05). The extravascular lung water index of the three groups after treatment was significantly decreased, and the LUS group and the EIT group decreased more significantly than the control group (P<0.05). Conclusion In the PEEP setting of ARDS patients, the use of EIT personalized adjustment method can effectively improve the patient’s lung compliance and oxygenation index, and reduce extravascular lung water, without affecting hemodynamics.
Objective To investigate the value of continuous blood purification （CBP）in early treatment of patients with ARDSexp （ARDS caused by extrapulmonary causes），especially in reducing inflammation mediators and extravascular lung water （EVLW）.Methods According the hospital admission sequence，the patients with APACHEⅡ scores from 15 to 20 and PaO2/FiO2 from 100 to 200 were recruited.The ARDSexp patients were divide into an intervention group treated with CBP （Mode：CVVHDF，rate of displacement liquid and dialysate：1.5 L/h，rate of blood：100-200 mL/h，and the time of CBP：72 hours），and a control group without CBP treatment. The NICO and PICCO monitoring data and the survival rates were recorded and analyzed using the SPSS software. Results The mortality rate of the intervention group was lower than that of the control group （6.3% vs. 36.8%，P=0.032）. In the 72 h monitoring dada of NICO and PICCO，the time of improving PCBF，Pm，Cdyn，VCO2，MValv，Pm，PIP，Raw，RSBI，Vd/Vt，and PaO2/FiO2 of the intervention group was severer than those in the control group，and the severety was also more than that of control group which was was significantly different at 72 h（Plt;0.05）. In the PICCO data，the time of decreasing EVWL and PVPI was shorter than the control group，and the decreasing extent was more than the control group，with significant difference at 72 h. But the changes of Apm，CI，and CVP were not significant （Pgt;0.05）. Conclusions In treatment of ARDSexp patients，CBP therapy can induce the PCBC and EVLW，improve pulmonary compliance and MValv，and reduce the mortality rate，while doesn’t influence heart function and the stability of circulation.
ObjectiveTo investigate the clinical signification of plasma interleukin-17 (IL-17) 1evel in patients with acute respiratory distress syndrome (ARDS).MethodsForty-five adult ARDS patients and 22 healthy controls were enrolled in this study. The plasma cytokine levels of IL-17, IL-6 and IL-10 were measured by enzyme linked immunosorbent assay. Meanwhile, the baseline data of demographic and clinical tests including oxygenation index, procalcitonin and brain natriuretic peprtide were collected, the acute physiological and chronic health Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score were recorded. The main outcome was defined as hospital mortality within 28-day follow-up.ResultsThe plasma concentration of IL-17, IL-6 were higher in the ARDS patients (P<0.05) compared with the controls and the mean levels of IL-17, IL-6 and the APACHEⅡ score and the SOFA score in the non-survivors was higher than those in the survivors (P<0.05). In particular, there was a significant correlation between the plasma levels of IL-17 and IL-6 (P<0.05). Logistic regression and COX multivariate survival analysis suggested that age and SOFA score may be prognostic factors for ARDS.ConclusionsThe plasma concentration of IL-17 is significantly increased in ARDS patients, and its expression is linearly related to the proinflammatory factor IL-6. Both are important inflammatory markers in the acute phase of ARDS and may be important disease severity and prognostic indicators in addition to age and SOFA score.