Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.
Acute respiratory distress syndrome is one of the forms of respiratory failure that seriously threaten human life. It has the characteristics of very high morbidity, mortality and hospitalization costs. How to treat acute respiratory distress syndrome to improve the quality of life of patients is particularly important. Mechanical ventilation is an important treatment for acute respiratory distress syndrome. This article will review the progress in mechanical ventilation therapy for acute respiratory distress syndrome, including non-invasive mechanical ventilation and invasive mechanical ventilation (tidal volume, lung recruitment, positive end-expiratory pressure, prone position ventilation, and high-frequency oscillatory ventilation), aiming to provide basis and reference for future exploration of the treatment direction of acute respiratory distress syndrome.
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.
Objective To assess the efficacy of ambroxol on acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) . Methods The randomized controlled study involving ambroxol on ALI/ARDS were searched and identified from Cochrane Library, PubMed, China Academic Journals Full-text Database, Chinese Biomedical Literature Database, WanFang Resource Database, and Chinese Journal Fulltext Database. The quality of the chosen randomized controlled studies was evaluated, and then the valid data was extracted for meta-analysis. Results Ten articles were included, all in Chinese, including 459 cases ofpatients ( 233 cases in experimental group,226 cases in control group) , with baseline comparability between the various experiments. Systematic review showed that in ALI/ARDS patients, high-dose ambroxol was in favor to improve PaO2 [ WMD =12. 23, 95% ( 9. 62, 14. 84) , P lt; 0. 0001] and PaO2 /FiO2 [ WMD = 32. 75,95% ( 30. 00, 35. 51) , P lt;0. 0001] , reduce lung injury score [ WMD = - 0. 49, 95% ( - 0. 66, - 0. 33) ,P lt;0. 0001] , decrease the duration of mechanical ventilation [ WMD = - 2. 70, 95% ( - 3. 24, - 1. 12) ,P lt;0. 0001] and the length of ICU stay [ WMD= - 2. 70, 95% ( - 3. 37, - 2. 04) , P lt;0. 0001] , and lower mortality [ OR=0. 46,95%( 0. 22, 1. 00) , P = 0. 05] . Conclusions The existing clinical evidence shows that, compared with conventional therapy, high-dose ambroxol plus can significantly improve PaO2 , PaO2 /FiO2 , lung injury score, duration of mechanical ventilation, length of ICU stay and mortality in ALI/ARDS patients. Due to the quality of research and the limitations of the study sample, there likely to exist a bias,and may affect the strength of result, so we expect more high-quality, large-scale randomized controlled clinical trial to verify.
ObjectiveTo investigate the changes of platelet-leukocyte aggregates (PLA) level in patients with sepsis and its diagnostic value in sepsis complicated with acute respiratory distress syndrome (ARDS).MethodsA prospective study was carried in adult sepsis patients admitted to our hospital from January 2015 to November 2016. According to the 2012 " Berlin definition” diagnostic criteria, 58 cases of sepsis with ARDS were allocated to an experimental group and 139 cases of sepsis non-ARDS patients were allocated to a control group. Immediately after the diagnosis of sepsis, elbow vein blood samples were collected for flow cytometry assay of PLA. The acute physiology and chronic health assessment II (APACHE II score) of each group was performed and the receiver operating characteristic (ROC) curve was drawn.ResultsPlatelet-neutrophil aggregates (PNA) and platelet-lymphocyte aggregates (PLyA) in the experimental group were higher than those in the control group, but there were no significant differences (both P>0.05). The platelet-monocyte aggregates (PMA) of the experimental group was significantly higher than that of the control group (P<0.05). Peripheral blood PMA was positively correlated with APACHE II score (r=0.671, P<0.001). When PMA was used as the test variable, the area under the curve (AUC) was 0.945 with significant diagnostic value (P<0.001), and optimal cutoff value of PMA was 8.25%, with diagnostic sensitivity of 0.806 and diagnostic specificity of 0.951. When APACHE II was used as the test variable, AUC was 0.930, with significant diagnostic value (P<0.001), and optimal threshold of APACHE II was 16.500 with diagnostic sensitivity of 0.871 and diagnostic specificity of 0.852.ConclusionPMA is of great value in the diagnosis of sepsis with ARDS.
Objective Making an individualized pharmacological treatment plan for a patient of acute respiratory distress syndrome after operation. Methods First, six clinical problems were put forward after assessing the patient’ s health state. Then we searched OVID versions of the ACP Journal Club (1991~2009), CENTRAL (1st Quarter 2009), CDSR (1st Quarter 2009), and MEDLINE (1991~2009) databases. Systematic reviews, meta-analyses, and randomized clinical trials about treatment of acute respiratory distress syndrome were included. The pharmacological treatment plan was made accordingly.Results After evaluation, 13 studies were eligible. The evidence indicated that the restrictive strategy of fluid management, corrected hypoproteinaemia, diuresis, and low-dose corticosteroids given in the early phase could improve oxygenation and prognosis; inhaled nitric oxide, exogenous surfactant supplement, other pharmacological drugs were associated with limited improvement in oxygenation in patients with ARDS but confer no mortality benefit and may cause harm, so we did not recommend their routine use in ARDS patients. The individual treatment plan was made based on the evidence found. After 8 days of treatment, the patient was out the ICU. He recovered and was discharged after 1 month. Conclusions The individual treatment plan, which was made based on high quality evidence and patient’s condition, improved treatment efficacy, shortened the stay in ICU, reduced mortality, and decreased adverse reactions.
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.
ObjectiveTo detect the concentration of 8-isoprostane (8-iso-PG) in exhaled breath condensate (EBC) of patients with or at risk for ARDS in ventilation, and investigate its clinical significance.MethodsFifty-five patients with or at risk for ARDS in ventilation admitted between February 2014 and June 2016 were recruited as an experimental group, and simultaneous 30 normal cases were recruited as a control group. Their EBC was collected with EcoScreen condenser. The EBC 8-iso-PG level of the patients between different grades of ARDS (mild, moderate, and sever) or at risk for ARDS was compared, and the correlation of EBC 8-iso-PG with the clinical indicators was analyzed.ResultsThe 8-iso-PG levels in EBC and serum of the patients with or at risk for ARDS in ventilation were higher than those in the control group [EBC: (44.83±11.58) ng/L vs. (19.47±4.06) ng/L; serum: (481.53±444.94) ng/L vs. (19.91±17.60) ng/L] (all P<0.05). The EBC 8-iso-PG of the patients with moderate ARDS (n=15) and severe ARDS (n=7) [(47.18±11.68) ng/L and (50.29±11.06) ng/L] was higher than those with mild ARDS (n=7) or at risk for ARDS (n=26) [(33.04±7.62) ng/L) and (37.17±11.08) ng/L] (all P<0.05). However EBC 8-iso-PG was not different between the patients with mild ARDS and those at risk for ARDS (P>0.05 ). The increased EBC 8-iso-PG could predict ARDS with an area under the receiver operating curve of 0.73. The EBC 8-iso-PG of the patients with or at risk for ARDS was correlated with lung injury score (r=0.418, P<0.01), PaO2/FiO2 (r=–0.378, P<0.05), chest radiograph scores (r=0.410, P<0.05), AaDO2 (r=0.368, P<0.05), and APACHEⅡ score (r=0.718, P<0.05).ConclusionEBC 8-iso-PG can reflect the oxidative stress in lung of ARDS patients in ventilation, and can contribute to the diagnosis and evaluation for moderate and severe ARDS.
Objective To investigate the expression of S100A12 protein in peripheral blood of patients with acute respiratory distress syndrome (ARDS) and its clinical significance. Methods Sixty ARDS patients admitted between October 2015 and December 2016 were included in the study. They were divided into a mild group (n=20), a moderate group (n=20) and a severe group (n=20) according to the oxygenation state. Meanwhile they were divided into a survival group (n=37) and a death group (n=23) according to the 30-day prognosis. Sixty simultaneous healthy subjects were selected as a control group. The clinical data of all subjects were collected. Fasting venous blood was collected in the morning for measurement of S100A12 expression in peripheral blood by ELISA method. Results Compared with the control group, the levels of S100A12, interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-α) in peripheral blood and APACHEⅡ score were significantly increased in the ARDS patients, and PaO 2/FiO 2 was significantly decreased (all P<0.05). The level of S100A12 in peripheral blood was positively correlated with the severity of ARDS. The level of S100A12 was much higher in the severe group than that in the moderate group and the mild group, and higher in the moderate group than that in the mild group (allP<0.05). Correlation analysis showed that S100A12 level in peripheral blood of the ARDS patients was positively correlated with IL-1, TNF-α and APACHEⅡ score (P<0.05), but negatively correlated with PaO 2/FiO 2 (P<0.05). Logistic regression analysis showed that IL-1, TNF-α, APACHEⅡ score and S100A12 were independent risk factors for prognosis of ARDS. PaO 2/FiO 2 was an independent protective factor for prognosis of ARDS. ROC curve analysis showed that the S100A12 level had a certain predictive value for ARDS and could be used as a prognostic indicator. Conclusions The level of S100A12 in peripheral blood of ARDS patients is significantly increased and is closely related to the severity of ARDS. It has a potential clinical value for early diagnosis, treatment and prognosis of ARDS.
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.