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PubMed2005

Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study.

BACKGROUND: It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele) of the angiotensin converting enzyme (ACE) gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS) in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D) polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. METHOD: One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. RESULTS: There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. CONCLUSION: The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.

Adult↗
PubMed1983

Type I collagen content is increased in lungs of patients with adult respiratory distress syndrome.

Collagen in lung tissue was examined from patients with adult respiratory distress syndrome, from patients who did not have this disease but required mechanical ventilation and oxygen treatment, and from patients without overt lung disease. Cyanogen bromide peptide mapping techniques were used to determine the ratio of type I to type III collagen present in these lungs. In the fibrotic lungs from patients with adult respiratory distress syndrome a shift was found in the ratio of type I to type III from the normal value of 2:1 to a mean value of 3.4:1. In patients with normal lungs and those with other lung diseases collagen type ratios were normal. Our data suggest that (i) changes in lung collagen of patients with adult respiratory distress syndrome resemble those previously described in patients with idiopathic pulmonary fibrosis, although the changes occur much more rapidly in the former; (ii) the increased content of collagen in lungs of patients with adult respiratory distress syndrome shown by others is predominantly of type I collagen; and (iii) the stimulus to the lung to produce excess type I collagen relative to type III is not solely of iatrogenic origin--that is, resulting from oxygen or ventilator treatment.

Adult↗
PubMed2004

[Secondary bronchiolitis obliterans organizing pneumonia with primary Sjögren's syndrome, resulting in acute respiratory distress syndrome: a case report].

A 71-year-old female who was taking 10 mg/day of prednisolone for Sjögren's syndrome was admitted because of fever and dyspnea with multiple infiltrative shadows on chest radiography and computed tomography (CT), although she had been discharged only 4 days before. On the 1st and 2nd admissions, a BOOP pattern had been suspected, and she was treated by tapering the prednisolone dose from 40 mg/day to 10 mg/day, which resulted in the disappearance of the infiltrative lung shadows. This time we confirmed the BOOP pattern with Sjögren's syndrome, because bronchoalveolar lavage showed an increase of total cells, with a high lymphocyte fraction, and a transbronchial lung biopsy revealed loose fibroblastic plugs in some alveolar ducts and alveoli. Also, there were intra-alveolar accumulations of foamy macrophages. Furthermore, we noticed migration of pulmonary opacity. Although the clinical symptoms of the patient improved, the response to the prednisolone therapy appeared to be poor. At 35 mg of prednisolone (which had been initiated at 40 mg/day), the disease became rapidly exacerbated by a common cold, and developed into ARDS on the 30th hospital day. In spite of intensive care, the patient died. Here we report a rare case in which the BOOP pattern based on Sjögren's syndrome resulted in ARDS. In general, prednisolone is effective against the BOOP pattern, but we need to be aware of the possibility of a poor response to this BOOP pattern in Sjögren's syndrome.

Aged↗
PubMed1991

Mortality rates and prognostic variables in children with adult respiratory distress syndrome.

In a retrospective chart review of cases of adult respiratory distress syndrome in our pediatric intensive care unit from 1987 to 1990, we attempted to identify the physiologic variables predictive of death. We identified 44 children with adult respiratory distress syndrome; the mortality rate was 75%. We found significant differences between survivors and nonsurvivors in intrapulmonary venous admixture (Qsp/Qt), mean airway pressure (Paw), alveolar-arterial oxygen tension difference (P(A-a)O2), oxygenation index, and peak inspirator pressure; Qsp/Qt greater than 0.5, Paw greater than 23 cm H2O, and P(A-a)O2 greater than 470 mm Hg were 93%, 90%, and 81% predictive of death, respectively, in this study population. Sensitivity and specificity were enhanced when we linked multiple predictors, but this linkage was seldom successful because few patients had more than one positive predictor. We propose to use the individual predictors that we have identified as randomization criteria in a future trial of extracorporeal membrane oxygenation for pediatric cases of adult respiratory distress syndrome.

Adolescent↗
PubMed2005

Surviving severe acute respiratory distress syndrome: utility of open-lung biopsy and large doses of dexamethasone.

The etiology of acute respiratory distress syndrome is wide and mortality is extremely high. We describe a patient dying from severe acute respiratory distress syndrome who had a tremendous recovery after receiving dexamethasone (1 g daily). This patient required positive end-expiratory pressure (up to 18 mm/Hg) and fractional inspiratory oxygen (up to 100%). Thirty-six hours after the large dose of corticosteroids, the respiratory mechanics and oxygenation were acceptable for extubation. Acute respiratory distress syndrome was proven and other etiologies of respiratory failure were ruled out by a bedside open-lung biopsy. The biopsy proven acute respiratory distress syndrome dramatically resolved with this salvage therapy. High-dose usage of corticosteroids for acute respiratory distress syndrome has tremendous potential.

Adult↗
PubMed2005

Prone position reduces lung stress and strain in severe acute respiratory distress syndrome.

The present authors hypothesised that in severe acute respiratory distress syndrome (ARDS), pronation may reduce ventilator-induced overall stress (i.e. transpulmonary pressure (P(L))) and strain of lung parenchyma (i.e. tidal volume (V(T))/end-expiratory lung volume (EELV) ratio), which constitute major ventilator-induced lung injury determinants. The authors sought to determine whether potential pronation benefits are maintained in post-prone semirecumbent (SR(PP)) posture under pressure-volume curve-dependent optimisation of positive end-expiratory pressure (PEEP). A total of 10 anesthetised/paralysed, mechanically ventilated (V(T) = 9.0+/-0.9 mL.kg(-1) predicted body weight; flow = 0.91+/-0.04 L.s(-1); PEEP = 9.4+/-1.3 cmH(2)O) patients with early/severe ARDS were studied in pre-prone semirecumbent (SR(BAS)), prone, and SR(PP) positions. Partitioned respiratory mechanics were determined during iso-flow (0.91 L.s(-1)) experiments (V(T) varied within 0.2-1.0 L), along with haemodynamics, gas exchange, and EELV. Compared with SR(BAS), pronation/SR(PP) resulted in reduced peak/plateau P(L) at V(T)s> or =0.6 L; static lung elastance and additional lung resistance decreased and chest wall elastance (in prone position) increased; EELV increased (23-33%); V(T)/EELV decreased (27-33%); arterial oxygen tension/inspiratory oxygen fraction and arterial carbon dioxide tension improved (21-43/10-14%, respectively), and shunt fraction/physiological dead space decreased (21-50/20-47%, respectively). In early/severe acute respiratory distress syndrome, pronation under positive end-expiratory pressure optimisation may reduce ventilator-induced lung injury risk. Pronation benefits may be maintained in post-prone semirecumbent position.

Adult↗
PubMed1979

Gas exchange, pulmonary mechanics and haemodynamics in adult respiratory distress syndrome: experimental results in Lewe miniature pigs.

Adult respiratory distress syndrome (ARDS) is a common medical emergency in respiratory care complicating a great variety of traumas and diseases. An animal model from Lewe miniature pigs has been developed to study the ARDS under standardized conditions; it is based on aspiration pneumonitis, a disorder often observed in ARDS, injuring the lung alveolar surfactant system. The experimental study was conducted under neuroleptanalgesia. ARDS was produced by intratracheal application of hydrochloric acid (0.2 mol/l) in an amount of 1.0 ml/kg body wt. The animals were ventilated automatically by a standardized ventilatory pattern in IPP mode. In all animals the time course of oxygenation ratio (Pa,O2/F1O2), arterial CO2 tension (Pa,CO2), ratio of alveolo--arterial oxygen tension difference to inspired oxygen fraction (Aa,DO2/F1O2), oxygen exchange ratio ((AaDO2/Pa,O2), lung compliance (CL), inspiratory airway resistance (RrsI), dead space ratio VD/VT), pulmonary artery pressure (PAP) and systemic blood pressure were studied. Changes in quasi-static volume--pressure curves, percentage change in lung water content and gross pathological finding were used to integrate the findings into a system of pathophysiological changes in ARDS. The animal group to which hydrochloric acid was administered shows severe pulmonary distress leading to death within 3.5--7.5 h. No significant changes in the measured parameters could be observed in the control group over a 14 h period. The results suggest that aspiration pneumonitis in Lewe miniature pigs is very suitable to investigate various problems in pathogenesis of ARDS. The model provides reproducible results which correlate very well with findings in different ARDS states. The models serves both to compare clinical states and to search for newer therapeutic manoeuvres.

Animals↗
PubMed2005

Wheezing illness and re-hospitalization in the first two years of life after neonatal respiratory distress syndrome.

OBJECTIVES: To determine the impact of respiratory distress syndrome (RDS) on wheezing illnesses and re-hospitalizations in children as old as 2 years of age. STUDY DESIGN: We observed 2 geographically defined cohorts of children with RDS born after 26 weeks of gestation during 1990 to 1995 and 1996 to 1999 and gestationally paired control subjects. Recurrent wheezing illness and the re-hospitalizations caused by a respiratory condition were recorded. RESULTS: In the first year of life, 47 of 224 infants with RDS and 18 of 224 control subjects born in 1990 to 1995 had recurrent wheezing illness (P <.005) compared with 21 of 109 infants with RDS and 14 of 109 control subjects in the latter cohort (P=.27). A higher number of infants with RDS were readmitted to the hospital (25% versus 13%, P=.002) in the former period, and they spent more days in hospital during both periods. The frequencies of wheezing remained constant in the second year of life, but hospital admissions decreased. Siblings at home, male sex, and bronchopulmonary dysplasia were additional risk factors of wheezing illnesses. CONCLUSION: RDS increases the incidence of wheezing illnesses during the first 2 years of life. Changes in the management of RDS during the 1990s was associated with a decreased incidence of subsequent RDS-associated respiratory morbidity.

Case-Control Studies↗
PubMed1976

Miliary tuberculosis and adult respiratory distress syndrome.

Three patients with miliary tuberculosis developed the adult respiratory distress syndrome. In two patients this complication developed despite treatment with antituberculous drugs. The third patient developed the syndrome, but miliary tuberculosis was not suspected. The presence of disseminated intravascular coagulation in all three cases suggests a possible pathophysiologic relation. Miliary tuberculosis should be considered in patients presenting with adult respiratory distress syndrome of unknown cause.

Adult↗
PubMed1976

Intravascular coagulation associated with the adult respiratory distress syndrome.

In seven of 30 consecutive patients with the adult respiratory distress syndrome, disseminated intravascular coagulation (DIC) developed. Increasing respiratory dysfunction characterized by decreased effective static compliance and increased hypoxemia coincided with the development of DIC. Patients in whom DIC developed were characterized by a high incidence of bleeding, gangrene of the extremities, renal dysfunction, mortality and autopsy evidence of fibrin microthrombi in the lungs, kidney and skin. In 12 of 23 patients who did not meet the criteria for DIC, the platelet count decreased by at least 50 per cent of the initial values at some time during their illness. Fibrin microthrombi were found in the lungs in the majority of the patients subjected to autopsy. These data support the concept that depostion of platelet on damaged pulmonary capillary endothelium may be more common in the adult respiratory distress syndrome than the DIC syndrome.

Adult↗
PubMed1999

Acute respiratory distress syndrome in children: a 10 year experience.

BACKGROUND: Acute respiratory distress syndrome is a well-recognized condition resulting in high permeability pulmonary edema associated with a high morbidity. OBJECTIVES: To examine a 10 year experience of predisposing factors, describe the clinical course, and assess predictors of mortality in children with this syndrome. METHODS: The medical records of all admissions to the pediatric intensive care unit over a 10 year period were evaluated to identify children with ARDS. Patients were considered to have ARDS if they met all of the following criteria: acute onset of diffuse bilateral pulmonary infiltrates of non-cardiac origin and severe hypoxemia defined by < 200 partial pressure of oxygen during > or = 6 cm H2O positive end-expiratory pressure for a minimum of 24 hours. The medical records were reviewed for demographic, clinical, and physiologic information including PaO2/forced expiratory O2, alveolar-arterial O2 difference, and ventilation index. RESULTS: We identified 39 children with the adult respiratory distress syndrome. Mean age was 7.4 years (range 50 days to 16 years) and the male:female ratio was 24:15. Predisposing insults included sepsis, pneumonias, malignancy, major trauma, shock, aspiration, near drowning, burns, and envenomation. The mortality rate was 61.5%. Predictors of death included the PaO2/FIO2, ventilation index and A-aDO2 on the second day after diagnosis. Nonsurvivors had significantly lower PaO2/FIO2 (116 +/- 12 vs. 175 +/- 8.3, P < 0.001), and higher A-aDO2 (368 +/- 28.9 vs. 228.0 +/- 15.5, P < 0.001) and ventilation index (43.3 +/- 2.9 vs. 53.1 +/- 18.0, P < 0.001) than survivors. CONCLUSIONS: Local mortality outcome for ARDS is comparable to those in tertiary referral institutions in the United States and Western Europe. The PaO2/FIO2, A-aDO2 and ventilation index are valuable for predicting outcome in ARDS by the second day of conventional therapy. The development of a local risk profile may allow early application of innovative therapies in this population.

Acute Disease↗
PubMed1987

Evaluating the clinical effectiveness of amniotic fluid assays in predicting respiratory distress syndrome in the neonate.

Amniotic fluid phospholipids from 346 patients' specimens were quantified and evaluated against the clinical outcome (i.e., respiratory distress syndrome or normal respiratory function). Concentrations of lecithin, sphingomyelin, phosphatidylglycerol, and the lecithin/sphingomyelin reflectance ratio were evaluated by ordered frequency distribution and stepwise discriminant function analysis. The lecithin/sphingomyelin ratio was the best single test for discriminating between respiratory distress syndrome and normal pulmonary function in the fetus, slightly superior to lecithin assay alone. A combination of lecithin/sphingomyelin ratio and lecithin concentration, however, appeared to optimize the discriminant function, although the clinical significance of this test combination remained marginal. High concentrations of phosphatidylglycerol were correlated with high concentrations of lecithin, and virtually ruled out respiratory distress syndrome. Absence of phosphatidylglycerol was not diagnostic. High concentrations of sphingomyelin increased the probability of respiratory distress syndrome. We suggest the following stepwise series of tests to optimize diagnosis: phosphatidylglycerol concentration, sphingomyelin concentration, and finally lecithin-sphingomyelin ratio.

Amniotic Fluid↗
PubMed2001

Elevated plasma surfactant protein-B predicts development of acute respiratory distress syndrome in patients with acute respiratory failure.

Surfactant protein-B is a lung specific protein secreted into the air spaces by pulmonary epithelial type II cells that leaks into the bloodstream in increased amounts in patients with ARDS. To test whether elevated plasma levels of surfactant protein-B would predict the development of ARDS in patients with acute hypoxemic respiratory failure, plasma and lung injury scores were collected at study entry and daily thereafter for 3 d from 54 patients admitted to our intensive care unit. ARDS was defined as a new bilateral infiltrate on chest radiograph and a lung injury score > or = 2.5. Twenty patients developed ARDS, of whom seven died. Although the initial lung injury score was not predictive of ARDS, the initial plasma surfactant protein-B was predictive (area under the curve = 0.77 [0.63 to 0.90], nonparametric receiver-operating characteristic analysis). In this cohort, plasma surfactant protein-B was particularly predictive of ARDS when applied to patients suffering a direct lung insult (area under the curve = 0.87 [0.72 to 1.02]), with a sensitivity of 85% (95% CI: 55 to 98%) and specificity of 78% (40 to 97%) at a cutoff of 4,994 ng/ml.

Acute Disease↗
PubMed1992

Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction.

The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case-controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri-operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (greater than 300 l) and age (greater than 60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.

Adult↗
PubMedDate not supplied

[Delayed respiratory distress syndrome of the newborn infant].

Apart from the early onset respiratory distress syndrome of the newborn, there is a "delayed" form of this syndrome beginning a few days or later after birth. Based on 24 patients the differential diagnosis of this "delayed" respiratory distress syndrome is discussed.

Diagnosis, Differential↗
PubMed1994

Clinical experiences with high-frequency oscillatory ventilation in newborns with severe respiratory distress syndrome.

OBJECTIVE: To generate hypotheses about which subgroups of newborns with severe respiratory distress syndrome might benefit most from high-frequency oscillatory ventilation. DESIGN: Retrospective analysis of a case series of newborns with severe respiratory distress syndrome who were treated in our department with high-frequency oscillatory ventilation. SETTING: Referral center for neonatal and pediatric intensive care medicine. PATIENTS: All newborns (n = 18), admitted between June 1991 and February 1993, of various gestational ages (26 to 41 wks), with severe respiratory distress syndrome caused by various underlying pulmonary diseases who did not respond to conventional therapy and who thus were treated with high-frequency oscillatory ventilation. MAIN OUTCOME MEASURES: Survival until discharge from our unit and persistent improvement of gas exchange. RESULTS: Eight (44%) of 18 patients survived; ten (55%) patients died. Four (22%) survivors showed marked clinical improvement with the initiation of high-frequency oscillatory ventilation. Four (22%) survivors did not respond to high-frequency oscillatory ventilation. The responder group consisted of term or near-term neonates (gestational age at least 35 wks) with pulmonary disease that was complicated by persistent pulmonary hypertension. The group of premature neonates with a gestational age of < 35 wks did not respond to high-frequency oscillatory ventilation. CONCLUSIONS: As a result of our analysis, we hypothesize that term newborns with severe respiratory distress syndrome complicated by persistent pulmonary hypertension and hypercarbia can benefit from high-frequency oscillatory ventilation. Premature neonates with ventilation-induced lung injury are not likely to respond to high-frequency oscillatory ventilation.

Female↗
PubMed1991

[Acute adult respiratory distress syndrome in leptospirosis].

The respiratory manifestations of leptospirosis are usually benign. A case is reported of leptospirosis with serious pulmonary affection. Pulmonary involvement in leptospirosis is infrequently predominant and usually without bearing on prognosis. Clinical and roentgenological features are reviewed. Severe forms with massive hemoptysis or acute respiratory failure occur occasionally. The clinical symptoms, the radiological manifestations and haemodynamic investigation were suggestive of an acute respiratory distress by non haemodynamic pulmonary oedema. In accordance with other authors, one could be justified in including this acute respiratory failure as part of the adult respiratory distress syndrome. Since leptospirosis has extremely diverse clinical features, physicians should have this diagnosis in mind in many circumstances and should request the appropriate examinations at the right moment. Carefully performed microbiological techniques may reduce the problems encountered in isolating leptospires. Serological tests requested after the 12th day of the disease and repeated several times should improve the diagnosis confirmation. The potential severity of certain forms justifies curative antibiotic therapy.

Adolescent↗
PubMed1998

Acute respiratory distress syndrome. Cellular biology and pathology.

The acute respiratory distress syndrome (ARDS) is a nonspecific host response to a variety of injurious agents that often are divided into those related to airways and those resulting from a vascular insult. The known predisposing factors usually result in the recognized clinical syndrome within 72 hours of exposure.

Animals↗