Volume15 June2003 Number6
CHINESE CRITICAL CARE MEDICINE
Volume15 June2003 Number6
CONTENT SOFORIGINAL ARTICLES
Attention should be paid to study the hospital response system to disaster and incident
HUANG Zhi-qiang (324)
Recommendations on corticosteroid therapy in patients with severe acute respiratory syndrome
HE Quan-ying (326)
, 百拇医药
Attention should be paid to understand the biological hazard and improve the ability for emergency response
CAO Wu-chun, CHENG Yun-song (327)
The important issues underlying the treatment of patients with severe SARS
YU Sen-yang (330)
Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome
GAO Zhan-cheng, ZHU Ji-hong, SUN Yan, et al (332)
, 百拇医药
Death risk factors of severe acute respirotary syndrome with acute respiratory distress syndrome
HE Wei-qun, CHEN Si-bei, LIU Xiao-qing, et al (336)
Analysis of chest X-ray manifestations in 118 patients with severe acute respiratory syndrome
MA Wei, CHEN Guo-feng, LI Tan-shi, et al (338)
Clinical therapy of severe SARS: 38 cases retrospective analysis
, 百拇医药
XU Yuan-da, LI Yi-min,LIU Xiao-qing, et al (343)
Corticosteroid therapy and changes in chest radiogram in five patients with severe acute respiratory syndrome
ZHANG Jin, YANG Xia, TAN Hai, et al (346)
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome
SONG Zhi-fang， GUO Xiao-hong, WANG Shu-yun, et al (349)
, 百拇医药
Effect of noninvasive positive pressure ventilation on treatment of acute respiratory distress syndrome
XU Si-cheng, HUANG Yi-fen, WANG Xi-yan， et al (354)
Nursing care for patients with severe acute respiratory syndrome
WANG Qiao-feng (357)
Evaluation of mechanical ventilation for patients with acute respiratory distress syndrome as a result of
, 百拇医药
interstitial pneumonia after renal transplantation
SONG Zhi-fang, YU Kang-long, SHAN Hong-wei, et al (358)
Potential role of cytokines in idiopathic pulmonary fibrosis
WU Xiao-mei, WANG Xin-yan, CHEN Fu-hui (362)
A design for new disinfector of ventilator associated with exhaust-gas
WANG Li-xiang (364)
, 百拇医药
Changes in interleukin-1β in serum and bronchoalveolar lavage fluid in the patient with acute respiratory distress syndrome
LUO Xian-rong, WU Wei-ling, WANG Lin, et al (365)
Effect of combination of nitric oxide inhalation and inverse ratio ventilation in endotoxin-induced acute respiratory distresssyndrome in sheep
LIU Shao-hua, XU Xin-rong, XU Ji, et al (367)
, 百拇医药
Mechanical ventilation strategies for patients with severe acute respiratory syndrome
QIN Ying-zhi, XU Lei, ZHANG Na-xin, et al (370)
A retrospective study in the treatment of five patients with severe acute respiratory syndrome
CAO Xiang-yuan, ZHENG Xi-wei, ZHANG Jin, et al (371)
Screening and cloning of susceptible genes related to acute lung injury
, 百拇医药
FENG Gang, WANG Zheng-guo (372)
Experience of nursing care in patients with severe acute respiratory syndrome
REN Ying-chun, LU Xia, LIANG Yan (375)
Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome
Departments of Respiratory Medicine, Peking University People's Hospital, Beijing 100044, China
, 百拇医药
OBJECTIVE: To summarize and analyze the clinical manifestation, diagnosis and therapeutic strategy of severe acute respiratory syndrome (SARS), and its characteristics of outbreak in hospital via infection transmission cluster associated with SARS patients. METHODS: ① Two hospitalized community acquired SARS cases with their clinical data and epidemiologically linked transmission clusters in our hospital were analyzed; ② The clinical data from 41 SARS cases were summarized. RESULTS: ① The contagiousness of SARS virus in SARS patients was extremely strong, especially in their acute stage. ② The majority of clinical manifestations were fever (100% cases), and there were no obvious respiratory symptoms in more than half of the patients (53.7%) at early SARS stage (day 1 to day 3), accompanied by leucopenia(52.6%) and lymphopenia (68.4%). ③ Timely administration of Ribavirin, Methylprednisolone, immunoenhancer (such as interferon α-2b, thymosin-α1) to SARS patients was efficacious to certain extent in controlling the development of the disease. CONCLUSION: It is very important for clinicians to pay great attention to protect themselves from infection of SARS. Early discovery of SARS, early isolation of SARS patients, and early treatment are very helpful to improving patient's prognosis and controlling SARS overspread.
, http://www.100md.com
Death risk factors of severe acute respirotary syndrome with acute respiratory distress syndrome
Guangzhou Institute of Respiratory Disease, Yingdong Critical Care Medical Center, Guangzhou 510120, Guangdong, China
OBJECTIVE: To discuss the possible death risk factors of severe acute respiratory syndrome (SARS) with acute respiratory distress syndrome (ARDS). METHODS: Twenty-five patients surfffered from SARS with ARDS in the intensive care unit were retrospectively analyzed from December 2002 to April 2003. Statistical analysis was made using SPSS 10.0 and forward stepwise (wald) logistic regression analysis were used to determine the interrelationships between multiple variables and death. P<0.05 was considered statistically significant. RESULTS: The following factors were associated with a significantly higher mortality rate in the SARS with ARDS patients, including age increase (OR=1.203, CI=1.036 to 1.396, P=0.016), long-time hypoxia(OR=1.067, CI=1.014 to 1.122, P=0.013), thrombocytopenia(OR=111.932, CI=6.096 to 2 055.252, P=0.001), hypernatremia (OR=26.667, CI=2.242 to 317.147, P=0.009), and elevation of serum creatinine levels (OR=111.932, CI=6.096 to 2 055.252, P=0.001). CONCLUSION: More attention should be paid to deal with these risk factors and to prevent the development of serious complications associated with SARS.
, 百拇医药
Analysis of chest X-ray manifestations in 118 patients with severe acute respiratory syndrome
The 302nd Hospital of People's Liberation Army, Beijing 100039, China
OBJECTIVE: To investigate the chest X-ray features and kinetic changes in patients with severe acute respiratory syndrome (SARS). METHODS: The appearing time, site, range and imaging features of pulmonary lesions in chest radiograms were observed in 118 patients with clinically confirmed SARS treated in our hospital. Meanwhile, their relation to clinical manifestations was also evaluated. RESULTS: Abnormal image appeared in the radiogram in 99.2% of the patients, and it was found in 79.7% of the patients within 4 days after onset of SARS. Lesions in both lungs and multi-lobe pathological changes were noted in 52.2% of the patients. In seven non-survivors, the lesions were included multi-lung lobes, revealing earlier appearance and faster progression compared with the others. CONCLUSION: The more serious clinical symptoms and poor prognosis are found in patients with earlier appearance, larger scope and faster progression of SARS lesions in the chest radiogram.
, 百拇医药
Clinical therapy of severe acute respiratory syndrome: 38 cases retrospective analysis
Guangzhou Institute of Respiratory Disease, Yingdong Critical Care Medical Center, Guangzhou 510120, Guandong, China
OBJECTIVE: To analyze the clinical features and therapy experience of severe acute respiratory syndrome (SARS). METHODS: From December 2002 to April 2003 in Guangzhou Institute of Respiratory Disease, 38 patients with severe SARS were retrospectively studied to evaluate the relationship between treatment strategy and prognosis. RESULTS: Thirty-eight cases of severe SARS were diagnosed. Comprehensive measures most commonly included corticosteroids, antibiotics, antivirotics, nutritional support and mechanical ventilation. Thirty cases were cured (78.9%), of them 11 cases had pulmonary fibrosis (36.7%), 8 patients died (21.1%) in all cases. CONCLUSION: Severe SARS might develop rapidly. In addition to early diagnosis, prompt isolation, and emergency therapy, appropriate use of corticosteroid and noninvasive ventilation should be recommended.
, 百拇医药
Corticosteroid therapy and changes in chest radiogram in five patients with severe acute respiratory syndrome
Department of Respiratory Medicine, Affiliated Hospital of Ningxia Medical College, Ningxia 750004, China
OBJECTIVE: To investigate the relationship between corticosteroid therapy and kinetic changes in chest X-ray in five patients with severe acute respiratory syndrome (SARS). METHODS: With the identical underlying therapy (levofloxacin or ceftriaxone and macrolide), intravenous methylprednisolone was given at 80 mg twice a day in five patients, and its effect on the development of chest radiogram was observed. RESULTS: Chest X-rays radiogram showed significant changes until peak stage (4-12 days) with the same doses of methylprednisolone, but it was dissolved consistently afterwards. CONCLUSION: It is appeared that corticosteroid therapy has no marked effect on the development of chest radiogram in patients with SARS. It might indicate there is self-limited in course of SARS.
, http://www.100md.com
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome
Medical Intensive Care Unit， Xinhua Hospital， The Second Medical University of Shanghai，Shanghai 200092, China
OBJECTIVE: To value of glucocorticoid (GC) in treatment for patients with acute respiratory distress syndrome (ARDS) was evaluated. METHODS: The clinical data from all patients with ARDS in medical ICU (MICU) during May 2000 to Aug. 2002 were collected. They were divided into two groups, GC and non-GC groups, in order to compare their age, sex, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, PaO2/FiO2, Qs/Qt, level of positive end-expiratory pressure(PEEP), mortality and dead reason of death, depending on whether GC was given or not. In cases with administration of GC, the dosage, as well as duration of treatment was analyzed in terms of the overcome. RESULTS: There were 77 cases totally, among them 60 cases were of GC group and 17 of non -GC. Their age, sex, APACHE Ⅱscore, PaO2/FiO2, Qs/Qt, use of artifical ventilation and its duration, level of PEEP, and the extent of relief from hypoxemia showed no significant differences between two groups (P>0.05). Even the mortality for patients who were treated with GC was higher than those without(71.7% vs. 52.9%)， though there was no statistically significant difference (P>0.05). The percentage of patients died primarily of ARDS was low in both groups (7.0% and 11.1%). The age, APACHE Ⅱ score and underlying diseases for non-survivors were older and higher than survivors (P<0.001 or P<0.005) and their duration of staying in ICU was shorter than the latter (P<0.05). The mortality of patients who were given GC before or during 24 hours of the establishment of the diagnosis of ARDS (66.7% and 68.2%) was lower than those who were given GC 24 hours after the diagnosis of ARDS (90.0%). CONCLUSION: GC could be one of effective treatments for ARDS, and it should be given without hesitation when refractory hypoxemia and shock were found.
, 百拇医药
Effect of noninvasive positive pressure ventilation on treatment of acute respiratory distress syndrome
Respiratory Department, First Affiliated Hospital of Xinjiang Medical University, Urmqi 830000, Xinjiang, China
OBJECTIVE: To investigate the factors affecting the effect of noninvasive positive pressure ventilation (NIPPV) on treatment of acute respiratory distress syndrome (ARDS). METHODS: According to the disease-induced factors, patients with ARDS were divided into two groups: group A (pulmonary factors), group B (extra-pulmonary factors). Different kinds of ventilator s were used in the course of NIPPV via facial or nasal mask. The mode, biphasic intermittent positive airway pressure (BiPAP, BiPAP vision), pressure support ventilation (PSV) + positive end-expiratory pressure (PEEP) or synchronized intermittent mandatory ventilation (SIMV) + PSV + PEEP, was administered. After 3-10 hours, the patients who were not fit to NIPPV were conducted intubation. RESULTS: Group A had 9 cases, of whom 5 cases were treated with NIPPV all the time, while in group B, 14 cases, of whom 12 cases The cure rate of group A by NIPPV was 55.6%(5/9), while that of group B was 85.7%(12/14), P<0.05. CONCLUSION: Selecting proper indication, reasonable ventilator mode and parameters, and improving the unfavorable factors can contribute to the decrease of intubation rate.
, 百拇医药
Evaluation of mechanical ventilation for patients with acute respiratory distress syndrome as a result of interstitial pneumonia after renal transplantation
Department of Medical Intensive Care Unit, Xinhua Hospital, The Second Medical University of Shanghai, Shanghai 200092, China
OBJECTIVE: To evaluate the clinical value of mechanical ventilation for patients with acute respiratory distress syndrome(ARDS) as a result of interstitial pneumonia after renal transplantation in the intensive care unit(ICU). METHODS: All the clinical data (totally 16 cases) were collected, including the improvement of hypoxemia before and after mechanical ventilation. RESULTS: Different levels of positive end-expiratory pressure(PEEP) 4-15 cm H2O(1 cm H2O=0.098 kPa) were applied in the patients in whom mechanical ventilation was instituted. The time for different mechanical ventilation was different [1-87 days, (15.4±21.1)days] and duration of survival was different [1-1 945 days, (154.4±497.1)days]. Only one of them was survived(6.7%), and the others died (93.3%). The causes of death were analyzed. Among the patients who received the mechanical ventilation, 3 patients were alive less than 3 days and their dire ct cause of death was not respiratory (circulation and central). Only one of them did not receive artifical ventilation and the cause of death was hypoxemia. The successful experience for one survivor among the patients who received the ventilator was that hypoxemia was improved by the mechanical ventilation, winning the time for the treatment of the original disease. CONCLUSION: The major value of mechanical ventilation was to correct the hypoxemia in order to win the time to cure the interstitial pneumonia and ARDS. The survival rate was still low for such a group of patients because the pathogenesis was not identified, and therefor the disease could not be controlled, even the mechanical ventilation is instituted in time.
, http://www.100md.com
Potential role of cytokines in idiopathic pulmonary fibrosis
Department of Respiratory Disease, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang, China
OBJECTIVE: To investigate the expression of platelet-derived growth factor(PDGF) and transforming growth factor-β(TGF-β) in transbronchial lung biopsy(TBLB) from patients
with idiopathic pulmonary fibrosis(IPF), and study the potential role of cytokines in the development of IPF. METHODS: The immunohistochemical methods were used to determine the expression of PDGF, TGF-β in TBLB from patients with IPF. RESULTS: In IPF patients, TGF-β mainly existed at tiny bronchial epithelial cells, alveolar epithelial type-Ⅱ cells and alveolar macrophages, showing strong expression compared with controls (P<0.01). PDGF mainly existed at fibroblast-like cells surrounding pulmonary vessels, fibroblasts, tiny bronchial epithelial cells, alveolar epithelial type-Ⅱ cells and alveolar macrophages, showing strong expression compared with controls (P<0.01). CONCLUSION: PDGF and TGF-β, which interact with pulmonary mesenchymal cells, are involved in the formation of pulmonary fibrosis.
, 百拇医药
Changes in interleukin-1β in serum and bronchoalveolar lavage fluid in the patient with acute respiratory distress syndrome
Department of Respiratory Disease, Airforce Hospital of People's Liberation Army, Guangzhou, 510602 Guangdong, China
OBJECTIVE: To study the role of interleukin-1β(IL-1β) in the pathogenesis of acute respiratory distress syndrome (ARDS). METHODS: The bronchoalveolar lavage fluid (BALF) and serum in 13 patients with ARDS and 9 healthy controls were collected. The contents of IL-1β were measured by enzyme-linked immunoadsorbent assay(ELISA). RESULTS: The levels of IL-1β in BALF [(144.67±80.79)ng/L] and serum [(45.71±7.09)ng/L] in patients with ARDS were significantly higher than those in the control groups [(20.39±1.87)ng/L， P＝0.000； (35.06±5.46)ng/L, P＝0.001, respectively], and the levels of IL-1β in BALF were also significantly higher than those of the serum in the patients with ARDS (P＝0.000). CONCLUSION: The results indicate that IL-1β is involved in the pathogenesis of ARDS. Early determination of IL-1β level in BALF may be more valuable in the evaluation of disease process of ARDS.
, 百拇医药
Effect of combination of nitric oxide inhalation and inverse ratio ventilation in endotoxin-induced acute respiratory distress syndrome in sheep
The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
OBJECTIVE: To observe the effect of combination of nitric oxide (NO) inhalation and inverse ratio ventilation (IRV) on oxygenation and hemodynamics in endotoxin-induced acute respiratory distress syndrome (ARDS) in sheep. METHODS: Sheep ARDS model was induced by an intravenous infusion of low dose endotoxin, and then animals were randomly divided into two groups. ① NO group (n=6), inhalation of 40×10 -6 nitric oxide. ② Combination group (n=6), receiving mechanical ventilation with IRV (inspiratory-to-expiratory ratio of 2∶1) and in halation of 40×10 -6 NO. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter and arterial blood gas analysis before and after the onset of, ARDS and 30 minutes after treatment. RESULTS: The combination of IRV and 40×10 -6 NO inhalation rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO2, decreased P(A-a)O 2, and Qs/Qt without inducing significant change in systemic hemodynamics, and it was a more effective method of correcting hypoxemia than inhalation of nitric oxide alone. NO inhalation did not change the airway pressure of the model, but the combined treatment resulted in reduction of peak inspiratory pressure and increase of mean airway pressure. CONCLUSION: The combined use of IRV and NO inhalation has an additive effect on improving oxygenation in endotoxin-induced acute respiratory distress syndrome in sheep., 百拇医药
Volume15 June2003 Number6
CONTENT SOFORIGINAL ARTICLES
Attention should be paid to study the hospital response system to disaster and incident
HUANG Zhi-qiang (324)
Recommendations on corticosteroid therapy in patients with severe acute respiratory syndrome
HE Quan-ying (326)
, 百拇医药
Attention should be paid to understand the biological hazard and improve the ability for emergency response
CAO Wu-chun, CHENG Yun-song (327)
The important issues underlying the treatment of patients with severe SARS
YU Sen-yang (330)
Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome
GAO Zhan-cheng, ZHU Ji-hong, SUN Yan, et al (332)
, 百拇医药
Death risk factors of severe acute respirotary syndrome with acute respiratory distress syndrome
HE Wei-qun, CHEN Si-bei, LIU Xiao-qing, et al (336)
Analysis of chest X-ray manifestations in 118 patients with severe acute respiratory syndrome
MA Wei, CHEN Guo-feng, LI Tan-shi, et al (338)
Clinical therapy of severe SARS: 38 cases retrospective analysis
, 百拇医药
XU Yuan-da, LI Yi-min,LIU Xiao-qing, et al (343)
Corticosteroid therapy and changes in chest radiogram in five patients with severe acute respiratory syndrome
ZHANG Jin, YANG Xia, TAN Hai, et al (346)
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome
SONG Zhi-fang， GUO Xiao-hong, WANG Shu-yun, et al (349)
, 百拇医药
Effect of noninvasive positive pressure ventilation on treatment of acute respiratory distress syndrome
XU Si-cheng, HUANG Yi-fen, WANG Xi-yan， et al (354)
Nursing care for patients with severe acute respiratory syndrome
WANG Qiao-feng (357)
Evaluation of mechanical ventilation for patients with acute respiratory distress syndrome as a result of
, 百拇医药
interstitial pneumonia after renal transplantation
SONG Zhi-fang, YU Kang-long, SHAN Hong-wei, et al (358)
Potential role of cytokines in idiopathic pulmonary fibrosis
WU Xiao-mei, WANG Xin-yan, CHEN Fu-hui (362)
A design for new disinfector of ventilator associated with exhaust-gas
WANG Li-xiang (364)
, 百拇医药
Changes in interleukin-1β in serum and bronchoalveolar lavage fluid in the patient with acute respiratory distress syndrome
LUO Xian-rong, WU Wei-ling, WANG Lin, et al (365)
Effect of combination of nitric oxide inhalation and inverse ratio ventilation in endotoxin-induced acute respiratory distresssyndrome in sheep
LIU Shao-hua, XU Xin-rong, XU Ji, et al (367)
, 百拇医药
Mechanical ventilation strategies for patients with severe acute respiratory syndrome
QIN Ying-zhi, XU Lei, ZHANG Na-xin, et al (370)
A retrospective study in the treatment of five patients with severe acute respiratory syndrome
CAO Xiang-yuan, ZHENG Xi-wei, ZHANG Jin, et al (371)
Screening and cloning of susceptible genes related to acute lung injury
, 百拇医药
FENG Gang, WANG Zheng-guo (372)
Experience of nursing care in patients with severe acute respiratory syndrome
REN Ying-chun, LU Xia, LIANG Yan (375)
Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome
Departments of Respiratory Medicine, Peking University People's Hospital, Beijing 100044, China
, 百拇医药
OBJECTIVE: To summarize and analyze the clinical manifestation, diagnosis and therapeutic strategy of severe acute respiratory syndrome (SARS), and its characteristics of outbreak in hospital via infection transmission cluster associated with SARS patients. METHODS: ① Two hospitalized community acquired SARS cases with their clinical data and epidemiologically linked transmission clusters in our hospital were analyzed; ② The clinical data from 41 SARS cases were summarized. RESULTS: ① The contagiousness of SARS virus in SARS patients was extremely strong, especially in their acute stage. ② The majority of clinical manifestations were fever (100% cases), and there were no obvious respiratory symptoms in more than half of the patients (53.7%) at early SARS stage (day 1 to day 3), accompanied by leucopenia(52.6%) and lymphopenia (68.4%). ③ Timely administration of Ribavirin, Methylprednisolone, immunoenhancer (such as interferon α-2b, thymosin-α1) to SARS patients was efficacious to certain extent in controlling the development of the disease. CONCLUSION: It is very important for clinicians to pay great attention to protect themselves from infection of SARS. Early discovery of SARS, early isolation of SARS patients, and early treatment are very helpful to improving patient's prognosis and controlling SARS overspread.
, http://www.100md.com
Death risk factors of severe acute respirotary syndrome with acute respiratory distress syndrome
Guangzhou Institute of Respiratory Disease, Yingdong Critical Care Medical Center, Guangzhou 510120, Guangdong, China
OBJECTIVE: To discuss the possible death risk factors of severe acute respiratory syndrome (SARS) with acute respiratory distress syndrome (ARDS). METHODS: Twenty-five patients surfffered from SARS with ARDS in the intensive care unit were retrospectively analyzed from December 2002 to April 2003. Statistical analysis was made using SPSS 10.0 and forward stepwise (wald) logistic regression analysis were used to determine the interrelationships between multiple variables and death. P<0.05 was considered statistically significant. RESULTS: The following factors were associated with a significantly higher mortality rate in the SARS with ARDS patients, including age increase (OR=1.203, CI=1.036 to 1.396, P=0.016), long-time hypoxia(OR=1.067, CI=1.014 to 1.122, P=0.013), thrombocytopenia(OR=111.932, CI=6.096 to 2 055.252, P=0.001), hypernatremia (OR=26.667, CI=2.242 to 317.147, P=0.009), and elevation of serum creatinine levels (OR=111.932, CI=6.096 to 2 055.252, P=0.001). CONCLUSION: More attention should be paid to deal with these risk factors and to prevent the development of serious complications associated with SARS.
, 百拇医药
Analysis of chest X-ray manifestations in 118 patients with severe acute respiratory syndrome
The 302nd Hospital of People's Liberation Army, Beijing 100039, China
OBJECTIVE: To investigate the chest X-ray features and kinetic changes in patients with severe acute respiratory syndrome (SARS). METHODS: The appearing time, site, range and imaging features of pulmonary lesions in chest radiograms were observed in 118 patients with clinically confirmed SARS treated in our hospital. Meanwhile, their relation to clinical manifestations was also evaluated. RESULTS: Abnormal image appeared in the radiogram in 99.2% of the patients, and it was found in 79.7% of the patients within 4 days after onset of SARS. Lesions in both lungs and multi-lobe pathological changes were noted in 52.2% of the patients. In seven non-survivors, the lesions were included multi-lung lobes, revealing earlier appearance and faster progression compared with the others. CONCLUSION: The more serious clinical symptoms and poor prognosis are found in patients with earlier appearance, larger scope and faster progression of SARS lesions in the chest radiogram.
, 百拇医药
Clinical therapy of severe acute respiratory syndrome: 38 cases retrospective analysis
Guangzhou Institute of Respiratory Disease, Yingdong Critical Care Medical Center, Guangzhou 510120, Guandong, China
OBJECTIVE: To analyze the clinical features and therapy experience of severe acute respiratory syndrome (SARS). METHODS: From December 2002 to April 2003 in Guangzhou Institute of Respiratory Disease, 38 patients with severe SARS were retrospectively studied to evaluate the relationship between treatment strategy and prognosis. RESULTS: Thirty-eight cases of severe SARS were diagnosed. Comprehensive measures most commonly included corticosteroids, antibiotics, antivirotics, nutritional support and mechanical ventilation. Thirty cases were cured (78.9%), of them 11 cases had pulmonary fibrosis (36.7%), 8 patients died (21.1%) in all cases. CONCLUSION: Severe SARS might develop rapidly. In addition to early diagnosis, prompt isolation, and emergency therapy, appropriate use of corticosteroid and noninvasive ventilation should be recommended.
, 百拇医药
Corticosteroid therapy and changes in chest radiogram in five patients with severe acute respiratory syndrome
Department of Respiratory Medicine, Affiliated Hospital of Ningxia Medical College, Ningxia 750004, China
OBJECTIVE: To investigate the relationship between corticosteroid therapy and kinetic changes in chest X-ray in five patients with severe acute respiratory syndrome (SARS). METHODS: With the identical underlying therapy (levofloxacin or ceftriaxone and macrolide), intravenous methylprednisolone was given at 80 mg twice a day in five patients, and its effect on the development of chest radiogram was observed. RESULTS: Chest X-rays radiogram showed significant changes until peak stage (4-12 days) with the same doses of methylprednisolone, but it was dissolved consistently afterwards. CONCLUSION: It is appeared that corticosteroid therapy has no marked effect on the development of chest radiogram in patients with SARS. It might indicate there is self-limited in course of SARS.
, http://www.100md.com
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome
Medical Intensive Care Unit， Xinhua Hospital， The Second Medical University of Shanghai，Shanghai 200092, China
OBJECTIVE: To value of glucocorticoid (GC) in treatment for patients with acute respiratory distress syndrome (ARDS) was evaluated. METHODS: The clinical data from all patients with ARDS in medical ICU (MICU) during May 2000 to Aug. 2002 were collected. They were divided into two groups, GC and non-GC groups, in order to compare their age, sex, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, PaO2/FiO2, Qs/Qt, level of positive end-expiratory pressure(PEEP), mortality and dead reason of death, depending on whether GC was given or not. In cases with administration of GC, the dosage, as well as duration of treatment was analyzed in terms of the overcome. RESULTS: There were 77 cases totally, among them 60 cases were of GC group and 17 of non -GC. Their age, sex, APACHE Ⅱscore, PaO2/FiO2, Qs/Qt, use of artifical ventilation and its duration, level of PEEP, and the extent of relief from hypoxemia showed no significant differences between two groups (P>0.05). Even the mortality for patients who were treated with GC was higher than those without(71.7% vs. 52.9%)， though there was no statistically significant difference (P>0.05). The percentage of patients died primarily of ARDS was low in both groups (7.0% and 11.1%). The age, APACHE Ⅱ score and underlying diseases for non-survivors were older and higher than survivors (P<0.001 or P<0.005) and their duration of staying in ICU was shorter than the latter (P<0.05). The mortality of patients who were given GC before or during 24 hours of the establishment of the diagnosis of ARDS (66.7% and 68.2%) was lower than those who were given GC 24 hours after the diagnosis of ARDS (90.0%). CONCLUSION: GC could be one of effective treatments for ARDS, and it should be given without hesitation when refractory hypoxemia and shock were found.
, 百拇医药
Effect of noninvasive positive pressure ventilation on treatment of acute respiratory distress syndrome
Respiratory Department, First Affiliated Hospital of Xinjiang Medical University, Urmqi 830000, Xinjiang, China
OBJECTIVE: To investigate the factors affecting the effect of noninvasive positive pressure ventilation (NIPPV) on treatment of acute respiratory distress syndrome (ARDS). METHODS: According to the disease-induced factors, patients with ARDS were divided into two groups: group A (pulmonary factors), group B (extra-pulmonary factors). Different kinds of ventilator s were used in the course of NIPPV via facial or nasal mask. The mode, biphasic intermittent positive airway pressure (BiPAP, BiPAP vision), pressure support ventilation (PSV) + positive end-expiratory pressure (PEEP) or synchronized intermittent mandatory ventilation (SIMV) + PSV + PEEP, was administered. After 3-10 hours, the patients who were not fit to NIPPV were conducted intubation. RESULTS: Group A had 9 cases, of whom 5 cases were treated with NIPPV all the time, while in group B, 14 cases, of whom 12 cases The cure rate of group A by NIPPV was 55.6%(5/9), while that of group B was 85.7%(12/14), P<0.05. CONCLUSION: Selecting proper indication, reasonable ventilator mode and parameters, and improving the unfavorable factors can contribute to the decrease of intubation rate.
, 百拇医药
Evaluation of mechanical ventilation for patients with acute respiratory distress syndrome as a result of interstitial pneumonia after renal transplantation
Department of Medical Intensive Care Unit, Xinhua Hospital, The Second Medical University of Shanghai, Shanghai 200092, China
OBJECTIVE: To evaluate the clinical value of mechanical ventilation for patients with acute respiratory distress syndrome(ARDS) as a result of interstitial pneumonia after renal transplantation in the intensive care unit(ICU). METHODS: All the clinical data (totally 16 cases) were collected, including the improvement of hypoxemia before and after mechanical ventilation. RESULTS: Different levels of positive end-expiratory pressure(PEEP) 4-15 cm H2O(1 cm H2O=0.098 kPa) were applied in the patients in whom mechanical ventilation was instituted. The time for different mechanical ventilation was different [1-87 days, (15.4±21.1)days] and duration of survival was different [1-1 945 days, (154.4±497.1)days]. Only one of them was survived(6.7%), and the others died (93.3%). The causes of death were analyzed. Among the patients who received the mechanical ventilation, 3 patients were alive less than 3 days and their dire ct cause of death was not respiratory (circulation and central). Only one of them did not receive artifical ventilation and the cause of death was hypoxemia. The successful experience for one survivor among the patients who received the ventilator was that hypoxemia was improved by the mechanical ventilation, winning the time for the treatment of the original disease. CONCLUSION: The major value of mechanical ventilation was to correct the hypoxemia in order to win the time to cure the interstitial pneumonia and ARDS. The survival rate was still low for such a group of patients because the pathogenesis was not identified, and therefor the disease could not be controlled, even the mechanical ventilation is instituted in time.
, http://www.100md.com
Potential role of cytokines in idiopathic pulmonary fibrosis
Department of Respiratory Disease, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang, China
OBJECTIVE: To investigate the expression of platelet-derived growth factor(PDGF) and transforming growth factor-β(TGF-β) in transbronchial lung biopsy(TBLB) from patients
with idiopathic pulmonary fibrosis(IPF), and study the potential role of cytokines in the development of IPF. METHODS: The immunohistochemical methods were used to determine the expression of PDGF, TGF-β in TBLB from patients with IPF. RESULTS: In IPF patients, TGF-β mainly existed at tiny bronchial epithelial cells, alveolar epithelial type-Ⅱ cells and alveolar macrophages, showing strong expression compared with controls (P<0.01). PDGF mainly existed at fibroblast-like cells surrounding pulmonary vessels, fibroblasts, tiny bronchial epithelial cells, alveolar epithelial type-Ⅱ cells and alveolar macrophages, showing strong expression compared with controls (P<0.01). CONCLUSION: PDGF and TGF-β, which interact with pulmonary mesenchymal cells, are involved in the formation of pulmonary fibrosis.
, 百拇医药
Changes in interleukin-1β in serum and bronchoalveolar lavage fluid in the patient with acute respiratory distress syndrome
Department of Respiratory Disease, Airforce Hospital of People's Liberation Army, Guangzhou, 510602 Guangdong, China
OBJECTIVE: To study the role of interleukin-1β(IL-1β) in the pathogenesis of acute respiratory distress syndrome (ARDS). METHODS: The bronchoalveolar lavage fluid (BALF) and serum in 13 patients with ARDS and 9 healthy controls were collected. The contents of IL-1β were measured by enzyme-linked immunoadsorbent assay(ELISA). RESULTS: The levels of IL-1β in BALF [(144.67±80.79)ng/L] and serum [(45.71±7.09)ng/L] in patients with ARDS were significantly higher than those in the control groups [(20.39±1.87)ng/L， P＝0.000； (35.06±5.46)ng/L, P＝0.001, respectively], and the levels of IL-1β in BALF were also significantly higher than those of the serum in the patients with ARDS (P＝0.000). CONCLUSION: The results indicate that IL-1β is involved in the pathogenesis of ARDS. Early determination of IL-1β level in BALF may be more valuable in the evaluation of disease process of ARDS.
, 百拇医药
Effect of combination of nitric oxide inhalation and inverse ratio ventilation in endotoxin-induced acute respiratory distress syndrome in sheep
The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
OBJECTIVE: To observe the effect of combination of nitric oxide (NO) inhalation and inverse ratio ventilation (IRV) on oxygenation and hemodynamics in endotoxin-induced acute respiratory distress syndrome (ARDS) in sheep. METHODS: Sheep ARDS model was induced by an intravenous infusion of low dose endotoxin, and then animals were randomly divided into two groups. ① NO group (n=6), inhalation of 40×10 -6 nitric oxide. ② Combination group (n=6), receiving mechanical ventilation with IRV (inspiratory-to-expiratory ratio of 2∶1) and in halation of 40×10 -6 NO. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter and arterial blood gas analysis before and after the onset of, ARDS and 30 minutes after treatment. RESULTS: The combination of IRV and 40×10 -6 NO inhalation rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO2, decreased P(A-a)O 2, and Qs/Qt without inducing significant change in systemic hemodynamics, and it was a more effective method of correcting hypoxemia than inhalation of nitric oxide alone. NO inhalation did not change the airway pressure of the model, but the combined treatment resulted in reduction of peak inspiratory pressure and increase of mean airway pressure. CONCLUSION: The combined use of IRV and NO inhalation has an additive effect on improving oxygenation in endotoxin-induced acute respiratory distress syndrome in sheep., 百拇医药