scholarly journals Protective effect of HTK solution on postoperative pulmonary function in infants with CHD and PAH

2017 ◽  
Vol 37 (6) ◽  
Author(s):  
Jindong Li ◽  
Yanhong Wu ◽  
Xudong Tian ◽  
Jiantang Wang ◽  
Mingfeng Dong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Inflammatory Cells ◽  
Pathological Examination ◽  
Control Group ◽  
Lung Protection ◽  
Arterial Perfusion ◽  
Icu Stay ◽  
Htk Solution ◽  
Pulmonary Arterial ◽  
Postoperative Mechanical Ventilation

Objective: In the present study, we aimed to investigate the effect of pulmonary arterial perfusion (PAP) with Histidine–tryptophan–ketoglutarate (HTK) on lung protection in infants with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). Methods: Fifty infant patients with CHD and PAH at our hospital from January, 2016 to February, 2017 were randomly divided into control group and HTK group. The levels of interleukin-6 (IL-6), malondialdehyde (MDA), and endothelin-1 (ET-1) in serum were detected using ELISA Kit. Oxygen index (OI) and respiratory index (RI) were calculated at each time point. The time of postoperative mechanical ventilation and ICU stay was counted, and the right lower lung tissues in patients were taken for pathological examination. Results: Compared with preanesthesia, the levels of IL-6, MDA, and ET-1 in the two groups were significantly increased after CPB, and their levels in HTK group were significantly lower than that in control group. Moreover, OI in control group decreased markedly and RI in control group increased significantly after CPB. Compared with control group, the postoperative mechanical ventilation time, postoperative ICU stay, and total hospital stay in HTK group were markedly short. In addition, inflammatory cells infiltration decreased and pulmonary interstitial showed mild edema in HTK group. Conclusion: PAP with HTK could effectively reduce CPB-induced lung injury and improve lung function.

scholarly journals Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series

2020 ◽  
pp. 088506662098189
Author(s):  
Samuel Wiles ◽  
Eduardo Mireles-Cabodevila ◽  
Scott Neuhofs ◽  
Sanjay Mukhopadhyay ◽  
Jordan P. Reynolds ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Airway Resistance ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Inflammatory Cells ◽  
Pathological Examination ◽  
Tube Obstruction

Background: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing endotracheal tube (ETT) obstruction that has not been previously described in patients with ARDS due to other causes. The purpose of this report is to describe a case series of patients with COVID-19 and ARDS in which ETT occlusion resulted in significant clinical consequences and to define the pathology of the obstructing material. Methods: Incidents of ETT occlusion during mechanical ventilation of COVID-19 patients were reported by clinicians and retrospective chart review was conducted. Statistical analysis was performed comparing event rates between COVID-19 and non-COVID 19 patients on mechanical ventilation over the predefined period. Specimens were collected and submitted for pathological examination. Findings: Eleven COVID-19 patients experienced endotracheal tube occlusion over a period of 2 months. Average age was 69 (14.3, range 33-85) years. Mean APACHE III score was 73.6 (17.3). All patients had AKI and cytokine storm. Nine exhibited biomarkers for hypercoagulability. Average days on mechanical ventilation before intervention for ETT occlusion was 14 (5.18) days (range of 9 to 23 days). Five patients were discharged from the ICU, and 4 expired. Average documented airway resistance on admission was 14.2 (3.0) cm H2O/L/sec. Airway resistance before tube exchange was 28.1 (8.0) cm H2O /L/sec. No similar events of endotracheal tube occlusion were identified in non-COVID patients on mechanical ventilation during the same time period. Microscopically, the material consisted of mucin admixed with necrotic cell debris, variable numbers of degenerated inflammatory cells, oral contaminants and red blood cells. Interpretation: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing ETT obstruction due to deposition of a thick, tenacious material within the tube that consists primarily of mucin and cellular debris. Clinicians should be aware of this dangerous but treatable complication.

scholarly journals The Efficacy and Safety of Pulmonary Vasodilators in Pediatric Pulmonary Hypertension (PH): A Systematic Review and Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Tingting Shu ◽  
Huaqiao Chen ◽  
Lu Wang ◽  
Wuwan Wang ◽  
Panpan Feng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Meta Analysis ◽  
Control Group ◽  
Efficacy And Safety ◽  
Pulmonary Vasodilators ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Pulmonary Arterial

Background: We performed a meta-analysis to evaluate the efficacy and safety of pulmonary vasodilators in pediatric pulmonary hypertension (PH) patients.Methods: We searched electronic databases including PubMed, EMBASE, and the Cochrane Library up to May 2020, and conducted a subgroup analysis for pulmonary vasodilators or underlying disease.Results: Fifteen studies with 719 pediatric PH patients were included in the meta-analysis. Adverse events did not differ (p = 0.11, I2 = 15%) between the pulmonary vasodilators group and the control group, neither in the subgroups. In total, compared with the control group treatment, pulmonary vasodilators significantly decreased the mortality (p = 0.002), mean pulmonary artery pressure (mPAP, p = 0.02), and mechanical ventilation duration (p = 0.03), also improved the oxygenation index (OI, p = 0.01). In the persistent pulmonary hypertension of the newborn (PPHN) subgroup, phosphodiesterase type 5 inhibitors (PDE5i) significantly reduced mortality (p = 0.03), OI (p = 0.007) and mechanical ventilation duration (p = 0.004). Administration of endothelin receptor antagonists (ERAs) improved OI (p = 0.04) and mechanical ventilation duration (p < 0.00001) in PPHN. We also found that in the pediatric pulmonary arterial hypertension (PPAH) subgroup, mPAP was pronouncedly declined with ERAs (p = 0.006). Systolic pulmonary artery pressure (sPAP, p < 0.0001) and pulmonary arterial/aortic pressure (PA/AO, p < 0.00001) were significantly relieved with PDE5i, partial pressure of arterial oxygen (PaO2) was improved with prostacyclin in postoperative PH (POPH) subgroup (p = 0.001). Compared with the control group, pulmonary vasodilators could significantly decrease PA/AO pressure (p < 0.00001) and OI (p < 0.00001) in the short-term (duration <7 days) follow-up subgroup, improve mPAP (p = 0.03) and PaO2 (p = 0.01) in the mid-term (7–30 days) follow-up subgroup, also decrease mortality, mPAP (p = 0.0001), PA/AO pressure (p = 0.0007), duration of mechanical ventilation (p = 0.004), and ICU stay (p < 0.00001) in the long-term follow subgroup (>30 days).Conclusion: Pulmonary vasodilators decrease the mortality in pediatric PH patients, improve the respiratory and hemodynamic parameters, reduce the mechanical ventilation duration.

scholarly journals Evaluating the Neuroprotective Effect of Melatonin on Patients with Hemorrhagic Stroke Using Serum S100B Protein as a Prognostic Marker

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hamidreza Sharifnia ◽  
Mojtaba Mojtahedzadeh ◽  
Mehrnoush Dianatkhah ◽  
Atabak Najafi ◽  
Arezoo Ahmadi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hemorrhagic Stroke ◽  
Neuroprotective Effect ◽  
Plasma Concentrations ◽  
Control Group ◽  
P Value ◽  
Neuroprotective Agents ◽  
Icu Stay ◽  
Baseline Values ◽  
Length Of Icu Stay

Background: Intracerebral hemorrhage (ICH) is one of the most debilitating kinds of stroke. Recent evidence shows that the proper initiation of neuroprotective agents might save at risk neurons and improve the outcome. Objectives: The focus of this study is to evaluate the neuroprotective effect of melatonin on patients with hemorrhagic stroke. Methods: Forty adult patients with confirmed nontraumatic ICH, who were admitted to the ICU within 24 hours of the stroke onset were enrolled in this study. Subjects in the melatonin group received 30 mg of melatonin every night for 5 consecutive nights. In order to evaluate the intensity of the neuronal injury, S100B was assessed once on day 1 and, day 5 post ICU admission. Additionally, the length of ICU stay, mortality, and the duration of mechanical ventilation were also recorded. Results: Forty patients completed the study. In both groups the plasma concentrations of S100B decreased after 5 days compared with their baseline values. However, this reduction was more significant in the melatonin compared to the control group (P-value < 0.05). The duration of mechanical ventilation and length of ICU stay was shorter in the melatonin group, and this difference was statistically significant for the length of ICU stay (P-value < 0.05), and marginally significant for the duration of mechanical ventilation (P-value = 0.065). The in-ICU mortality rate of the melatonin group was 15%, almost half of that of the control group (30%). However, this difference was not statistically significant. Conclusions: In conclusion, melatonin can be considered as a harmless and effective nueroprotective agent with some unique features which has made it an appropriate adjunctive medicine for critically ill intubated patients.

Screening and topical decolonization of preoperative nasal Staphylococcus aureus carriers to reduce the incidence of postoperative infections after lung cancer surgery: a propensity matched study

2019 ◽  
Vol 30 (4) ◽  
pp. 552-558
Author(s):  
Alex Fourdrain ◽  
Ilies Bouabdallah ◽  
Lucile Gust ◽  
Nadim Cassir ◽  
Geoffrey Brioude ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Staphylococcus Aureus ◽  
Mechanical Ventilation ◽  
Lung Resection ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Control Group ◽  
Preoperative Screening ◽  
Experimental Group ◽  
Postoperative Mechanical Ventilation

Abstract OBJECTIVES Health care-associated infections (HAIs) are serious issues following lung cancer surgery, leading to an increased risk of morbidity and hospital cost burden. The aim of this study was to evaluate the impact on postoperative outcomes of a preoperative screening and decolonization strategy of nasal carriers for Staphylococcus aureus prior to lung cancer surgery. METHODS We performed a retrospective study comparing 2 cohorts of patients undergoing major lung resection: a control group of patients from the placebo arm of the randomized Clinical Study to Evaluate the Efficacy of Chlorhexidine Mouthwashes operated on between July 2012 and April 2015 without any nasopharyngeal screening (N = 224); an experimental group, with preoperative screening for S. aureus of nasal carriers and selective 5-day decolonization in positive carriers using mupirocin ointment between January 2017 and December 2017 (N = 310). The 2 groups were matched according to a propensity score analysis with 1:1 matching. The primary outcome was the rate of postoperative HAIs, and the secondary outcome was the need for postoperative mechanical ventilation after surgery. RESULTS After matching, 2 similar groups of 108 patients each were obtained. In the experimental group, 26 patients had positive results for nasal carriage, and a significant decrease was observed in the rate of overall postoperative HAIs [control n = 19, 17.6%; experimental group n = 9, 8.3%; P = 0.043; relative risk 0.47 (0.22–1)] and in the rate of postoperative mechanical ventilation [control n = 12, 11.1%; experimental group n = 4, 3.7%; P = 0.038; relative risk 0.33 (0.11–1)]. After logistic regression and multivariable analysis, screening of S. aureus nasal carriers reduced the rate of HAIs [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.11–0.76; P = 0.01] and reduced the risk of the need for postoperative mechanical ventilation (OR 0.19, 95% CI 0.05–0.74; P = 0.02). There was no significant statistical difference between the 2 groups regarding the rate of postoperative S. aureus-associated infection (control group n = 6, 5.6%; experimental group n = 2, 1.9%; P = 0.28). CONCLUSIONS Identification of nasal carriers of S. aureus and selective decontamination using mupirocin appeared to have a beneficial effect on postoperative infectious events after lung resection surgery.

Pro-oxidant effects of a high α-tocopherol dose on kidney antioxidant biomarkers and histopathological aspects

2017 ◽  
Vol 87 (3-4) ◽  
pp. 179-190
Author(s):  
Amel Kanane ◽  
Fayrouz Rouaki ◽  
Mohamed Brahim Errahmani ◽  
Abdenour Laraba ◽  
Hayet Mesbah ◽  
...  
Keyword(s):  
Sunflower Oil ◽  
Antioxidant Status ◽  
Basal Diet ◽  
Inflammatory Cells ◽  
Significant Rise ◽  
Control Group ◽  
Histopathological Changes ◽  
Group 5 ◽  
Oxidant Effect ◽  
Higher Doses

Abstract. The aim of this study is to evaluate the effect of α-tocopherol supplementation at two doses (600 and 1200 mg × kg–1) on kidney antioxidant status and the histopathological changes in Wistar rats after 12 weeks of exposure at different diets. Forty rats has been divided into 4 groups of 10 rats each, the control group received basal diet with 5 % fresh sunflower oil (FSO), the second group: 5 % oxidized sunflower oil (OSO), the third group: 5 % OSO supplemented with 600 mg × kg–1 α-tocopherol and the fourth group: 5 % OSO supplemented with 1200 mg × kg–1 α-tocopherol. In OSO groups, the results showed highly significant increases of LPO (from 31.3 ± 0.9 to 53.8 ± 1.2 nmol of MDA formed/min/mg protein, p < 0.0001) with a significant decrease (p < = 0.001) of the antioxidant enzymatic activities (CAT, SOD, GPX, GR and G6PDH), body weight (339 ± 9 to 290 ± 3 g) and α-tocopherol levels (13.6 ± 0.6 to 6.5 ± 0.4 μg/mg protein). In OSO groups with 600 mg × kg–1 α-tocopherol, an antioxidant effect was found, reflected by a return of the parameters to values similar to those of the control group. However, higher doses of α-tocopherol (1200 mg × kg–1) induced a depletion of antioxidant status, α-tocopherol levels (6.0 ± 0.3 μg/mg protein, p < 0.001) and a very highly significant rise (p < 0.0001) of LPO content (54.86 ± 0.01 nmol of MDA formed/min/mg protein). The kidney tissues also showed changes in glomerular, severe inflammatory cells infiltration, and formation of novel vessels. So, we can conclude that the oxidative stress is attenuated by a moderate administration of 600 mg × kg–1 α-tocopherol, while a pro-oxidant effect occurs at 1200 mg × kg–1 α-tocopherol.

scholarly journals Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoqiang Yin ◽  
Mei Xin ◽  
Sheng Ding ◽  
Feng Gao ◽  
Fan Wu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arterial ◽  
Mechanical Ventilation Time

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

scholarly journals Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maria Clara Saad Menezes ◽  
Alicia Dudy Müller Veiga ◽  
Thais Martins de Lima ◽  
Suely Kunimi Kubo Ariga ◽  
Hermes Vieira Barbeiro ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Peripheral Blood ◽  
World Health ◽  
Control Group ◽  
Pyrin Domain ◽  
Peripheral Blood Gene Expression ◽  
Severe Group ◽  
Health Organization ◽  
The Impact

AbstractThe role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5–9 days, and between 10–15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.

scholarly journals Target identification of hepatic fibrosis using Pien Tze Huang based on mRNA and lncRNA

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinhang Zhu ◽  
Di Zhang ◽  
Ting Wang ◽  
Zhiliang Chen ◽  
Luan Chen ◽  
...  
Keyword(s):  
Liver Injury ◽  
Hepatic Fibrosis ◽  
Drug Targets ◽  
Enrichment Analysis ◽  
Inflammatory Cells ◽  
Differentially Expressed ◽  
Control Group ◽  
Traditional Chinese Herbal Medicine ◽  
Hepatic Diseases ◽  
Pien Tze Huang

AbstractHepatic fibrosis is a spontaneous wound-healing response triggered by chronic liver injury. Pien Tze Huang (PZH), a traditional Chinese herbal medicine, has been widely used to treat various hepatic diseases in Asia. We used a CCl4-induced mouse model to establish a PZH group of hepatic fibrosis mice treated with PZH and a control group of hepatic fibrosis mice without any treatment. We performed RNA-seq and mass spectrometry sequencing to investigate the mechanism of the PZH response in hepatic fibrosis and identified multiple differentially expressed transcripts (DETs) and proteins (DEPs) that may be drug targets of PZH. Liver functional indices, including serum albumin (ALB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), were significantly decreased in the PZH treatment group (P < 0.05) in the eighth week. Hematoxylin–eosin (HE), Masson and Sirius red staining demonstrated that PZH significantly inhibited infiltration of inflammatory cells and collagen deposition. A total of 928 transcripts and 138 proteins were differentially expressed in PZH-treated mice compared to the control group. Gene Ontology (GO) enrichment analysis suggested that PZH may alleviate liver injury and fibrosis by enhancing the immune process. Taken together, our results revealed that multiple DETs and DEPs may serve as drug targets of PZH in hepatic fibrosis patient in future clinical practice.

scholarly journals Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 09 (03) ◽  
pp. 201-206
Author(s):  
Surabhi Chandra ◽  
Sahil Goel ◽  
Ritika Dawra
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Neuromuscular Blockade ◽  
Distress Syndrome ◽  
Control Group ◽  
Case Group ◽  
The Mean ◽  
Mean Time

AbstractPediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case–control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24–48) for case group patients, significantly lower (p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90–126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower (p < 0.0001; 95% confidence interval: 5.9129–9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

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