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    Disseminated herpes zoster causing acute respiratory distress syndrome in an immunocompetent patient.
    BMJ Case Rep 2017 Sep 23;2017. Epub 2017 Sep 23.
    Department of Internal Medicine, Ohio Health Riverside Methodist Hospital, Columbus, Ohio, USA.
    Disseminated cutaneous varicella herpes zoster with visceral involvement is rare and seen almost exclusively in immunocompromised patients. We describe an unusual case of fulminant herpes zoster (HZ) in a healthy, immunocompetent 37-year-old woman. She initially presented to an urgent care centre with a classic HZ rash localised to her neck, and upper respiratory symptoms and was treated with prednisone and cephalexin. Read More

    Pathophysiology and Management of Acute Respiratory Distress Syndrome in Children.
    Pediatr Clin North Am 2017 Oct;64(5):1017-1037
    Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110 San Francisco, CA 94143, USA; Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address:
    Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pao2/Fio2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Read More

    Determination of respiratory system compliance during pressure support ventilation by small variations of pressure support.
    J Clin Monit Comput 2017 Sep 22. Epub 2017 Sep 22.
    Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 12, 24105, Kiel, Germany.
    In mechanically ventilated patients, measurement of respiratory system compliance (Crs) is of high clinical interest. Spontaneous breathing activity during pressure support ventilation (PSV) can impede the correct assessment of Crs and also alter the true Crs by inducing lung recruitment. We describe a method for determination of Crs during PSV and assess its accuracy in a study on 20 mechanically ventilated patients. Read More

    Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
    Intensive Care Med 2017 Sep 21. Epub 2017 Sep 21.
    Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University and Hospitals, Louvain, 3000, Belgium.
    Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.

    Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine.

    Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Read More

    Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
    Crit Care Med 2017 Sep 21. Epub 2017 Sep 21.
    1General ICU Department, Raymond Poincaré Hospital (APHP), Health Science. 2Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. 4Institute of Metabolism and Systems Research (IMSR), University of Birmingham and Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK. 5Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA. 6Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, The Netherlands. 7Anesthesiology and Critical Care Medicine, Klinik für Anästhesiologie, Klinikum der Universität, Munich, Germany. 8Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9Department of Endocrinology, Diabetology and Metabolism, Clinical Research, University Hospital Basel, Basel, Switzerland. 10Department of Endocrinology, Concord Hospital, University of Sidney, Sidney, NSW, Australia. 11Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA. 12Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center, Memphis, TN, USA. 13College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 14Clinical Adjunct Faculty, University of New Mexico and Sandoval Regional Medical Center, Albuquerque, NM, USA. 15Division of Critical Care Medicine, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. 16Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University and Hospitals, Louvain, Belgium. Dr. Djillali Annane and Dr. Stephen M. Pastores were co-chairs of the task force and contributed equally to this work.
    Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.

    Participants: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine.

    Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Read More

    Practice Bulletin No. 183: Postpartum Hemorrhage.
    • Authors:
    Obstet Gynecol 2017 10;130(4):e168-e186
    Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). Read More

    Practice Bulletin No. 183 Summary: Postpartum Hemorrhage.
    • Authors:
    Obstet Gynecol 2017 Oct;130(4):923-925
    Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). Read More

    Experimental models of acute lung injury in the newborns.
    Physiol Res 2017 Sep;66(Supplementum 2):S187-S201
    Biomedical Center Martin and Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
    Acute lung injury in the preterm newborns can originate from prematurity of the lung and insufficient synthesis of pulmonary surfactant. This situation is known as respiratory distress syndrome (RDS). In the term neonates, the respiratory insufficiency is related to a secondary inactivation of the pulmonary surfactant, for instance, by action of endotoxins in bacterial pneumonia or by effects of aspirated meconium. Read More

    Serum cystatin C as an earlier predictor of acute kidney injury than serum creatinine in preterm neonates with respiratory distress syndrome.
    Saudi J Kidney Dis Transpl 2017 Sep-Oct;28(5):1003-1014
    Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
    In this study, we aimed to evaluate serum cystatin C (sCysC) as an early predictor of acute kidney injury (AKI) in preterm neonates with respiratory distress syndrome (RDS). Sixty preterm neonates diagnosed with RDS and 40 healthy controls (28-36 weeks) admitted to the neonatal Intensive Care Unit were investigated. AKI was defined on the 3rd day of life (DOL-3) as an increase in serum creatinine (sCr) of >0. Read More

    [Microvesicles derived from mesenchymal stem cells: new hope of the treatment for ARDS].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 Sep;29(9):774-777
    Department of Critical Care Medicine, Subei People' Hospital, Yangzhou 225001, Jiangsu, China (Chen QH, Zheng RQ); Department of Cardiology, Subei People' Hospital, Yangzhou 225001, Jiangsu, China (Wang HL). Corresponding author: Wang Hualing, Email:
    Objective: Acute respiratory distress syndrome (ARDS) is a serious state threaten human health with a high mortality about 30%-40%. At present, there is no effective treatment for ARDS. Microvesicles derived from mesenchymal stem cells (MSC-MVs) have a heterogeneous subcellular structure secreted by MSCs. Read More

    Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome.
    Intensive Care Med 2017 Sep 22. Epub 2017 Sep 22.
    Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China.
    Purpose: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV).

    Methods: A total of 138 patients with ARDS who received mechanical ventilation for <48 h between May 2015 to October 2016 while in the critical care medicine unit (ICU) of the West China Hospital of Sichuan University were enrolled in the study. Read More

    Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial.
    Lancet Respir Med 2017 Sep 18. Epub 2017 Sep 18.
    Department of Anaesthesia and Intensive Care, Montpellier University Saint Eloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
    Background: Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes.

    Methods: We did a randomised, parallel-group, clinical trial at three ICUs in France. Read More

    Recent Directions in Personalised Acute Respiratory Distress Syndrome Medicine.
    Anaesth Crit Care Pain Med 2017 Sep 18. Epub 2017 Sep 18.
    CHU Clermont-Ferrand, Department of Perioperative Medicine, 58 Rue Montalembert, 63000, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS 6293, INSERM U1103, GReD, 1 Place Lucie Aubrac, 63003 Clermont-Ferrand Cedex 1, France.
    Acute respiratory distress syndrome (ARDS) is heterogeneous by definition and patient response varies depending on underlying biology and their severity of illness. Although ARDS subtypes have been identified with different prognoses in past studies, the concept of phenotypes or endotypes does not extend to the clinical definition of ARDS. This has possibly hampered the development of therapeutic interventions that target select biological mechanisms of ARDS. Read More

    Attenuation of hemorrhage-associated lung injury by adjuvant treatment with C23, an oligopeptide derived from cold-inducible RNA-binding protein.
    J Trauma Acute Care Surg 2017 Oct;83(4):690-697
    From the Center for Immunology and Inflammation (F.Z., W.-L.Y., M.B., P.W.), The Feinstein Institute for Medical Research; and Department of Surgery (W-L.Y., P.W.), Hofstra Northwell School of Medicine, Manhasset, NY.
    Background: Hemorrhagic shock (HS) is an important cause of mortality. HS is associated with an elevated incidence of acute lung injury and acute respiratory distress syndrome, significantly contributing to HS morbidity and mortality. Cold-inducible RNA-binding protein (CIRP) is released into the circulation during HS and can cause lung injury. Read More

    Variability in Usual Care Mechanical Ventilation for Pediatric Acute Respiratory Distress Syndrome: Time for a Decision Support Protocol?
    Pediatr Crit Care Med 2017 Sep 19. Epub 2017 Sep 19.
    1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 2Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 3University of Utah College of Nursing, Salt Lake City, UT. 4Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 5Department of Pediatrics, Division of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, University of Michigan, Ann Arbor, MI. 9Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 12Department of Pediatrics, Mattel Children's Hospital, UCLA, Los Angeles, CA. 13Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 14Pediatric Trauma and Critical Illness Branch, National Institutes of Child Health and Human Development (NICHD), Bethesda, MD. 15Formerly Pediatric Trauma and Critical Illness Branch, National Institutes of Child Health and Human Development (NICHD), Bethesda, MD.
    Objectives: Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol. Read More

    50 Years of Research in ARDS. Tidal Volume Selection in the Acute Respiratory Distress Syndrome.
    Am J Respir Crit Care Med 2017 Sep 20. Epub 2017 Sep 20.
    School of Medicine, Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States ;
    Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Read More

    Experience with the SynCardia total artificial heart in a Canadian centre.
    Can J Surg 2017 Oct 1;60(6):3617. Epub 2017 Oct 1.
    From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Nguyen, Pellerin, Perrault, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Ducharme, Racine).
    Background: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. Read More

    Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: A meta-analysis.
    Exp Ther Med 2017 Oct 7;14(4):2863-2868. Epub 2017 Aug 7.
    Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.
    Acute respiratory distress syndrome (ARDS) is a serious complication of acute lung injury. Severe systemic inflammation is the main cause of multiple organ dysfunction and high mortality. Removal of reactive oxygen species by anti-oxidants has been applied in clinical practice. Read More

    Potential Acceptability of a Pediatric Ventilator Management Computer Protocol.
    Pediatr Crit Care Med 2017 Sep 16. Epub 2017 Sep 16.
    1University of Utah College of Nursing, Salt Lake City, UT. 2Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 5Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 9Department of Pediatrics, University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 12Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 13Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 14Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 15Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD. 16Formerly Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD.
    Objectives: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome.

    Design: Survey/questionnaire.

    Setting: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. Read More

    Use of corticosteroids in acute respiratory distress syndrome: Perspective from an Indian intensive care unit.
    Med J Armed Forces India 2017 Apr 16;73(2):118-122. Epub 2016 Dec 16.
    Professor (Medicine), Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
    Background: Acute respiratory distress syndrome (ARDS) causes overwhelming inflammation, which serves as a potential target for corticosteroids. Despite extensive Western literature, there are no Indian studies evaluating steroids in ARDS.

    Methods: This was a retrospective study at an Indian intensive care unit (ICU) on ARDS patients. Read More

    Microtubules-associated Rac regulation of endothelial barrier: a role of Asef in acute lung injury.
    J Investig Med 2017 Sep 18. Epub 2017 Sep 18.
    Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
    The endothelial barrier function regulated by the cytoskeletal reorganizations has been implicated in the pathogenesis of multiple lung diseases including asthma, sepsis, edema, and acute respiratory distress syndrome. The extensive studies have established that activation of small GTPase Rac is a key mechanism in endothelial barrier protection but the role of microtubules-associated Rac in the endothelial functions remains poorly understood. With the emerging evidences that microtubules disassembly also plays a critical role in actin cytoskeleton remodeling leading to endothelial permeability, the knowledge on microtubules-mediated regulation of endothelial barrier is imperative to better understand the etiology of lung injuries as well as to develop novel therapeutics against these disorders. Read More

    Decision-making Process by Users and Providers of Health Care Services During the AH1N1 Epidemic Influenza in Mexico: Lessons Learned and Challenges Ahead.
    Arch Med Res 2017 Apr;48(3):276-283
    Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. Electronic address:
    Objective: The aim of the study was to analyze, using a decision analysis approach, the probability of severity of illness due to delayed utilization of health services and inappropriate hospital medical treatment during the 2009 AH1N1 influenza epidemic in Mexico.

    Methods: Patients with influenza AH1N1 confirmed by the polymerase chain reaction (PCR) test from two hospitals in Mexico City, were included. Path methodology based upon literature and validated by clinical experts was followed. Read More

    Interstitial pneumonia with autoimmune features: an additional risk factor for ARDS?
    Ann Intensive Care 2017 Sep 18;7(1):98. Epub 2017 Sep 18.
    Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
    Background: Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period. Read More

    Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term survivors.
    Thorax 2017 Sep 16. Epub 2017 Sep 16.
    Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.
    Background: Delayed return to work is common after acute respiratory distress syndrome (ARDS), but has undergone little detailed evaluation. We examined factors associated with the timing of return to work after ARDS, along with lost earnings and shifts in healthcare coverage.

    Methods: Five-year, multisite prospective, longitudinal cohort study of 138 2-year ARDS survivors hospitalised between 2004 and 2007. Read More

    Do we need randomized clinical trials in extracorporeal respiratory support? Yes.
    Intensive Care Med 2017 Sep 15. Epub 2017 Sep 15.
    Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, Columbia University, New York, NY, USA.
    Extracorporeal respiratory support, also known as extracorporeal gas exchange, may be used to rescue the most severe forms of acute hypoxemic respiratory failure with high blood flow venovenous extracorporeal membrane oxygenation. Alternatively, lower flow extracorporeal carbon dioxide removal might be applied to reduce the intensity of mechanical ventilation in patients with less severe forms of the disease. However, critical reading of the results of the randomized trials and case series published to date reveals major methodological biases. Read More

    In Vivo Evaluation of the Acute Pulmonary Response to Poractant Alfa and Bovactant Treatments in Lung-Lavaged Adult Rabbits and in Preterm Lambs with Respiratory Distress Syndrome.
    Front Pediatr 2017 31;5:186. Epub 2017 Aug 31.
    Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A., Parma, Italy.
    Background: Poractant alfa (Curosurf(®)) and Bovactant (Alveofact(®)) are two animal-derived pulmonary surfactants preparations approved for the treatment of neonatal respiratory distress syndrome (nRDS). They differ in their source, composition, pharmaceutical form, and clinical dose. How much these differences affect the acute pulmonary response to treatment is unknown. Read More

    Vγ4(+)γδT Cells Aggravate Severe H1N1 Influenza Virus Infection-Induced Acute Pulmonary Immunopathological Injury via Secreting Interleukin-17A.
    Front Immunol 2017 31;8:1054. Epub 2017 Aug 31.
    Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
    The influenza A (H1N1) pdm09 virus remains a critical global health concern and causes high levels of morbidity and mortality. Severe acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are the major outcomes among severely infected patients. Our previous study found that interleukin (IL)-17A production by humans or mice infected with influenza A (H1N1) pdm09 substantially contributes to ALI and subsequent morbidity and mortality. Read More

    [Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series].
    Zhonghua Jie He He Hu Xi Za Zhi 2017 Sep;49(9):678-682
    Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
    Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Read More

    Management of ARDS and Refractory Hypoxemia: A Multicenter Observational Study.
    Ann Am Thorac Soc 2017 Sep 14. Epub 2017 Sep 14.
    McMaster University, Clinical Epidemiology & Biostatistics , HSC-2C10 , 1200 Main Street West , Hamilton, Ontario, Canada , L9H 2M7 ;
    Rationale: Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described.

    Objectives: To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS including refractory hypoxemia.

    Methods: Prospective cohort study (March 2014-February 2015) of mechanically ventilated adults with moderate-to-severe ARDS requiring FiO2 ≥0. Read More

    Nrf2 Transfection Enhances the Efficacy of Human Amniotic Mesenchymal Stem Cells to Repair Lung Injury Induced by Lipopolysaccharide.
    J Cell Biochem 2017 Sep 14. Epub 2017 Sep 14.
    Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are clinical emergencies with no effective pharmaceutical treatment. This study aims to determine the protective effects of Nrf2-transfected human amniotic mesenchymal stem cells (hAMSCs) against lipopolysaccharide (LPS)-induced lung injury in mice. hAMSCs stably transfected with Nrf2 or green fluorescent protein control were transplanted into male C57BL/6 mice via the tail vein 4 h after intratracheal instillation of LPS. Read More

    Extracorporeal membrane oxygenation in spina bifida and (H1N1)-induced acute respiratory distress syndrome.
    J Artif Organs 2017 Sep 13. Epub 2017 Sep 13.
    Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
    Acute respiratory distress syndrome (ARDS) is characterized as an acute hypoxemic and/or hypercapnic respiratory failure seen in critically ill patients and is still, although decreased over the past few years, associated with high mortality. Furthermore, ARDS may be a life-threatening complication of H1N1 pneumonia. We report on a 45-year-old spina bifida patient with confirmed H1N1 influenza virus infection causing acute respiratory failure, who was successfully weaned from 42-day veno-venous extracorporeal membrane oxygenation (vv-ECMO) treatment with an excellent outcome. Read More

    [Life after ARDS].
    Med Klin Intensivmed Notfmed 2017 Sep 13. Epub 2017 Sep 13.
    Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
    Patients who survive acute respiratory distress syndrome (ARDS) often suffer from long-term physical and psychological sequelae. Lung function is commonly only mildly reduced, whereas general physical activity and walking distance are often compromised. Most markedly, these patients have a high incidence of depression, anxiety, and posttraumatic stress disorder. Read More

    Enterovirus-Human Rhinovirus: A Rare Cause of Acute Respiratory Distress Syndrome.
    J Investig Med High Impact Case Rep 2017 Jul-Sep;5(3):2324709617728526. Epub 2017 Sep 5.
    Maimonides Medical Center, Brooklyn, NY, USA.
    A 22-year-old Asian woman presented with respiratory distress, cough, and wheezing for 1 week. Prior history included asthma and Turner syndrome. On presentation to the emergency department, the patient was hypotensive, tachycardic, tachypneic, with an oxyhemoglobin saturation in the mid 80% range while breathing ambient air. Read More

    Mathematics of Ventilator-induced Lung Injury.
    Indian J Crit Care Med 2017 Aug;21(8):521-524
    Department of Critical Care Medicine, King Saud Medical City, Riyadh, Saudi Arabia.
    Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Read More

    How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit?
    Indian J Crit Care Med 2017 Aug;21(8):494-499
    Department of Anaesthesiology and Critical Care, NEIGRIHMS, Shillong, Meghalaya, India.
    Context: The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

    Aims: This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. Read More

    Glycogen synthase kinase‑3β inhibitor reduces LPS‑induced acute lung injury in mice.
    Mol Med Rep 2017 Sep 12. Epub 2017 Sep 12.
    Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Jiangsu 215006, P.R. China.
    The aim of the present study was to examine the role of Wnt signaling in lipopolysaccharide (LPS)‑induced acute respiratory distress syndrome (ARDS). ARDS was induced by LPS and compared in mice treated with either glycogen synthase kinase‑3β inhibitor (GSKI) or PBS. The protein expression levels of interleukin (IL)‑6, IL‑8, tumor necrosis factor (TNF)‑α, IL‑17, IL‑18 and IL‑1β in the bronchoalveolar lavage fluid (BALF) were examined using murine cytokine‑specific enzyme‑linked immunosorbent assays. Read More

    Phosphorylation of epidermal growth factor receptor at serine 1047 in cultured lung alveolar epithelial cells by bradykinin B2 receptor stimulation.
    Pulm Pharmacol Ther 2017 Sep 9. Epub 2017 Sep 9.
    Departments of Biochemistry, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan. Electronic address:
    Accumulating evidence indicates that epidermal growth factor receptor (EGFR) is desensitized by phosphorylation of serine 1047 (Ser1047). We and other groups have reported that stimulation of a receptor of tumor-necrosis factor α (TNFα) and Toll-like receptor 5 (TLR5) induced the phosphorylation of Ser1047 through activation of p38 mitogen-activated protein kinase (p38 MAPK) in cultured lung alveolar epithelial A549 cells. However, phosphorylation of EGFR at Ser1047 by stimulation of any G-protein coupled receptors (GPCRs) has not been reported in any cultured cells. Read More

    Respiratory support in patients with acute respiratory distress syndrome: an expert opinion.
    Crit Care 2017 Sep 12;21(1):240. Epub 2017 Sep 12.
    Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
    Acute respiratory distress syndrome (ARDS) is a common condition in intensive care unit patients and remains a major concern, with mortality rates of around 30-45% and considerable long-term morbidity. Respiratory support in these patients must be optimized to ensure adequate gas exchange while minimizing the risks of ventilator-induced lung injury. The aim of this expert opinion document is to review the available clinical evidence related to ventilator support and adjuvant therapies in order to provide evidence-based and experience-based clinical recommendations for the management of patients with ARDS. Read More

    Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007-2016).
    Malar J 2017 Sep 11;16(1):365. Epub 2017 Sep 11.
    Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia, Spain.
    Background: Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. Read More

    Cytomegalovirus associated severe pneumonia, multi-organ failure and Ganciclovir associated arrhythmia in immunocompetent child.
    J Infect Chemother 2017 Sep 6. Epub 2017 Sep 6.
    Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
    Cytomegalovirus (CMV) can rarely cause severe manifestations in immunocompetent individuals. Hereby, we report a twelve-year-old boy who presented with tachycardia, tachypnea, fever and leukocytosis, which progressed to hypoxemic respiratory failure and severe acute respiratory distress syndrome (ARDS). Subsequently, he developed multi-organ failure despite the ongoing full supportive care and empiric broad spectrum antibiotics. Read More

    Role of biomarkers in acute traumatic lung injury.
    Injury 2017 Aug 24. Epub 2017 Aug 24.
    Department of Trauma, Hand and Reconstructive Surgery Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany.
    In severely injured patients severe thoracic trauma is common and can significantly influence the outcome of these critically ill patients by increased rates of mainly pulmonary complications. Furthermore, patients who sustained thoracic trauma are at increased risk for Acute Lung Injury (ALI) or Adult Respiratory Distress Syndrome (ARDS). Therapeutic options are limited, basically consisting of prophylactic antibiotic therapy and changing patient's positions. Read More

    Management Strategies for Severe Respiratory Failure: As Extracorporeal Membrane Oxygenation Is Being Considered.
    Crit Care Clin 2017 Oct 29;33(4):795-811. Epub 2017 Jul 29.
    Division of Pulmonary and Critical Care Medicine, Department of Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA. Electronic address:
    Pulmonary and critical care physicians must be facile in recognition and management of patients with acute respiratory distress syndrome (ARDS). Part of the current critical care knowledge base must include an understanding of how extracorporeal membrane oxygenation fits into the paradigm of ARDS management without using it as a "salvage therapy." This article provides a basic understanding of the evolution of ARDS to multiple organ dysfunction syndrome, recognizing benefits and limits of rescue therapies, indications and contraindications of extracorporeal membrane oxygenation, and coordination of care for severe respiratory failure. Read More

    Interleukin-22 level is negatively correlated with neutrophil recruitment in the lungs in a Pseudomonas aeruginosa pneumonia model.
    Sci Rep 2017 Sep 8;7(1):11010. Epub 2017 Sep 8.
    Laboratoire UPRES EA3826 « Thérapeutiques cliniques et expérimentales des infections », IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.
    Pseudomonas aeruginosa is a major threat for immune-compromised patients. Bacterial pneumonia can induce uncontrolled and massive neutrophil recruitment ultimately leading to acute respiratory distress syndrome and epithelium damage. Interleukin-22 plays a central role in the protection of the epithelium. Read More

    Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Lower-Surgical-Risk Patients With Chronic Obstructive Pulmonary Disease.
    Am J Cardiol 2017 Aug 7. Epub 2017 Aug 7.
    Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:
    Respiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study. Read More

    Clinical Pearls in Venovenous Extracorporeal Life Support for Adult Respiratory Failure.
    ASAIO J 2017 Sep 6. Epub 2017 Sep 6.
    From the *Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore; and †Department of Thoracic & Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea.
    Extracorporeal life support (ECLS) has been widely utilized to treat neonatal respiratory failure for two decades. However, its uptake in the case of adult respiratory failure has been slow because of a paucity of quality evidence and a sluggish tempo of ECLS-related technological advances. In recent years, interest in ECLS has been piqued after encouraging results were reported from its use during the 2009 H1N1 influenza pandemic. Read More

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