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Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Among those who survive, a decreased quality of life is relatively common.

Causes may include sepsis, pancreatitis, trauma, pneumonia, and aspiration. The underlying mechanism involves diffuse injury to cells which form the barrier of the microscopic air sacs of the lungs, surfactant dysfunction, activation of the immune system, and dysfunction of the body's regulation of blood clotting. In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide. Diagnosis is based on a PaO2/FiO2 ratio of less than 300 mmHg despite a PEEP of more than 5 cm H20.

The primary treatment involves mechanical ventilation together with treatments directed at the underlying cause. Ventilation strategies include using low volumes and low pressures. If oxygenation remains insufficient lung recruitment maneuvers and paralysis may be tried. If this is insufficient ECMO may be an option. The syndrome is associated with a death rate between 35 and 50%.

ARDS affects about 3 million people a year. The condition was first described in 1967. Although the terminology of "adult respiratory distress syndrome" has at times been used to differentiate ARDS from "infant respiratory distress syndrome" in newborns, the international consensus is that "acute respiratory distress syndrome" is the best term because ARDS can affect people of all ages.

  • Acute Respiratory Distress Syndrome

    Acute respiratory distress syndrome (ARDS) is type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath, rapid breathing, and bluish skin coloration. Among those who survive, a decreased quality of life is relatively common.

    Causes may include sepsis, pancreatitis, trauma, pneumonia, and aspiration. The underlying mechanism involves diffuse injury to cells which form the barrier of the microscopic air sacs of the lungs, surfactant dysfunction, activation of the immune system, and dysfunction of the body's regulation of blood clotting. In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide. Diagnosis is based on a PaO2/FiO2 ratio of less than 300 mmHg despite a PEEP of more than 5 cm H20.

    The primary treatment involves mechanical ventilation together with treatments directed at the underlying cause. Ventilation strategies include using low volumes and low pressures. If oxygenation remains insufficient lung recruitment maneuvers and paralysis may be tried. If this is insufficient ECMO may be an option. The syndrome is associated with a death rate between 35 and 50%.

    ARDS affects about 3 million people a year. The condition was first described in 1967. Although the terminology of "adult respiratory distress syndrome" has at times been used to differentiate ARDS from "infant respiratory distress syndrome" in newborns, the international consensus is that "acute respiratory distress syndrome" is the best term because ARDS can affect people of all ages.

  • COVID-19: Melatonin as a potential adjuvant treatment📎

    Abstract Title:

    COVID-19: Melatonin as a potential adjuvant treatment.

    Abstract Source:

    Life Sci. 2020 Mar 23:117583. Epub 2020 Mar 23. PMID: 32217117

    Abstract Author(s):

    Rui Zhang, Xuebin Wang, Leng Ni, Xiao Di, Baitao Ma, Shuai Niu, Changwei Liu, Russel J Reiter

    Article Affiliation:

    Rui Zhang

    Abstract:

    This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.

    Article Published Date : Mar 22, 2020

  • High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients.

    Abstract Title:

    High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients.

    Abstract Source:

    Intensive Care Med. 1989 ;15(5):290-5. PMID: 2504796

    Abstract Author(s):

    N M al-Saady, C M Blackmore, E D Bennett

    Article Affiliation:

    N M al-Saady

    Abstract:

    The objective of this study was to compare the effect of a high fat, low carbohydrate enteral feed with a standard isocaloric, isonitrogenous enteral feed on PaCO2 and ventilation time in patients with acute respiratory failure requiring artificial ventilation. 20 clinically stable patients requiring enteral feeding were randomized to either feed in a double-blind fashion. Initial ventilator standard settings were adjusted according to clinical state. Measurements including minute volume and arterial blood gases were made twice daily. Weaning was carried out according to set criteria. During the feeding period, PaCO2 just prior to weaning fell by 16% in the high fat group but increased by 4% in the standard feed group (p = 0.003). The high fat group spent a mean of 62 h less time on the ventilator (p = 0.006). A high fat, low carbohydrate enteral feed appears to be beneficial in patients undergoing artificial ventilation.

    Article Published Date : Jan 01, 1989

  • Intravenous Vitamin C for reduction of cytokines storm in Acute Respiratory Distress Syndrome📎

    Abstract Title:

    Intravenous Vitamin C for reduction of cytokines storm in Acute Respiratory Distress Syndrome.

    Abstract Source:

    PharmaNutrition. 2020 Apr 21:100190. Epub 2020 Apr 21. PMID: 32322486

    Abstract Author(s):

    Alberto Boretti, Bimal Krishna Banik

    Article Affiliation:

    Alberto Boretti

    Abstract:

    The recent outbreak of Covid19 has required urgent treatments for numerous patients. No suitable vaccines or antivirals are available for Covid19. The efficiency against Covid19 of WHO therapies of choice, that are two antivirals developed for other pathologies, is controversial. Therefore, alternative approaches are required. Intravenous (IV) Vitamin C (Vit-C) has emerged as one of the other alternatives for this purpose. Here we review the effects of IV Vit-C on the immune system response, the antiviral properties of IV Vit-C, and finally the antioxidant properties of IV Vit-C to specifically address the cytokines' storm characteristic of the Acute Respiratory Distress Syndrome (ARDS) that occur in the later cycle of the Covid19 infectious disease.

    Article Published Date : Apr 20, 2020