BACKGROUND: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. RESEARCH QUESTION: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). STUDY DESIGN AND METHODS: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. RESULTS: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. INTERPRETATION: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
- MeSH
- dechový objem fyziologie MeSH
- hostitel s imunodeficiencí * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanika dýchání fyziologie MeSH
- následné studie MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- syndrom dechové tísně imunologie patofyziologie terapie MeSH
- ventilace umělá s výdechovým přetlakem metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Inflammation associated with acute respiratory distress syndrome (ARDS) can damage the alveolar epithelium and surfactant and worsen the respiratory failure. Glucocorticoids (GC) appear to be a rational therapeutic approach, but the effect is still unclear, especially for early administration and low-dose. In this study we compared two low doses of dexamethasone in early phase of surfactant-depleted model of acute respiratory distress syndrome (ARDS). In the study, lung-lavaged New Zealand rabbits with respiratory failure (PaO(2)<26.7 kPa in FiO(2) 1.0) were treated with intravenous dexamethasone (DEX): 0.5 mg/kg (DEX-0.5) and 1.0 mg/kg (DEX-1.0), or were untreated (ARDS). Animals without ARDS served as controls. Respiratory parameters, lung edema, leukocyte shifts, markers of inflammation and oxidative damage in the plasma and lung were evaluated. Both doses of DEX improved the lung function vs. untreated animals. DEX-1.0 had faster onset with significant improvement in gas exchange and ventilation efficiency vs. DEX-0.5. DEX-1.0 showed a trend to reduce lung neutrophils, local oxidative damage, and levels of TNFalpha, IL-6, IL-8 more effectively than DEX-0.5 vs. ARDS group. Both dosages of dexamethasone significantly improved the lung function and suppressed inflammation in early phase ARDS, while some additional enhancement was observed for higher dose (1 mg/kg) of DEX.
- MeSH
- antiflogistika aplikace a dávkování MeSH
- bronchoalveolární lavážní tekutina cytologie MeSH
- dexamethason aplikace a dávkování MeSH
- králíci MeSH
- modely nemocí na zvířatech MeSH
- plíce účinky léků MeSH
- počet leukocytů MeSH
- preklinické hodnocení léčiv MeSH
- respirační funkční testy MeSH
- syndrom dechové tísně krev farmakoterapie imunologie MeSH
- zánět farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Acute respiratory distress syndrome (ARDS) is a serious medical condition occurring in patients with polytrauma, pulmonary or non-pulmonary sepsis, pneumonia and many other circumstances. It causes inflammation of the lung parenchyma leading to impaired gas exchange with a systemic release of inflammatory mediators, causing consequential lung tissue injury, hypoxemia and frequently multiple organ failure. The aim of current study was to describe expression of inflammatory markers (myeloperoxidase, CD163 and vascular endothelial growth factor) by the cells in acute phase of ARDS. The lung samples of a 20-year-old man who had suffered a serious motorbike accident were obtained for histological examination. He died on the seventh day as a consequence of respiratory failure. Our results imply that expression of CD163 was restricted to activated alveolar macrophages and monocytes. Immunopositivityof MPO was observed in neutrophil granulocytes within lung alveoli and lung blood vessels. Myeloperoxidase positivity was observed in alveolar macrophages, too. Vascular endothelial growth factor was expressed in cytoplasm of neutrophil granulocytes, monocytes, small-sized alveolar macrophages and type II pneumocytes localized mostly inside lung alveoli. On the contrary, no positivity was observed in lung endothelial cells of blood vessels.
- MeSH
- alveolární makrofágy imunologie metabolismus MeSH
- antigeny diferenciační myelomonocytární biosyntéza MeSH
- CD antigeny biosyntéza MeSH
- dopravní nehody MeSH
- imunohistochemie MeSH
- lidé MeSH
- mimosilniční motorová vozidla MeSH
- mladý dospělý MeSH
- monocyty imunologie metabolismus MeSH
- neutrofily imunologie metabolismus MeSH
- peroxidasa biosyntéza MeSH
- pneumocyty imunologie metabolismus MeSH
- receptory buněčného povrchu biosyntéza MeSH
- syndrom dechové tísně imunologie metabolismus patologie MeSH
- vaskulární endoteliální růstový faktor A biosyntéza MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
BACKGROUND: Capnocytophaga canimorsus is a commensal bacterium found in the saliva of dogs and cats. Clinically significant infections in humans after a bite are often associated with the presence of immune deficiency. Early recognition and appropriate treatment are crucial for patient survival. In addition, patients with immune deficiency are susceptible to serious life-threatening nosocomial infections, which may also influence the prognosis of patients with Capnocytophaga canimorsus infection. CASE PRESENTATION: A 62-year-old Caucasian female was admitted with septic shock, acute respiratory distress syndrome, acute renal failure, metabolic acidosis and disseminated intravascular coagulation after suffering two small bites from her dog. She had received a splenectomy during childhood. The patient survived after early empiric treatment with antibiotics and intensive supportive care, including ventilation support, a high dose of noradrenalin, and continuous venovenous hemodialysis applied prior to the definitive diagnosis of Capnocytophaga canimorsus sepsis. She improved within 2 weeks but, despite all efforts to prevent nosocomial infection, her hospital course was complicated by Enterococcus species and Candida albicans pleuropneumonia that prolonged her stay in the intensive care unit, and necessitated ventilation support for 2 months. CONCLUSION: Severe Capnocytophaga canimorsus sepsis may be complicated by life-threatening nosocomial infection in immunocompromized patients. The prophylactic application of antibiotics after a dog bite should be considered in high-risk individuals with immune deficiency in order to prevent both Capnocytophyga canimorsus sepsis and serious nosocomial complications.
- MeSH
- akutní poškození ledvin komplikace farmakoterapie imunologie mikrobiologie MeSH
- antibakteriální látky terapeutické užití MeSH
- Capnocytophaga imunologie MeSH
- diseminovaná intravaskulární koagulace komplikace farmakoterapie imunologie mikrobiologie MeSH
- hostitel s imunodeficiencí * MeSH
- kousnutí a bodnutí komplikace farmakoterapie imunologie mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pleuropneumonie farmakoterapie imunologie mikrobiologie patologie MeSH
- psi MeSH
- septický šok komplikace farmakoterapie imunologie mikrobiologie MeSH
- syndrom dechové tísně komplikace farmakoterapie imunologie mikrobiologie MeSH
- zvířata MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- psi MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- aspergilóza alergická bronchopulmonální imunologie MeSH
- bronchiální astma MeSH
- chronická obstrukční plicní nemoc imunologie MeSH
- lidé MeSH
- nemoci dýchací soustavy imunologie klasifikace patologie MeSH
- pneumonie etiologie imunologie klasifikace MeSH
- syndrom dechové tísně diagnóza imunologie patologie MeSH
- Check Tag
- lidé MeSH
- MeSH
- endotoxiny imunologie škodlivé účinky MeSH
- NF-kappa B imunologie MeSH
- potkani Wistar anatomie a histologie MeSH
- receptory aktivované proliferátory peroxizomů fyziologie imunologie MeSH
- sérum metabolismus MeSH
- syndrom dechové tísně etiologie imunologie komplikace MeSH
- TNF-alfa analýza imunologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- srovnávací studie MeSH
