Background: Although there are many advances in the treatment of Acute Respiratory Distress Syndrome (ARDS), the mortality rate is still high (40%-60%). The new strategy \u2018protective ventilation\u2019 helped to lower the fatality rate and shortening the duration of mechanical ventilation in comparison with traditional modes. However, there is controversy about the effects of protective ventilation. Objectives: (1) To estimate the change of arterial blood gas and hemodynamic in the first 48hrs in the patients suffering from ALI or ARDS under protective ventilation. (2) To discover the disadvantages of this ventilation mode. Subjects: 30 ALI and ARDS patients (22 males and 8 females) treated at ICU, Viet Duc Hospital between April 2005 and October 2005. Method: Prospective and self-control study. Protective ventilation was applied for these patients. Artery blood gas, hemodynamic and disadvantages of protective ventilation were monitored during first 48hrs. Results: Protective ventilation significantly lowers airway pressure (p < 0.001). There was no change of PaCO2 (p > 0.05), and PaO2 was improved clearly after 12hrs of ventilation (p < 0.05). There were no significant changes of mean arterial pressure, heart rate and central venous pressure. 83.3% patients needed a high dose of sedation during protective ventilation. Conclusion: Protective ventilation lowered airway pressure, improved PaO2 and had no hemodynamic effect. However, patients required a high dose of sedation during this mode of ventilation.
Protective ventilation ; acute lung injury ; acute respiratory distress syndrome

Acute Lung Injury ; therapy ; Humans ; Respiratory Distress Syndrome, Adult ; therapy

A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
Shock ; Respiratory Distress Syndrome, Adult ; Pneumonia ; Kidney Failure, Acute ; Complicated

Acute Lung Injury ; therapy ; Child ; Humans ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; therapy

Acute Disease ; Fatal Outcome ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy

Acute Lung Injury ; epidemiology ; etiology ; therapy ; Humans ; Respiratory Distress Syndrome, Adult ; epidemiology ; etiology ; therapy

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.
Acute Kidney Injury ; Myocarditis* ; Orientia tsutsugamushi ; Respiratory Distress Syndrome, Adult ; Scrub Typhus* ; Shock, Septic ; Vasculitis

Acute respiratory distress syndrome (ARDS) is a common disorder associated with significant mortality and morbidity. The American-European Consensus Conference (AECC) definition of ARDS, established in 1994, has advanced the knowledge of ARDS by allowing the acquisition of clinical and epidemiological data, which in turn have led to improvements in care for patients with ARDS. However, after 18 years of applied research, a number of issues regarding various criteria of AECC definition have emerged. For these reason, and because all disease definitions should be reviewed periodically, the European Society of Intensive Care Medicine convened an international expert panel to revise the ARDS definition from September 30 to October 2, 2011, Berlin, Germany, with endorsement from American Thoracic Society and the Society of Critical Care Medicine. This consensus discussion, following empirical evaluation and consensus revision, addressed some of the limitations of the AECC definition by incorporating current data, physiologic concepts, and clinical trials to develop a new definition of ARDS (Berlin definition). The Berlin definition should facilitate case recognition and better match treatment options to severity in both the research trials and clinical practice.
Acute Lung Injury ; Berlin ; Consensus ; Critical Care ; Germany ; Humans ; Critical Care ; Respiratory Distress Syndrome, Adult

Phosgene is not only a dangerous asphyxiating chemical warfare agent, but also an important chemical raw material, which is widely used in chemical production. According to statistics, there are more than 1 000 phosgene production enterprises in China, with an annual production volume of more than 3 million tons and hundreds of thousands of employees. Therefore, once the leakage accident occurs during production, storage and transportation, it often causes a large number of casualties. In the past 20 years, phosgene poisoning accidents in China have occurred from time to time, and due to the weak irritation, high density, and high concentration of phosgene at the scene of the accident, it often results in acute high-concentration inhalation of the exposed, triggering acute lung injury (ALI), and is very likely to progress to acute respiratory distress syndrome (ARDS), with a mortality rate up to 40%-50%. In view of the characteristics of sudden, mass, concealed, rapid and highly fatal phosgene, and the mechanism of its toxicity and pathogenicity is still not clear, there is no effective treatment and standardized guidance for the sudden group phosgene poisoning. In order to improve the efficiency of clinical treatment and reduce the mortality, this paper has summarized the pathophysiological mechanism of phosgene poisoning, clinical manifestations, on-site treatment, research progress, and innovative clinical therapies by combining the extensive basic research on phosgene over the years with the abundant experience in the on-site treatment of sudden mass phosgene poisoning. This consensus aims to provide guidance for the clinical rescue and treatment of patients with sudden mass phosgene poisoning, and to improve the level of treatment.
Humans ; Phosgene ; Chemical Warfare Agents ; Acute Lung Injury/drug therapy* ; Respiratory Distress Syndrome/therapy* ; Treatment Outcome

Pathologic findings of scrub typhus have been characterized by vasculitis of the microvasculature of the involved organ resulting from a direct invasion by Orientia tsutsugamushi. We experienced a case of acute respiratory distress syndrome (ARDS) associated with scrub typhus. The case was proven by eschar and high titer of serum IgM antibody (positive at 1:1280). Open lung biopsy showed diffuse alveolar damage (DAD) in the organizing stage without evidence of vasculitis. Immunofluorescent antibody staining and polymerase chain reaction for O. tsutsugamushi failed to demonstrate the organism in the lung tissue. The patient expired due to progressive respiratory failure despite doxycycline therapy. Immunologic mechanism, without direct invasion of the organism, may participate in the pathogenesis of ARDS associated with scrub typhus.
Acute Disease ; Aged ; Case Report ; Fatal Outcome ; Female ; Human ; Infant, Newborn ; Pulmonary Alveoli/pathology ; Pulmonary Alveoli/injuries ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/pathology ; Respiratory Distress Syndrome/immunology ; Respiratory Distress Syndrome/complications* ; Scrub Typhus/physiopathology ; Scrub Typhus/pathology ; Scrub Typhus/immunology ; Scrub Typhus/complications* ; Vasculitis