The 2019 novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has occurred in China and around the world. SARS-CoV-2-infected patients with severe pneumonia rapidly develop acute respiratory distress syndrome (ARDS) and die of multiple organ failure. Despite advances in supportive care approaches, ARDS is still associated with high mortality and morbidity. Mesenchymal stem cell (MSC)-based therapy may be an potential alternative strategy for treating ARDS by targeting the various pathophysiological events of ARDS. By releasing a variety of paracrine factors and extracellular vesicles, MSC can exert anti-inflammatory, anti-apoptotic, anti-microbial, and pro-angiogenic effects, promote bacterial and alveolar fluid clearance, disrupt the pulmonary endothelial and epithelial cell damage, eventually avoiding the lung and distal organ injuries to rescue patients with ARDS. An increasing number of experimental animal studies and early clinical studies verify the safety and efficacy of MSC therapy in ARDS. Since low cell engraftment and survival in lung limit MSC therapeutic potentials, several strategies have been developed to enhance their engraftment in the lung and their intrinsic, therapeutic properties. Here, we provide a comprehensive review of the mechanisms and optimization of MSC therapy in ARDS and highlighted the potentials and possible barriers of MSC therapy for COVID-19 patients with ARDS.
Adoptive Transfer ; Alveolar Epithelial Cells ; pathology ; Animals ; Apoptosis ; Betacoronavirus ; Body Fluids ; metabolism ; CD4-Positive T-Lymphocytes ; immunology ; Clinical Trials as Topic ; Coinfection ; prevention & control ; therapy ; Coronavirus Infections ; complications ; immunology ; Disease Models, Animal ; Endothelial Cells ; pathology ; Extracorporeal Membrane Oxygenation ; Genetic Therapy ; methods ; Genetic Vectors ; administration & dosage ; therapeutic use ; Humans ; Immunity, Innate ; Inflammation Mediators ; metabolism ; Lung ; pathology ; physiopathology ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stem Cells ; physiology ; Multiple Organ Failure ; etiology ; prevention & control ; Pandemics ; Pneumonia, Viral ; complications ; immunology ; Respiratory Distress Syndrome, Adult ; immunology ; pathology ; therapy ; Translational Medical Research

Adolescent ; Adult ; Aged ; China ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; complications ; Male ; Middle Aged ; Respiratory Distress Syndrome, Adult ; etiology ; therapy ; Young Adult

Abdominal Neoplasms ; complications ; secondary ; therapy ; Acute Lung Injury ; diagnostic imaging ; etiology ; Anemia ; complications ; therapy ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child, Preschool ; Etoposide ; administration & dosage ; Fluoroscopy ; Humans ; Ifosfamide ; administration & dosage ; Kidney Neoplasms ; pathology ; Lung Neoplasms ; complications ; secondary ; therapy ; Male ; Postoperative Complications ; diagnostic imaging ; etiology ; Prosthesis Implantation ; Radiography, Thoracic ; Radiotherapy ; Respiratory Distress Syndrome, Adult ; diagnostic imaging ; etiology ; Transfusion Reaction ; Vascular Access Devices

We report a case of bronchiolitis obliterans associated with Stevens-Johnson syndrome. A 59-year-old man presented with respiratory distress that gradually worsened over 3 months. He had been diagnosed with Stevens-Johnson syndrome 3 months before admission. He had no history of previous airway disease. On physical examination, expiratory breathing sounds were not audible, and a chest X-ray revealed a hyperinflated lung. A pulmonary function test indicated a severe obstructive pattern. Computed tomography scans of inspiratory and expiratory phases of respiration showed oligemia and air trapping, and both were more prominent on expiration view than on inspiration view. The pathogenesis of bronchiolitis obliterans associated with Stevens-Johnson syndrome is largely unknown.
Anti-Bacterial Agents/therapeutic use ; Bronchiolitis Obliterans/etiology/*radiography/therapy ; Bronchoscopy ; Dyspnea/*complications ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Radiography, Thoracic ; Respiratory Distress Syndrome, Adult/*etiology/therapy ; Respiratory Function Tests ; Roxithromycin/therapeutic use ; Stevens-Johnson Syndrome/*complications/drug therapy ; Tomography, X-Ray Computed/methods ; Tracheostomy

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (> or =0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.
Acute Lung Injury/epidemiology/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/epidemiology ; *Blood Transfusion/adverse effects ; *Erythrocyte Transfusion/adverse effects ; Female ; Hemorrhage/etiology/*prevention & control ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Patients ; Respiratory Distress Syndrome, Adult/epidemiology/etiology ; Resuscitation ; Retrospective Studies ; Wounds and Injuries/complications/mortality/*therapy ; Young Adult

Adult ; Extracorporeal Membrane Oxygenation ; methods ; Humans ; Influenza, Human ; complications ; Male ; Respiratory Distress Syndrome, Adult ; etiology ; therapy

Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome that lacks definitive treatment. The cornerstone of management is sound intensive care treatment and early anticipatory ventilation support. A mechanical ventilation strategy aiming at optimal alveolar recruitment, judicious use of positive end-respiratory pressure (PEEP) and low tidal volumes (VT) remains the mainstay for managing this lung disease. Several treatments have been proposed in rescue settings, but confirmation is needed from large controlled clinical trials before they be recommended for routine care. Non-invasive ventilation (NIV) is suggested with a cautious approach and a strict selection of candidates for treatment. Mild and moderate cases can be efficiently treated by NIV, but this is contra-indicated with severe ARDS. The extra-corporeal carbon dioxide removal (ECCO2 R), used as an integrated tool with conventional ventilation, is playing a new role in adjusting respiratory acidosis and CO2. The proposed benefits of ECCO2 R over extra-corporeal membrane oxygenation (ECMO) consist in a reduction of artificial surface contact, avoidance of pump-related side effects and technical complications, as well as lower costs. The advantages and disadvantages of inhaled nitric oxide (iNO) are better recognized today and iNO is not recommended for ARDS and acute lung injury (ALI) in children and adults because iNO results in a transient improvement in oxygenation but does not reduce mortality, and may be harmful. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS. However, studies which are still controversial have shown that surfactant supplementation can improve oxygenation and decrease mortality in pediatric and adolescent patients in specific conditions and, when applied in different modes and doses, also in neonatal respiratory distress syndrome (RDS) of preemies. Management of ARDS remains supportive, aimed at improving gas exchange and preventing complications. Progress in the treatment of ARDS must be addressed toward the new paradigm of the disease pathobiology to be applied to the disease definition and to predict the treatment outcome, also with the perspective to develop predictive and personalized medicine that highlights new and challenging opportunities in terms of benefit for patient's safety and doctor's responsibility, with further medico-legal implication.
Child ; Humans ; Nitric Oxide ; administration & dosage ; Noninvasive Ventilation ; Positive-Pressure Respiration ; Prone Position ; Pulmonary Atelectasis ; etiology ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Adult ; therapy

OBJECTIVETo discuss the distribution of the respiratory complications in severely burned patients and the prevention and treatment experience against them.

METHODSMedical records of 922 adult patients with severe or extremely severe burn hospitalized in our burn ICU from January 2005 to December 2012 were screened and retrospectively analyzed, including patients transferred from other hospitals, patients with total burn area above 50% TBSA, the distribution and treatment of respiratory complications, and the mortality. Data were processed with chi-square test.

RESULTSThe constituent ratio of patients transferred to our hospital was 71.1% in 2007 and 40.2% in 2010, while it remained about 50.0% in the other years. The ratios of patients with total burn area larger than 50% TBSA and that of patients with respiratory complications (χ(2) = 2.637, P > 0.05) showed no significant changes each year. Among these 922 burn patients, 523 patients suffered respiratory complications, among which laryngeal edema (50.9%, 266 cases), pulmonary infection (21.6%, 113 cases), and ARDS (11.9%, 62 cases) were the main components, with no significant change each year (with χ(2) values respectively 6.132, 6.319, 0.016, P values above 0.05). Among the patients with respiratory complications, except for 36 were not treated actively, 487 were treated by ventilator among which 228 had undergone tracheostomy, and the constituent ratios in the 8 years were close. Fifteen patients died, with 2 died of laryngeal edema, 3 of ARDS, and 10 of sepsis or MODS as a result of sepsis.

CONCLUSIONSPatients with severe burns were at high risk of respiratory complications, among which laryngeal edema was common, followed by pulmonary infection and ARDS. Prophylactic tracheostomy, mechanical ventilation, wound therapy, and anti-infection were all effective measures of prevention and treatment against these complications.

Adult ; Aged ; Burns ; complications ; therapy ; Humans ; Laryngeal Edema ; etiology ; physiopathology ; therapy ; Lung ; physiopathology ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; etiology ; physiopathology ; therapy ; Retrospective Studies ; Sepsis ; etiology ; physiopathology ; therapy ; Treatment Outcome

BACKGROUNDAlthough noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure, the data are limited regarding its application in postoperative respiratory failure after cardiac surgery. Therefore, we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery, and explore the predicting factors of NPPV failure.

METHODSFrom September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group). The between-group differences in the patients' baseline characteristics, re-intubation rate, tracheotomy rate, ventilator associated pneumonia (VAP) incidence, in-hospital mortality, mechanical ventilation time after enrollment (MV time), intensive care unit (ICU) and postoperative hospital stays were compared. The factors that predict NPPV failure were analyzed.

RESULTSDuring the study period, a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded, and 95 of them met the inclusion criteria, which included 59 males and 36 females with a mean age of (61.5 ± 11.2) years. Forty-three patients underwent coronary artery bypass grafting (CABG), 23 underwent valve surgery, 13 underwent CABG+valve surgery, 13 underwent major vascular surgery, and three underwent other surgeries. The NPPV group had 48 patients and the control group had 47 patients. In the NPPV group, the re-intubation rate was 18.8%, tracheotomy rate was 12.5%, VAP incidence was 0, and the in-hospital mortality was 18.8%, significantly lower than in the control group 80.9%, 29.8%, 17.0% and 38.3% respectively, P < 0.05 or P < 0.01. The MV time and ICU stay (expressed as the median (P25, P75)) were 18.0 (9.2, 35.0) hours and 4.0 (2.0, 5.0) days, which were significantly shorter than in the control group, 96.0 (26.0, 240.0) hours and 6.0 (4.0, 9.0) days respectively, P < 0.05 or P < 0.01. The postoperative hospital stays of the two groups were similar. The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury (ALI) (17 vs. 0, P = 0.038), fewer patients with pneumonia (2 vs. 7, P < 0.001) and lower acute physiology and chronic health evaluation II (APACHE II) scores (16.1 ± 2.8 vs. 21.8 ± 3.2, P < 0.001). Multivariate analysis showed that pneumonia (P = 0.027) and a high APACHE II score >20 (P = 0.002) were the independent risk factors of NPPV failure.

CONCLUSIONSWe conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment. Pneumonia and a high APACHE II score >20 might be the independent risk factors of NPPV failure in this group of patients.

Aged ; Cardiac Surgical Procedures ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Prospective Studies ; Respiration, Artificial ; adverse effects ; Respiratory Distress Syndrome, Adult ; etiology ; therapy ; Respiratory Insufficiency ; diagnosis ; therapy ; Treatment Outcome

OBJECTIVETo study clinical effectiveness and possible side effects of lower tidal volume combine with lung recruitment on acute respiratory distress syndrome (ARDS) for post operative esophageal carcinoma surgery patients.

METHODSTwenty six hypoxemie post operative esophageal carcinoma surgery patients from Cancer Hospital and Peking Union Medical College Hospital were included from 1st January 2007 to 30th September 2009. There were 20 male and 6 female with an average age of 65.5 years (51 - 76 years). Circulation was stable among them. They could not weaned from mechanical ventilation due to ARDS. Bedside monitoring included noninvasive continuous artery blood pressure (NBP), pulse oximetry saturation (SPO2). Patients were ventilated on volume control mode. Tidal volumes set to 6 ml/kg. Recruitment maneuvers were conducted by stepwise rising of positive end expiratory pressure (PEEP) level. PEEP, fraction of inspired oxygen (FiO2), static compliance of lung (CLS) and arterial blood gas analysis (ABG) before and at 30 min after each of twice applying recruitment maneuvers were measured.

RESULTSFifty-two recruitments were completed on these 26 cases. PaO2/FiO2 improved significantly in 26 cases. The level of FiO2 were significantly lowered, CLS were increased significantly 30 min after each of twice applying recruitment maneuvers in all 26 cases. No complication was encountered. All patients were discharged successfully.

CONCLUSIONHypoxemia of ARDS following esophageal carcinoma surgery can be improved by lower tidal volume combine with lung recruitment maneuver.

Aged ; Esophageal Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Positive-Pressure Respiration ; Postoperative Complications ; therapy ; Respiration, Artificial ; adverse effects ; methods ; Respiratory Distress Syndrome, Adult ; etiology ; therapy ; Thoracotomy ; adverse effects ; Tidal Volume ; Treatment Outcome