Daily Ards Research Analysis

Acute respiratory distress syndrome (ARDS) is featured with acute lung inflammatory injury. Our prospective study found that higher levels of peroxiredoxin 6(PRDX6) were detected in bronchoalveolar lavage (BAL) fluid from ARDS patients. Elevated PRDX6 was also correlated with monocytic activation and poor prognosis in ARDS patients. To investigate the origin of extracellular PRDX6, we conducted in vitro and in vivo experiments, demonstrating that PRDX6 can be actively released from alveolar epithelial cells under stress conditions. Our study demonstrated that it could be released from injured lung epithelial cells into the bronchoalveolar interstitial space in mice with acute lung injury and in vitro experiments. Moreover, exogenous PRDX6 was shown to activate the TLR4/NF-κB signalling pathway and induce M1 polarization of macrophages. Notably, the inflammatory effects of PRDX6 were mitigated by specific inhibition of the TLR4 (Toll-like receptor 4)-MD2 (Myeloid differentiation factor 2) complex. Using molecular docking simulations and in vitro binding assays, we confirmed a direct interaction between PRDX6 and MD2, further supporting its role as a damage-associated molecular patterns (DAMP) in ARDS. Our findings suggest that extracellular PRDX6 in bronchoalveolar lavage fluid could be a new DAMP factor in ALI, providing new insights into the pathogenesis of secondary hit in ALI/ARDS and highlighting PRDX6 as a potential therapeutic target for mitigating lung inflammation.

BACKGROUND: Despite the physiological advantages of positive end-expiratory pressure (PEEP), its optimal utilization during one-lung ventilation (OLV) remains uncertain. We aimed to investigate whether individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until April 1, 2024, to identify published randomized controlled trials that compared individualized PEEP titration by lung compliance with fixed PEEP during OLV. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included clinical outcomes (pneumonia, atelectasis, ARDS, cardiovascular complications, mortality), respiratory mechanics, gas exchanges, and hemodynamic variables. Subgroup analyses were conducted for the primary outcome according to the PEEP titration method (dynamic compliance vs. driving pressure/static compliance, stepwise decremental vs. incremental strategy). RESULTS: Ten trials involving 3426 patients were included. Compared with fixed PEEP, individualized PEEP titration by lung compliance was associated with reduced risk of a composite of postoperative pulmonary complications (eight trials, 3351 patients, risk ratio [RR] 0.55, 95% CI 0.38-0.78). Subgroup analyses suggested the association was evident in the subgroup with titration by dynamic compliance rather than driving pressure/static compliance and in the subgroup with PEEP titration by stepwise decremental but not stepwise incremental strategy. Individualized PEEP titration by lung compliance was also associated with a reduced risk of pneumonia (RR 0.71, 95% CI 0.52-0.96) and atelectasis (RR 0.63, 95% CI 0.45-0.88), higher dynamic compliance, PaO CONCLUSIONS: Compared with fixed PEEP, individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV, especially in PEEP titration by dynamic compliance or stepwise decremental strategy. It improves respiratory mechanics and oxygenation with no difference in hemodynamic variables. Trial registration number ClinicalTrials.gov (PROSPERO No. CRD42024529980).

OBJECTIVES: To analyze the clinical and biological characteristics and to evaluate the risk factors associated with the mortality of patients with COVID-19 in Commune IV of the District of Bamako. METHODS: The cohort consisted of COVID-19 patients managed from March 2020 to June 2022 at the Bamako Dermatology Hospital and the Pasteur Polyclinic in Commune IV in Bamako. The studied variables were sociodemographic, clinical, and biological. For the analysis of deaths, explanatory variables were grouped into sociodemographic factors, comorbidities and symptoms. Binomial logistic regression models were used to identify mortality associated risk factors. RESULTS: Among the 1319 included patients, 38.4% were asymptomatic, 46% and 15.5% developed moderate or severe COVID-19 respectively. The predominant signs were cough (48.5%), respiratory difficulty (24.6%) and headache (19.7%). Male were more common (58.2%). High blood pressure (19.9%) and diabetes (10%) were the main comorbidities. D-dimers < 0.5 μg/l was found in 53.3% of cases and the mean hemoglobin level was 12.9 ± 1.7 g/l. The case fatality rate was 3.71% in our series. In bivariate analysis, age > 60 years, high blood pressure, diabetes, clinical severity, D-dimers < 0.5 μg/l were associated with death. Using binomial logistic regression method, age > 60 years, increased heart rate, disease severity level and mainly acute respiratory distress syndrome (polypnea, difficulty breathing) were the factors found associated with death. After adjusting for all the assessed factors, age < 60 years [aHR = 0.15 (0.06-0.35)] and administration of azithromycin [aHR = 0.31 (0.1-0.97)] were protective factors while higher respiratory rate [aHR = 1.14 (1.07-1.22)] and difficulty breathing [aHR = 3.06 (1.03-9.13)] were risk factors associated with death. CONCLUSION: These main findings elucidate the factors associated with severity and lethality external of health care system constraints. Advanced age, higher heart rate and the development of respiratory distress were the factors significantly associated with increased fatalities.