Daily Ards Research Analysis

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe inflammatory disorder characterized by acute respiratory failure, alveolar barrier dysfunction, edema, and dysregulated alveolar macrophage-mediated pulmonary inflammation. Despite advancements in treatment strategies, the mortality rate in patients with ARDS remains high, ranging from 40-60 %. Current approaches are limited to supportive care, necessitating the exploration of effective therapeutic options such as suppressing broad inflammatory responses. Although Cirsium japonicum leaves possess anti-inflammatory properties, their specific effects on ARDS have not yet been investigated. METHODS: The anti-inflammatory activity of Cirsium japonicum extract (CJE) was investigated in a lipopolysaccharide (LPS)-induced ARDS model. RESULTS: CJE significantly attenuated LPS-induced lung injury, including reduced alveolar wall thickness, inflammatory cell infiltration, proteinaceous debris, and hyaline membranes. Moreover, CJE repressed infiltration of inflammatory cells and pro-inflammatory gene expression in bronchoalveolar lavage fluid. Concordantly, CJE mitigated alveolar macrophage activation, which consequently reduced neutrophil chemoattractic infiltration. Additionally, CJE suppressed NLRP3 and HIF1α expression in the lungs of the ARDS mouse. Similarly, LPS-induced NLRP3 and HIF1α pathway-associated inflammatory and glycolytic gene expressions significantly diminished by CJE in murine alveolar macrophage cell line, MH-S cells, and bone marrow-derived macrophages. CONCLUSION: CJE suppressed multiple inflammatory responses through the regulation of NLRP3 and HIF1α signaling-related gene expression in macrophages of LPS-induced ARDS mice. These results suggest that CJE has therapeutic potential for treating patients with ARDS via macrophage regulation.

BACKGROUND: Although studies have revealed the benefits of using dexmedetomidine (DEX) in treating rodent models of acute lung injury (ALI) by improving their survival rates, clinical investigation on the effect of DEX on patients with acute respiratory distress syndrome (ARDS) remains scarce. Through this retrospective study, we aim to better understand the underlying mechanism of sepsis-induced ARDS and the effect of DEX on patients' standard treatment. METHODS: A total of 208 patients with sepsis-induced ARDS, admitted to the intensive care unit (ICU) at Affiliated Hospital of Jiangsu University, China, from January 2017 to December 2019, were included. The patients were divided into the control group (n = 102) and the DEX group (n = 106). Both groups of patients received mechanical ventilation and standard care; however, the DEX group was additionally treated with DEX as a sedative. Demographic information, baseline characteristics, laboratory parameters, arterial blood gas (ABG) analyses, and inflammatory indicators were compared between the two groups to evaluate the therapeutic outcomes of different treatment approaches. RESULTS: Age and male gender constituted risk factors for high ARDS incidence, and hypertension led in the list of patients' comorbidities. The baseline characteristics including primary diagnosis and ARDS causes, and prognostic values such as the Acute Physiology and Chronic Health Evaluation (APACHE) II score and predicted mortality, were comparable between the two groups of patients. However, the multiple organ dysfunction syndrome (MODS) incidence and actual mortality rate were significantly lower in the DEX group compared to the control group. Additionally, the DEX group demonstrated improved ABG metrics, representing better acid-base balance and oxygenation, and enhanced inflammatory responses. CONCLUSIONS: Intravenous administration of DEX was associated with reduced in-hospital mortality, at least in part, by ameliorating ABG indices and inflammatory mediators.

BACKGROUND Atrial fibrillation (AF) is a common arrhythmia in the general population and the most frequently presented arrhythmia in the intensive care unit. We investigated the effects of AF on the outcomes of critical COVID-19 patients, especially focusing on differences between chronic (CAF) and new-onset AF (NOAF) during critical disease. MATERIAL AND METHODS In this case-control study, we investigated the association of CAF and NOAF as an exposure, with in-hospital mortality as an outcome. We identified 2 patient groups, NOAF and CAF, which were compared with controls (all other hospitalized patients with critical COVID-19 pneumonia). No specific selection or matching was performed. The chi-square test was used for categorical variables; t test and Mann-Whitney U tests were used for continuous variables, depending on distribution. P<0.05 was considered significant. RESULTS In-hospital mortality was significantly higher in the NOAF group, while in the CAF group, it was similar to that of the control group. The NOAF group had significantly higher markers of inflammation and more severe acute respiratory distress syndrome (ARDS), measured with computed tomography. NOAF was strongly associated with in-hospital death, with OR 6.392 (95% CI, 2.758-14.815), P<0.000. In comparison, the CAF group was older and had more cardiovascular comorbidities, with similar markers of inflammation and severity of ARDS as the control group. CONCLUSIONS NOAF in COVID-19 was linked with significant risk of death, being a sign of extreme cardiac, pulmonary, and metabolic instability. NOAF should be considered as an important marker of instability and predictor of poor outcomes among patients with COVID-19.