Daily Ards Research Analysis

BACKGROUND: Previous investigations have indicated the potential of mesenchymal stem cell (MSC) transplantation in treating COVID-19. However, the limited lifespan of transplanted cells constrains this therapeutic approach. the immunomodulatory, anti-inflammatory, and regenerative properties of MSCs secretome could be a promising solution to improve patient outcomes. MATERIALS AND METHODS: A randomized clinical trial was conducted in Kerman, a region in south-central Iran. This study enrolled twenty patients in the severe phase of COVID-19 pneumonia, randomly allocated into either investigation or control groups. Both groups received standard therapy, the investigation group additionally received nebulized concentrated MSCs secretome, 2 mL administered twice daily for five consecutive days. To evaluate the effect of MSCs secretome therapy, the length of stay in the intensive care unit (ICU), oximetry, and paraclinical results were assessed at baseline and 5 days after ICU admission. RESULTS: Baseline characteristics were balanced and distributed among the two groups. No adverse effect was observed in MSCs secretome-treated patients. Compared to the control group, the investigated group exhibited a decrease in ICU stay duration (10.90 ± 3.75 vs. 5.50 ± 1.64 days, CONCLUSIONS: The findings of this study underscore the prospective advantages and safety of the secretome of MSCs as a viable therapeutic choice in COVID-19 patients. We advise verifying our results through additional clinical trials at various disease stages.

OBJECTIVES: Our study aimed to investigate the effects of sevoflurane inhalation on mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistances (PVRs) in acute respiratory distress syndrome (ARDS) patients during lung protective ventilation. DESIGN: Prospective cohort study. SETTING: Medical ICU of a university teaching hospital. PATIENTS: Deeply sedated, intubated adult patients with moderate to severe ARDS with Pa o2 /F io2 less than 150 mm Hg, with a positive end-expiratory pressure of greater than or equal to 5 cm H 2 O and septic shock monitored with a pulmonary arterial catheter. INTERVENTIONS: Sedation was switched from IV midazolam to sevoflurane inhalation. MEASUREMENTS AND MAIN RESULTS: Main objective was the change in mPAP between before (T0) and 1 hour (H + 1) after sevoflurane inhalation. Main secondary outcomes were mPAP 12-18 hours (H + 12-18) after inclusion, PVR indexed (PVRI), cardiac index, Pa o2 /F io2 , pulmonary shunt at H + 1, and H + 12-18 after inclusion. The H + 12-18 measurements were performed either in supine position (SP) or in prone position (PP), if Pa o2 /F io2 ratio was less than 150 mm Hg at H + 1. Fifteen patients were included in interim analysis. mPAP was 24 ± 4 mm Hg at inclusion and remained unchanged after 1 hour (24 ± 5 mm Hg) and 12-18 hours (23 ± 6 mm Hg) of sevoflurane inhalation. The mean expired fraction of sevoflurane was 0.75% ± 0.25% at H + 1 and 0.71% ± 0.25% at H + 12-18. No significant variations in PVRI, cardiac index, mean arterial pressure, pulmonary shunt were observed at H + 1 and H + 12-18. An improvement of Pa o2 /F io2 was observed at H + 12-18 in patients who remained in SP (from 158 ± 49 to 249 ± 86 mm Hg; p = 0.015) and in those turned prone (from 134 ± 36 to 241 ± 109 mm Hg; p = 0.018). CONCLUSIONS: In mechanically ventilated moderate to severe ARDS patients receiving lung protective ventilation, sevoflurane inhalation was not associated with decreases in mPAPs and PVRs. However, the smaller than planned sample size does not allow definitive conclusions.

BackgroundPatients with multiple rib fractures may require mechanical ventilation due to respiratory insufficiency. We hypothesized that delayed intubation leads to worse outcomes compared to early intubation.MethodsWe analyzed data from the Trauma Quality Improvement Program database (2017-2021) for adults with ≥ 3 rib fractures requiring intubation. Patients were divided into groups of early and delayed intubation (after 24 hours from admission). Outcomes included in-hospital mortality, complications, and tracheostomy need. Resource utilization metrics were compared. Groups were balanced using inverse probability of treatment weighting, and complex samples logistic regression was used to evaluate the effect of delayed intubation on outcomes while controlling for covariates.ResultsOut of 191,816 patients with ≥3 rib fractures, 5339 underwent early intubation and 4004 underwent delayed intubation. Delayed intubation patients were older, more often female, less severely injured, had fewer bilateral fractures and flail chest, but higher tracheostomy need. Factors associated with delayed intubation included age > 60, ISS < 16, absence of bilateral fractures, smoking, and COPD. After adjustment, delayed intubation was associated with higher mortality (19.7% vs 13.7%), longer hospital and ICU stays, increased mechanical ventilation duration, and fewer ICU- and ventilator-free days. Additionally, delayed intubation was linked to increased ARDS, pulmonary embolism, severe sepsis, and acute kidney injury. It independently increased mortality odds (OR 1.584).DiscussionDelayed intubation in patients with multiple rib fractures is associated with worse clinical outcomes and increased resource utilization. This link between delayed intubation and worse outcomes highlights the importance of recognizing at-risk individuals and considering early intubation.