A New Global Definition of Acute Respiratory Distress Syndrome
文章来源:PubMed
摘要信息:Background. Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Methods. A Consensus Conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021-March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would: (1) identify patients with the currently accepted conceptual framework for ARDS; (2) facilitate rapid ARDS diagnosis for clinical care and research; (3) be applicable in resource-limited settings; (4) be useful for testing specific therapies; and (5) be practical for communication to patients and caregivers. Results. The committee made four main recommendations: (1) Include HFNO with a minimum flow rate of 30 liters/min; (2) Use arterial oxygen tension (PaO2)/FiO2 300 mmHg or SpO2/FiO2 < 315 (if SpO2 97%) to identify hypoxemia; (3) Retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and (4) In resource-limited settings, do not require PEEP, oxygen flow rate, or specific respiratory support devices. Conclusions. We propose a New Global Definition of ARDS that builds on the Berlin Definition. The recommendations also identify areas for future research, including the need for prospective assessments of feasibility, reliability, and prognostic validity of the proposed Global Definition.
Efficacy of sivelestat in alleviating postoperative pulmonary injury in patients with acute aortic dissection undergoing total arch replacement: a retrospective cohort study
文章来源:PubMed
摘要信息:Objective:Sivelestat may reduce postoperative pulmonary injury after total arch replacement (TAR). This study aimed to evaluate whether the preoperative PaO2/FiO2(P/F) ratio affects the efficacy of sivelestat in reducing postoperative pulmonary injury in patients with acute aortic dissection (AAD) who underwent TAR using deep hypothermic circulatory arrest (DHCA). Methods:Data of patients with AAD who underwent TAR using DHCA in a tertiary hospital between February 1, 2022, and December 30, 2022, were retrospectively reviewed. The patients were divided into the sivelestat and control groups. Three subgroup analyses were performed based on the postoperative P/F ratio. The primary clinical outcomes were assessed to determine the efficacy and safety of sivelestat in managing postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass. Results:A total of 187 patients were included, with 95 in the sivelestat group and 92 in the control group. No significant differences were found in the clinical variables between the two groups (all P > 0.05), except for some improvements in the inflammatory biomarker levels (including white blood cell count, neutrophil count, and C-reactive protein). Subgroup analysis revealed that sivelestat treatment significantly increased the P/F ratio on the 4th day and 3rd day after TAR in patients with mild lung injury (P = 0.02) and moderate lung injury (P = 0.03), respectively. Additionally, sivelestat reduced the levels of several postoperative inflammatory biomarkers in both subgroups. Conclusions:Among patients with AAD with mild or moderate preoperative lung injury, defined by a low P/F ratio, sivelestat significantly improved the postoperative P/F ratio and attenuated inflammatory responses after TAR. These findings suggest an important avenue for further research.
西维来司他钠与乌司他丁对急性Stanford A型主动脉夹层手术患者术后切口感染的效果对比
文章来源:中国知网
摘要信息:目的 比较西维来司他钠与乌司他丁对急性Stanford A型主动脉夹层(ATAAD)手术患者术后切口感染的效果。方法 回顾性分析2022年1月至2023年1月行ATAAD患者109例,分为观察组(50例)和对照组(59例)。观察组患者接受西维来司他钠治疗,对照组患者接受乌司他丁治疗。主要结局指标为术后至出院前的切口感染发生率。次要结局指标为术后肺部并发症(PPCs)、术后气管导管拔管时间、重症监护室(ICU)入住时间及术后住院时间;麻醉诱导前10 min(T0)、切皮时(T1)、术毕即刻(T2)、术后24 h (T3)及术后72 h(T4)时测量患者肺泡-动脉血氧分压差(PA-aDO2)、肺泡氧合指数(OI)及呼吸指数(RI)。术前1 d、术后1 d及术后3 d时分别采集患者外周静脉血样本,测定白细胞计数(WBC)、中性粒细胞数量(NEUT)、中性粒细胞百分比(NEUT%)及C反应蛋白(CRP)水平。结果 对照组术后切口感染发生率为13.6%(8/59),观察组为4.0%(2/50),观察组低于对照组(P<0.05)。观察组患者术后气管导管拔管时间及ICU停留时间均较对照组缩短(P<0.05)。术后至出院前,与对照组比较,观察组高碳酸血症发生率降低(P<0.05)。观察组和对照组PPCs总发生率分别为10.0%和38.0%,前者较后者降低(P<0.05)。观察组T1~4时PA-aDO2和RI低于对照组、OI高于对照组(P<0.05)。观察组术后1 d和3 d时WBC、NEUT和NEUT%以及CRP水平均低于对照组,差异有统计学意义(P<0.05)。结论 与乌司他丁相比较,西维来司他钠可降低ATAAD患者术后切口感染发生率,抑制炎症反应。
西维来司他钠对LPS诱导大鼠心肌细胞损伤的保护作用
文章来源:中国知网
摘要信息:目的:探讨西维来司他钠对脂多糖(LPS)诱导的大鼠心肌细胞损伤的保护作用。方法:海南省人民医院于2021年7月—2022年2月采用LPS建立大鼠H9c2心肌细胞损伤模型,分为对照组、LPS组、西维来司他钠+LPS组。其中西维来司他钠+LPS组分为高浓度组(LPS+high,10 μg/mL)、中浓度组(LPS+medium,4.8 μg/mL)、低浓度组(LPS+low,1.6 μg/mL)。LPS诱导心肌细胞损伤6 h后,检测心肌细胞上清液中的白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、丙二醛(MDA)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)的水平,对比各组上述因子水平的差异性。结果:与对照组比较,LPS组及低浓度组、中浓度组、高浓度组的IL-6、TNF-α、IL-1β、LDH水平均显著升高,SOD均下降,差异均有统计学意义(P<0.05);与对照组比较,LPS组及低浓度组、中浓度组的MDA水平均显著升高(P<0.05);与LPS组比较,低浓度组、中浓度组、高浓度组的IL-6、TNF-α、IL-1β、MDA、LDH均下降,SOD水平均升高,差异均有统计学意义(P<0.05)。结论:西维来司他钠可减少LPS诱导的心肌细胞炎症因子和氧化应激因子的产生,减轻心肌细胞损伤,从而起到保护心肌细胞的作用。
专家PPT:注射用西维来司他钠药理毒理学研究及药代动力学研究
文章来源:免疫炎症事业部中央市场部