Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove ...Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome （ARDS） using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units （ICUs） at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups： control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight （PBW） in both groups. RM was performed by continuous positive airway pressure （CPAP） of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two （P=0.007and P=0.001）. There were no significant differences between the RM and control group in hospital mortality （41.8% vs.56.4%, P=0.13）, 28-day mortality （29.1% vs. 43.6%, P=0.11） and ventilator-free days at day 28 （10.8±10.1 vs. 7.4±10.0,P=0.08）. ICU mortality （32.7% vs. 52.7%, P=0.03）, the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 （58.2% vs. 36.2%, P=0.02）, and nonpulmonary organ failure-free days at day 28 （17.4±11.1vs. 13.0±12.0, P=0.03） favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60,展开更多
Objective: To investigate the effect of radix paeoniae rubra (RPR) on expression of p38 mitogen activated protein kinase ( MAPK )/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury and explore the mol...Objective: To investigate the effect of radix paeoniae rubra (RPR) on expression of p38 mitogen activated protein kinase ( MAPK )/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury and explore the molecular mechanism.Methods: Forty healthy male Wistar rats, weighing 200-250 g, aged 6-8 weeks (mean =7 weeks), provided by the Experimental Center, Medical College, Wuhan University, Wuhan, China, were employed in this study.Under anesthesia with 7% chloraldurat (5 ml/kg body weight) through intraperitoneal injection, the trachea of the rat was exposed and an arterial puncture needle pricked into the trachea via cricothyroid membrane. Then they were randomly divided into five groups: 8 rats receiving 1 ml normal saline through the puncture needle (Group A),8 receiving 1 ml lipopolysaccharide (LPS, 2.5 mg/kg,Group B), 8 receiving LPS and RPR (30 mg/kg, pumped through the femoral vein for 2 hours, Group C ), 8 receiving RPR 2 hours before dripping LPS ( Group D),and 8 receiving hemin (75 μmol/L through intraperitoneal injection) 18 hours before dripping LPS (Group E). After 6 hours of LPS dripping, blood samples were obtained through the carotid artery to perform blood gas analysis,then all the rats were exsanguinated to death and specimens of lung tissues were obtained. The pathomorphological changes of the lung tissues were observed. The expression of p38 MAPK/iNOS/HO-1, the neutrophil ratio, protein content in alveolar irrigating solution and malonaldehyde (MDA) content in the lung tissues were also detected.Results: Compared with Group A, the expression of p38 MAPK, iNOS and HO-1 markedly increased in Groups B, C, D, and E (P ＜0.01). But in Groups C, D, and E,the expression of p38 MAPK and iNOS were significantly lower than that of Group B, while expression of HO-1 was obviously higher than that of Group B ( P ＜ 0.05 ). The protein content, the ratio of neutrophils in bronchoalveolar lavage fluid ( BALF), the content of MDA and the activities of serum NO in Group B were significantly higher tha展开更多
文摘Background The recruitment maneuver （RM） has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome （ARDS） using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units （ICUs） at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups： control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight （PBW） in both groups. RM was performed by continuous positive airway pressure （CPAP） of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two （P=0.007and P=0.001）. There were no significant differences between the RM and control group in hospital mortality （41.8% vs.56.4%, P=0.13）, 28-day mortality （29.1% vs. 43.6%, P=0.11） and ventilator-free days at day 28 （10.8±10.1 vs. 7.4±10.0,P=0.08）. ICU mortality （32.7% vs. 52.7%, P=0.03）, the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 （58.2% vs. 36.2%, P=0.02）, and nonpulmonary organ failure-free days at day 28 （17.4±11.1vs. 13.0±12.0, P=0.03） favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60,
基金the Research Task of the Department of Education in Hubei Province(No.2003X125).
文摘Objective: To investigate the effect of radix paeoniae rubra (RPR) on expression of p38 mitogen activated protein kinase ( MAPK )/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury and explore the molecular mechanism.Methods: Forty healthy male Wistar rats, weighing 200-250 g, aged 6-8 weeks (mean =7 weeks), provided by the Experimental Center, Medical College, Wuhan University, Wuhan, China, were employed in this study.Under anesthesia with 7% chloraldurat (5 ml/kg body weight) through intraperitoneal injection, the trachea of the rat was exposed and an arterial puncture needle pricked into the trachea via cricothyroid membrane. Then they were randomly divided into five groups: 8 rats receiving 1 ml normal saline through the puncture needle (Group A),8 receiving 1 ml lipopolysaccharide (LPS, 2.5 mg/kg,Group B), 8 receiving LPS and RPR (30 mg/kg, pumped through the femoral vein for 2 hours, Group C ), 8 receiving RPR 2 hours before dripping LPS ( Group D),and 8 receiving hemin (75 μmol/L through intraperitoneal injection) 18 hours before dripping LPS (Group E). After 6 hours of LPS dripping, blood samples were obtained through the carotid artery to perform blood gas analysis,then all the rats were exsanguinated to death and specimens of lung tissues were obtained. The pathomorphological changes of the lung tissues were observed. The expression of p38 MAPK/iNOS/HO-1, the neutrophil ratio, protein content in alveolar irrigating solution and malonaldehyde (MDA) content in the lung tissues were also detected.Results: Compared with Group A, the expression of p38 MAPK, iNOS and HO-1 markedly increased in Groups B, C, D, and E (P ＜0.01). But in Groups C, D, and E,the expression of p38 MAPK and iNOS were significantly lower than that of Group B, while expression of HO-1 was obviously higher than that of Group B ( P ＜ 0.05 ). The protein content, the ratio of neutrophils in bronchoalveolar lavage fluid ( BALF), the content of MDA and the activities of serum NO in Group B were significantly higher tha
