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Original Articles
Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France
Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman
Acute Crit Care. 2023;38(2):172-181.   Published online May 25, 2023
DOI: https://doi.org/10.4266/acc.2022.01494
  • 2,406 View
  • 83 Download
AbstractAbstract PDFSupplementary Material
Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods: This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results: Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions: In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.
Neurology
Cytokine profiles in intensive care unit delirium
Ryan J. Smith, Christian Lachner, Vijay P. Singh, Shubham Trivedi, Biswajit Khatua, Rodrigo Cartin-Ceba
Acute Crit Care. 2022;37(3):415-428.   Published online June 20, 2022
DOI: https://doi.org/10.4266/acc.2021.01508
  • 4,731 View
  • 182 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Neuroinflammation causing disruption of the blood-brain barrier and immune cell extravasation into the brain parenchyma may cause delirium; however, knowledge of the exact pathophysiologic mechanism remains incomplete. The purpose of our study was to determine whether cytokine profiles differ depending on whether delirium occurs in the setting of sepsis, coronavirus disease 2019 (COVID-19), or recent surgery.
Methods
This prospective observational cohort study involved 119 critically ill patients admitted to a multidisciplinary intensive care unit (ICU) during 2019 and 2020. Delirium was identified using the validated confusion assessment method for the ICU. Multiple delirium risk factors were collected daily including clinical characteristics, hospital course, lab values, vital signs, surgical exposure, drug exposure, and COVID-19 characteristics. Serums samples were collected within 12 hours of ICU admission and cytokine levels were measured.
Results
The following proinflammatory cytokines were elevated in our delirium population: tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-18, C-C motif ligand (CCL) 2, CCL3, C-X-C motif chemokine ligand (CXCL)1, CXCL10, IL-8, IL-1 receptor antagonist, and IL-10. Analysis of relative cytokine levels in those patients that developed delirium in the setting of sepsis, COVID-19, and recent surgery showed elevations of CCL2, CXCL10, and TNF-α in both the sepsis and COVID-19 group in comparison to the postsurgical population. In the postsurgical group, granulocyte colony-stimulating factor was elevated and CXCL10 was decreased relative to the opposing groups.
Conclusions
We identify several cytokines and precipitating factors known to be associated with delirium. However, our study suggests that the cytokine profile associated with delirium is variable and contingent upon delirium precipitating factors.

Citations

Citations to this article as recorded by  
  • Association of postoperative delirium with serum and cerebrospinal fluid proteomic profiles: a prospective cohort study in older hip fracture patients
    Lucía Lozano-Vicario, Ángel Javier Muñoz-Vázquez, Robinson Ramírez-Vélez, Arkaitz Galbete-Jiménez, Joaquín Fernández-Irigoyen, Enrique Santamaría, Bernardo Abel Cedeno-Veloz, Fabricio Zambom-Ferraresi, Barbara C. Van Munster, José Ramón Ortiz-Gómez, Ángel
    GeroScience.2024; 46(3): 3235.     CrossRef
  • Association of peripheral B cells and delirium: combined single-cell sequencing and Mendelian randomization analysis
    Siyou Tan, Sining Pan, Lai Wei, Wenyan Chen, Bingbing Pan, Gaoyin Kong, Jing Chen, Yubo Xie
    Frontiers in Neurology.2024;[Epub]     CrossRef
  • Brain injury biomarkers do not predict delirium in acutely ill older patients: a prospective cohort study
    Júlio César Garcia de Alencar, Flávia Barreto Garcez, Agnes Araujo Sardinha Pinto, Lucas Oliveira Junqueira e Silva, Lucas de Moraes Soler, Shirley Steffany Muñoz Fernandez, Victor Van Vaisberg, Luz Marina Gomez Gomez, Sandra Maria Lima Ribeiro, Thiago Ju
    Scientific Reports.2023;[Epub]     CrossRef
  • Systemic interleukin-6 inhibition ameliorates acute neuropsychiatric phenotypes in a murine model of acute lung injury
    Faizan Anwar, Nicklaus A. Sparrow, Mohammad Harun Rashid, Gena Guidry, Michael M. Gezalian, Eric J. Ley, Maya Koronyo-Hamaoui, Itai Danovitch, E. Wesley Ely, S. Ananth Karumanchi, Shouri Lahiri
    Critical Care.2022;[Epub]     CrossRef
Review Article
Basic science and research
Two-photon intravital imaging of leukocyte migration during inflammation in the respiratory system
Young Min Kim, Soi Jeong, Young Ho Choe, Young-Min Hyun
Acute Crit Care. 2019;34(2):101-107.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00542
  • 8,976 View
  • 185 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Two-photon intravital imaging is a powerful method by which researchers are able to directly observe biological phenomena in live organisms. Researchers in various biomedical research fields have applied two-photon imaging to a variety of target organs by utilizing this technology’s ability to penetrate to significant depths with minimal phototoxicity. The mouse respiratory system in inflammation models is a good example, as two-photon intravital imaging can provide insights as to how the immune system is activated in response to inflammation within the respiratory system. Inflammation models can be generated via influenza viral, bacterial, or lipopolysaccharide injection. To exteriorize the lungs or trachea, thoracotomy or tracheotomy is performed, respectively; the appropriate combination of inflammation induction and organ exposure is selected depending on the study purpose. On the other hand, visualizing the movement of leukocytes is also an important component; to this end, immune cell populations of interest are either labeled via the genetic attachment of fluorescent proteins or stained with antibodies or dyes. With the proper selection of methods at each step, twophoton intravital imaging can yield visual evidence regarding immune responses to inflammation.

Citations

Citations to this article as recorded by  
  • Live-Cell Imaging Quantifies Changes in Function and Metabolic NADH Autofluorescence During Macrophage-Mediated Phagocytosis of Tumor Cells
    Shelby N. Bess, Matthew J. Igoe, Timothy J. Muldoon
    Immunological Investigations.2024; 53(2): 210.     CrossRef
  • Integration of immune cells in organs-on-chips: a tutorial
    Lisette Van Os, Britta Engelhardt, Olivier T. Guenat
    Frontiers in Bioengineering and Biotechnology.2023;[Epub]     CrossRef
  • Intravital Imaging of Pulmonary Immune Response in Inflammation and Infection
    Nazli Alizadeh-Tabrizi, Stefan Hall, Christian Lehmann
    Frontiers in Cell and Developmental Biology.2021;[Epub]     CrossRef
  • Probe-based intravital microscopy: filling the gap between in vivo imaging and tissue sample microscopy in basic research and clinical applications
    Katrien Van Dyck, Eliane Vanhoffelen, Jonas Yserbyt, Patrick Van Dijck, Marco Erreni, Sophie Hernot, Greetje Vande Velde
    Journal of Physics: Photonics.2021; 3(3): 032003.     CrossRef
Original Articles
Basic science and research
Anti-inflammatory Role of Mesenchymal Stem Cells in an Acute Lung Injury Mouse Model
Jin Won Huh, Won Young Kim, Yun Young Park, Chae-Man Lim, Younsuck Koh, Mi-Jung Kim, Sang-Bum Hong
Acute Crit Care. 2018;33(3):154-161.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00619
  • 6,188 View
  • 189 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Mesenchymal stem cells (MSCs) attenuate injury in various lung injury models through paracrine effects. We hypothesized that intratracheal transplantation of allogenic MSCs could attenuate lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice, mediated by anti-inflammatory responses.
Methods
Six-week-old male mice were randomized to either the control or the ALI group. ALI was induced by intratracheal LPS instillation. Four hours after LPS instillation, MSCs or phosphate-buffered saline was randomly intratracheally administered. Neutrophil count and protein concentration in bronchoalveolar lavage fluid (BALF); lung histology; levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and macrophage inflammatory protein-2; and the expression of proliferation cell nuclear antigen (PCNA), caspase-3, and caspase-9 were evaluated at 48 hours after injury.
Results
Treatment with MSCs attenuated lung injury in ALI mice by decreasing protein level and neutrophil recruitment into the BALF and improving the histologic change. MSCs also decreased the protein levels of proinflammatory cytokines including IL-1β, IL-6, and TNF-α, but had little effect on the protein expression of PCNA, caspase-3, and caspase-9.
Conclusions
Intratracheal injection of bone marrow-derived allogenic MSCs attenuates LPSinduced ALI via immunomodulatory effects.

Citations

Citations to this article as recorded by  
  • The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
    Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
    Journal of Personalized Medicine.2024; 14(1): 121.     CrossRef
  • Cyclic Phytosphingosine-1-Phosphate Primed Mesenchymal Stem Cells Ameliorate LPS-Induced Acute Lung Injury in Mice
    Youngheon Park, Jimin Jang, Jooyeon Lee, Hyosin Baek, Jaehyun Park, Sang-Ryul Cha, Se Bi Lee, Sunghun Na, Jae-Woo Kwon, Seok-Ho Hong, Se-Ran Yang
    International Journal of Stem Cells.2023; 16(2): 191.     CrossRef
  • Mesenchymal stem cells and their derived exosomes to combat Covid–19
    Maryam Yousefi Dehbidi, Nima Goodarzi, Mohammad H. Azhdari, Mohammad Doroudian
    Reviews in Medical Virology.2022;[Epub]     CrossRef
  • Stem Cell‐based therapies for COVID‐19‐related acute respiratory distress syndrome
    Hoi Wa Ngai, Dae Hong Kim, Mohamed Hammad, Margarita Gutova, Karen Aboody, Christopher D. Cox
    Journal of Cellular and Molecular Medicine.2022; 26(9): 2483.     CrossRef
  • Development of a physiomimetic model of acute respiratory distress syndrome by using ECM hydrogels and organ-on-a-chip devices
    Esther Marhuenda, Alvaro Villarino, Maria Narciso, Linda Elowsson, Isaac Almendros, Gunilla Westergren-Thorsson, Ramon Farré, Núria Gavara, Jorge Otero
    Frontiers in Pharmacology.2022;[Epub]     CrossRef
  • Advances in mesenchymal stromal cell therapy for acute lung injury/acute respiratory distress syndrome
    Chang Liu, Kun Xiao, Lixin Xie
    Frontiers in Cell and Developmental Biology.2022;[Epub]     CrossRef
  • Auxiliary role of mesenchymal stem cells as regenerative medicine soldiers to attenuate inflammatory processes of severe acute respiratory infections caused by COVID-19
    Peyvand Parhizkar Roudsari, Sepideh Alavi-Moghadam, Moloud Payab, Forough Azam Sayahpour, Hamid Reza Aghayan, Parisa Goodarzi, Fereshteh Mohamadi-jahani, Bagher Larijani, Babak Arjmand
    Cell and Tissue Banking.2020; 21(3): 405.     CrossRef
  • The Role of MSC Therapy in Attenuating the Damaging Effects of the Cytokine Storm Induced by COVID-19 on the Heart and Cardiovascular System
    Georgina M. Ellison-Hughes, Liam Colley, Katie A. O'Brien, Kirsty A. Roberts, Thomas A. Agbaedeng, Mark D. Ross
    Frontiers in Cardiovascular Medicine.2020;[Epub]     CrossRef
The Utility of Serum Procalcitonin Levels in the Management of Systemic Inflammatory Response Syndrome in the Emergency Department
Kyung Hye Park, Kang Hyun Lee, Kyoung Chul Cha, Hyun Kim, Sung Oh Hwang
Korean J Crit Care Med. 2012;27(1):10-15.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.10
  • 2,815 View
  • 25 Download
AbstractAbstract PDF
BACKGROUND
The aim of this study was to investigate whether obtaining serum procalcitonin (PCT) levels in patients with systemic inflammatory response syndrome (SIRS) helps the differential diagnosis between sepsis and non-sepsis and predicts disease severity in the emergency department (ED).
METHODS
This prospective study enrolled 132 consecutive adult patients with SIRS who visited the ED. Serum C-reactive protein (CRP) levels and serum PCT levels were compared between sepsis and non-sepsis groups upon ED admission. Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were calculated, and their correlations with CRP and PCT levels were evaluated. The PCT and CRP levels were assessed to predict sepsis in terms of comparing receiver operating characteristic (ROC) curves.
RESULTS
Eighty patients were included in the sepsis group. The levels of PCT and CRP in the sepsis group were significantly higher. In the sepsis group, the initial serum PCT correlated with the SOFA and MODS scores, and this also correlated in the non-sepsis group, but CRP did not. No differences were found when the PCT and CRP ROCs were compared.
CONCLUSIONS
Correlation between PCT and severity in the non-sepsis group is considered to be clinically meaningless because of low levels. Additionally, PCT levels had similar diagnostic value for sepsis as CRP levels. PCT is recommended for prediction of severity in sepsis patients in ED, but not for differential diagnosis between sepsis and non-sepsis.

ACC : Acute and Critical Care