Wuhan Coronavirus
 

This disease is being discussed on the Pandemic Flu thread. Since the coronavirus is not influenza, I thought it deserves it's own thread. I am not in the medical field, but I am in the affected region. I'll kick this off with my now removed post from the flu thread:

Under 3,000 total Wuhan Coronavirus cases globally (vast majority in China) and 80 deaths (all in China). Surgical masks are now almost impossible to find in China and Hong Kong. By contrast, here's a fun infographic on what the flu has done in the United States alone just since 01 OCT. Everyone take a step back and breathe...through your mask if you have one.

Staggering numbers but we have gotten use to the flu whereas this new bug is well it's new and folks tend to be perhaps more afraid of the unknown. Gonna have to give this sometime and see what takes place. I live in the middle of the largest community of Amish West of the Mississippi, they do not visit China and neither do I.:munchin

Every time I hear about this I think the last hangover I had down in Mexico. :D:p

My Team Sgt. told me "Statistics are just numbers, unless you're one of them...

This event aught to give us a perspective on the global supply chain and get folks thinking about the problems with our sourcing much of our manufacturing to China and other countries. The masks being just one example.

I remember learning back in the nineties the government was still offering subsidies regarding mohair, and insulation we needed in WWII and Korea. At the time I had no problem with that because it supported domestic ranching... except the part that many had bought the subsidies for investment and didn’t seem to be in a position to produce if needed. Today I think its safe to say we’ve moved in from mohair insulation and we actually produce some excellent synthetic insulation domestically for Berry Amendment Compliant products however I’ll bet your civilian garments are using imported types...food for thought.

Edit: Regarding the situation as it stands now, I thought this was informative and offered some practical advice from an MD.
advice. https://m.*******.com/watch?v=QA5AbqlCHuc

It's worse than what the Chinese government is reporting but not worth worrying about, for now at least. China was more concerned protecting their markets and trade, under reporting the initial outbreak. Now they've built a new hospital within a week and quarantined millions.

LOL, good stuff. That was exactly the answer I gave to a previous Commie governor when we were pushing for a carry bill, right after he'd made a big statement in the paper, to wit: "Statistically, our state is among the safest in the nation."

I wonder if it's because of their fucked up food handling/ consumption practices.

Fools think alike!! :D I had the same idea about the flu. I used this site https://nyshc.health.ny.gov/web/nyap...te-flu-tracker
elsewhere to compare China's problem to US flu. But my conclusion is that the Chinese are lying about the numbers. They are shutting down provinces and cities over a mere 3000+- sick and 80 +- dead?? Rushing to build hospitals??

Color me cynical. I'm inclined to believe that a lot of other governments are not poo pooing the numbers so as not to cause panic in their own countries.

^^ my WAG is this is much worse than the Chinese are allowing to leak out. No one rapidly builds quarantine centers (aka hospitals) because less than one-millionths of the local population gets a cold.

Not holding my breath on this, let’s see what it takes to treat this and what the mortality rate ends up being.

In the nature of such governments. Anyone remember a little burg called Chernobyl?

I will also, as you say, take a wait & see attitude however. The building of quarantine centers would not be irrational in many places. How many actual physical facilities, or even numbers of beds - existing right now - are in the US to handle more than a few affected with any number of such illnesses? I mean no shit, real certified, quarantine facilities.

Practically, surgical masks have a modest ability to prevent an infected person from spreading respiratory infections but really do not actually prevent an uninfected person. The take home message here is you want to get masks on sick people, especially if they are coughing and sneezing to minimize risks to others. Putting a surgical mask on healthy people really does not change their risk.

CDC has better resources than sensationalist websites.
https://www.cdc.gov/coronavirus/2019...out/index.html

Also a no-nonsense tips from BTDT
https://foreignpolicy.com/2020/01/25...-safety-china/

I for one am monitoring the stock market....and getting ready to buy the dip on airline stocks :o

Here’s a useful map that is in near real-time using WHO/CDC+ datasets:

https://gisanddata.maps.arcgis.com/a...23467b48e9ecf6

How often does the CDC say "This is a serious public health threat." ???
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html

I'd like to know what I should obtain for my disaster medical kit, now, before it becomes unobtanium.

How does one dose & administer ACE2 inhibitors - wait until a cytokine storm is in progress? Administer when bedridden but prior? Better case is hospital bed / MD available and I can hand the MD my personal stash of a drug.

Need to find an MD willing to prescribe it for such a purpose.

Out from DOT NHTSA

In the 2003 SARS coronavirus outbreak, 95% of cases and 93% of deaths were in the PRC or areas near China with significant Chinese populations (Taiwan, Hong Kong, Singapore, Vietnam and the Philippines). The one outlier was Canada, which accounted for 5%-6% of deaths.

A few days ago, an article appeared on globalnews.ca entitled "Doctor on front lines of SARS outbreak says Canadian hospitals prepared for coronavirus". A quote from the article:

I'm sorry. Hospitals didn't focus on handwashing until after 2003? Washing your hands is something 21st century health professionals needed to be told?

Is this a Canadian thing? I know hygiene issues are a big problem with disease outbreaks in the Third World, but I did not realize Toronto was in the Third World.

I'm sorry... couldn't resist...

Enlightenment is a terrible thing. I’m sure the native Canadians didn’t see it coming either...but then it happened...they became Chinese, Iranian, Turkish, Syrian, and Somalian in just the last 40 years. Toronto is the Paris of North America.

If your a male Asian, you might be SoL...

Here's an interesting bit out of a pre-print paper thought granted it is not peer reviewed and is an extremely small data set: https://www.biorxiv.org/content/10.1....919985v1.full


Quote:
"We further compared the characteristics of the donors and their ACE2 expressing patterns. No association was detected between the ACE2-expressing cell number and the age or smoking status of donors.

“Of note, the 2 male donors have a higher ACE2-expressing cell ratio than all other 6 female donors (1.66% vs. 0.41% of all cells, P value=0.07, Mann Whitney Test). In addition, the distribution of ACE2 is also more widespread in male donors than females: at least 5 different types of cells in male lung express this receptor, while only 2~4 types of cells in female lung express the receptor. “

“This result is highly consistent with the epidemic investigation showing that most of the confirmed 2019-nCov infected patients were men (30 vs. 11, by Jan 2, 2020)."

"We also noticed that the only Asian donor (male) has a much higher ACE2-expressing cell ratio than white and African American donors (2.50% vs. 0.47% of all cells). This might explain the observation that the new Coronavirus pandemic and previous SARS-Cov pandemic are concentrated in the Asian area."

"The result indicates that the ACE2 virus receptor expression is concentrated in a small population of type II alveolar cells (AT2). Surprisingly, we found that this population of ACE2-expressing AT2 also highly expressed many other genes that positively regulating viral reproduction and transmission. A comparison between eight individual samples demonstrated that the Asian male one has an extremely large number of ACE2-expressing cells in the lung"

Is This The Man Behind The Global Coronavirus Pandemic?

Radio talk show host, Chris Plante, called it Kung Flu this morning. :D

In the lead up to the 1997 handover of Hong Kong, there was a wave of Chinese who gained residency and citizenship in Canada, Australia, New Zealand, and USA as a hedge against PRC heavy handed ness in Hong Kong, with the biggest single clusters in Vancouver, Sydney, Auckland, and LA/San Francisco.

A generation later, with the wealth boom in Mainland China, many Chinese decided to hedge their bets in western countries buying real estate “life boats” and sending their kids to be educated in the same locations theirs aunts/uncles/cousins set up a generation prior.

Based on those really strong network connections, those are the places I suspect have some of the highest risk of viral “break-in” to 4 of the FVEY.

Just my amateur anthropological 0.02c

ā sō desu ka?

I started a new thread with this announcement of a Harvard Prof's arrest for selling bio info to china as it was to tin foilish,,

Maybe not??

Does it need to be moved to this thread?

https://www.professionalsoldiers.com...ad.php?t=54633

So WHO has finally declared an international healthcare emergency. Which changes absolutely nothing. It’s been one since the first h2h outside of China.

The human-to-human transmission in the US also means nothing...the new case is in the spouse of the confirmed Chicago infection. Your ears should perk up when there are reports of new infections with no known connection to a confirmed case. That means some undiscovered infection locus is out there.

The Ro, virulence, and future course of this disease are all unknowns with conflicting reports and prognostications.

The fact is nobody knows what is going to happen. The next month should give you a feeling for where this is going. It’s either going to start tapering off, in which case we have the equivalent of another bad case of the flu going around, or it’s going to explode.

So...frequent hand washing, increased avoidance of risky social interactions, and reasonable preps for the worst case, if it develops.

Sounds solid, given the CHICOMs have earned their place in the Top-2 probably in the category of draconian information control.

Supplies are already drying up. N95 masks are out of stock at a lot of places. Hand sanitizer too. If you have not stocked, now might be the time to get off your duff.

This Doc does some pretty good analysis on the virus.

I've watched a few of his earlier ones.

https://www.*******.com/watch?v=nW3xqcGidpQ

A virus similar to the Chinese Coronavirus (2019-nCoV) was engineered at UNC around 2015 and researcher #8, listed in the study - is listed as one “Zheng-li Shi” attached to*the*“Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences,*Wuhan, China.”

I'm not certain of the validity of the following linked article, however, it makes sense and sounds as if this may be a case of research gone wrong......


Another Chinese virologist, Xing-Yi Ge, appears as an author on the 2016 UNC paper and is also attached to the lab in Wuhan. Previously in 2013, he’d*successfully isolated a SARS-like coronavirus from bats which targets the ACE2 receptor, just like our present virus, the Wuhan Coronavirus 2019-nCoV.

Link below:


https://harvardtothebighouse.com/202...vZS8GJlKzyZ4xA

I tried to get some background on Harvard to the Big House site.

The site leads to Dan Sirotkin on LinkedIn, Twitter, & Instagram

https://www.instagram.com/harvard2thebighouse/
https://twitter.com/Harvard2H

Appears to be a one-man show.
"big house" like-in he did/doing some jail time.
See Maryland SOR entry at the bottom.

Adding what I found,
Making no judgment on this guy,
BUT he resumes is weak??


needs verification, but hi LinkedIn pic and jail pic are simular
...

Not counting the fact that those of us of a certain vintage enjoy our nappy-poo's, you just did in 8 hours more vetting than was done for murderous Saudi aviation exchange students.
:lifter

Thanks JJ BPK! I'm guessing since that article seems footnoted fairly well with links to scientific articles, the prisoner must not have written it. Lol

Edited to add:

From what I can tell, it appears the author of the article on "Harvard to the Big House" blog originated from "Medium(dot)com" and was posted by "@siradrianbond" whoever that is.

This coming weekend (Feb 8/9) will be interesting. When this first started three epidemiological curves of infection rates were predicted from SARS/MERS experience showing optimistic, expected, and worst-case plots of the growth of total cases. Basically, they predicted scenarios when the total number of infections would peak and then flatten and decline. The virus has blown past the optimistic and expected peaks. The pessimistic number should be achieved Thurs/Fri. If we hear of flat numbers this weekend that would be sublime---the disease will taper off in China and contagion pressure will ease. If not, we're looking at pandemic, most likely. Even then, we probably need to wait til the end of of the month to understand what's going to happen here in NA.

There's going to be a long hard look at the Wuhan's Institute of Virology when the dust settles. And, I hope, forensic accounting investigations of the top WHO cats.

Everyone is holding their breath and looking at Lagos, Mumbai, Mexico City.

How dangerous this truly is is all over the map. They need the total number of cases to make that estimate and they just don't have the data (lies, exhaustion, insufficient test supplies, lack of resource). Epidemiologists were totally counting on Hong Kong (considered first-world reliable) to report hard data on the prevalence of mild/asymptomatic cases. They're just not seeing them, at least not yet. So that's disappointing, and a blow to the hopes that this is a mild infection that's only culling the weak.

The fatalities aren't dying quickly, many taking 5-7 days to succumb. This is leading a lot of amateurs (and unsophisticated docs) to say "200 deaths, 12,000 cases, that's <2%--bad but severe-flu bad, not catastrophic." The problem is those 200 folks who died contracted the disease 10-15 days ago, when there were only 4,000 cases. Meaning a 5% death rate. Less good. The people who exhibit symptoms today are going to contribute to fatality stats in a week or so. If you see new cases flatten this weekend while deaths keep increasing, it's expected--within reason.

The bottom line is, no one knows how serious this is. It could be less than 1%, maybe much less if there are lots and lots of mild cases. Or it could be >5%, which would be bad bad bad to the supply chain and heartbreaking on the personal level.

The top three medical supply producers (China, India, Thailand) have halted all exports to conserve supplies for local use. No masks, gowns, IV sets, O2 cannulae...Every time I hear some US health administrator boasting about their preparedness I wince. Hubris. Gods. Eek. STFU

Social distancing remains the only option and it's a legitimate and successful tactic. Avoid all crowds as much as possible. Wash hands like an obsessive-compulsive at an STD clinic. Hand sanitizer. "Gel in, gel out" as the medicos say. Doorknobs/handles, handrails, grocery cart handles, elevator buttons, etc...all are enemies. Use your elbows and shoulders to open doors. Shoes and outerclothes off outside. Don't touch your face. Plan on wanting to stay indoors for extended periods.

Good luck to us all.

Mug, are you doing all your posting in this thread now, not the original Pandemic Flu thread?

I'll repeat a couple of items:
1) Where can we find info on "how to use" ACE2 inhibitors if the hospitals are full and someone is sick? Better case is there are beds but you have to provide your own meds, or you can contact an MD for advice.

2) what should one ask his MD for NOW, in the way of a prescription for a supply of ACE2 inhibitor, to put it in our disaster med kit?

3) Is alcohol hand sanitizer sufficient to kill virii?

I see there are BAC based hand sanitizers (Benzalkonium Chloride), and one using something they call BAC-D which claims to have an ionic charge added to it, which disrupts cell walls. And to remain active on the skin for hours.

You can get 2% BAC disinfectant by the gallon at any big box hardware store, in the janitorial supply section.

I’m not really posting much anywhere since the first flurry because I don’t have any inside gouge. I’m following the suggestion to post here.

Chinese docs on Weibo were begging for injectable ACE2 inhibitors but those are not available in the US. No real use, normally. The Celestials obvs make it for something but I don’t know what. There are reagent grade samples sold here but I think my daughter or one of her colleagues figured it cost about $12.5K per 500mg dose, two doses per day x 10 days. They sell in micrograms and you administer in grams. “A mite dear” as granny used to say.

So, nothing to ask for.

ACE1 inhibitors for the cytokine storm are an unknown to me. I’ve seen no talk of their use. Those are as common as mud...lisinopril and the like.

There’s a cocktail of old school AIDS antivirals that’s supposed to work against the virus but now we’re fighting supply chain voids and I just assume none will be around. Leronlimab, Abbvie’s alluvia, I think and some ebola antiviral I can't remember the name of. Lisinopril/ACE1 for h5n1 was a possibility because it worked, it’s common as mud and just as cheap, but aids antiretrovirals for someone without aids would be a stretch. Maybe a scrip from a medical marijuana hack with a few gold eagles jingling in your hand. Dunno. But all this stuff is made in India/Thailand/China so a scrip might be useless anyway.

Hand gel works. Bar soap with good method for >20 seconds works. Social distancing works. Buy bar/liquid soap. The gougers are on the purell.

Hand sanitizer is 62-65% ethanol. If you can’t get bulk purell buy 151 rum and dilute :) The water %age is an important part of the process I hear. All the Purell looks to be gone on amazon (I wasn’t exhaustive) with that ‘available March 5th’ joke, same as masks, gloves. Pro tip: it’s not going to be available March 5 :) Maybe on a local shelf.

I know nothing first hand about BAC. Maybe that is what the Chinese are spraying on every surface in the vids? It’s still available on amazon and claims efficacy so ???



The good news is youngsters are currently underrepresented in the Chinese dead. They are catching it but not dying. So there’s that. There are also decent odds this won’t be terribly virulent, will be contained, at least here, blah blah.

That said just be ready for supply chain disruption. China has its hooks into Nigeria via debt/infrastructure and thousands were going back and forth. If Lagos starts to burn it’ll be magnitude 9 on the cable news Richter scale. Investor panic. Payments late on Hamptons vacay homes. Kias on Wall and Broad instead of range rovers.

My daughter keeps telling me that critical meds are short now, any worse and people die. get that 90 days ASAP, even if nothing develops twitter could kill you. Sorry to ramble

Macau stops shaking it's money maker. They will be closing their casinos for two weeks (I expect it will be longer).

Macau just got its 10th case. Hong Kong is at 15 with one death. The fatality was a 39 yr old male.

Most HK land crossings with the mainland are closed. The 2-3 remaining open are naturally seeing increased traffic, which puts more pressure on the ability to conduct medical screening. HK medical workers went on strike to protest the lack of a total closure.

The ferry service between HK & Macau has temperature screening at the customs and immigration points.

Some hotels in HK are taking temps of new guest arrivals and turning away those who come up hot.

If Hong Kong is closed entirely, no in/out international flights or shipping, the impact to global markets will be not good.

Mug - Prayers for you. Don't ring the bell !!! You still have knowledge, you can still do good.

Questions for all:

I don't know the difference between ACE1 and ACE2, but reading indicates ACE2 is the choice. I thought the ACE2 class was a commonly used oral drug? If so, what are some brand & generic names? Or is it still a researchers' unicorn ?

I have dug out my notes from October 2006 in the Pandemic Flu thread.

Statins, like Zocor, 20mg twice a day at first hint of symptoms, and once a day for family members who are asymptomatic. Seems like 10-12 day course probably reasonable risk.

ACE2 seemed to be "new" vs flu in 2006 -- No dosage info.

By now, doesn't WHO etc have a medical protocol for treating SARS & MERS etc which specifies drugs & dosage etc ? I am searching but the web is full of spam; need to find a portal to real physician information.

Wondering if "vasodilatory shock" is synonymous with ARDS (acute respiratory distress syndrome). Not sure if this article contains useful knowledge:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067786/
Angiotensin II: a new therapeutic option for vasodilatory shock

Angiotensin II (Ang II), part of the renin–angiotensin–aldosterone system (RAS), is a potent vasoconstrictor and has been recently approved for use by the US Food and Drug Administration in high-output shock.

Though not a new drug, the recently published Angiotensin II for the Treatment of High Output Shock (ATHOS-3) trial, as well as a number of retrospective analyses have sparked renewed interest in the use of Ang II, which may have a role in treating refractory shock.

We describe refractory shock, the unique mechanism of action of Ang II, RAS dysregulation in shock, and the evidence supporting the use of Ang II to restore blood pressure.

Evidence suggests that Ang II may preferentially be of benefit in acute kidney injury and acute respiratory distress syndrome, where the RAS is known to be disrupted.

Additionally, there may be a role for Ang II in cardiogenic shock, angiotensin converting enzyme inhibitor overdose, cardiac arrest, liver failure, and in settings of extracorporeal circulation.
********

Don't know about dehydration & fluids. How many liters of IV bags might be needed? What type of fluid? Is subcutaneous administration feasible in adults (I know how to do that).

Goldpharma.com still exists, but maybe it only allows drug searches if you register first. I can't get anything but the home page to show.

More from the 2006 thread:
Get vaccinated for HiB and Pneumovax II. Sometimes this is a combined shot.

Ferry service between Hong Kong & Macau is suspended as of 0000 04 FEB HK time.

turbojet.com.hk/en/routing-sailing-schedule/hong-kong-macau/sailing-schedule-fares.aspx

Physician-grade drug info
 

Gone down the rabbit hole.

1) US Dept Health & Human Services
Chemical Hazards Emergency Medical Management
Home > Medical Countermeasures Database > Statins
https://chemm.nlm.nih.gov/countermeasure_statins.htm

Above article on statins. Cites lots of research articles. Opinions seem to be mixed as to whether statins lower mortality.

edit: No dosing information for ARDS:
"2. Chemical Defense therapeutic area(s)
— including key possible uses

Statins can be used as anti-inflammatory treatment for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) induced by pulmonary agent such as phosgene."


2) You have to register here, but you can do so as a non-medical pro. Site provides info & Continuing Education credits for the medical field.

Everything you could ever want to know about diagnosing & treating ARDS:
Drugs & Diseases > Critical Care
Acute Respiratory Distress Syndrome
Updated: Oct 17, 2018

https://emedicine.medscape.com/article/165139-overview

ALSO:
Drugs & Diseases > Critical Care
Acute Respiratory Distress Syndrome Questions & Answers
Updated: Oct 17, 2018

https://emedicine.medscape.com/artic...ns-and-answers

Field expedient ARDS
 

Long post. PART 1
Trying to treat ARDS in the field seems futile.

My summary drawn from:
https://emedicine.medscape.com/article/165139-overview
Acute Respiratory Distress Syndrome
Updated: Oct 17, 2018
*****

Early use Corticosteriods seem NOT to improve mortality, but I have not necessary seen the latest study data on that.

FLUIDS: "Type one reflects primarily acute lung injury without antecedent systemic processes like sepsis or pancreatitis. Type two is acute lung injury with an overwhelming systemic insult like sepsis.

Important to note, type one patients benefit from a fluid-restrictive management strategy (infra vide)"


VENTILATION: One item is that those positive-pressure breathing masks (CPAP) so many people have can, so some extent, substitute for a real ventilator. Lots of technical issues in the pressure curves and oxygen saturation, but in the field helping respiration might be the best you can do.

"The use of positive end-expiratory pressure (PEEP) to diminish alveolar collapse and the use of low tidal volumes and limited levels of inspiratory filling pressures appear to be beneficial in diminishing the observed VALI.

"Generally, oxygen concentrations higher than 65% for prolonged periods (days) can result in DAD, hyaline membrane formation, and, eventually, fibrosis.

ARDS is uniformly associated with pulmonary hypertension"

MORBIDITY PREDICTORS:
"Indices of oxygenation and ventilation, including the PaO2/FiO2 ratio, do not predict the outcome or risk of death. The severity of hypoxemia at the time of diagnosis does not correlate well with survival rates. However, the failure of pulmonary function to improve in the first week of treatment is a poor prognostic factor.

Peripheral blood levels of decoy receptor 3 (DcR3), a soluble protein with immunomodulatory effects, independently predict 28-day mortality in ARDS patients.

In a study comparing DcR3, soluble triggering receptor expressed on myeloid cells (sTREM)-1, TNF-alpha, and IL-6 in ARDS patients, plasma DcR3 levels were the only biomarker to distinguish survivors from nonsurvivors at all time points in week 1 of ARDS. [11] Nonsurvivors had higher DcR3 levels than survivors, regardless of APACHE II scores, and mortality was higher in patients with higher DcR3 levels."

PRESENTATION:
"With the onset of lung injury, patients initially note dyspnea with exertion. This rapidly progresses to severe dyspnea at rest, tachypnea, anxiety, agitation, and the need for increasingly high concentrations of inspired oxygen.

Physical Examination

Physical findings often are nonspecific and include tachypnea, tachycardia, and the need for a high fraction of inspired oxygen (FiO2) to maintain oxygen saturation. The patient may be febrile or hypothermic. Because ARDS often occurs in the context of sepsis, associated hypotension and peripheral vasoconstriction with cold extremities may be present. Cyanosis of the lips and nail beds may occur.

Examination of the lungs may reveal bilateral rales. Rales may not be present despite widespread involvement."

"Because cardiogenic pulmonary edema must be distinguished from ARDS, carefully look for signs of congestive heart failure or intravascular volume overload, including jugular venous distention, cardiac murmurs and gallops, hepatomegaly, and edema."


COMPLICATIONS:
"ventilator-associated pneumonia (VAP) and line sepsis. The incidence of VAP in ARDS patients may be as high as 55% and appears to be higher than that in other populations requiring mechanical ventilation. Preventive strategies including elevation of head of the bed, use of subglottic suction endotracheal tubes, and oral decontamination."

"Renal failure is a frequent complication of ARDS, particularly in the context of sepsis. Renal failure may be related to hypotension, nephrotoxic drugs, or underlying illness. Fluid management is complicated in this context, especially if the patient is oliguric. Multisystem organ failure, rather than respiratory failure alone, is usually the cause of death in ARDS.

Other potential complications include ileus, stress gastritis, and anemia. Stress ulcer prophylaxis is indicated for these patients. Anemia may be prevented by the use of growth factors (erythropoietin)."

FIELD EXPEDIENT WORKUP ITEMS:
"Approach Considerations

Acute respiratory distress syndrome (ARDS) is defined by the acute onset of bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence of cardiogenic pulmonary edema. Workup includes selected laboratory tests, diagnostic imaging, hemodynamic monitoring, and bronchoscopy. ARDS is a clinical diagnosis, and no specific laboratory abnormalities are noted beyond the expected disturbances in gas exchange and radiographic findings.

Laboratory Tests

In ARDS, if the partial pressure of oxygen in the patient’s arterial blood (PaO2) is divided by the fraction of oxygen in the inspired air (FiO2), the result is 300 or less. For patients breathing 100% oxygen, this means that the PaO2 is less than 300.

In addition to hypoxemia, arterial blood gases often initially show a respiratory alkalosis. However, in ARDS occurring in the context of sepsis, a metabolic acidosis with or without respiratory compensation may be present.

As the condition progresses and the work of breathing increases, the partial pressure of carbon dioxide (PCO2) begins to rise and respiratory alkalosis gives way to respiratory acidosis. Patients on mechanical ventilation for ARDS may be allowed to remain hypercapnic (permissive hypercapnia) to achieve the goals of low tidal volume and limited plateau pressure ventilator strategies aimed at limiting ventilator-associated lung injury."

MANAGEMENT:
" A study by Martin-Loeches et al concluded that the early use of corticosteroids was also ineffective in patients with the pandemic H1N1 influenza A infection, resulting in an increased risk of superinfections. [23] This finding was also echoed in a study by Brun-Buisson et al, who found no evidence of benefit associated with corticosteroids in patients with ARDS secondary to influenza pneumonia but did find that early corticosteroid therapy may be harmful. [24]

Numerous pharmacologic therapies, including the use of inhaled synthetic surfactant, intravenous (IV) antibody to endotoxin, ketoconazole, simvastatin, and ibuprofen, have been tried and are not effective. [25]

A study that examined the use and outcomes associated with rescue therapies in patients with ARDS determined that these therapies offered no survival benefit. [26] The study also determined that rescue therapies are most often used in younger patients with more severe oxygenation deficits.

Inhaled nitric oxide (NO), a potent pulmonary vasodilator, seemed promising in early trials, but in larger controlled trials, it did not change mortality rates in adults with ARDS. [27, 28] A systematic review, meta-analysis, and trial sequential analysis of 14 randomized controlled trials, including 1303 patients, found that inhaled nitric oxide did not reduce mortality and results in only a transient improvement in oxygenation. [29]

Although no specific therapy exists for ARDS, treatment of the underlying condition is essential, along with supportive care, noninvasive ventilation or mechanical ventilation using low tidal volumes, and conservative fluid management.

Because infection is often the underlying cause of ARDS, early administration of appropriate antibiotic therapy broad enough to cover suspected pathogens is essential," ...
...

"With the development of the National Institutes of Health (NIH)–sponsored ARDS Clinical Trials Network, several large well-controlled trials of ARDS therapies have been completed. Thus far, the only treatment found to improve survival in ARDS is a mechanical ventilation strategy using low tidal volumes (6 mL/kg based upon ideal body weight).

The main concerns are missing a potentially treatable underlying cause or complication of ARDS. In these critically ill patients, pay careful attention to early recognition of potential complications in the intensive care unit (ICU), including pneumothorax, IV line infections, skin breakdown, inadequate nutrition, arterial occlusion at the site of intra-arterial monitoring devices, DVT and pulmonary embolism (PE), retroperitoneal hemorrhage, gastrointestinal (GI) hemorrhage, erroneous placement of lines and tubes, and the development of muscle weakness."