Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Mahboob, Hafiz; Richeson, Robert; McCain, Robert

doi:10.1155/2017/7952782

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…Also, the 2006 ARDS Network Trial (26) found worse outcomes when steroids were started late in the disease course, and no change in outcomes when they were started earlier (despite short term improvements in physiologic measures of ventilation and perfusion). On the other hand, the use of steroids has been associated with survival in elderly patients in one registry based review (27) as well as dramatic clinical improvement on VA-ECLS in a number of case reports (28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

The inflammasome of circulatory collapse: single cell analysis of survival on extracorporeal life support

Kort

Weiland

Grins

et al. 2019

Preprint

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As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an accessible and attractive target for clinical application of high throughput, fluidics based single cell RNASeq (scRNASeq). However, new analytic tools required by unique characteristics of scRNASeq data lack validation in acutely ill patients. We report scRNASeq analysis of ~1,000 20 cells from each of 38 patients requiring veno-arterial extracorporeal life support (VA-ECLS)-a diverse group of critically ill patients experiencing circulatory collapse as a common endpoint to wide ranging diseases. We established an analysis pipeline capturing major biological signals from theses samples, confirmed by flow cytometry. Further, we found that these patients appeared immunologically poised at the outset of treatment as either reactive or permissive, and 25 this balance predicted their survival. Annotated code detailing the analysis is available at https://github.com/vanandelinstitute/va_ecls.

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Section: Discussionmentioning

confidence: 99%

The inflammasome of circulatory collapse: single cell analysis of survival on extracorporeal life support

Kort

Weiland

Grins

et al. 2019

Preprint

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“…Also, pirfenidone has been suggested and tried successfully in the treatment of ARDS due to white smoke-induced ARDS [11]. As another example, Zinc Chloride smoke (white smoke) inhalation induced severe ARDS has been successfully treated with a combination of pirfenidone and corticosteroids [35,64].…”

Section: Evaluation Of the Hypothesismentioning

confidence: 99%

Pirfenidone: A novel hypothetical treatment for COVID-19

Seifirad

2020

Medical Hypotheses

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Cytokine storm, multiorgan failure, and particularly acute respiratory distress syndrome (ARDS) is the leading cause of mortality and morbidity in patients with COVID-19. A fulminant ARDS kills the majority of COVID-19 victims. Pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone), is a novel anti-fibrotic agent with trivial adverse effects. Pirfenidone is approved for the treatment of Idiopathic Pulmonary Fibrosis (IPF) for patients with mild to moderate disease. Pirfenidone could inhibit apoptosis, downregulate ACE receptors expression, decrease inflammation by several mechanisms and ameliorate oxidative stress and hence protect pneumocytes and other cells from COVID-19 invasion and cytokine storm simultaneously. Based on the pirfenidone mechanism of action and the known pathophysiology of COVID-19, I believe that pirfenidone has the potential for the treatment of COVID-19 patients. The Hypothesis/theory Cytokine storm, severe inflammation, oxidative stress, and reactive oxygen species damage and increased permeability of vascular bed are responsible for the development of ARDS and multi-organ damage in

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“…The produced smoke (ZnCl 2 smoke) mainly contains zinc chloride (ZnCl 2 ), zinc oxide, and other chemical ingredients. Inhalation of the high doses of ZnCl 2 smoke would likely cause acute lung injury (ALI), even then develop acute respiratory distress syndrome (ARDS) (Mahboob et al., 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary delivery of resveratrol-β-cyclodextrin inclusion complexes for the prevention of zinc chloride smoke-induced acute lung injury

Wang

Liu²,

Pan

et al. 2022

Drug Delivery

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Smoke bombs are often used in military/fire training, which can produce a large amount of zinc chloride (ZnCl 2 ) smoke. Inhalation of ZnCl 2 smoke usually causes acute lung injury (ALI) that would likely develop to acute respiratory distress syndrome (ARDS). However, there is no effective prevention or treatment strategy for the smoke-induced ALI. Resveratrol (RES) is a natural polyphenol with good anti-inflammatory and anti-apoptotic activities, but its low solubility, stability, and bioavailability restrict its clinical application. In this study, an inhalable RES formulation composed of RES- β -cyclodextrin inclusion complexes (RES- β -CD) was prepared for the prevention of ZnCl 2 smoke-induced ALI. RES- β -CD powders had a small mass median aerodynamic diameter of 3.61 μm and a high fine particle fraction of 38.84%, suitable for pulmonary inhalation. RES- β -CD exhibited low BEAS-2B cytotoxicity. Pulmonary delivery of RES- β -CD to mice remarkably prevented the smoke-induced ALI with downregulation of TNF- α , IL-1 β , STAT3, and GATA3, and upregulation of T-bet and Foxp3. RES- β -CD protected the respiratory function, percutaneous oxygen saturation, physical activity, lung capillary integrity, and lung liquid balance, alleviating inflammation and apoptosis. Pulmonary delivery of the positive drug, budesonide (BUD), also alleviated the smoke-induced ALI by reduction of inflammation and cell apoptosis. RES- β -CD exhibited the regulation of the Th1/Th2 and Treg/Th17 balances, while BUD did not show any effect on immune balances. In conclusion, pulmonary delivery of RES- β -CD is a promising anti-inflammatory and anti-apoptosis strategy for the prevention of ZnCl 2 smoke-induced ALI by direct lung drug distribution and regulation of immune balance.

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Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Cited by 4 publications

References 37 publications

The inflammasome of circulatory collapse: single cell analysis of survival on extracorporeal life support

The inflammasome of circulatory collapse: single cell analysis of survival on extracorporeal life support

Pirfenidone: A novel hypothetical treatment for COVID-19

Pulmonary delivery of resveratrol-β-cyclodextrin inclusion complexes for the prevention of zinc chloride smoke-induced acute lung injury

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