Clinical study of rhGM-CSF for the treatment of pulmonary exogenous acute respiratory distress syndrome by modulating alveolar macrophage subtypes: A randomized controlled trial.

BACKGROUND: By modulating the oxygen partial pressure of alveolar epithelial cells, the granulocyte-macrophage colony-stimulating factor (GM-CSF) can stimulate and enhance the innate immune response in the lungs. This study aimed to investigate the therapeutic efficacy of rhGM-CSF in patients suffering from extrapulmonary-induced acute respiratory distress syndrome (ARDS). METHODS: A randomized, double-blind, placebo-controlled clinical trial was conducted between February 2018 to July 2019, in which 66 sepsis patients with ARDS were recruited. The study randomly allocated the patients into 2 groups: an experimental group (34 cases receiving rhGM-CSF) and a control group (32 cases receiving placebo). The changes in lung function were assessed using the scores of PaO2/FIO2 ratio, acute physiology and chronic health evaluation II, sequential organ failure assessment, and lung injury. Additionally, the study analyzed the levels of inflammatory cells, HLA-DR (%), high mobility group protein B1 (HMGB-1) (ng/mL), tumor necrosis factor-alpha (pg/mL), IL-6 (pg/mL), and GM-CSF (pg/mL) in both blood and bronchoalveolar lavage fluid. RESULTS: The study results revealed that the experimental group significantly enhanced their pulmonary function compared to the control group. Moreover, the experimental group demonstrated higher levels of inflammatory cells and HLA-DR, whereas levels of HMGB-1 and tumor necrosis factor-alpha were lower in blood (P < .05, respectively). In addition, the experimental group displayed a higher alternatively activated cell ratio and GM-CSF levels in bronchoalveolar lavage fluid (both P < .05); while HMGB-1 levels were significantly reduced (P < .05). However, no notable difference observed in mortality between the 2 groups (P > .05). CONCLUSIONS: Administering rhGM-CSF to ARDS patients improves lung function and decreases blood inflammation. Nonetheless, while this treatment demonstrates efficacy in reducing these parameters, it does not significantly impact the incidence of ventilator-associated pneumonia or 28-day mortality in ARDS patients.

Predictive efficacy of weaning index on mechanical ventilation evacuation.

BACKGROUND: The timely weaning of mechanical ventilation can shorten intensive care unit (ICU) stay times and reduce the complications related to mechanical ventilation. This study sought to investigate the predictive role of a weaning index (WI) on mechanical ventilation evacuation by measuring minute ventilation volume (MVV) across different ventilation modes. METHODS: Patients suffering from respiratory failure for a variety of reasons were included in the study if they received mechanical ventilation for more than 48 hours in the ICU. The patients were randomly allocated to either the assist/control (A/C) group or the pressure support ventilation (PSV) group according to the ventilator mode. The factors associated with weaning success and failure were analyzed. RESULTS: A total of 40 patients participated in this study. Of these, 25 weaning cases were successful and 15 were failures. There were 19 cases in the A/C group, yielding a success rate of 63%, and 21 cases in the PSV group, yielding a success rate of 62%. There were no significant differences between the two groups in terms of age, gender, ideal weight, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ICU stay time and hospitalization time. There were significant differences in the mechanical ventilation duration between the two groups (P<0.05). When the WI was less than 50.44, the sensitivity and specificity of predicting weaning success were 72% and 98%. The area under the receiver operating characteristic (ROC) curve was 0.928±0.03. When the WI of the A/C group was less than 61.45, the sensitivity and specificity of predicting weaning success were 98% and 72%, respectively. The area under the ROC curve was 0.917±0.068. When the WI of the PSV group was less than 51.45, the sensitivity and specificity of predicting weaning success were 74.6% and 100%, respectively. The area under the ROC curve was 0.933±0.046. CONCLUSIONS: Compared with RSBI, WI shows a better value in predicting weaning, especially for mechanically ventilated patients in PSV mode, WI has greater value in predicting weaning.