Airway pressure release ventilation (APRV) is a new mode of ventilation. APRV is used in the acute respiratory distress syndrome when the low tidal volume strategy was not responding to assisted controlled mandatory ventilation (ACMV). Four cases of acute respiratory distress syndrome and severe life threatening hypoxia with ACMV whom were successfully managed with APRV are reported in this article. Although hypoxemia patients were treated by APRV method but eventually two patients died.

Acute respiratory distress syndrome (ARDS) is one of the most important complications associated with traumatic brain injury (TBI). ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013) done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH) 48 (60%) and Subdural hemorrhage (SDH) was Next Level with 39 (48%) Correlation between Glasgow Coma Scale (GCS) and Respiratory Distress Syndrome (ARDS) were significantly decreased (P< 0.0001). The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009) [(2.3±4.6) vs (4.02±7.07)]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%). Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis demonstrates that Acute respiratory distress syndrome is common after traumatic brain injury. Management of traumatic brain injury is necessary to manage and reduce the mortality.

Wasp stings usually cause local reactions such as itching, urticaria, angioedema and anaphylaxis. Life-threatening complications following multiple wasp stings are relatively rare and unexpected. However, rhabdomyolysis and acute respiratory distress syndrome following wasp stings are possible.
A middle-aged male worker was stung by a swarm of wasps all over his body while attacking a wasp’s nest. He had pain, a swollen face and multiple blisters on his entire body. He initially received the standard treatment of intravenous antihistamine, anesthetic and steroid medications. On admission day, his urine output progressively decreased in volume and turned from clear to bloody in appearance, with the color tending to become progressively darker. A serum creatinine of 0.87 mg/dL and a creatinine phosphokinase of 1403 IU/L at admission confirmed rhabdomyolysis. The following day, his serum creatinine and creatinine phosphokinase rose, with the development of tachypnea with desaturation; a chest radiograph showed bilateral diffuse lung infiltration. He was subsequently diagnosed with acute respiratory distress syndrome (ARDS). A medical record review revealed that he had received only 1150 ml of intravenous fluid in 8 hours. Consequently, his ARDS may have been caused by an anaphylactic reaction to the wasp toxin rather than by a cardiogenic cause or volume overload. He was intubated and transferred from the general ward to the intensive care unit for close clinical monitoring. Mechanical ventilation and intravenous fluid support were given to achieve a minimum urine output of 1 ml/kg/hr. His clinical and biochemical pictures started to improve and normalize from the fourth day after ICU admission.
Wasp stings may cause both rhabdomyolysis and acute respiratory distress syndrome. Early detection and immediate supportive treatment is the mainstay to reduce morbidity and mortality in such cases.

Acute Respiratory Distress Syndrome (ARDS) is a clinical syndrome consisting of tachypnea, refractory hypoxemia, and diffuse opacities on chest radiographs after infection or trauma which ultimately leads to respiratory failure. The principles of treatment are based on patient care in ICU, mechanical ventilation and medical treatments. By using lower plateau, less tidal volume, higher positive end-expiratory pressure, fluid restriction, treatment of infections and avoiding any high‐dose steroids can improve the survival of these patients. In this paper, we present a case of ARDS in a patient with suspected influenza.

The majority of scorpion stings are generally seen with a set of simple clinical findings, such as pain, oedema, numbness, and tenderness in the area of the sting. However, occasionally events, such as toxic myocarditis, acute heart failure, acute pulmonary oedema, and Acute Respiratory Distress Syndrome (ARDS), which occur in scorpion sting cases are a significant problem which determine mortality and morbidity. The case presented here was a 38-year-old man who developed acute toxic myocarditis, acute heart failure, and acute pulmonary oedema following a scorpion sting on the 3rd finger of his right hand..

Coronavirus disease 2019 (COVID-19) is caused by a new severe acute respiratory syndrome Coronavirus. COVID-19 patients are at risk for acute respiratory distress syndrome and death from respiratory failure.

In this study the complete genome of the SARS-CoV-2 reference sequence, geologically isolated types, and Coronavirus related to human diseases were compared by the Molecular Phylogenetic Maximum Likelihood method. The secondary and tertiary structures of the main protease of SARS-CoV were defined as the most similar viruses to SARS-CoV-2, aligned with chimera software. Therefore, considering ineffective antiviral medications used for SARS-CoV and the importance of preventing acute respiratory distress syndrome as the main cause of mortality, 2 strategies were adopted to acquire the most effective drug combination.

The results of phylogenic analysis showed that SARS-CoV is the most similar virus to SARS-CoV-2. The secondary structure and superimposing of tertiary structure did not show a significant difference between SARS and SARS-CoV-2 3C-like main protease and the root means square deviation between Cα atoms did not support the difference between the 2 protein structures. Thus, these 2 mechanisms were fostered in accordance with the correlation between acute respiratory distress syndrome-related Coronavirus, angiotensin-converting enzyme 2 on one side and the possible treatments for reducing the respiratory side effects on the other. The analysis of renin-angiotensin system as well as the tested drugs applied to acute respiratory distress syndrome cases, indicated that angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, and C21 as nonpeptide agonist might possess a promising modality of treatment for acute respiratory distress syndrome. Furthermore, implementing recombinant human ACE2 as a competitive receptor might be an effective way to trap and chelate the SARS-CoV-2 particles.

The data suggest that combination therapy of angiotensin II receptor blockers and C21 could be a potential pharmacologic regimen to control and reduce acute respiratory distress syndrome. Moreover, rhACE2 can be recommended as an effective protective antiviral therapy in the treatment of COVID-19 and its complications.

Coronavirus, discovered in the 1960s, is able to infect human hosts and causes mild to serious respiratory problems. In the last two decades, the severe acute respiratory syndrome coronavirus (SARS‑CoV), Middle East respiratory syndrome coronavirus (MERS‑CoV) and severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) have been recognized. It has long been demonstrated that MERS‑CoV binds to dipeptidyl peptidase 4 and SARS‑CoV binds to angiotensin‑converting enzyme 2. A “cytokine storm” is the main pathophysiology of aforementioned viruses. Infiltration of neutrophils at the site of the infection is a risk factor for the development of acute respiratory distress syndrome and death. The new coronavirus, SARS‑CoV‑2, has infected more people than SARS‑Cov and MERS‑CoV as it can easily be transmitted from person to person. Epidemiological studies indicate that majority of individuals are asymptomatic; therefore, an effective and an efficient tool is required for rapid testing. Identification of various cytokine and inflammatory factor expression levels can help in outcome prediction. In this study we reviewed immune responses in SARS-CoV, Mers-CoV, and SARS-COV-2 infections and the role of inflammatory cells.

Parsonage-Turner syndrome (PTS) is a rare syndrome of unknown etiology; however, it is believed that an abnormality of immune response after a previous infection may be the cause of the disease. We report neuralgic amyotrophy in a patient with a history of kidney transplantation with severe acute respiratory distress syndrome coronavirus 2 infection. This literature is reviewed regarding clinical presentation, etiology, treatment, and prognosis of PTS after COVID‑19 infection. We should consider PTS as another complication of COVID‑19 infection.

The basis of treatment in acute respiratory syndrome in neonatal has been the exchange of oxygen and carbon dioxide which was performed by various therapeutic modes such as INSURE protocol. Therefore, this study was performed to compare the prone and supine positions on respiratory status of acute respiratory distress syndrome newborns treated by INSURE protocol. This was an experimental study with crossover design that was performed on 30 newborn with respiratory problems undergoing NCPAP mode after application of INSURE protocol. Research samples were assigned randomly into two groups. Newborns in first group were placed in prone-supine position for three hours in each position. Second groups contrary to first group placed in supine-prone position for three hours in each position as well. In every position, oxygen saturation percentage, respiratory and pulse rate were measured every 15 minutes. Finally, the data were analyzed by descriptive and inferential statistics. Results showed an increasing of oxygen saturation, and decreasing of respiratory and pulse rate in prone to supine position significantly (p< 0.001). But there were no significant difference between two groups for bradycardia, desaturation and Fio2 alteration. The finding showed that prone to supine position has useful effects in gas exchange in newborn, which may be considered as an effective and affordable care to establish respiratory status of acute respiratory distress syndrome.

In December 2019, in Wuhan, China began the outbreak of the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) epidemic. As a result of rapid spread, it turned into a pandemic announced by WHO on March 11, 2020. SARS-CoV-2 is an etiological factor of a new disease called COVID-19. The virus is transmitted mainly through the droplet route. In most cases, it causes mild symptoms such as fever, dry cough, weakness, and muscle pain; less common symptoms include sore throat, runny nose, diarrhea, and chills. However, among people with impaired immunity and comorbidities, as well as among older people, it leads to lifethreatening complications in the form of acute respiratory distress syndrome (ARDS), sepsis, and septic shock. Moreover, SARS-CoV2 is the third highly pathogenic in humans and easily spreading coronavirus after the virus of a severe acute respiratory syndrome (SARS) in 2002 - 2003 and virus of the Middle East respiratory syndrome (MERS) in 2012. This review summarizes current information on the emergence, origin, diversity, and common characteristics, as well as the epidemiology of the above three highly contagious coronaviruses.