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Not long ago, the journal Nature announced the top ten people with scientific impact in 2022, and Cao Yunlong, associate researcher of Peking University's Biomedical Frontier Innovation Center (BIOPIC) and leading scientist of Beijing Changping Laboratory, was selected as a "new crown predictor", he said, there may be multiple peak infections every year
.
The sudden release of the epidemic has followed the large-scale infection, and it is now more obvious than in early December that the proportion of severe emergency cases has increased, and local medical runs have occurred
in some areas.
In response to the current tense situation of "short supply" of intensive medical resources, the number of beds continues to expand, as of December 25, the total number of ICU beds in the country reached 181,000, equivalent to 12.
8 / 100,000 people, although the bed has been greatly adjusted in half a month, but for the overall trend of various places is still "one bed is difficult to find", the situation in mainstream departments such as emergency, critical care, and respiratory is still anxious
.
Recently, the term "white lung" has been reported by major media networks, and the popularity has not decreased for a while, although the clinical proportion is not high, but it is undeniable that the mortality rate of severe white lung patients is as high as more than
40%.
On December 27, Jiao Yahui, director of the Department of Medical Administration of the National Health Commission, introduced at the National Defense Joint Control Conference that it is not called white lung as long as there is inflammation in the lungs, and white lung should be a relatively serious manifestation
of pneumonia.
Generally speaking, the inflammation of the lungs is relatively heavy, and when there is more exudation, that is, the area of the white image area reaches 70%-80%, which is clinically colloquially called white lung
.
Patients at this stage develop hypoxemia or respiratory distress, especially in the current wave of the epidemic, which may occur
in older patients with severe underlying medical conditions.
"White lung" is a typical imaging manifestation of acute respiratory distress syndrome (ARDS), generally refers to severe pneumonia in the X-ray or CT examination of the lungs developed in a large white area and named, clinical manifestations of chest tightness, shortness of breath, poor breathing, is one of the most common and serious respiratory complications of
new coronary pneumonia (COVID-19).
Clinical study data found that of the 417 COVID-19-positive patients, ARDS accounted for 21% [1].
Another study from Zhongnan Hospital of Wuhan University showed that 26.
1% of positive patients were admitted to the ICU due to complications, and 61.
1% of them developed ARDS [2].
Patients with moderate to severe ARDS with COVID-19 have a mortality rate of up to 81.
3 percent [3], and a separate study published in The Lancet showed a higher incidence of ARDS in patients with COVID-19 deaths compared with survivors (81 versus 45 percent) [4].
As a core link in the occurrence of inflammatory storm - neutrophil elastase-targeted inhibitor, sivilastat, effectively inhibits inflammatory storm and protects important organs from damage
。 CDE annual report evaluation of cevilastat sodium is the world's only drug used for ALI/ARDS (acute lung injury/acute respiratory distress syndrome), its approval to fill the gap in the field of ALI/ARDS drug treatment in China, since March 2020 at the beginning of the COVID-19 global epidemic, approved by NMPA rapid listing, after more than 2 years of national respiratory, emergency, ICU and other fields of clinical use, received wide praise, including Xi'an, Xinjiang, Hainan, The new crown critically ill patients in Shanghai, Dalian and other places have turned hundreds of thousands of critically ill respiratory patients into safety
.
Clinical data show that ceverlastat rapidly improves respiratory status and lung imaging changes in patients with severe COVID-19, leading to successful removal from ventilators [5].
In addition, the first evidence-based results of sepsis in China [6] showed that silvilastat sodium could reduce ICU stay by 4.
56 days and mechanical ventilation time by 52 hours, while sivilastat sodium could increase oxygenation index by 37.
1mmHg, reduce APACHE II score by 3.
89 points and SOFA score by 3 points
.
The results of the phase III trial in Japan [7] showed that cevilastat sodium could significantly improve lung function and shorten the median ICU time by 12.
5 days, which is equivalent to increasing the ICU bed turnover rate by 71.
4%.
Another retrospective analysis of 4276 ALI/ARDS cases [8] showed that cevilastat significantly improved survival at 30, 60, and 90 days (p=0.
0022); The risk of death at 90 days decreased by 17%.
China's population is aging, but the vaccination rate of the elderly population is not high
.
At the time of the peak of severe infection, there has begun to be panic about the purchase of medicines, the expansion of medical resources, and the arrival of medical care with illness
.
All indications are that even though Omicron infection is predominantly mild, the challenges to the critical medical force cannot be ignored
due to the huge Chinese population.
Siverristal sodium can alleviate the current shortage and shortage of ICU beds brought about by the current epidemic, accelerate bed turnover, and provide medication options
for critically ill patients in China.
References:
[1] Wang D, Hu B, Hu C.
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China.
JAMA.
2020; 323(11):1061-1069.
[2] Tahvildari Azin, et al.
Clinical Features, Diagnosis, and Treatment of COVID-19 in Hospitalized Patients: A Systematic Review of Case Reports and Case Series.
[J] .
Front Med (Lausanne), 2020, 7: 231.
[3] Liu, Yanli, et al.
Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019.
MedRxiv (2020).
[4] Yang X, Yu Y, Xu J, et al.
Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study[J].
Lancet Respir Med, 2020.
[5] style="FONT-SIZE: 10.
5pt; FONT-FAMILY: ; TEXT-TRANSFORM: none; COLOR: rgb(0,0,0); FONT-STYLE: normal; LETTER-SPACING: 0pt; mso-spacerun: 'yes'; mso-font-kerning: 0.
0000pt">
[6] Gao Xiaoxin, et al.
Ann Palliat Med.
2021, 10(11):11910-11917.
[7] Tamakuma S, Ogawa M, Aikawa N, et al.
Relationship between neutrophil elastase and acute lung injury in humans.
Pulm Pharmacol Ther.
2004; 17(5):271-9.
[8] Kido T, Muramatsu K, Yatera K, et al.
Efficacy of early sivelestat administration on acute lung injury and acute respiratory distress syndrome.
Respirology.
2017; 22(4):708-713.
