# Chain management reduces inflammation (IL-1b, IL-6, IL-8, TNF-a, PCT) and improves vascular (NO, DD, VWF, and ET-1)/immune function in acute respiratory failure: A retrospective cohort study

## TL;DR

A systematic care approach called chain management reduces inflammation and improves vascular and immune function in acute respiratory failure patients.

## Contribution

Demonstrates that chain management improves outcomes in ARF by targeting inflammation and vascular function.

## Key findings

- Chain management reduced inflammatory markers like IL-1b, TNF-a, and PCT compared to conventional care.
- Patients under chain management had shorter ICU and ventilation durations and better blood gas levels.
- Chain management improved vascular function with higher NO and lower ET-1 levels.

## Abstract

Given the critical importance of inflammation, immune and endothelial function in acute respiratory failure (ARF), it is essential to evaluate therapeutic strategies that target these pathways to confirm their application value. This study aimed to investigate the impact of chain management (defined as a systematic protocol integrating dynamic risk assessment, standardised nursing pathways, multidisciplinary coordination, and real-time biomarker monitoring to optimise clinical decision-making) on inflammatory markers (interleukin [IL]-1b, IL-6, IL-8, tumour necrosis factor[TNF]-a, and procalcitonin[PCT]), vascular endothelial function, blood gas parameters, and T lymphocyte subsets in patients with ARF.

A retrospective analysis was conducted on 101 ARF patients admitted between October 2023 and December 2024. The patients were categorised into two groups: a conventional group (55 cases, receiving standard risk warning management) and a chain group (46 cases, undergoing chain management). Levels of inflammatory factors and vascular endothelial markers (nitric oxide[NO], endothelin-1 [ET-1], etc.) were measured using enzyme-linked immunosorbent assay (ELISA), blood gas function was evaluated with a blood gas analyser, and T lymphocyte subsets (CD3+, CD4+, and CD8+) were analysed via flow cytometry.

Compared to the conventional group, the chain group demonstrated significantly shorter durations of mechanical ventilation and ICU stays (P<0.05). Moreover, the chain group exhibited more pronounced reductions in inflammatory factors, including IL-1b, TNF-a, and PCT (P<0.05). Improvements in vascular endothelial function were also more evident in the chain group, with higher NO levels and lower ET-1 levels (P<0.05). Additionally, the chain group achieved better blood gas outcomes, characterised by higher PaO2 and lower PaCO2 levels (P<0.05), as well as greater increases in CD3+ and CD4+ cell counts (P<0.05).

Chain management effectively mitigates inflammatory responses and enhances vascular immune function, endothelial function in ARF patients through multi-targeted interventions.