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Sample records for acute respiratory failure

  1. Submersion and acute respiratory failure

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su

    2014-01-01

    Objectives:To know the relationship between hypothermia, etiology, respiratory failure and prognosis of submersion in environmental emergency medicine.Methods:FromDecember1, 2002 toSeptember30,2007, there were52 hospitalized near- drowning cases in a medical center at northernTaiwan.Retrospective study of52 submersion patients who were hospitalized during the duration was analyzed.Results:The hypothermic groups are more commonly seen in acute respiratory failure after submersion,36%vs.21%,P<0.05.The hypothermic submersion patients who are older in age than normothermic submersion patients(44vs.27 years old,P<0.05).The suicidal submersion patients are older, hypothermic and longer length of stay than accidental submersion patients.Conclusions:Submersion patients who are hypothermic on arrival of emergency department(ED) are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  2. Submersion and acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2014-01-01

    Conclusions: Submersion patients who are hypothermic on arrival of emergency department (ED are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  3. Intravenous naloxone in acute respiratory failure.

    OpenAIRE

    Ayres, J.; J Rees; Lee, T.; Cochrane, G M

    1982-01-01

    A 58-year-old man presented with acute on chronic respiratory failure. In the acute stage of his illness an infusion of the opiate antagonist naloxone caused an improvement in oxygen saturation as measured by ear oximetry from 74% to 85%, while a saline infusion resulted in a return of oxygen saturation to the original value. When he had recovered from the acute episode the same dose of naloxone had no effect on oxygen saturation. These findings suggest that in acute respiratory failure there...

  4. Emergency thyroidectomy: Due to acute respiratory failure

    OpenAIRE

    Zulfu Bayhan; Sezgin Zeren; Bercis Imge Ucar; Isa Ozbay; Yalcin Sonmez; Metin Mestan; Onur Balaban; Nilufer Araz Bayhan; Mehmet Fatih Ekici

    2014-01-01

    INTRODUCTION: Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention. PRESENTATION OF CASE: A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cer...

  5. Respiratory failure in acute pancreatitis.

    OpenAIRE

    Banerjee, A K; Haggie, S J; Jones, R B; Basran, G. S.

    1995-01-01

    There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

  6. Respiratory Failure in Acute Organophosphorus Pesticide Self-Poisoning

    OpenAIRE

    Eddleston, Michael; Mohamed, Fahim; Davies, James OJ; Eyer, Peter; Worek, Franz; Sheriff, Mh Rezvi; Buckley, Nick A.

    2006-01-01

    Background: Acute organophosphorus (OP) pesticide poisoning is a major clinical problem in the developing world. Textbooks ascribe most deaths to respiratory failure occurring in one of two distinct clinical syndromes - acute cholinergic respiratory failure or the intermediate syndrome. The delayed failure appears to be due to respiratory muscle weakness, but its pathophysiology is not yet clear.

  7. Acute respiratory failure following ovarian hyperstimulation syndrome

    Directory of Open Access Journals (Sweden)

    Antonello Nicolini

    2013-03-01

    Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non

  8. Critical care ultrasonography in acute respiratory failure.

    Science.gov (United States)

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-01-01

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript. PMID:27524204

  9. Critical care ultrasonography in acute respiratory failure.

    Science.gov (United States)

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-08-15

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.

  10. Non-invasive mechanic ventilation in treating acute respiratory failure

    OpenAIRE

    Federico Lari; Novella Scandellari; Ferdinando De Maria; Virna Zecchi; Gianpaolo Bragagni; Fabrizio Giostra; Nicola DiBattista

    2009-01-01

    Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease ...

  11. An Unusual Cause of Acute Hypercapneic Respiratory Failure

    OpenAIRE

    Janice Wang; Astha Chichra; Seth Koenig

    2011-01-01

    We present a rare cause of hypercapneic respiratory failure through this case report of a 72-year-old man presenting with progressive dyspnea and dysphagia over two years. Hypercapneic respiratory failure was acute on chronic in nature without an obvious etiology. Extensive workup for intrinsic pulmonary disease and neurologic causes were negative. Laryngoscopy and diagnostic imaging confirmed the diagnosis of diffuse idiopathic skeletal hyperostosis, also known as DISH, as the cause of upper...

  12. Acute respiratory failure in 3 children with juvenile myelomonocytic leukemia

    DEFF Research Database (Denmark)

    Gustafsson, Britt; Hellebostad, Marit; Ifversen, Marianne;

    2011-01-01

    Juvenile myelomonocytic leukemia is a rare hematopoietic stem cell disease in children with features of both myelodysplasia and myeloproliferation. Extramedullary involvement has been reported and pulmonary involvement secondary to leukemic infiltration is an initial manifestation, which may resu...... in acute respiratory failure....

  13. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  14. Non-invasive ventilation for surgical patients with acute respiratory failure

    OpenAIRE

    Lee, Byoung Chul; Kyoung, Kyu Hyouck; Kim, Young Hwan; Hong, Suk-Kyung

    2011-01-01

    Purpose Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. Methods We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory...

  15. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

    OpenAIRE

    Hidalgo, V.; Giugliano-Jaramillo, C; Pérez, R.; Cerpa, F; Budini, H; Cáceres, D.; Gutiérrez, T.; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatmen...

  16. CLINICAL ANALYSIS OF OBSTRUCTIVE SLEEP APNEASYNDROME WITH ACUTE RESPIRATORY FAILURE

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To study the clinical characteristics of obstructive sleep apnea syndrome (OSAS) induced acute respiratory failure. Methods The clinical and laboratory characteristics of 9 patients were reviewed. Results 9 patients (8 females, 1 male) presented with obesity and mental disturbance, with a BMI being 44.97 kg /m2, (45.25 kg/m2 in the fe male). The mean age of the group was 67.89 years (61~74 years). All had respiratory acidosis (mean pH 7.17), hypercapni a (mean PaCO2 94.10mmHg) (63.97~143.18mmHg), and hypoxemia (mean PaO2 39mmHg) (29.03~44.03mmHg). During periods of clinical stability all but 2 had awaken hypercapnia (mean PaCO2 46.73mmHg) (38.25~54.68mmHg). Four of the 9 patients had pulmonary function test showing FEV1>70%. Conclusion OSAS induced acute respiratory fail ure has a sudden onset and various presentations and can be reversed with early and proper treatment. The severity of abnormal pulmonary function was less than what would be expected to cause respiratory failure.

  17. Non-invasive mechanic ventilation in treating acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2009-12-01

    Full Text Available Non invasive ventilation (NIV in acute respiratory failure (ARF improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI rate also outside the intensive care units (ICUs. Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE, exacerbation of chronic obstructive pulmonary disease (COPD, Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS. NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5% met primary endpoint (NIV failure: 11 Pts (17% needed ETI (5ALI/ARDS p < 0,0001, 6COPD 16,6%, 1 Patient (1,5% died (Pneumonia. No Pts with ACPE failed (p = 0,0027. Secondary endpoints: significant improvement in Respiratory Rate (RR, Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff’s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting.

  18. Acute respiratory failure due to ehrlichiosis - CT findings: case report

    International Nuclear Information System (INIS)

    Ehrlichiosis is a rare disease, with approximately 400 cases having been documented in the US since its recognition in 1986. Most of the reported cases were in the southeastern US, although 6 cases have been described in Washington state. Although most of these reported patients were admitted to hospital, severe complications developed in only a small proportion. Findings on chest imaging have been described in 3 children. To our knowledge, this is the first reported case of computed tomographic (CT) findings in a young adult with erhlichiosis in whom acute respiratory failure developed. (author)

  19. Respiratory Failure

    Science.gov (United States)

    Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body's organs, such ... brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can't ...

  20. An undiagnosed myasthenia gravis presenting as isolated recurrent acute respiratory failure

    OpenAIRE

    Shri Ram Sharma; Nalini Sharma; Yeolekar, M E

    2012-01-01

    Acute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider M...

  1. Acute respiratory failure due to thyroid storm developing immediately after delivery

    OpenAIRE

    Kitazawa, Chie; Aoki, Shigeru; Takahashi, Tsuneo; Hirahara, Fumiki

    2015-01-01

    Key Clinical Message Acute respiratory failure occurs in less than 0.1% of pregnancies. Thyroid storm should be included in the differential diagnosis of possible causes of acute respiratory failure occurring immediately after delivery, and delivery is a high risk factor for thyroid storm in pregnant women with thyrotoxicosis.

  2. Acute respiratory failure as a manifestation of an arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Pillai Lalitha

    2008-01-01

    Full Text Available Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs since the age of seven years who presented with acute onset syncopal attacks and respiratory failure. She was intubated and ventilated. An magnetic resonance imaging scan showed large posterior fossa cyst extending up to mid second cervical vertebra causing compression of the medulla and pons, with mild hydrocephalus. After a failed attempt to wean her from the ventilator a cysto peritoneal shunt surgery was performed following which she was weaned from the ventilator successfully. Weakness in the upper and lower limbs, which had increased in the preceding month, also improved following the surgery.

  3. Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure

    OpenAIRE

    2014-01-01

    Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functio...

  4. Extracorporeal life support for adults with severe acute respiratory failure.

    Science.gov (United States)

    Del Sorbo, Lorenzo; Cypel, Marcelo; Fan, Eddy

    2014-02-01

    Extracorporeal life support (ECLS) is an artificial means of maintaining adequate oxygenation and carbon dioxide elimination to enable injured lungs to recover from underlying disease. Technological advances have made ECLS devices smaller, less invasive, and easier to use. ECLS might, therefore, represent an important step towards improved management and outcomes of patients with acute respiratory distress syndrome. Nevertheless, rigorous evidence of the ability of ECLS to improve short-term and long-term outcomes is needed before it can be widely implemented. Moreover, how to select patients and the timing and indications for ECLS in severe acute respiratory distress syndrome remain unclear. We describe the physiological principles, the putative risks and benefits, and the clinical evidence supporting the use of ECLS in patients with acute respiratory distress syndrome. Additionally, we discuss controversies and future directions, such as novel technologies and indications, mechanical ventilation of the native lung during ECLS, and ethics considerations. PMID:24503270

  5. Noninvasive ventilation in acute respiratory failure due to H1N1 influenza

    OpenAIRE

    Mohapatra, Prasanta R.; Naveen Dutt; Sushant Khanduri; Baijayantimala Mishra; Janmeja, Ashok K

    2011-01-01

    We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.

  6. Respiratory Failure

    OpenAIRE

    Özyılmaz, Ezgi

    2014-01-01

    The main function of the lungs is to maintain the exchange between the pulmonary capillary and the air in the alveoli. By this way, the arteriel oxygen and carbondioxide tension remains constant. Respiratory failure is a syndrome which is defined as the loss of the ability of respiratory system to exchange oxygen and carbondioxide elimination function. The main pathophysiological causes of respiratory failure include ventilation-perfusion mismatch, alveolar hypoventilation, impaired diffusion...

  7. The experience of extracorporeal membrane oxygenation for severe acute respiratory failure in adults

    Institute of Scientific and Technical Information of China (English)

    孙兵

    2013-01-01

    Objective To summarize the experience of extracor-poreal membrane oxygenation(ECMO) for patients with severe acute respiratory failure in adults and to investigate the factors associated with death. Methods The

  8. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    Directory of Open Access Journals (Sweden)

    Massa Zantah

    2016-01-01

    Full Text Available Neuromyelitis Optica (NMO is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  9. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    OpenAIRE

    Massa Zantah; Coyle, Timothy B.; Debapriya Datta

    2016-01-01

    Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  10. January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

    OpenAIRE

    Mathew M

    2015-01-01

    No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmon...

  11. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930118 Facial or nasal mask pressure supportventilation in managing acute exacerbation ofchronic respiratory failure in COPD patients.CHEN Rongchang(陈荣昌),et al.GuangzhouInstit Respir Dis,Guangzhou 510120.Chin Tu-berc & Respir Dis 1992;15(5)285-287.Eleven COPD patients(age:65±9 yrs)withacute exacerbation of chronic respiratory failure(PaCO2 11.3±1.1kPa)were treated with maskpressure support ventilation,another 10 similarpatients(age:68±12yrs)served as controls.Bi-PAP ventilator was used with the followingmodifications:(1)Non-rehreathing valve set-in proximal to mask;(2)5 LPM oxygen flow de-livered into mask to reduce the dead space ef-fect.Mask ventilation was given 2-3 hours ev-ery time and 1-2 times daily for 7 days.Syn-

  12. Acute respiratory distress syndrome

    Science.gov (United States)

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst ... A.M. Editorial team. Related MedlinePlus Health Topics Respiratory Failure Browse the Encyclopedia A.D.A.M., Inc. ...

  13. Rare Presentation of Pulmonary Alveolar Proteinosis Causing Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Ryan R. Kroll

    2016-01-01

    Full Text Available Pulmonary alveolar proteinosis (PAP is a rare condition characterized by dysfunctional alveolar macrophages, which ineffectively clear surfactant and typically cause mild hypoxemia. Characteristic Computed Tomography findings are septal reticulations superimposed on ground-glass opacities in a crazy paving pattern, with a clear juxtaposition between affected and unaffected parenchyma. While traditionally PAP was diagnosed via biopsy, bronchoalveolar lavage (BAL is usually sufficient; the fluid appears milky, and on microscopic examination there are foamy macrophages with eosinophilic granules and extracellular hyaline material that is Periodic Acid-Schiff positive. Standard therapy is whole lung lavage (WLL, although novel treatments are under development. The case presented is a 55-year-old woman with six months of progressive dyspnea, who developed hypoxemic respiratory failure requiring mechanical ventilation; she had typical findings of PAP on imaging and BAL. WLL was ultimately successful in restoring adequate oxygenation. Respiratory failure of this magnitude is a rare finding in PAP.

  14. Intravenous colistin-induced acute respiratory failure: A case report and a review of literature.

    Science.gov (United States)

    Shrestha, Amardeep; Soriano, Sheryll Mae; Song, Mingchen; Chihara, Shingo

    2014-07-01

    The emergence of multi-drug-resistant gram negative bacillary infections has regained popularity of ancient drugs such as polymyxins. We report a case of acute respiratory failure induced by use of intravenous colistimethate, which is one of the forms of polymyxin. The patient is a 31 year old female with paraplegia due to spina bifida who underwent excisional debridement of large lumbosacral decubitus ulcer with osteomyelitis infected with pan-resistant Pseudomonas aeruginosa and MRSA. Six days after initiation of intravenous colistimethate and vancomycin, she developed acute respiratory failure requiring mechanical ventilation. Pan-culture was negative including a chest radiograph. V/Q scan showed low probability for pulmonary embolism. Echocardiogram showed normal right ventricle with no strain or pulmonary hypertension. Colistimethate was discontinued. Within 24 hours, she was extubated. In the early years after introduction of polymyxin, there were several reports of acute respiratory paralysis. The mechanism is thought to be noncompetitive myoneuronal presynaptic blockade of acetylcholine release. Though a direct causal relationship for respiratory failure is often difficult to establish in current era with multiple co morbidities, the timeframe of apnea, acuity of onset as well as rapid recovery in our case clearly point out the causal relationship. In addition, our patient also developed acute renal failure, presumably due to colistimethate induced nephrotoxicity, a possible contributing factor for her acute respiratory failure. In summary, colistimethate can induce acute neurotoxicity including respiratory muscular weakness and acute respiratory failure. Clinicians should consider its toxicity in the differential diagnosis of acute respiratory failure especially in critically ill patients. PMID:25337492

  15. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    OpenAIRE

    Paolo Ruggeri; Salvatore Calcaterra; Antonio Bottari; Giuseppe Girbino; Vincenzo Fodale

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drow...

  16. Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Ezgi Ozyilmaz

    2014-06-01

    Full Text Available The main function of the lungs is to maintain the exchange between the pulmonary capillary and the air in the alveoli. By this way, the arteriel oxygen and carbondioxide tension remains constant. Respiratory failure is a syndrome which is defined as the loss of the ability of respiratory system to exchange oxygen and carbondioxide elimination function. The main pathophysiological causes of respiratory failure include ventilation-perfusion mismatch, alveolar hypoventilation, impaired diffusion capacity and increased shunt. A number of diseases may result in respiratory failure by different pathophysiological reasons. The most common causes are Type 1 (hypoxemic and Type 2 (hypercapnic respiratory failure. When suspected with clinical signs and symptoms, the diagnosis should be confirmed with arterial blood gases. At this step, other diagnostic interventions, which could be performed, may be used to enlighten the underlying pathophysiological cause. Although the main therapeutic approach is similar, specific treatment are also required based on the underlying cause. The basic pathophysiological points, diagnosis and basic treatment approach have been evaluated in this review article. [Cukurova Med J 2014; 39(3.000: 428-442

  17. Acute respiratory failure after endoscopic third ventriculostomy: A case report and review of the literature

    OpenAIRE

    Elgamal, Essam A.; Mansoor Aqil

    2012-01-01

    Endoscopic third ventriculostomy (ETV) is a relatively safe procedure. However, postoperative acute respiratory failure may be fatal. The authors report an 8-month-old patient with obstructive hydrocephalus secondary to posterior fossa cyst, and Chiari malformation. After ETV he developed difficulty in breathing, and had to be reintubated and ventilated. The infant recovered fully after craniocervical decompression and insertion of cystoperitoneal shunt. We speculate that respiratory failure ...

  18. Role of serotonin in patients with acute respiratory failure.

    Science.gov (United States)

    Huval, W V; Lelcuk, S; Shepro, D; Hechtman, H B

    1984-08-01

    An early event in the evolution of acute respiratory failure (ARF) is thought to be the activation of platelets, their pulmonary entrapment and subsequent release of the smooth muscle constrictor serotonin (5HT). This study tests the thesis that inhibition of 5HT will improve lung function. The etiology of ARF in the 18 study patients was sepsis (N = 10), aspiration (N = 3), pancreatitis (N = 1), embolism (N = 2), and abdominal aortic aneurysm surgery (N = 2). Patients were divided into two groups determined by whether their period of endotracheal intubation was less than or equal to 4 days (early ARF, N = 12) or greater than 4 days (late ARF, N = 6). Transpulmonary platelet counts in the early group showed entrapment of 26,300 +/- 5900 platelets/mm3 in contrast to the late group where there was no entrapment (p less than 0.05). The platelet 5HT levels in the early group were 55 +/- 5 ng/10(9) platelets, values lower than 95 +/- 15 ng/10(9) platelets in the late ARF group (p less than 0.05), and 290 +/- 70 ng/10(9) platelets in normals. The selective 5HT receptor antagonist, ketanserin was given as an intravenous bolus over 3 minutes in a dose of 0.1 mg/kg, followed by a 30-minute infusion of 0.08 mg/kg. During this period mean arterial pressure (MAP) fell from 87 +/- 5 to 74 +/- 6 mmHg (mean +/- SEM) (p less than 0.05). One and one-half hours following the start of therapy, MAP returned to baseline. At this time, patients with early ARF showed decreases in: physiologic shunt (Qs/QT) from 26 +/- 3 to 19 +/- 3 (p less than 0.05); peak inspiratory pressure from 35 +/- 2 to 32 +/- 2 cmH2O (p less than 0.05) and in mean pulmonary arterial pressure from 32 +/- 2 to 29 +/- 1 mmHg (p less than 0.05). At 4 hours all changes returned to baseline levels. In early ARF ketanserin did not alter pretreatment values of: pulmonary arterial wedge pressure, 17 +/- 3 mmHg; cardiac index, 2.8 +/- 0.3 L/min X m2; platelet count, 219,000 +/- 45,000/mm3; platelet 5HT, 55 +/- 5 ng/10

  19. Electrophysiological correlates of respiratory failure in acute organophosphate poisoning: Evidence for differential roles of muscarinic and nicotinic stimulation

    OpenAIRE

    Jayawardane, Pradeepa; Senanayake, Nimal; Buckley, Nick A.; Dawson, Andrew H

    2012-01-01

    Background. Respiratory failure in acute organophosphate (OP) poisoning can occur early and also relatively late in the clinical course, and the pathophysiology of respiratory failure at these different phases may have important clinical implications. Objective. To compare the electrophysiological findings in patients with early and late respiratory failure following acute OP poisoning. Methods. A prospective observational case series of consenting symptomatic patients with acute OP poisoning...

  20. Variables predictive of outcome in patients with acute hypercapneic respiratory failure treated with noninvasive ventilation

    International Nuclear Information System (INIS)

    To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors. This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of 35 Meq/L (adjusted Odds ratio 0.9; 95% CI 0.83, 0.98, p < 0.015) identified those less at risk for intubation. NIV was found to be both safe and effective in the management of acute hypercapneic respiratory failure. Sepsis and serum HCO/sub 3/ at admission identified patients having poor outcomes (JPMA 60:13; 2010). (author)

  1. Acute respiratory failure induced by bleomycin and hyperoxia

    International Nuclear Information System (INIS)

    Bleomycin, a chemotherapeutic agent, and oxygen at concentrations greater than 20%, induce acute pulmonary damage separately and when administered together. The interaction of 5 U/kg intratracheal bleomycin and 24 hours of exposure to 80% oxygen in hamsters produces delayed onset acute respiratory distress syndrome three days after treatment. As little as 12 hours of 80% O2 exposure, after intratracheal bleomycin, induces severe pulmonary damage. Lung lesions are characterized as diffuse alveolar damage. Significantly pulmonary edema, measured by iodine-125-bovine serum albumin and technetium-99m-diethylenetriaminepentaacetate, occurs 72 hours after treatment. Lesions progress from focal mild alveolar interstitial and air-space macrophage and granulocyte infiltrates at 24 hours to marked infiltrates and severe interstitial and air space edema with hemorrhages and hyaline membranes at 96 hours. Significant changes measured by electron microscopy morphometry are increases in volume fractions of neutrophils, alveolar tissue and mononuclear leukocytes. Surfactant assay of bronchoalveolar lavage fluid shows a marked decrease in the lecithin/sphingomyelin ratio at 72 hours. Proposed mechanisms of bleomycin and hyperoxia synergism include enhanced production of superoxide radicals either directly or indirectly by increasing neutrophil activity or numbers, or by alteration of cell mediators. The pulmonary edema, without evidence of severe morphological changes, may be secondary to alterations of transalveolar transport mechanisms

  2. Acute respiratory distress syndrome

    Science.gov (United States)

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016: ...

  3. Pulmonary hydatid cyst in a pregnant patient causing acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Hijazi Mohammed

    2007-01-01

    Full Text Available A 21-year-old primigravida, at 32 weeks of gestation, presented with acute onset of respiratory failure and circulatory shock. Chest imaging showed findings suggestive of ruptured hydatid cyst, which was confirmed by histology post-thoracotomy. Tissue cultures from the removed cyst grew Mycobacterium tuberculosis also. She was successfully managed in the intensive care unit and was then discharged home on antituberculosis medications in addition to albendazole after prolonged hospitalization and a need for chest tube for bronchopleural fistula. Acute respiratory failure and anaphylactic shock secondary to ruptured pulmonary hydatid cyst and superimposed pulmonary tuberculosis in a pregnant lady should be considered in patients living in endemic areas.

  4. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

    DEFF Research Database (Denmark)

    Titlestad, Ingrid L; Lassen, Annmarie T; Vestbo, Jørgen

    2013-01-01

    controlled trials show lowered mortality rates in highly selected patients with acute exacerbation and respiratory failure, there are only few reports on long-term survival after receiving NIV. We present long-term all-cause mortality data from patients receiving NIV for the first time.......Implementation of noninvasive ventilation (NIV) as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomized...

  5. Prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    臧芝栋

    2014-01-01

    Objective To investigate the prognostic significanceof early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-three patients with severe acute respiratory failure supported by venous-venous(v-v)ECMO were enrolled from January 2007 to January 2013.Arterial blood lactate at pre-ECMO support(0 h)and at

  6. Use of Noninvasive Ventilation in Patients with Acute Respiratory Failure, 2000–2009: A Population-Based Study

    OpenAIRE

    Walkey, Allan J.; Wiener, Renda Soylemez

    2013-01-01

    Rationale: Although evidence supporting use of noninvasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD) is strong, evidence varies widely for other causes of acute respiratory failure.

  7. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department.

    Science.gov (United States)

    Mosier, Jarrod M; Hypes, Cameron; Joshi, Raj; Whitmore, Sage; Parthasarathy, Sairam; Cairns, Charles B

    2015-11-01

    Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation. PMID:26014437

  8. Acute respiratory failure after endoscopic third ventriculostomy: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Essam A Elgamal

    2012-01-01

    Full Text Available Endoscopic third ventriculostomy (ETV is a relatively safe procedure. However, postoperative acute respiratory failure may be fatal. The authors report an 8-month-old patient with obstructive hydrocephalus secondary to posterior fossa cyst, and Chiari malformation. After ETV he developed difficulty in breathing, and had to be reintubated and ventilated. The infant recovered fully after craniocervical decompression and insertion of cystoperitoneal shunt. We speculate that respiratory failure is related to relative expansion of the posterior fossa arachnoid cyst, causing significant compression on the brain stem. Supportive care with mechanical ventilation and brain stem decompression were the mainstay of treatment.

  9. January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-01-01

    Full Text Available No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmonary edema, asthma and COPD exacerbations. During this month's journal club we reviewed 3 articles evaluating the efficacy of noninvasive ventilation in acute respiratory failure. Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5:536-43. [PubMed] This was a small unblinded randomized controlled trial (RCT looking at the efficacy using noninvasive ventilation (NIV in acute asthma. A total of 53 patients were included and divided into 2 groups of 28 patients ...

  10. Acute Intermittent Porphyria Associated with Respiratory Failure: A Multidisciplinary Approach

    OpenAIRE

    Mayra Gonçalves Menegueti; Alkmim-Teixeira Gil Cezar; Karin Aparecida Casarini; Kátia Simone Muniz Cordeiro; Anibal Basile-Filho; Olindo Assis Martins-Filho; Maria Auxiliadora-Martins

    2011-01-01

    Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroen...

  11. The usage of the Boussignac continuous positive airway pressure system in acute respiratory failure.

    Science.gov (United States)

    Wong, D T; Tam, A D; Van Zundert, T C R V

    2013-05-01

    Traditionally, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices have been used to treat patients in acute respiratory failure. However they require an electric power source, are relatively large in size, and may be difficult to use in prehospital settings. The recently introduced Boussignac CPAP system is capable of delivering 10 cmH2O of CPAP, is compact, portable and requires only an oxygen source. This paper reviews the efficacy of using Boussignac CPAP as a treatment for acute respiratory failure in both prehospital and hospital settings. All studies mainly focused on patients treated for cardiogenic pulmonary edema. In the prehospital setting, Boussigac CPAP significantly improved respiratory parameters and oxygenation from baseline values. In the emergency department setting, Boussignac CPAP was more effective than standard oxygen delivery and just as effective as BiPAP in improving patient oxygenation and respiration. In one study, implementing Boussignac CPAP reduced intubation rate and hospital stay. Most hospital staff found Boussignac CPAP easy to use and complication rates were low. Boussigac CPAP is a useful device in the treatment of patients with acute respiratory failure, especially in the prehospital setting. PMID:23419338

  12. Acute Intermittent Porphyria Associated with Respiratory Failure: A Multidisciplinary Approach

    Directory of Open Access Journals (Sweden)

    Mayra Gonçalves Menegueti

    2011-01-01

    Full Text Available Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroenterological disorders on patients whose routine investigation tests are normal, especially when precipitating factors exist. Intensive care measures and a multidisciplinary team approach are essential.

  13. Acute intermittent porphyria associated with respiratory failure: a multidisciplinary approach.

    Science.gov (United States)

    Menegueti, Mayra Gonçalves; Gil Cezar, Alkmim-Teixeira; Casarini, Karin Aparecida; Muniz Cordeiro, Kátia Simone; Basile-Filho, Anibal; Martins-Filho, Olindo Assis; Auxiliadora-Martins, Maria

    2011-01-01

    Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroenterological disorders on patients whose routine investigation tests are normal, especially when precipitating factors exist. Intensive care measures and a multidisciplinary team approach are essential. PMID:21687623

  14. Acute Intermittent Porphyria Associated with Respiratory Failure: A Multidisciplinary Approach

    Science.gov (United States)

    Menegueti, Mayra Gonçalves; Gil Cezar, Alkmim-Teixeira; Casarini, Karin Aparecida; Muniz Cordeiro, Kátia Simone; Basile-Filho, Anibal; Martins-Filho, Olindo Assis; Auxiliadora-Martins, Maria

    2011-01-01

    Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroenterological disorders on patients whose routine investigation tests are normal, especially when precipitating factors exist. Intensive care measures and a multidisciplinary team approach are essential. PMID:21687623

  15. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient.

    Science.gov (United States)

    Ruggeri, Paolo; Calcaterra, Salvatore; Bottari, Antonio; Girbino, Giuseppe; Fodale, Vincenzo

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  16. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    Directory of Open Access Journals (Sweden)

    Paolo Ruggeri

    2016-01-01

    Full Text Available Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  17. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient.

    Science.gov (United States)

    Ruggeri, Paolo; Calcaterra, Salvatore; Bottari, Antonio; Girbino, Giuseppe; Fodale, Vincenzo

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome. PMID:27222793

  18. Acute respiratory failure as a manifestation of an arachnoid cyst

    OpenAIRE

    Pillai Lalitha; Achari Gopal; Desai Sanjay; Patil Vinayak

    2008-01-01

    Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs...

  19. Intravenous colistin-induced acute respiratory failure: A case report and a review of literature

    OpenAIRE

    Shrestha, Amardeep; Soriano, Sheryll Mae; Song, Mingchen; Chihara, Shingo

    2014-01-01

    The emergence of multi-drug-resistant gram negative bacillary infections has regained popularity of ancient drugs such as polymyxins. We report a case of acute respiratory failure induced by use of intravenous colistimethate, which is one of the forms of polymyxin. The patient is a 31 year old female with paraplegia due to spina bifida who underwent excisional debridement of large lumbosacral decubitus ulcer with osteomyelitis infected with pan-resistant Pseudomonas aeruginosa and MRSA. Six d...

  20. Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition.

    Science.gov (United States)

    Patel, Utpal; Sriram, Krishnan

    2009-03-01

    We report a case of acute respiratory failure due to refeeding syndrome caused by hypocaloric enteral tube feeds. A 60-y-old obese man, with a diagnosis of esophageal carcinoma with local metastases, underwent feeding jejunostomy tube insertion. Enteral tube feeding was initiated at small volumes providing 4.4 kcal x kg(-1) x d(-1) and gradually increased over 48 h to 29 kcal x kg(-1) x d(-1) (based on adjusted body weight). The patient then developed acute respiratory distress requiring intubation and ventilatory support. Serum phosphorus (P) level was extremely low at 4 d to adequately correct the electrolyte derangements. Successful liberation from mechanical ventilation was then possible. In chronically malnourished patients undergoing nutritional support, even hypocaloric feeding should be considered a risk factor for developing refeeding syndrome leading to severe and acute electrolyte fluid-balance and metabolic abnormalities.

  1. Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children

    Institute of Scientific and Technical Information of China (English)

    ZHU Yan-feng; YU Wen-liang; XIE Min-hui; YAN Chao-ying; LU Zhu-jin; SUN Bo; XU Feng; LU Xiu-lan; WANG Ying; CHEN Jian-li; CHAO Jian-xin; ZHOU Xiao-wen; ZHANG Jian-hui; HUANG Yan-zhi

    2012-01-01

    Background Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS),and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively.This study aimed at prospectively investigating incidence,causes,mortality and its risk factors,and any relationship to initial tidal volume (VT) levels of mechanical ventilation,in children ≤5 years of age with AHRF and ARDS.Methods In 12 consecutive months in 23 pediatric intensive care units (PICU),AHRF and ARDS were identified in those requiring >12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge.ARDS was diagnosed according to the American-European Consensus definitions.The mortality and ventilation free days (VFD) were measured as the primary outcome,and major complications,initial disease severity,and burden were measured as the secondary outcome.Results In 13 491 PICU admissions,there were 439 AHRE,of which 345 (78.6%) developed ARDS,resulting in incidences of 3.3% and 2.6%,and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively.No association was found in VT levels during the first 7 days with mortality,nor for VT at levels <6,6-8,8-10,and >10 ml/kg in the first 3 days with mortality or length of VFD.By binary Logistic regression analyses,higher pediatric risk of mortality score Ⅲ,higher initial oxygenation index,and age <1 year were associated with higher mortality or shorter VFD in AHRF.Conclusions The incidence and mortalities of AHRF and ARDS in children ≤5 years were similar to or lower than the previously reported rates (in age up to 15 years),associated with initial disease severity and other confounders,but causal relationship for the initial VT levels as the independent factor to the major outcome

  2. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

    OpenAIRE

    Ambrosino, N; Foglio, K; Rubini, F.; Clini, E.; Nava, S.; M. Vitacca

    1995-01-01

    BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according t...

  3. Guillain-Barre syndrome masquerading as acute respiratory failure in an infant

    Science.gov (United States)

    Kishore, Praveen; Sharma, Pradeep Kumar; Saikia, Bhaskar; Khilnani, Praveen

    2015-01-01

    Guillain-Barré syndrome (GBS) is a rare entity in infants. We report a case of GBS in a 5-month-old girl. The child presented with cough, loose stools, breathing difficulty, and listlessness. The child was treated as pneumonia with respiratory failure. Due to difficulty in weaning from ventilation with areflexia, marked hypotonia, and reduced power in all four limbs; possibilities of spinal muscular atrophy, poliomyelitis, and myopathies were kept. Nerve conduction velocity study was suggestive of mixed sensory-motor, severe axonal, and demyelinating polyradiculoneuropathy. Cerebrospinal fluid study revealed albuminocytological dissociation. Child was diagnosed as GBS and treated with intravenous immunoglobulin. Child recovered completely on follow-up. GBS should be considered as a differential diagnosis in acute onset respiratory failure with neuromuscular weakness in infants. PMID:26962356

  4. Guillain-Barre syndrome masquerading as acute respiratory failure in an infant

    Directory of Open Access Journals (Sweden)

    Praveen Kishore

    2015-01-01

    Full Text Available Guillain-Barré syndrome (GBS is a rare entity in infants. We report a case of GBS in a 5-month-old girl. The child presented with cough, loose stools, breathing difficulty, and listlessness. The child was treated as pneumonia with respiratory failure. Due to difficulty in weaning from ventilation with areflexia, marked hypotonia, and reduced power in all four limbs; possibilities of spinal muscular atrophy, poliomyelitis, and myopathies were kept. Nerve conduction velocity study was suggestive of mixed sensory-motor, severe axonal, and demyelinating polyradiculoneuropathy. Cerebrospinal fluid study revealed albuminocytological dissociation. Child was diagnosed as GBS and treated with intravenous immunoglobulin. Child recovered completely on follow-up. GBS should be considered as a differential diagnosis in acute onset respiratory failure with neuromuscular weakness in infants.

  5. Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review.

    Science.gov (United States)

    Fitzgerald, Marianne; Millar, Jonathan; Blackwood, Bronagh; Davies, Andrew; Brett, Stephen J; McAuley, Daniel F; McNamee, James J

    2014-01-01

    Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO₂R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO₂R was used in seven studies, and venovenous ECCO₂R in seven studies. Available evidence suggests no mortality benefit to ECCO₂R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO₂R is a rapidly evolving technology and is an efficacious treatment

  6. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950301 Endotoxin induced acute lung injury and theprotective effects with prostaglandin E1 in rabbits.WANG Jianxin(汪建新),et al.General Hosp,PLA,Beijing,100853.Med J Chin PLA 1995;20(1):36-38.A model of acute lung injury was successfully repro-duced by intravenous injection of E coli endotoxin(700μg/kg) to rabbits.It has been found that therewas a series of changes in the lungs in group B,such asgranulocyte seguestration,disturbance in pulmonary

  7. Noninvasive ventilation for acute respiratory failure: state of the art (II part

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2013-04-01

    Full Text Available Background: In the last years Non-Invasive Ventilation (NIV has been playing an important role in the treatment of Acute Respiratory Failure (ARF. Prospective randomised controlled trials have shown improvements in clinical features (respiratory rate, neurological score, pH and arterial blood gases and in particular clinical conditions (Acute Cardiogenic Pulmonary Edema, ACPE, and acute exacerbation of Chronic Obstructive Pulmonary Disease, COPD systematic reviews and metha-analysis confirm a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. Methods: The most important techniques of ventilation in spontaneous breathing are: Continuous Positive Airway Pression (CPAP, usually performed with Venturi-like flow generators, and bi-level positive pressure ventilation (an high inspiratory pressure and a low expiratory pressure, performed with ventilators. Facial mask rather than nasal mask is used in ARF: the helmet is useful for prolonged treatments. Results: NIV’s success seems to be determined by early application, correct selection of patients and staff training. Controindications to NIV are: cardiac or respiratory arrest, a respiratory rate < 12 per minute, upper airway obstruction, hemodynamic instability or unstable cardiac arrhythmia, encephalopathy (Kelly score > 3, facial surgery trauma or deformity, inability to cooperate or protect the airway, high risk of aspiration and an inability to clear respiratory secretions. Conclusions: Bi-level ventilation for ARF due to COPD and CPAP or bi-level bentilation for ARF due to ACPE are feasible, safe and effective also in a General Medical ward if the selection of patients, the staff’s training and the monitoring are appropriate: they improve clinical parameters, arterial blood gases, prevent ETI, decrease mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting.

  8. Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.

    Science.gov (United States)

    López-Cuenca, Sonia; Morales-García, Silvia; Martín-Hita, Ana; Frutos-Vivar, Fernando; Fernández-Segoviano, Pilar; Esteban, Andrés

    2012-08-01

    A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.

  9. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008428 The protective effects and mechanisms of peroxisome proliferator-activated receptor-γ agonist in rats with acute lung injury. WANG Jianchun(王建春), et al. Instit Respir Med PLA, Xinqiao Hosp, 3rd Milit Med Univ, Chongqing 400037.Chin J Tuberc Respir Dis 2008;31(6):425-430. Objective To observe if peroxisome proliferator-activated receptor-γ(PPAR-γ) agonist

  10. Acute respiratory failure secondary to eosinophilic pneumonia following influenza vaccination in an elderly man with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Prapaporn Pornsuriyasak

    2014-09-01

    Full Text Available Acute respiratory failure with diffuse pulmonary opacities is an unusual manifestation following influenza vaccination. We report herein a patient with chronic obstructive pulmonary disease who developed fever with worsening of respiratory symptoms and severe hypoxemia requiring ventilatory support shortly after influenza vaccination. Bronchoalveolar lavage was compatible with acute eosinophilic pneumonia. Rapid clinical improvement was observed 2 weeks after systemic corticosteroid treatment, followed by radiographic improvement at 4 weeks. No disease recurrence was observed at the 6-month follow-up.

  11. Prothrombotic state in senile patients with acute exacerbations of chronic obstructive pulmonary disease combined with respiratory failure

    OpenAIRE

    SONG, YA-JUN; ZHOU, ZHE-HUI; LIU, YAO-KANG; RAO, SHI-MING; HUANG, YING-JUN

    2013-01-01

    The aim of this study was to study the clinical value of prethrombotic state and treatment with low molecular weight heparin (LMWH) in senile patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure. Hemorheological markers (hematocrit, blood viscosity and plasma viscosity), fibrinogen (FIB), D-dimer and gas analysis were evaluated in 30 senile patients with AECOPD combined with respiratory failure and compared with those in 30 case...

  12. Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    McLean, Barbara

    2015-12-01

    In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. Generally, the right ventricle operates passively to support the ejection of the left ventricular diastolic volume. A loss of right ventricular wall compliance secondary to pulmonary pressures may result in an alteration in the normal pressure-volume relationship, ultimately affecting the stroke volume and cardiac output. Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale. PMID:26567491

  13. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930502 Clinical significance of changes in plas- ma renin—angiotensin aldosterone system in pa-tients with high altitude pulmonary edema.LIYingyue(李英悦),et al.General Hosp,TibetCommand,Lhasa,850003.Chin J Intern Med1993;32(4):232—234.Plasma levels of renin activity,angiotensin IIand aldosterone were determined in 16 patientswith high altitude pulmonary edema(HAPE)byradioimmunoassay and compared with those inthe controls including 9 patients with high alti-tude acute response(HAAR)and 14 healthy sub-jects.All of them arrived recently in Lhasa,aplace with an altitude of 3658m.The resultsshowed that the concentration of plasma reninactivity,angiotensin II,and aldosterone was sig-

  14. Applying a low-flow CO2 removal device in severe acute hypercapnic respiratory failure.

    Science.gov (United States)

    Sharma, Ajay S; Weerwind, Patrick W; Strauch, Uli; van Belle, Arne; Maessen, Jos G; Wouters, Emiel F M

    2016-03-01

    A novel and portable extracorporeal CO2-removal device was evaluated to provide additional gas transfer, auxiliary to standard therapy in severe acute hypercapnic respiratory failure. A dual-lumen catheter was inserted percutaneously in five subjects (mean age 55 ± 0.4 years) and, subsequently, connected to the CO2-removal device. The median duration on support was 45 hours (interquartile range 26-156), with a blood flow rate of approximately 500 mL/min. The mean PaCO2 decreased from 95.8 ± 21.9 mmHg to 63.9 ± 19.6 mmHg with the pH improving from 7.11 ± 0.1 to 7.26 ± 0.1 in the initial 4 hours of support. Three subjects were directly weaned from the CO2-removal device and mechanical ventilation, one subject was converted to ECMO and one subject died following withdrawal of support. No systemic bleeding or device complications were observed. Low-flow CO2 removal adjuvant to standard therapy was effective in steadily removing CO2, limiting the progression of acidosis in subjects with severe acute hypercapnic respiratory failure. PMID:26040584

  15. Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Chun Pan; Lu Chen; Yun-Hang Zhang; Wei Liu; Rosario Urbino; V Marco Ranieri; Hai-Bo Qiu

    2016-01-01

    Background:Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients.However,airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance.This study was to evaluate the Paw stress index on lung mechanics and the correlation between Paw stress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients.Methods:Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital,Nanjing,China and Ospedale S.Giovanni Battista-Molinette Hospital,Turin,Italy.All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min.PEEP was set according to the ARDSnet study protocol.The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio.The high elastance group (H group,n =14) had a ratio ≥30%,and the low elastance group (L group,n =10) had a ratio <30%.Respiratory elastance,gas-exchange,Paw stress index,and PL stress index were measured.Student's t-test,regression analysis,and Bland-Altman analysis were used for statistical analysis.Results:Pneumonia was the major cause of respiratory failure (71.0%).Compared with the L group,PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs.9.0 ± 2.3 cm2O,P < 0.01).Compared with the H group,lung elastance was higher (20.0 ± 7.8 cmH2O/L vs.11.6 ± 3.6 cmH2O/L,P < 0.01),and stress was higher in the L group (7.0 ± 1.9 vs.4.9 ± 1.9,P =0.02).A linear relationship was observed between the Paw stress index and the PL stress index in H group (R2 =0.56,P < 0.01) and L group (R2 =0.85,P < 0.01).Conclusion:In the ARF patients with MV,Paw stress index can substitute for PL to guide ventilator settings.

  16. What Causes Respiratory Failure?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Causes Respiratory Failure? Diseases and conditions that impair breathing can cause ... injure your lungs. Normal Lungs and Conditions Causing Respiratory Failure Figure A shows the location of the lungs, ...

  17. [A case of Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure].

    Science.gov (United States)

    Sato, K; Nakamura, S; Koseki, T; Yamauchi, F; Baba, M; Mikami, M; Kobayashi, R; Fujikawa, T; Nagaoka, S

    1991-08-01

    The authors report a 56-year-old woman with Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure. Five days before admission, she experienced right otalgia and right facial pain and consulted an otolaryngologist of our hospital, who diagnosed the illness as acute parotitis and laryngopharyngitis. One day before admission, she experienced mild dyspnea and general fatigue and came to our hospital emergency room. A chest X-ray film revealed no abnormalities but some blisters were observed around her right ear. The next day, her dyspnea became more severe and she was admitted. A chest X-ray film on admission revealed right lower lobe consolidation, and neurological examination disclosed multiple cranial nerve paralysis, i.e., paralysis of the right fifth, seventh, eighth, ninth, tenth, eleventh, twelfth and left tenth cranial nerve. The serum titer of anti-herpes zoster antibody was elevated to 1,024, and the patient was diagnosed as having Ramsey Hunt syndrome with multiple cranial nerve paralysis. Arterial blood gas analysis revealed hypoxemia with hypercapnea, which was considered to be due to aspiration pneumonia and central airway obstruction caused by vocal cord paralysis. Mechanical ventilation was soon instituted and several antibiotics and acyclovir were administered intravenously, with marked effects. Three months after admission, the patient was discharged with no sequelae except mild hoarseness. Patients with herpes zoster oticus, facial nerve paralysis and auditory symptoms are diagnosed as having Ramsey Hunt syndrome. This case was complicated by lower cranial nerve paralysis and acute respiratory failure, which is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  19. Acute respiratory failure, due to severe obstructive sleep apnoea syndrome, managed with nasal positive pressure ventilation.

    Science.gov (United States)

    Sturani, C; Galavotti, V; Scarduelli, C; Sella, D; Rosa, A; Cauzzi, R; Buzzi, G

    1994-12-01

    The complications of endotracheal intubation are particularly frequent in patients with obstructive sleep apnoea syndrome (OSAS). We prospectively tested nasal ventilation in such patients admitted for acute respiratory failure. Six consecutive patients, aged 17-70 yrs, were selected for the study. All patients were confused or severely obtunded, Glasgow Coma Score (GCS) 10 (SD 2). With nasal bi-level positive airways pressure (BiPAP) all these patients improved clinical status and arterial blood gas values, avoiding intubation and invasive mechanical ventilation. The median pH increased from 7.26 (SD 0.06) to 7.36 (0.01) and to 7.43 (0.02) after, 1-3 and 24 h of nasal ventilation, respectively. Nasal ventilation lasted an average of 21 (3) h on the first day. All patients were discharged home after a median hospital stay of 28 (11) days. PMID:7711717

  20. Acute Respiratory Failure Caused by Hepatopulmonary Fistula in a Patient with Hepatocellular Carcinoma.

    Science.gov (United States)

    Lee, Jungsil; Kim, Yoon Jun; Kim, Hyung-Jun; Kim, Jee-Min; Kim, Young-Chan; Choi, Sun Mi

    2016-07-01

    A 59-year-old man presented with acute dyspnea following sudden productive cough and expectoration of a full cup of "blood-tinged" sputum. He had been diagnosed with hepatitis B virus-related hepatocellular carcinoma and had received transarterial chemoembolization 5 years ago for a 20-cm hepatic mass; he denied any history of hematemesis and the last esophagogastroduodenoscopy from a year ago showed absence of varix. Chest computed tomography (CT) with angiography showed new appearance of right basal lung consolidation but no bleeding focus. Despite the use of systemic antibiotics, the patient developed respiratory failure on day 7 of hospitalization. After intubation, a massive amount of brown sputum with anchovy-paste-like consistency was suctioned via the endotracheal tube. Bronchoscopic toileting was performed and the patient was extubated. In the ward, he continued to expectorate the brown sputum. On day 25 of hospitalization, a repeat CT scan showed simultaneous disappearance of the pneumonic consolidation and the necrotic fluid within the hepatic mass, suggesting the presence of a fistula. He has continued to receive systemic antibiotics, sorafenib, and entecavir, and follow up by respiratory and hepato-oncology specialists. PMID:27433178

  1. A Critical Care and Transplantation-Based Approach to Acute Respiratory Failure after Hematopoietic Stem Cell Transplantation in Children.

    Science.gov (United States)

    Elbahlawan, Lama; Srinivasan, Ashok; Morrison, R Ray

    2016-04-01

    Acute respiratory failure contributes significantly to nonrelapse mortality after allogeneic hematopoietic stem cell transplantation. Although there is a trend of improved survival over time, mortality remains unacceptably high. An understanding of the pathophysiology of early respiratory failure, opportunities for targeted therapy, assessment of the patient at risk, optimal use of noninvasive positive pressure ventilation, strategies to improve alveolar recruitment, appropriate fluid management, care of the patient with chronic lung disease, and importantly, a team approach between critical care and transplantation services may improve outcomes. PMID:26409244

  2. An open randomized controlled trial of noninvasive positive pressure ventilation in patients of acute on chronic hypercapnic respiratory failure in a general respiratory ward setting

    Directory of Open Access Journals (Sweden)

    Prasad R

    2007-01-01

    Full Text Available Objective : To compare the standard medical therapy (SMT and noninvasive posi-tive pressure ventilation (NPPV in acute on chronic hypercapnic respiratory fail-ure due to exacerbation of chronic obstructive pulmonary disease (COPD. Method : Between June 2002 and May 2003, 19 patients with acute on chronic hypercapnic respiratory failure were prospectively and randomly recruited to re-ceive either SMT (n=10 or NPPV plus SMT (n=9 in a general respiratory ward and followed up after 4 to 6 weeks after discharge. NPPV was given with a silicone cushioned nasal mask via a bilevel ventilator with initial pressure support of 5 cm of H 2 O. Results : At the time of randomization there was no significant difference in respiratory rate, PaO 2 , PaCO 2 , pH and HCO3 - , between the two groups. At 2 hours with SMT, there was significant improvement only in respiratory rate (p = 0.0000 and PaO 2 (p=0.0014. However with NPPV, respiratory rate (p=0.0000, PaO2 (p=0.0011, pH (0.0002, pulse rate (p=0.0329 and mean arterial pressure (p=0.0096 improved significantly at 2 hours while PaCO2 (p=0.0008 significantly improved at24 hours. Hospital stay was significantly shorter for NPPV group as compared to SMT group (9.63 + 1.4 days vs. 13.33 + 4.69 days, p < 0.05. There was 1 failure (12.5% in NPPV group as compared to 2 failures (20% in SMT group of which one was salvaged by NPPV. Conclusion : The study suggests that early application of NPPV in acute on chronic hypercapnic respiratory failure due to COPD facilitates improvement, favors early mobiliation and discharge from hospital.

  3. Demographic, etiological, and histological pulmonary analysis of patients with acute respiratory failure: a study of 19 years of autopsies

    Directory of Open Access Journals (Sweden)

    Alexandre de Matos Soeiro

    2011-01-01

    Full Text Available INTRODUCTION: Acute respiratory failure has been one of the most important causes of death in intensive care units, and certain aspects of its pulmonary pathology are currently unknown. OBJECTIVES: The objective was to describe the demographic data, etiology, and pulmonary histopathological findings of different diseases in the autopsies of patients with acute respiratory failure. METHOD: Autopsies of 4,710 patients with acute respiratory failure from 1990 to 2008 were reviewed, and the following data were obtained: age, sex, and major associated diseases. The pulmonary histopathology was categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoplasmacytic interstitial pneumonia. The odds ratio of the concordance between the major associated diseases and specific autopsy findings was calculated using logistic regression. RESULTS: Bacterial bronchopneumonia was present in 33.9% of the cases and cancer in 28.1%. The pulmonary histopathology showed diffuse alveolar damage in 40.7% (1,917 of the cases. A multivariate analysis showed a significant and powerful association between diffuse alveolar damage and bronchopneumonia, HIV/AIDS, sepsis, and septic shock, between liver cirrhosis and pulmonary embolism, between pulmonary edema and acute myocardial infarction, between dilated cardiomyopathy and cancer, between alveolar hemorrhage and bronchopneumonia and pulmonary embolism, and between lymphoplasmacytic interstitial pneumonia and HIV/ AIDS and liver cirrhosis. CONCLUSIONS: Bronchopneumonia was the most common diagnosis in these cases. The most prevalent pulmonary histopathological pattern was diffuse alveolar damage, which was associated with different inflammatory conditions. Further studies are necessary to elucidate the complete pathophysiological mechanisms involved with each disease and the development of acute respiratory failure.

  4. Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

    OpenAIRE

    Linda Smith; Nicola Jane Willis; Tharindu Vithanage; Gerben Keijzers; Tara Cochrane

    2013-01-01

    Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED) with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats). In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He devel...

  5. CT in the evaluation of patients on ECMO due to acute respiratory failure

    International Nuclear Information System (INIS)

    Heading AbstractBackground. In patients with acute severe respiratory failure (ARF) treated with extracorporeal membrane oxygenation (ECMO) the radiological evaluation has until now almost exclusively relied on bedside radiography and US. At St. Goeran/Karolinska ECMO centre CT has become a routine complement to bedside examinations.Objective. To review retrospectively the frequency, indications and findings on CT of patients with ARF on ECMO and to evaluate the risk of complications associated with transportation for CT examinations.Materials and methods. One hundred twelve neonates, children and adults were treated with ECMO from May 1994 to January 2001. Forty-six per cent of these patients had CT examinations on one or more occasions during ECMO, giving a total number of 238 examination sites on 104 occasions. All CT examinations were performed in the Paediatric Radiology Department and included a 10-min transport using a mobile ECMO system.Results. CT was more often performed in older patients and in patients with long ECMO runs. The main indications were suspected complications of ECMO and/or the underlying disease or a delay in clinical improvement. In 57% of the CT occasions, significant findings affecting treatment were revealed. There were no complications associated with the examinations or transport.Conclusions. CT is safe and useful in evaluation of patients with ARF during ECMO. (orig.)

  6. Radiographic findings of miliary tuberculosis: difference in patients with and those without associated acute respiratory failure

    International Nuclear Information System (INIS)

    To determine the differences in the radiography findings of miliary tuberculosis between patients with and without associated acute respiratory failure (ARF). We retrospectively 32 patients in whom miliary tuberculosis had been diagnosed, and assigned them to one of two groups: with ARF (n=10), and without ARF (n=22). Chest radiographic findings such as presence of miliary modules, consolidation, ground-glass opacity (GGO), pleural effusion, small calcified nodules and linear opacities were assessed, the size and profusion of nodules in each of four zones were analyzed and scored using the standard radiographs of the international labor organization, and the extent of consolidation and GGO were scored according to the percentage on involved lung. We compared the radiologic findings between the two groups. Ground-glass opacity, consolidation, and pleural effusion were seen more frequently in miliary tuberculosis patinets with ARF than in those without ARF. Although the size and profusion of nodules were similar in both groups (p>0.05), consolidation and ground-glass opacity in cases of miliary tuberculosis with ARF were significantly more extensive than in those without ARF (p<0.005). GGO and consolidation were more extensive in miliary tuberculosis patients with ARF. A finding of ground-glass opacity in miliary tuberculosis patients might be an early indication of developing ARF

  7. Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis.

    OpenAIRE

    Goodacre, Steve; Stevens, John W; Pandor, Abdullah; Poku, Edith; Ren, Shijie; Cantrell, Anna; Bounes, Vincent; Mas, Arantxa; Payen, Didier; Petrie, David; Roessler, Markus Soeren; Weitz, Gunther; Ducros, Laurent; Plaisance, Patrick

    2014-01-01

    OBJECTIVES: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure. METHODS: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator...

  8. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation.

    OpenAIRE

    Pandor, A; Thokala, P.; Goodacre, S; Poku, E.; Stevens, J.W.; Ren, S.; Cantrell, A.; Perkins, G.D.; Ward, M.; Penn-Ashman, J.

    2015-01-01

    BACKGROUND: Non-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources. OBJECTIVES: We aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to t...

  9. Comparison of Noninvasive Positive Pressure Ventilation and Invasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Jian Li; De-hou Zhang; Xian-feng Huang; Ming Ding; Guo-rong Shu

    2005-01-01

    @@ The use of noninvasive positive pressure ventilation (NPPV)in the treatment of acute respiratory failure (ARF) has been supported by a number of randomised controlled trials. We conducted a controlled prospective randomised study to compare the efficacy of NPPV with the efficacy of invasive positive pressure ventilation (IPPV) in ARF patients whose conditions had not improved under aggressive medical therapy thus requiring mechanical ventilation (MV).

  10. Porcine surfactant (Curosurf) for acute respiratory failure after near-drowning in 12 year old.

    Science.gov (United States)

    Onarheim, H; Vik, V

    2004-07-01

    This case report describes rapid and persistent improvement after one single dose of porcine surfactant (Curosurf) 0.5 ml/kg(-1) (40 mg/kg) intratracheally for adult respiratory distress syndrome (ARDS) with severe oxygenation failure 8 h after freshwater near-drowning in a 12-year-old girl.

  11. Acute respiratory failure caused by aspiration of high density barium: A case report

    International Nuclear Information System (INIS)

    Accidental aspiration of barium contrast medium during the upper gastrointestinal study can occur in patients with swallowing disorder, especially in the elderly patients. We experienced a case of respiratory failure followed by death within a few hours in 85 year-old patient after barium aspiration

  12. Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

    Directory of Open Access Journals (Sweden)

    Tharindu Vithanage

    2013-01-01

    Full Text Available Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats. In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He developed hypercapnic respiratory failure in the ED after a coughing episode. A normal nasopharyngoscopic examination and a subtle mediastinal abnormality on chest radiograph lead to a working diagnosis of retrosternal subglottic obstruction. The complexities of his airway management and suggestions for multidisciplinary approach are discussed.

  13. Living with Respiratory Failure

    Science.gov (United States)

    ... tips below. Ongoing Care If you have respiratory failure, see your doctor for ongoing medical care. Your doctor may refer you to pulmonary rehabilitation (rehab). Rehab can involve exercise training, education, and counseling. Your rehab team might include doctors, ...

  14. Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; WANG Di-jia; LIU Shuang; JIA Ming; JIA Shi-jie

    2013-01-01

    Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8%,tracheotomy rate was 12.5%,VAP incidence was 0,and the in-hospital mortality was 18.8%,significantly lower than in the control group 80.9%,29.8%,17.0% and 38.3% respectively,P <0.05 or P <0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9

  15. Outcome of coal worker's pneumoconiosis with acute respiratory failure

    Energy Technology Data Exchange (ETDEWEB)

    Shen, H.N.; Jerng, J.S.; Yu, C.J.; Yang, P.C. [National Taiwan University Hospital, Taipei (Taiwan). Dept. of International Medicine

    2004-03-01

    Study objective: To investigate the clinical features and prognosis of patients with coal worker's pneumoconiosis (CWP) requiring invasive mechanical ventilation (MV) in the ICU for their first episode of acute respiratory failure (ARF), with special attention to the prognostic implication of radiographic progressive massive fibrosis (PMF). Design: Retrospective study. Setting: A 16-bed medical ICU at a community hospital. Patients and methods: We reviewed 53 patients with CWP and ARF requiring invasive MV in the ICU for the first time between August 1998 and March 2002. Results: Of the 53 patients with CWP, 28 patients (53%) with PMF had their first ARF at a younger age than those without PMF. Pneumonia (49%) was the most common cause of ARF. The mean APACHE (acute physiology and chronic health evaluation) II score was 26.0 {+-}9.9, and the mean ICU stay was 14.7 {+-}16.1 days. Twenty-one patients (40%) were weaned successfully in the ICU, with mean ventilator time of 17.0 {+-}25.1 days. The ICU and in-hospital mortality rates were 40% and 43%, respectively. The median survivals for all patients and the ICU survivors were 2.6 months and 14.3 months, respectively. Multivariate analysis showed the following risk (or protective) factors for the ICU mortality: Paco(2) {gt} 45 mm Hg at the time of intubation (adjusted odds ratio (OR), 0.04; 95% confidence interval (CI), 0.003 to 0.44), Pao(2)/fraction of inspired oxygen ratio {lt} 200 mm Hg at the time of intubation (OR, 8.78; 95% CI, 1.36 to 56.48), and APACHE II score greater than or equal to 25 (OR, 11.99; 95% CI, 1.49 to 96.78). PMF was not associated with the ICU mortality (OR, 1.18; 95% CI, 0.20 to 7.10). Conclusions: Radiographic PMF was not associated with the ICU mortality in patients with CWP and ARF receiving invasive MV in the ICU. Although a substantial proportion of them could be weaned from the ventilator and discharged from the hospital, their long-term prognosis was poor.

  16. The acute respiratory distress syndrome

    OpenAIRE

    Modrykamien, Ariel M.; Gupta, Pooja

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss t...

  17. Acute kidney failure

    Science.gov (United States)

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... To prevent acute kidney failure: Health problems such as high blood pressure or diabetes should be well controlled. Avoid drugs and medicines that can cause kidney injury.

  18. Pulmonary infection control window as a switching point for consequential ventilation: an encouraging finding in treatment of acute respiratory failure of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long

    2005-01-01

    @@ I read with great interest the article by Collaborating Research Group for Noninvasive Mechanical Ventilation of Chinese Respiratory Society.1 Based on the concept mentioned in this paper, I have found that it is really an encouraging new finding in the field of clinical application of mechanical ventilation and treatment of acute respiratory failure (ARF) of chronic obstructive pulmonary disease (COPD).

  19. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S. G.; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Background Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. Methods We prospectively enrolled SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. Results SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). Conclusion and Significance The result suggests that SAM children with cough or

  20. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+).

    Science.gov (United States)

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-09-01

    The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+) after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure), respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy "Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?" [1]. PMID:27358909

  1. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+

    Directory of Open Access Journals (Sweden)

    Dimitris Georgopoulos

    2016-09-01

    Full Text Available The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+ after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure, respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy “Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?” [1].

  2. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+).

    Science.gov (United States)

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-09-01

    The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+) after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure), respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy "Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?" [1].

  3. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    OpenAIRE

    Chang SC; Shi JD; Fu CP; Wu X; Li SQ

    2016-01-01

    Suchi Chang,1 Jindong Shi,2 Cuiping Fu,1 Xu Wu,1 Shanqun Li1 1Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive car...

  4. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    OpenAIRE

    Chang, Su Chi

    2016-01-01

    Suchi Chang,1 Jindong Shi,2 Cuiping Fu,1 Xu Wu,1 Shanqun Li1 1Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Inten...

  5. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

    Directory of Open Access Journals (Sweden)

    Kamolwish Laoprasopwattana

    Full Text Available To determine the outcome of severe dengue viral infection (DVI and the main dengue fatality risk factors.The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic, impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.Of the 238 children with severe DVI, 30 (12.6% died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%, repeated shock (93.3% vs 27.9%, acute respiratory failure (ARF (100% vs 6.7%, acute liver failure (ALF (96.6% vs 6.3%, acute kidney injury (AKI (79.3% vs 4.5%, and active bleeding requiring blood transfusion (93.3% vs 5.4%, all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99, 0.97 (0.93-0.99, 0.99 (0.97-1.00, and 0.82 (0.65-0.93, respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7 and 0.07 (0.02-0.26, respectively.Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

  6. Non-invasive ventilation in acute respiratory failure: a randomised comparison of continuous positive airway pressure and bi-level positive airway pressure

    OpenAIRE

    Cross, A.; Cameron, P.; Kierce, M; Ragg, M; Kelly, A.

    2003-01-01

    Objectives: To determine whether there is a difference in required duration of non-invasive ventilation between continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) in the treatment of a heterogeneous group of emergency department (ED) patients suffering acute respiratory failure and the subgroup of patients with acute pulmonary oedema (APO). Secondary objectives were to compare complications, failure rate, disposition, length of stay parameters, and mortal...

  7. Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Haja Mydin H

    2013-03-01

    Full Text Available Helmy Haja Mydin, Stephen Murphy, Howell Clague, Kishore Sridharan, Ian K TaylorDepartment of Respiratory Medicine, Sunderland Royal Infirmary, Sunderland, United KingdomBackground: In patients with acute hypercapnic respiratory failure (AHRF during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV. For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD.Methods: COPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1, World Health Organization performance status (WHO-PS, clinical observations, a composite physiological score (Early Warning Score, routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded.Results: In total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ≥ 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ≥ 3, severe acidosis (pH < 7.20, and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ≥ 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%.Conclusion: WHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV.Keywords: acute exacerbations of COPD, noninvasive ventilation, emphysema, prognostic markers

  8. Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?

    International Nuclear Information System (INIS)

    Aim: To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). Methods: In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements (51Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP). Results: At the time of study, 25 patients presented with increased permeability (NSI > 1 x 10-3 min-1) indicating an exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p > 0.05). With respect to survival, there was a negative correlation to PAP (p < 0.01). Apart from that no correlations between the individual parameters were found. Especially no correlation was found between permeability impairment and oxygenation, duration of disease of PAP. Conclusion: In ALI and ARDS, pulmonary capillary permeability is a diagnostic parameter which is independent from clinical variables. Permeability measurement makes a stage classification (exudative versus non exudative phase) of ALI/ARDS possible based on a measurable pathophysiological correlate. (orig.)

  9. Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study

    Directory of Open Access Journals (Sweden)

    Chen CW

    2015-06-01

    Full Text Available Char-Wen Chen,1,* Yih-Yuan Chen,2,* Chin-Li Lu,3 Solomon Chih-Cheng Chen,3 Yi-Jen Chen,1,4 Ming-Shian Lin,1,4 Wei Chen1,5,6 1Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, 2Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, 3Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, 4Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus; Changhua, 5College of Nursing, Dayeh University, Changhua 6Department of Respiratory Therapy, China Medical University, Taichung, Taiwan *These authors contributed equally to this work Background: Acute respiratory failure (ARF is a life-threatening event, which is frequently associated with the severe exacerbations of chronic obstructive pulmonary disease (COPD. Hypoalbuminemia is associated with increased mortality in patients with COPD. However, to date, little is known regarding whether or not hypoalbuminemia is a risk factor for developing ARF in COPD.Methods: We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. A total of 42,732 newly diagnosed COPD patients (age ≥40 years from 1997 to 2011 were enrolled. Among them, 1,861 (4.36% patients who had received albumin supplementation were defined as hypoalbuminemia, and 40,871 (95.6% patients who had not received albumin supplementation were defined as no hypoalbuminemia.Results: Of 42,732 newly diagnosed COPD patients, 5,248 patients (12.3% developed ARF during the 6 years follow-up period. Patients with hypoalbuminemia were older, predominantly male, had more comorbidities, and required more steroid treatment and blood transfusions than patients without hypoalbuminemia. In a multivariable Cox regression analysis model, being elderly was the strongest independent risk factor for ARF (adjusted hazard ratio [HR]: 4.63, P<0.001, followed by hypoalbuminemia (adjusted HR: 2

  10. Sequential Oxygenation Index and Organ Dysfunction Assessment within the First 3 Days of Mechanical Ventilation Predict the Outcome of Adult Patients with Severe Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Hsu-Ching Kao

    2013-01-01

    Full Text Available Objective. To determine early predictors of outcomes of adult patients with severe acute respiratory failure. Method. 100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw, and oxygenation index (OI on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure. Results. 38 out of 100 (38% patients died within the study period. 48 patients (48% failed to wean from ventilator. Multivariate analysis showed day 3 OI ( and SOFA ( score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA ( was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, . Conclusion. Early OI (within 3 days and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.

  11. Intrapleural steroid instillation for multiple organ failure with acute respiratory distress syndrome.

    Science.gov (United States)

    Huang, Pei-Ming; Lin, Tzu-Hsin; Tsai, Pi-Ru; Ko, Wen-Je

    2013-11-01

    Acute respiratory distress syndrome (ARDS) increases mortality in patients with multiorgan dysfunction syndrome (MODS). This study evaluates the feasibility of intrapleural steroid instillation (IPSI) in patients with ARDS and MODS unresponsive to conventional extracorporeal membrane oxygenation (ECMO). Ninety-two of 467 patients who underwent ECMO between 2005 and 2009 had ARDS, and 30 consecutive adult patients of these 92 patients with severe ARDS and MODS were retrospectively analyzed in this study. Nine of these 30 patients, who did not respond to therapy and whose condition deteriorated, were managed with IPSI. All patients met the inclusion criteria of hemodynamic instability with high catecholamine infusion requirement and 100% oxygen demand in ventilation and ECMO flow. On initial diagnosis of ARDS, no differences in prognostic scorings were observed in patients who underwent conventional treatment (n = 21) and those who underwent IPSI (n = 9). Blood oxygenation, tidal volume, changing in chest radiographic findings, and survival rates were analyzed. The primary outcome was survival until discharge from the hospital. Pulmonary radiographic appearance improved after 3 days of IPSI treatment (P = 0.008); the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen also increased significantly after 5 days of IPSI treatment (P = 0.028). Moreover, the 28-day mortality rate (P = 0.017), 60-day mortality rate (P = 0.003), and survival rate (78% vs. 19%; P = 0.003) significantly improved in patients undergoing IPSI, which therefore appears to be an easily implemented and highly effective treatment for patients with severe ARDS in combination with MODS, particularly in patients who fail to respond to conventional treatment.

  12. Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Carmen Sílvia Valente Barbas

    2012-01-01

    Full Text Available This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA, biomarkers and response to infection therapy allows changes in the initial treatment plans and can help decrease ARDS mortality.

  13. [Acute respiratory distress syndrome].

    Science.gov (United States)

    Estenssoro, Elisa; Dubin, Arnaldo

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance. ARDS always occurs within a week of exposition to a precipitating factor; most frequently pneumonia, shock, aspiration of gastric contents, sepsis, and trauma. In CT scan, the disease is frequently inhomogeneous, with gravitational infiltrates coexisting with normal-density areas and also with hyperaerated parenchyma. Mortality is high (30-60%) especially in ARDS associated with septic shock and neurocritical diseases. The cornerstone of therapy lies in the treatment of the underlying cause and in the use mechanical ventilation which, if inappropriately administered, can lead to ventilator-induced lung injury. Tidal volume = 6 ml/kg of ideal body weight to maintain an end-inspiratory (plateau) pressure = 30 cm H2O ("protective ventilation") is the only variable consistently associated with decreased mortality. Moderate-to-high PEEP levels are frequently required to treat hypoxemia, yet no specific level or titration strategy has improved outcomes. Recently, the use of early prone positioning in patients with PaO2/FIO2 = 150 was associated with increased survival. In severely hypoxemic patients, it may be necessary to use adjuvants of mechanical ventilation as recruitment maneuvers, pressure-controlled modes, neuromuscular blocking agents, and extracorporeal-membrane oxygenation. Fluid restriction appears beneficial. PMID:27576283

  14. Treatment of respiratory failure in COPD

    Directory of Open Access Journals (Sweden)

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  15. [A case of acute chronic respiratory failure due to fat embolism syndrome after the left femoral neck fracture].

    Science.gov (United States)

    Oda, Keishi; Kawanami, Toshinori; Yatera, Kazuhiro; Ogoshi, Takaaki; Kozaki, Minako; Nagata, Shuya; Nishida, Chinatsu; Yamasaki, Kei; Ishimoto, Hiroshi; Mukae, Hiroshi

    2011-09-01

    A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome. PMID:21913383

  16. Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study

    Directory of Open Access Journals (Sweden)

    Langlet Ketty

    2012-10-01

    Full Text Available Abstract Background Mechanical ventilation (MV is imperative in many forms of acute respiratory failure (ARF in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL score may help to predict the outcome of these patients. Methods We studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68% or failure (group B n = 8, 32%. We investigated the correlation between the ADL score and the outcome and mortality. Results The ADL score was higher in group A (5.1 ±1.1 vs 3.7 ± 0.7 in group B, p  Conclusion Our pilot study demonstrates that the ADL score is predictive of weaning success and mortality at 6 months, suggesting that the assessment of daily activities should be an important component of ARF management in COPD patients.

  17. TWO CASES OF TYPE II RESPIRATORY FAILURE IN COPD TREATED IN KATURI MEDICAL COLLEGE HOSPITAL, GUNTUR AND AN OVERVIEW OF TREATMENT OF ACUTE EXACERBATION AND RESPIRATORY FAILURE

    Directory of Open Access Journals (Sweden)

    Ramakrishna

    2015-04-01

    Full Text Available Treatment of Type II Respiratory Failure in a COPD patient is a difficult task for the ICU and Pulmonary physician. Multi factorial and multi - disciplinary approach is required . Our experience of two cases treated recently in Katuri medical College Hospita l have common features. One is a male of 54 years age and the other is a female of similar age. Both of them were obese and were nonsmokers. Both were poor and could not afford any ICU treatment on their own. Both were rescued by State sponsored Arogyasree programme. Both of them had the advantage of support from their families. Aided by Arogyasree programme, dedicated staff of ICU, Pulmonology, ENT departments , timely interventions with electrolyte balance, balanced antibiotic therapy, Noninvasive and inva sive ventilator strategies, Nutritional support, Blood transfusions, Timely Tracheostomy and excellent nursing care and drug administration in ICU both patients recovered back to normalcy . Initially both required home oxygen therapy and both were subsequen tly seen maintaining normal oxygenation status even without oxygen causing happiness to family members and the treating physicians

  18. Recurrent acute renal failure

    OpenAIRE

    Satish, S.; Rajesh, R.; Kurian, G.; Seethalekshmi, N. V.; Unni, M.; Unni, V. N.

    2010-01-01

    While acute renal failure secondary to intravascular hemolysis is well described in hemolytic anemias, recurrent acute renal failure as the presenting manifestation of a hemolytic anemia is rare. We report a patient with recurrent acute renal failure who was found to have paroxysmal nocturnal hemoglobinuria (PNH), on evaluation.

  19. Respiratory failure in diabetic ketoacidosis

    OpenAIRE

    Konstantinov, Nikifor K; Rohrscheib, Mark; Agaba, Emmanuel I.; Dorin, Richard I.; Murata, Glen H.; Tzamaloukas, Antonios H.

    2015-01-01

    Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include de...

  20. Surfactant inhibition in acute respiratory failure : consequences for exogenous surfactant therapy

    OpenAIRE

    Eijking, Eric

    1993-01-01

    textabstractThe neonatal respiratory distress syndrome (RDS) is characterized by immaturity of the lung, resulting in relative or absolute absence of pulmonary surfactant. Worldwide, neonates suffering from RDS have been treated successfully with exogenous surfactant preparations. Currently, exogenous surfactant administration has been accepted as a valuable treatment for this syndrome. Nevertheless, many questions on exogenous surfactant treatment remain unanswered. It has been observed that...

  1. Respiratory failure in diabetic ketoacidosis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Respiratory failure complicating the course of diabeticketoacidosis (DKA) is a source of increased morbidityand mortality. Detection of respiratory failure in DKA requiresfocused clinical monitoring, careful interpretationof arterial blood gases, and investigation for conditionsthat can affect adversely the respiration. Conditions thatcompromise respiratory function caused by DKA can bedetected at presentation but are usually more prevalentduring treatment. These conditions include deficits ofpotassium, magnesium and phosphate and hydrostatic ornon-hydrostatic pulmonary edema. Conditions not causedby DKA that can worsen respiratory function under theadded stress of DKA include infections of the respiratorysystem, pre-existing respiratory or neuromuscular diseaseand miscellaneous other conditions. Prompt recognitionand management of the conditions that can lead torespiratory failure in DKA may prevent respiratory failureand improve mortality from DKA.

  2. [Update on current care guidelines: acute respiratory failure--preoperative evaluation].

    Science.gov (United States)

    2014-01-01

    Concomitant diseases, the patient's general condition, exercise capacity and the extent of surgery are determinants of the operative risk. Increasing number of patients with endovascular stents and antithrombotic medication need special perioperative precautions as well as the eventual endocarditis prophylaxis. The risk of perioperative complications can probably be decreased by respiratory physiotherapy, correction of anaemia and smoking cessation. Severe liver or kidney insufficiency need be evaluated. Principles of preoperative fasting and perioperative strategies with concomitant medication are described, and use of preoperative carbohydrate drinks are encouraged. PMID:25272790

  3. Doxapram hydrochloride in the treatment of acute exacerbation of chronic respiratory failure. A patient with four episodes treated without use of a respirator.

    Science.gov (United States)

    Ohi, M; Nakashima, M; Heki, S; Kato, M; Sagawa, Y

    1978-10-01

    A 51-year-old woman with chronic respiratory failure (status after tuberculosis) was given an infusion of doxapram hydrochloride (1 to 2 mg/kg of body weight per hour) for four episodes of acute exacerbation of her condition. Treatment with the drug prevented worsening of hypercapnia in the four episodes, when administration of 24 percent oxygen had occasioned rises in the arterial carbon dioxide tension of 23, 10, 9, and 7 mm Hg.

  4. How Is Respiratory Failure Treated?

    Science.gov (United States)

    ... Once your doctor figures out what's causing your respiratory failure, he or she will plan how to treat that disease or condition. Treatments may include medicines, procedures, and other therapies. Rate This Content: NEXT >> Updated: December 19, 2011 Twitter ...

  5. Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis

    DEFF Research Database (Denmark)

    Dombernowsky, Tilde; Kristensen, Marlene Østermark; Rysgaard, Sisse;

    2016-01-01

    %) continuous positive airway pressure, and six (2%) mechanical ventilation. Thirty-two patients (9%) were treated with bronchodilators and 12 (3%) with steroids. Thirty-one patients (9%) fulfilled the diagnostic criteria for respiratory failure. Five of these patients (16%) did not have effusion, atelectasis...

  6. Acute liver failure

    DEFF Research Database (Denmark)

    Larsen, Fin Stolze; Bjerring, Peter Nissen

    2011-01-01

    Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....

  7. Unsuspected myasthenia gravis presenting as respiratory failure.

    OpenAIRE

    Mier, A; Laroche, C; Green, M

    1990-01-01

    A patient developed respiratory failure after surgical removal of a recurrent thymoma, which necessitated removal of part of the diaphragm. The respiratory failure was due to previously undiagnosed myasthenia gravis, which had selectively affected the respiratory muscles.

  8. [Impact of acute respiratory failure on survival of COPD patients managed with long-term non-invasive ventilation and oxygen therapy].

    Science.gov (United States)

    Perrin, C; Vandenbos, F; Tamisier, R; Lemoigne, F; Blaive, B

    2000-02-01

    Our study aimed to assess the impact of acute respiratory failure (ARF) on survival of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) plus nasal intermittent positive pressure ventilation (NIPPV). Survival was analysed retrospectively in 24 patients with severe COPD initiated to NIPPV in addition to LTOT. Fourteen patients were established on NIPPV following exacerbation of acute respiratory failure which has required mechanical ventilation (group 1). Ten patients (group 2) have never been hospitalized for ARF. Comparison of clinical details at baseline, 6 months, 1, 2, and 3 years for the two groups failed to reveal any difference with the exception of prior episodes of ARF. The probability of survival at 3 years was 65% (95% confidence interval [CI] 43-86) for the overall population, 46% (95% CI 15-77) in group 1, and 74% (95% CI 42-105) in group 2. The difference between the two groups was statistically significant. We show that ARF requiring mechanical ventilation appears to be a factor that is negatively correlated with survival for patients treated by LTOT plus NIPPV. This data suggests that NIPPV should be tried before ARF arising in COPD patients who present a deterioration in chronic respiratory failure with hypercapnia. PMID:10756560

  9. Postoperative rescue closure of patent foramen ovale in the clinical setting of acute hypoxemic respiratory failure and stroke following coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    José L Díaz-Gómez

    2015-01-01

    Full Text Available We describe a case of intraoperative diagnosis and successful deferred percutaneous closure of a patent foramen ovale (PFO in the clinical setting of acute refractory hypoxemic respiratory failure and new-onset ischemic stroke in an elderly patient after coronary artery bypass graft. Perioperative morbidity (i.e. severe hypoxemia, worsening right ventricular dysfunction, and embolic stroke that is potentially related to intraoperatively diagnosed PFO during cardiac surgery can complicate management in the Intensive Care Unit and perhaps affect the patient′s outcome. Although the PFO closure can be challenging in the clinical setting of hypoxemic respiratory failure and stroke following cardiac surgery, it can be a reasonable perioperative option.

  10. Pharmacotherapy of Acute Lung Injury and Acute Respiratory Distress Syndrome

    OpenAIRE

    Raghavendran, Krishnan; Pryhuber, Gloria S.; Chess, Patricia R.; Davidson, Bruce A.; Paul R. Knight; Notter, Robert H.

    2008-01-01

    Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Mortality from ALI/ARDS is substantial, and current therapy primarily emphasizes mechanical ventilation and judicial fluid management plus standard treatment of the initiating insult and any known underlying disease. Current pharmacotherapy for ALI/ARDS is not optimal, a...

  11. A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

    Directory of Open Access Journals (Sweden)

    Chang SC

    2016-05-01

    Full Text Available Suchi Chang,1 Jindong Shi,2 Cuiping Fu,1 Xu Wu,1 Shanqun Li1 1Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, People’s Republic of China Background: COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. Objective: We evaluated pressure-regulated volume control (PRVC ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Patients and methods: Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours. Results: Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2, and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2 levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both; after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05. Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05. The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48

  12. Acute respiratory failure induced by mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH2O.

    Science.gov (United States)

    Tsuno, K; Sakanashi, Y; Kishi, Y; Urata, K; Tanoue, T; Higashi, K; Yano, T; Terasaki, H; Morioka, T

    1988-09-01

    The effects of high pressure mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH(2)O were studied on the lungs of healthy newborn pigs (14-21 days after birth). Forty percent oxygen in nitrogen was used for ventilation to prevent oxygen intoxication. The control group (6 pigs) was ventilated for 48 hours at a peak inspiratory pressure less than 18 cmH(2)O and a PEEP of 3-5 cmH(2)O with a normal tidal volume, and a respiratory rate of 20 times/min. The control group showed few deleterious changes in the lungs for 48 hours. Eleven newborn pigs were ventilated at a peak inspiratory pressure of 40 cmH(2)O with a PEEP of 3-5 cmH(2)O and a respiratory rate of 20 times/min. To avoid respiratory alkalosis, a dead space was placed in the respiratory circuit, and normocarbia was maintained by adjusting dead space volume. In all cases in the latter group, severe pulmonary impairments, such as abnormal chest roentgenograms, hypoxemia, decreased total static lung compliance, high incidence of pneumothorax, congestive atelectasis, and increased lung weight were found within 48 hours of ventilation. When the pulmonary impairments became manifest, 6 of the 11 newborn pigs were switched to the conventional medical and ventilatory therapies for 3-6 days. However, all of them became ventilator dependent, and severe lung pathology was found at autopsy. These pulmonary insults by high pressure mechanical pulmonary ventilation could be occurring not infrequently in the respiratory management of patients with respiratory failure. PMID:15236077

  13. SMART phones and the acute respiratory patient.

    LENUS (Irish Health Repository)

    Gleeson, L

    2012-05-01

    Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2\\/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2\\/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.

  14. Respiratory muscle strength and muscle endurance are not affected by acute metabolic acidemia.

    NARCIS (Netherlands)

    Nizet, T.; Heijdra, Y.F.; Elshout, F.J.J. van den; Ven, M.J.T. van de; Bosch, F.H.; Mulder, P.H.M. de; Folgering, H.T.M.

    2009-01-01

    Respiratory muscle fatigue in asthma and chronic obstructive lung disease (COPD) contributes to respiratory failure with hypercapnia, and subsequent respiratory acidosis. Therapeutic induction of acute metabolic acidosis further increases the respiratory drive and, therefore, may diminish ventilator

  15. Early intervention of patients at risk for acute respiratory failure and prolonged mechanical ventilation with a checklist aimed at the prevention of organ failure: protocol for a pragmatic stepped-wedged cluster trial of PROOFCheck

    Science.gov (United States)

    Gong, M N; Schenk, L; Gajic, O; Mirhaji, P; Sloan, J; Dong, Y; Festic, E; Herasevich, V

    2016-01-01

    Introduction Acute respiratory failure (ARF) often presents and progresses outside of the intensive care unit. However, recognition and treatment of acute critical illness is often delayed with inconsistent adherence to evidence-based care known to decrease the duration of mechanical ventilation (MV) and complications of critical illness. The goal of this trial is to determine whether the implementation of an electronic medical record-based early alert for progressive respiratory failure coupled with a checklist to promote early compliance to best practice in respiratory failure can improve the outcomes of patients at risk for prolonged respiratory failure and death. Methods and analysis A pragmatic stepped-wedged cluster clinical trial involving 6 hospitals is planned. The study will include adult hospitalised patients identified as high risk for MV >48 hours or death because they were mechanically ventilated outside of the operating room or they were identified as high risk for ARF on the Accurate Prediction of PROlonged VEntilation (APPROVE) score. Patients with advanced directives limiting intubation will be excluded. The intervention will consist of (1) automated identification and notification of clinician of high-risk patients by APPROVE or by invasive MV and (2) checklist of evidence-based practices in ARF (Prevention of Organ Failure Checklist—PROOFCheck). APPROVE and PROOFCheck will be developed in the pretrial period. Primary outcome is hospital mortality. Secondary outcomes include length of stay, ventilator and organ failure-free days and 6-month and 12-month mortality. Predefined subgroup analysis of patients with limitation of aggressive care after study entry is planned. Generalised estimating equations will be used to compare patients in the intervention phase with the control phase, adjusting for clustering within hospitals and time. Ethics and dissemination The study was approved by the institutional review boards. Results will be published

  16. Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

    Directory of Open Access Journals (Sweden)

    Yalcinsoy M

    2016-05-01

    Full Text Available Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF. We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25 and group 2 (pH=7.26–7.30.Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female and group 2 included 171 patients (mean age: 67±11 years, 28.7% female. On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2 ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward.Conclusion: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. Keywords: noninvasive mechanical ventilation

  17. Hypoventilatory respiratory failure in generalised scleroderma

    OpenAIRE

    Iliffe, Gerald D; Pettigrew, Norman M

    1983-01-01

    A patient with generalised cutaneous and gastrointestinal scleroderma subsequently died from respiratory failure secondary to hyperventilation. At necropsy changes consistent with scleroderma of the diaphragm were found; these were thought to have contributed appreciably to the terminal respiratory failure.

  18. Rigid spine syndrome with respiratory failure.

    OpenAIRE

    Morita, H.; Kondo, K.; Hoshino, K; Maruyama, K; Yanagisawa, N

    1990-01-01

    The pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance. In both cases, the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and %VC was less than 30%. Remission from respiratory failure has been obtained by the use of a ventilator during the night. The cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme...

  19. Efficacy of non-invasive positive pressure ventilation in the treatment of respiratory failure in patients with COPD at the acute exacerbation stage

    Institute of Scientific and Technical Information of China (English)

    De-Peng Li

    2016-01-01

    Objective:To observe the efficacy of non-invasive positive pressure ventilation (NIPPV) in the treatment of respiratory failure in patients with COPD at the acute exacerbation stage. Methods:A total of 38 COPD patients at the acute exacerbation stage with respiratory failure who were admitted in our hospital from January, 2012 to January, 2013 with complete medical materials were included in the study and divided into the observation group and the control group according to different treatment methods. On admission, the patients in the two groups were given oxygen inhalation, positive infection control, and drugs that could improve the respiratory function. On the basis, the patients in the observation group were given additional NIPPV. The improvement of blood gas indicators 4, 24, 72 d after admission, and 5, 30 d after discharge in the two groups was compared. The hospitalization time and the number of second hospitalization within 3 months in the two groups were compared.Results: In the observation group, pH value after 4 h ventilation was significantly elevated, and maintained at a stable state after 24 h ventilation, while in the control group, the change of pH value was not statistically significant, and after 5 d treatment, pH value was yet low. In the observation group, PaCO2 was significantly reduced in a short ventilation time, while in the control group, the descending range was small. The comparison of pH and PaCO2 4 h, 24 h, 72 h, and 5 d after treatment between the two groups was statistically significant, but PaCO2 in the two groups could not reduce to the normal level. PaO2 after treatment in the two groups was improved, but the improved degree in the observation degree was significantly superior to that in the control group. The comparison of blood gas indicators 30 d after discharge between the two groups was not statistically significant. The hospitalization time in the observation group was shortened, and the number of second hospitalization

  20. Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order

    Directory of Open Access Journals (Sweden)

    Paolo Scarpazza

    2008-10-01

    Full Text Available Paolo Scarpazza1, Cristoforo Incorvaia2, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Silvia Vanni1, Serena Bencini1, Chiara Pravettoni2, Giuseppe Di Cara3, Mona-Rita Yacoub4, Gian Galeazzo Riario-Sforza2, Enrico Guffanti5, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3University Department of Medical and Surgical Specialties and Public Health, Perugia, Italy; 4Allergy and Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy; 5Pulmonary rehabilitation, INRCA, Casatenovo, ItalyAbstract: Noninvasive mechanical ventilation (NIMV is effective in the treatment of patients with acute respiratory failure (ARF. It proved to reduce the need of endotracheal intubation (ETI, the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER for ARF, and with a do-not-intubate (DNI status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 ± 4.8 years, range 79–91 years referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived. Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response

  1. THE SUCCESSFUL TREATMENT OF A PERIPHERAL VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR SEVERE ACUTE RESPIRATORY FAILURE IN THE EARLY PERIOD AFTER ADULT LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2014-01-01

    Full Text Available Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg with acute respiratory distress syndrome (ARDS in the early period after liver transplantation against satisfactory liver graft function. Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml were also. Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function. Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

  2. Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Yadam, Suman; Bihler, Eric; Balaan, Marvin

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a serious inflammatory disorder with high mortality. Its main pathologic mechanism seems to result from increased alveolar permeability. Its definition has also changed since first being described according to the Berlin definition, which now classifies ARDS on a severity scale based on PaO2 (partial pressure of oxygen, arterial)/FIO2 (fraction of inspired oxygen) ratio. The cornerstone of therapy was found to be a low tidal volume strategy featuring volumes of 6 to 8 mL per kg of ideal body weight that has been shown to have decreased mortality as proven by the ARDSnet trials. There are other areas of treatment right now that include extracorporeal membrane oxygenation, as well for severe refractory hypoxemia. Other methods that include prone positioning for ventilation have also shown improvements in oxygenation. Positive end-expiratory pressure with lung recruitment maneuvers has also been found to be helpful. Other therapies that include vasodilators and neuromuscular agents are still being explored and need further studies to define their role in ARDS. PMID:26919679

  3. Pathophysiology and Classification of Respiratory Failure.

    Science.gov (United States)

    Lamba, Tejpreet Singh; Sharara, Rihab Saeed; Singh, Anil C; Balaan, Marvin

    2016-01-01

    Respiratory failure is a condition in which the respiratory system fails in one or both of its gas exchange functions. It is a major cause of morbidity and mortality in patients admitted to intensive care units. It is a result of either lung failure, resulting in hypoxemia, or pump failure, resulting in alveolar hypoventilation and hypercapnia. This article covers the basic lung anatomy, pathophysiology, and classification of respiratory failure. PMID:26919670

  4. Acute liver failure

    DEFF Research Database (Denmark)

    Bernal, William; Lee, William M; Wendon, Julia;

    2015-01-01

    Over the last three decades acute liver failure (ALF) has been transformed from a rare and poorly understood condition with a near universally fatal outcome, to one with a well characterized phenotype and disease course. Complex critical care protocols are now applied and emergency liver...

  5. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  6. Acute dengue myositis with rhabdomyolysis and acute renal failure

    Directory of Open Access Journals (Sweden)

    Acharya Sourya

    2010-01-01

    Full Text Available Dengue is an acute mosquito-borne infection caused by dengue viruses from the genus flavivirus. Neurologic complications have been attributed chiefly to metabolic alterations and to focal and sometimes massive intracranial haemorrhages, but anecdotal cases and limited case series have indicated the possibility of viral CNS and skeletal muscle invasion causing encephalitis and myositis. We present a case of a 40-year-old male who presented with severe dengue myositis resulting in quadriparesis, respiratory failure and acute renal failure with red urine. His elevated serum creatine kinase (CK, serum and urine myoglobin levels justified rhabdomyolysis as the cause of acute renal failure. A muscle biopsy revealed inflammatory myositis. He required ventilator support for respiratory failure and was treated conservatively. This case highlights the severe and persistent muscle involvement in dengue which is a rarity.

  7. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

    Directory of Open Access Journals (Sweden)

    Banga Amit

    2004-11-01

    Full Text Available Abstract Background Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD commonly require hospitalization and admission to intensive care unit (ICU. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. Methods Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. Results Invasive ventilation was required in 69 patients (84.1%. Fifty-two patients survived to hospital discharge (63.4%. APACHE II score at the time of admission to ICU {odds ratio (95 % CI: 1.32 (1.138–1.532; p Conclusion APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

  8. Central Neurogenic Respiratory Failure: A Challenging Diagnosis

    OpenAIRE

    Carvalho, Flávio A.; Bernardino, Tenille; Maciel, Ricardo O.H.; Felizola, Sérgio F.A.; Costa, Eduardo L.V.; Silva, Gisele S

    2011-01-01

    Background Central nervous system lesions are rare causes of respiratory failure. Simple observation of the breathing pattern can help localize the lesion, but the examiner needs to be aware of potential pitfalls such as metabolic or pulmonary alterations. Methods We describe 3 cases in which central neurogenic respiratory failure occurred simultaneously with other alterations or in an unusual presentation. Results All patients were diagnosed with central neurogenic respiratory failure and tr...

  9. Surfactant therapy for acute respiratory distress in infants

    OpenAIRE

    Corrado Moretti; Barbàra, Caterina S; Rosanna Grossi; Stefano Luciani; Fabio Midulla; Paola Papoff

    2014-01-01

    Acute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Dat...

  10. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

    OpenAIRE

    Inderpaul Singh Sehgal; Sahajal Dhooria; Digambar Behera; Ritesh Agarwal

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure m...

  11. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

    Directory of Open Access Journals (Sweden)

    Inderpaul Singh Sehgal

    2016-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp and extrapulmonary ARDS (ARDSexp with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy.

  12. ACUTE RESPIRATORY DISTRESS SYNDROME IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Madhumala

    2015-04-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure. ARDS occurs in pregnancy and may have unique causes. Overall mortality for both the mother and the fetus is high and significant morbidity can persist even after initial recovery. ARDS is associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or non - obstetr ic causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. Here is a 24 years old female admitted with 7months of amenorrhea, who presented with respiratory failure, she was intubated and ventilated for 47da ys. She recovered, and a live baby was delivered. She was discharged after 73days.

  13. Severe acute respiratory failure managed with continuous positive airway pressure and partial extracorporeal carbon dioxide removal by an artificial membrane lung. A controlled, randomized animal study.

    Science.gov (United States)

    Borelli, M; Kolobow, T; Spatola, R; Prato, P; Tsuno, K

    1988-12-01

    Using an animal model of acute respiratory failure (ARF), we evaluated two treatments: conventional mechanical pulmonary ventilation (MV) and continuous positive airway pressure (CPAP) with extracorporeal removal of CO2 by an artificial membrane lung. We developed a model of "mild" ARF and a model of "severe" ARF after ventilating healthy sheep at a peak inspiratory pressure of 50 cm H2O for various lengths of time. Sheep from either injury models were randomly assigned to one of the above treatment groups. All 16 sheep from the model with "severe" ARF died, with progressive deterioration in pulmonary function and multiorgan failure irrespective of the treatment. Of 11 sheep from the model with "mild" ARF treated by MV, only three survived, whereas all 11 sheep from the model with "mild" ARF treated with CPAP and extracorporeal removal of CO2 responded well, and nine sheep ultimately recovered. We conclude that CPAP with extracorporeal removal of CO2 provided a better environment for the recovery in our model with "mild" ARF than the conventional arrangement centered on MV alone. Our studies also suggest that lung injury can progress (i.e., model with "severe" ARF) to where neither of the two treatments can succeed. PMID:3144216

  14. Abnormal lung lymphatics and respiratory failure.

    OpenAIRE

    Moss, S F; Currie, D C; Sheffield, E A; M. Baxter; Corrin, B.; Evans, T. W.

    1989-01-01

    A 65 year old man presented with respiratory failure, pleural effusions, fine reticulonodular shadowing on a chest radiograph, and severe impairment of carbon monoxide diffusing capacity (transfer factor). Open lung biopsy showed only dilated pleural and subpleural lymphatic channels. Hypoplastic deep pulmonary lymphatics may have led to respiratory failure.

  15. Sexual intercourse and respiratory failure.

    Science.gov (United States)

    Polverino, Francesca; Santoriello, Carlo; De Sio, Vittorio; Andò, Filippo; de Blasio, Francesco; Polverino, Mario

    2008-06-01

    Sexual activity is an important component of quality of life in patients suffering from chronic illnesses. To our knowledge, the effects of sexual activity on gas exchange in patients with respiratory failure have not been yet studied. To such an extent, we evaluated the oxygen saturation (SaO2), by a pulse oxymeter, during three different sexual performances in a 63-yr-old patient affected by chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). The sexual performances were divided in four periods: basal, sex, 10 min after sex and relax. In each performance during sex, we observed a significant increase of either heart rate (HR) or SaO2, with the highest value of the latter achieved within the 10 min of the post-sex period. SaO2 returned to basal value (pre-sex) by the end of the relax period. We conclude that the observed improvement of SaO2 during sexual activity might be due to a better ventilation/perfusion ratio (V/Q) obtained for either an increase of ventilation (hyperventilation) and perfusion (tachycardia), without significant muscle expenditure. PMID:18394872

  16. Heated, Humidified High-Flow Nasal Cannulae as a Form of Noninvasive Respiratory Support for Preterm Infants and Children with Acute Respiratory Failure.

    Science.gov (United States)

    Mardegan, Veronica; Priante, Elena; Lolli, Elisabetta; Lago, Paola; Baraldi, Eugenio

    2016-09-01

    Heated, humidified high-flow delivered by nasal cannulae (HHHFNC) is increasingly used for noninvasive respiratory support in preterm infants and critically ill children due to its perceived effectiveness and ease of use. Evidence from randomized controlled trials suggests that HHHFNC and continuous positive airway pressure (CPAP) are equally effective as postextubation support in preterm infants. HHHFNC is also used for weaning preterm infants from CPAP. Data on HHHFNC used as the primary support for treating respiratory distress syndrome are conflicting. HHHFNC use in preterm infants is associated with reduced nasal trauma. Inability to measure the pressure generated by HHHFNC systems is a concern because overexpansion can lead to an air leak and lung injury. Great caution is warranted when HHHFNC is used in extremely low-birth-weight infants (who were rarely included in these randomized controlled trials) because a recent retrospective study found its use is associated with a higher likelihood of bronchopulmonary dysplasia or death in this population. HHHFNC has also become popular in pediatric intensive care units and pediatric wards as a method for delivering oxygen and noninvasive respiratory support. Most published studies were conducted on infants and young children with bronchiolitis. The results of a few observational studies and two randomized trials suggest that HHHFNC therapy is effective in the treatment of bronchiolitis. This review discusses the proposed mechanisms of action behind HHHFNC, the results of observational studies, and the evidence emerging from clinical trials on the use of HHHFNC in preterm infants and children critically ill with bronchiolitis. PMID:27603535

  17. [Acute respiratory failure (ARDS) in a young child after drowning accident: therapy with exogenous surfactant and high frequency oscillatory ventilation].

    Science.gov (United States)

    Marx, M; Golej, J; Fürst, G; Hermon, M; Trittenwein, G

    1995-01-01

    The adult respiratory distress syndrome (ARDS) in children has a very poor prognosis with a mortality risk of between 55 and 85%, in spite of improvements due to the introduction of positive endexpiratory pressure ventilation. We describe the clinical course of a not yet 3 year-old boy with severe ARDS following near-drowing. Treatment with exogenous surfactant and high frequency oscillatory ventilation, a well-established procedure in neonatology, was responsible for the favorable outcome. The high cost of surfactant therapy, however, is the main limiting factor for this kind of treatment in children beyond the neonatal period, but it may be the last therapeutic resort in the management of severe ARDS.

  18. An evaluation of the role of noninvasive positive pressure ventilation in the management of acute respiratory failure in a developing country

    Directory of Open Access Journals (Sweden)

    George Ige

    2007-09-01

    Full Text Available Objective: Noninvasive positive pressure ventilation (NIPPV has been shown to decrease the need for invasive mechanical ventilation (MV in patients presenting with acute respiratory failure (ARF. We conducted a prospective study to assess if NIPPV use, in a developing country, was associated with clinical and physiological improvements. Design: Prospective observational study. Materials and Methods: Forty patients admitted to a medical intensive care unit during a 2-year period who fulfilled criteria for inclusion formed the study cohort to receive NIPPV. Findings: Baseline (mean ± SD pH, PaCO 2 and PaO 2 were 7.25 ± 0.08, 76.6 ± 20.9 and 79.18 ± 40.56 mmHg respectively. The primary indication for NIPPV was hypercapnic respiratory failure (n = 36, 90%. The success rate with NIPPV was 85%, with 34 of 40 patients weaned successfully. Significant improvements were observed at 1 hour following institution of NIPPV in pH (7.31 ± 0.09, P < 0.001 and PaCO 2 (65 ± 17.9, P < 0.001. These improvements continued up to the time of weaning (pH 7.38 ± 0.08, PaCO 2 54.7 ± 20 and maintained (within 12 h postweaning from the ventilator (pH 7.39 ± 0.08, PaCO 2 51.9 ± 12.4. No significant change in the PaO 2 was observed during NIPPV; PaO 2 after 1 h, prior to weaning and after weaning was 90.53 ± 42.85, 84.80 ± 33.76, 78.71 ± 43.81 respectively. Conclusion: This study has demonstrated benefits of NIPPV in avoiding the need for invasive MV in patients presenting with ARF of diverse etiology, with results comparable to developed nations. Increased use of NIPPV in ARF is likely to impact favorably in nations with limited resources.

  19. [Nitrogen oxide (nitrogen monoxide) administered via respirator. A new therapeutic alternative in acute respiratory failure and shock lung].

    Science.gov (United States)

    Aardal, S; Flaatten, H

    1996-04-20

    Adult respiratory distress syndrome (ARDS) still has a high rate of mortality. It is usually necessary to treat these patients with a respirator using a high inspiratory fraction of oxygen. The condition is often associated with pulmonary hypertension and increased pulmonary vascular resistance. Nitric oxide (NO) has been shown to be a potent endogenous vasodilator. It is a gas and can thus be delivered to the lungs of intubated patients by means of a respirator. Because of its very short halflife, the effect of inhaled nitric oxide is limited to the pulmonary vasculature and it has no systemic effects. The local vasodilatation caused by nitric oxide leads to improved oxygenation, primarily because of reduced intrapulmonary shunting of blood. From April 1993 to July 1995 we treated 14 patients with severe ARDS with inhaled nitric oxide. All patients were critically ill, with a mean APACHE II score of 24.5. Oxygenation was increased in all patients after treatment with nitric oxide, but in spite of this eight patients (56%) died. There were no significant differences between survivors and non-survivors as regards age or severity of the disease.

  20. [Respiratory preparation before surgery in patients with chronic respiratory failure].

    Science.gov (United States)

    Delay, Jean-Marc; Jaber, Samir

    2012-03-01

    Scheduled and/or thoracic, abdominal surgeries increase the risk of respiratory postoperative complications. In patients with chronic respiratory failure, preoperative evaluation should be performed to evaluate respiratory function in aim to optimize perioperative management. Preoperative gas exchange abnormalities (hypoxemia or hypercapnia) are associated with respiratory postoperative complications. Respiratory physiotherapy and prophylactic non-invasive ventilation should be integrated in a global rehabilitation management for cardiothoracic or abdominal surgery procedures, which are at high risk of postoperative respiratory dysfunction. Stopping tobacco consummation should be benefit, but decease risk of postoperative complications is relevant only after a period for 6 to 8 weeks of cessation. Bronchodilatator aerosol therapy (beta-agonists and atropinics) and inhaled corticotherapy allow a rapid preparation for 24 to 48 h. Systematic preoperative antibiotherapy should not be recommended. PMID:22004791

  1. Respiratory support for severe acute respiratory syndrome: integration of efficacy and safety

    Institute of Scientific and Technical Information of China (English)

    WANG Chen; CAO Zhi-xin

    2005-01-01

    @@ Severe acute respiratory syndrome (SARS) is an acute respiratory illness caused by infection with the SARS virus. The most obvious clinical characteristic of SARS is rapidly progressive pneumonia, and about 20% patients need intensive care due to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).1-3 In the absence of effective drugs for SARS, supportive care, especially respiratory support techniques (RSTs), is of primary importance. On the other hand, offering RSTs to SARS patients may carry a high-risk of infection to healthcare workers because of the high infectivity of SARS. Therefore, the strategy of RSTs for SARS should be the integration of efficacy and safety. In this issue of the Chinese Medical Journal, an article from Hong Kong has retrospectively compared both the safety and efficacy of noninvasive positive pressure ventilation (NIPPV) with that of invasive mechanical ventilation (IMV) in the treatment of respiratory failure in SARS.

  2. Respiratory Failure Associated with Ascariasis in a Patient with Immunodeficiency

    Directory of Open Access Journals (Sweden)

    Lanocha Aleksandra

    2016-01-01

    Full Text Available In industrialized countries, risk groups for parasitic diseases include travelers, recent immigrants, and patients with immunodeficiency following chemotherapy and radiotherapy and AIDS. A 66-year-old Polish male was admitted in December 2012 to the Department of Haematology in a fairly good general condition. On the basis of cytological, cytochemical, immunophenotypic, and cytogenetic analysis of bone marrow, the patient was diagnosed with acute myeloblastic leukemia. On the 7th day of hospitalization in the Department of Haematology, patient was moved to the Intensive Care Unit (ICU due to acute respiratory and circulatory failure. In March 2013, 3 months after the onset of respiratory failures, a mature form of Ascaris spp. appeared in the patient’s mouth. This report highlights the importance of considering an Ascaris infection in patients with low immunity presenting no eosinophilia but pulmonary failure in the central countries of Europe.

  3. Respiratory Failure Associated with Ascariasis in a Patient with Immunodeficiency.

    Science.gov (United States)

    Aleksandra, Lanocha; Barbara, Zdziarska; Natalia, Lanocha-Arendarczyk; Danuta, Kosik-Bogacka; Renata, Guzicka-Kazimierczak; Ewa, Marzec-Lewenstein

    2016-01-01

    In industrialized countries, risk groups for parasitic diseases include travelers, recent immigrants, and patients with immunodeficiency following chemotherapy and radiotherapy and AIDS. A 66-year-old Polish male was admitted in December 2012 to the Department of Haematology in a fairly good general condition. On the basis of cytological, cytochemical, immunophenotypic, and cytogenetic analysis of bone marrow, the patient was diagnosed with acute myeloblastic leukemia. On the 7th day of hospitalization in the Department of Haematology, patient was moved to the Intensive Care Unit (ICU) due to acute respiratory and circulatory failure. In March 2013, 3 months after the onset of respiratory failures, a mature form of Ascaris spp. appeared in the patient's mouth. This report highlights the importance of considering an Ascaris infection in patients with low immunity presenting no eosinophilia but pulmonary failure in the central countries of Europe. PMID:27313919

  4. Predictive Factors of Respiratory Failure in Children with Guillain-Barre Syndrome

    OpenAIRE

    Nemat Bilan; Mohammad Barzegar; Parinaz Habibi

    2015-01-01

    Introduction:Guillain-Barre Syndrome(GBS) is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients.moreover,60% of those who are intubated develop major complications including pnemonia,sepsis,GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. the aim of this study was to determine clinical predictors of respiratory failure to a...

  5. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute hypoxaemic respiratory failure (AHRF), defined as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), are critical conditions. AHRF results from a number of systemic conditions and is associated with high mortality and morbidity in all ages. Inhaled nitric oxide (INO) has...

  6. Present state of radiological diagnostics in acute pulmonary failure

    International Nuclear Information System (INIS)

    Acute pulmonary failure is a very serious cause of respiratory failure. Radiological diagnosis occupies a central position in intensive-care monitoring. X-ray film of the thorax is performed not only for detecting any complications, but mainly for noninvasive and semiquantitative determination of the extravascular pulmonary fluid and hence of the fluid balance. Other methods such as MR or methods of nuclear medicine have not acquired substantial importance in respect of diagnosis and monitoring acute pulmonary failure. (orig./GDG)

  7. Present state of radiological diagnostics in acute pulmonary failure

    Energy Technology Data Exchange (ETDEWEB)

    Jaspers, C.; Hoetzinger, H.; Toedt, H.C.; Beyer, H.K.

    1989-03-01

    Acute pulmonary failure is a very serious cause of respiratory failure. Radiological diagnosis occupies a central position in intensive-care monitoring. X-ray film of the thorax is performed not only for detecting any complications, but mainly for noninvasive and semiquantitative determination of the extravascular pulmonary fluid and hence of the fluid balance. Other methods such as MR or methods of nuclear medicine have not acquired substantial importance in respect of diagnosis and monitoring acute pulmonary failure. (orig./GDG).

  8. Decongestion in acute heart failure

    NARCIS (Netherlands)

    Mentz, Robert J.; Kjeldsen, Keld; Rossi, Gian Paolo; Voors, Adriaan A.; Cleland, John G. F.; Anker, Stefan D.; Gheorghiade, Mihai; Fiuzat, Mona; Rossignol, Patrick; Zannad, Faiez; Pitt, Bertram; O'Connor, Christopher; Felker, G. Michael

    2014-01-01

    Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants

  9. Polyhydramnios and acute renal failure

    OpenAIRE

    Hamilton, D. V.; Kelly, Moira B.; Pryor, J. S.

    1980-01-01

    Acute renal failure secondary to ureteric obstruction is described in a primigravida with twin gestation and polyhydramnios. Relief of the obstruction occurred on drainage of the liquor and return to normal renal function following delivery.

  10. 急性有机磷农药中毒致呼吸衰竭的影响因素分析%Study on correlated clinical factors of respiratory failure induced by acute organophosphorus pesticide poisoning

    Institute of Scientific and Technical Information of China (English)

    陶贤洲; 王佐

    2014-01-01

    目的:分析急性有机磷农药中毒( AOPP)致呼吸衰竭的相关临床因素,为制订有效的预防及干预措施提供科学依据。方法回顾分析94例重性AOPP患者临床资料,根据血气分析结果将患者分为呼吸衰竭组(41例)和非呼吸衰竭组(53例),观察患者的APACHEⅡ评分、胆碱酯酶、血糖、血清淀粉酶、肝肾功能及心肌酶谱等指标。结果胆碱酯酶水平呼吸衰竭组患者低于非呼吸衰竭组患者(P<0.05);APACHEⅡ评分、血清淀粉酶、肝肾功能及心肌酶谱等,呼吸衰竭组患者高于非呼吸衰竭组患者(P<0.05);Logistic回归分析显示APACHEⅡ评分、胆碱酯酶及血清淀粉酶与呼吸衰竭相关。结论 APACHEⅡ评分、胆碱酯酶及血清淀粉酶水平可作为AOPP引起呼吸衰竭的预测指标。%Objective To investigate the correlated clinical factors of respiratory failure induced by acute organophosphorus pesticide poisoning ( AOPP) ,and to provide relevant data for prevention and intervention of respiratory failure .Methods This retrospective study in-cluded 94 patients with severe AOPP ,and all patients were divided into respiratory failure group ( n=41 ) and non-respiratory failure group (n=53) according to arterial blood gas analysis .We observed APACHEⅡscores,cholinesterase,blood glucose,serum amylase,hepatic func-tion,renal function and myocardial enzyme between the two groups .Results Cholinesterase level in the respiratory failure group was lower than that in non-respiratory failure group (P<0.05);APACHEⅡ scores,serum amylase,hepatic function,renal function and myocardial enzyme in the respiratory failure group were higher than those of non-respiratory failure group (P<0.05).Spearman correlation analysis and Logistic regression analyses showed APACHEⅡscores,cholinesterase and serum amylase were related to respiratory failure ,and they had sig-nificant predictive effects on respiratory failure

  11. Feasibility study on full closed-loop control ventilation (IntelliVent-ASV™) in ICU patients with acute respiratory failure: a prospective observational comparative study

    OpenAIRE

    Arnal, Jean-Michel; Garnero, Aude; Novonti, Dominik; Demory, Didier; Ducros, Laurent; Berric, Audrey; Donati, Stéphane Yannis; Corno, Gaëlle; Jaber, Samir; Durand-Gasselin, Jacques

    2013-01-01

    Introduction IntelliVent-ASV™ is a full closed-loop ventilation mode that automatically adjusts ventilation and oxygenation parameters in both passive and active patients. This feasibility study compared oxygenation and ventilation settings automatically selected by IntelliVent-ASV™ among three predefined lung conditions (normal lung, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD)) in active and passive patients. The feasibility of IntelliVent-ASV™...

  12. Amyloid myopathy presenting with respiratory failure.

    OpenAIRE

    Ashe, J.; Borel, C O; Hart, G.; Humphrey, R L; Derrick, D A; Kuncl, R W

    1992-01-01

    Amyloidosis is a rare cause of myopathy. Its prominent or presenting feature may be respiratory failure. Physiological measurement of transdiaphragmatic pressure and biopsy specimens of muscle show the pathological mechanism to be diaphragm weakness due to amyloid infiltration of the diaphragm rather than parenchymal lung involvement. Thus amyloid myopathy even without the typical macroglossia and muscle pseudohypertrophy should be considered as one of the neurological causes of respiratory f...

  13. Respiratory failure, coma and cutaneous lesions due to disseminated strongyloidiasis

    Directory of Open Access Journals (Sweden)

    Mani R

    2003-01-01

    Full Text Available Objective: To enhance the clinician's awareness of Strongyloidiasis as a cause of critical illness. Design: A case report. Setting: A 600- bed, tertiary care hospital in New Delhi, India. Patient: A 53 years old diabetic male, presenting with acute respiratory failure, having received treatment for 2 weeks for acute bronchitis that included corticosteroids. He had a history of receiving several courses of treatment for Strongyloides stercoralis larvae detected in his stools. During this admission, he went on to develop neurological signs, cutaneous lesions and acute respiratory distress syndrome (ARDS. Negative stool examinations led to the diagnosis being delayed until the 7th day, when the larvae were demonstrated in the skin lesions and tracheal aspirate. Conclusion: Awareness of the varied presentations of Strongyloidiasis and a diligent search for the larvae at various sites are crucial for early diagnosis.

  14. The acute respiratory distress syndrome: from mechanism to translation

    OpenAIRE

    Han, SeungHye; Mallampalli, Rama K.

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a form of severe hypoxemic respiratory failure characterized by inflammatory injury to the alveolar capillary barrier with extravasation of protein-rich edema fluid into the airspace. Although many modalities have been investigated to treat ARDS for the past several decades, supportive therapies still remain the mainstay of treatment. Here, we briefly review the definition, epidemiology and pathophysiology of ARDS. Next, we present emerging as...

  15. Explore the related risk factors of acute respiratory failure after resection of esophageal carcinoma%食管癌术后急性呼吸衰竭的相关危险因素

    Institute of Scientific and Technical Information of China (English)

    白山

    2014-01-01

    Objective:To investigate the related risk factors of acute respiratory failure after resection of esophageal carcinoma,in order to improve the quality of life of patients after resection of esophageal carcinoma.Methods:108 cases with esophageal carcinoma were selected from February 2012 to December 2013.Analyse their clinical data retrospectively.All the patients were divided into two groups according to whether the occurrence of acute respiratory failure.48 patients in the acute respiratory failure group(ARF group) and 60 patients in the control group.Comparison of patient age,operation time,smoking history(>500/year) and other clinical information in two groups.Using univariate analysis and logistic multivariate analysis,to analyses the risk factors of acute respiratory failure after the operation of esophageal carcinoma.Results:In 108 patients with esophageal cancer,there were 48 patients occurred acute respiratory failure,and the incidence was 44.44% .Multivariate logistic analysis showed that the risk factors of acute respiratory failure after the operation of esophageal carcinoma including advanced age,smoking history, preoperative diabetes,operation time,postoperative combined thoracic complications,plasma albumin concentration decreased, second thoracotomy after operation and postoperative pain.Conclusion:Doctors and nurses should provide more targeted treatment and nursing care for patients with these risk factors,in order to improve the prognosis of patients.%目的:探讨食管癌术后急性呼吸衰竭的相关危险因素,改善食管癌患者的术后生存质量。方法:回顾性分析2012年2月-2013年12月收治食管癌患者108例的临床资料,依据术后是否发生急性呼吸衰竭进行分组,其中急性呼吸衰竭组(ARF)48例和对照组60例,比较两组患者的年龄、手术时间、吸烟史(>500支/年)等临床资料,采用单因素分析和logistic多因素分析食管癌患者术后急性呼吸衰竭的相

  16. 急性有机磷农药中毒合并呼吸衰竭69例临床分析%Analysis of Acute Organic Phosphorus Pesticide Poisoning Complicated with Respiratory Failure of 69 Cases

    Institute of Scientific and Technical Information of China (English)

    毛崇涛

    2012-01-01

      目的探讨并分析急性有机磷农药中毒合并呼吸衰竭的原因,为临床抢救急性有机磷农药中毒提供帮助。方法回顾分析69例重度有机磷农药中毒合并呼吸衰竭病例。结果抢救有机磷农药中毒的首要措施是恢复有效通气,改善缺氧,必要时行气管插管,这样才能提高抢救的成功率。结论正确分析呼吸衰竭,及时的机械通气支持可以有效提高有机磷农药中毒抢救成功率。%  Objective To study and analysis the acute organophosphorus pesticide poisoning combination of respiratory failure reasons, for clinical rescuing patients with acute organophosphorus pesticide poisoning offer help. Methods Retrospective analysis of 69 cases of severe organophosphorus pesticide poisoning combination of respiratory failure cases. Results The rescue organophosphorus pesticide poisoning first step was to restore effective ventilation, improve the lack of oxygen,make necessary endotracheal intubation,in order to improve the success rate of rescue. Conclusion Correct analysis of respiratory failure, timely mechanical ventilation support can effectively improve the organophosphorus pesticide poisoning rescue success rate.

  17. Acute otitis media and respiratory virus infections.

    Science.gov (United States)

    Ruuskanen, O; Arola, M; Putto-Laurila, A; Mertsola, J; Meurman, O; Viljanen, M K; Halonen, P

    1989-02-01

    We studied the association of acute otitis media with different respiratory virus infections in a pediatric department on the basis of epidemics between 1980 and 1985. Altogether 4524 cases of acute otitis media were diagnosed. The diagnosis was confirmed by tympanocentesis in 3332 ears. Respiratory virus infection was diagnosed during the same period in 989 patients by detecting viral antigen in nasopharyngeal mucus. There was a significant correlation between acute otitis media and respiratory virus epidemics, especially respiratory syncytial virus epidemics. There was no significant correlation between outbreaks of other respiratory viruses and acute otitis media. Acute otitis media was diagnosed in 57% of respiratory syncytial virus, 35% of influenza A virus, 33% of parainfluenza type 3 virus, 30% of adenovirus, 28% of parainfluenza type 1 virus, 18% of influenza B virus and 10% of parainfluenza type 2 virus infections. These observations show a clear association of respiratory virus infections with acute otitis media. In this study on hospitalized children Haemophilus influenzae strains were the most common bacteriologic pathogens in middle ear fluid, occurring in 19% of cases. Streptococcus pneumoniae was present in 16% and Branhamella catarrhalis in 7% of cases. There was no association between specific viruses and bacteria observed in this study.

  18. Myeshenia Gravis Presented with Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Vandana Dhangar, Snehal B Patel

    2014-01-01

    Full Text Available A case of 41 year old female known case of depression since 10 years, developed dry cough, low grade fever, breathlessness and drowsiness since 4 days was admitted in ICU and initially diagnosed as type 2 respiratory failure due to pneumonia but on further investigating for altered sensorium patient was found to be NCV positive and was diagnosed as seronegative myasthenia gravis.

  19. Acute respiratory distress syndrome associated with tumor lysis syndrome in a child with acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Alessandra Macaluso

    2015-03-01

    Full Text Available Tumor lysis syndrome is a serious and dangerous complication usually associated with antiblastic treatment in some malignancies characterized by high cell turn-over. Mild or severe electrolyte abnormalities including high serum levels of uric acid, potassium, phosphorus, creatinine, bun and reduction of calcium can be responsible for multi-organ failure, involving mostly kidneys, heart and central nervous system. Renal damage can be followed by acute renal failure, weight gain, progressive liver impairment, overproduction of cytokines, and subsequent maintenance of multi-organ damage. Life-threatening acute respiratory failure associated with tumor lysis syndrome is rare. We describe a child with T-cell acute lymphoblastic leukemia, who developed an unusually dramatic tumor lysis syndrome, after administration of the first low doses of steroid, that was rapidly associated with severe acute respiratory distress syndrome. Subsequent clinical course and treatment modalities that resulted in the gradual and full recovery of the child are also described.

  20. Acute respiratory distress syndrome associated with tumor lysis syndrome in a child with acute lymphoblastic leukemia.

    Science.gov (United States)

    Macaluso, Alessandra; Genova, Selene; Maringhini, Silvio; Coffaro, Giancarlo; Ziino, Ottavio; D'Angelo, Paolo

    2015-02-24

    Tumor lysis syndrome is a serious and dangerous complication usually associated with antiblastic treatment in some malignancies characterized by high cell turn-over. Mild or severe electrolyte abnormalities including high serum levels of uric acid, potassium, phosphorus, creatinine, bun and reduction of calcium can be responsible for multi-organ failure, involving mostly kidneys, heart and central nervous system. Renal damage can be followed by acute renal failure, weight gain, progressive liver impairment, overproduction of cytokines, and subsequent maintenance of multi-organ damage. Life-threatening acute respiratory failure associated with tumor lysis syndrome is rare. We describe a child with T-cell acute lymphoblastic leukemia, who developed an unusually dramatic tumor lysis syndrome, after administration of the first low doses of steroid, that was rapidly associated with severe acute respiratory distress syndrome. Subsequent clinical course and treatment modalities that resulted in the gradual and full recovery of the child are also described. PMID:25918625

  1. Pathobiology of acute respiratory distress syndrome.

    Science.gov (United States)

    Sapru, Anil; Flori, Heidi; Quasney, Michael W; Dahmer, Mary K

    2015-06-01

    The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance of the air-filled, fluid-free status of the alveoli essential for facilitating gas exchange, maintaining alveolar stability, and defending the lung against inhaled pathogens. The hallmark of pathophysiology in acute respiratory distress syndrome is the loss of the alveolar capillary permeability barrier and the presence of protein-rich edema fluid in the alveoli. This alteration in permeability and accumulation of fluid in the alveoli accompanies damage to the lung epithelium and vascular endothelium along with dysregulated inflammation and inappropriate activity of leukocytes and platelets. In addition, there is uncontrolled activation of coagulation along with suppression of fibrinolysis and loss of surfactant. These pathophysiological changes result in the clinical manifestations of acute respiratory distress syndrome, which include hypoxemia, radiographic opacities, decreased functional residual capacity, increased physiologic deadspace, and decreased lung compliance. Resolution of acute respiratory distress syndrome involves the migration of cells to the site of injury and re-establishment of the epithelium and endothelium with or without the development of fibrosis. Most of the data related to acute respiratory distress syndrome, however, originate from studies in adults or in mature animals with very few studies performed in children or juvenile animals. The lack of studies in children is particularly problematic because the lungs and immune system are still developing during childhood and consequently the pathophysiology of pediatric acute respiratory distress syndrome may differ in significant ways from that seen in acute respiratory distress syndrome in adults. This article describes what is known of the pathophysiologic processes of pediatric acute respiratory distress syndrome as we know it today while also presenting the much

  2. Management of respiratory failure in severe neuroparalytic snake envenomation.

    Directory of Open Access Journals (Sweden)

    Agrawal P

    2001-01-01

    Full Text Available Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50% had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.

  3. Acute Respiratory Distress Syndrome: Pathophysiology and Therapeutic Options

    OpenAIRE

    Pierrakos, Charalampos; Karanikolas, Menelaos; Scolletta, Sabino; Karamouzos, Vasilios; Velissaris, Dimitrios

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a common entity in critical care. ARDS is associated with many diagnoses, including trauma and sepsis, can lead to multiple organ failure and has high mortality. The present article is a narrative review of the literature on ARDS, including ARDS pathophysiology and therapeutic options currently being evaluated or in use in clinical practice. The literature review covers relevant publications until January 2011. Recent developments in the therapeut...

  4. Acute respiratory distress syndrome--two decades later.

    OpenAIRE

    Cunningham, A. J.

    1991-01-01

    Twenty years have now elapsed since Ashbaugh and Petty first described the syndrome of acute respiratory failure associated with a wide spectrum of clinical conditions. During the past two decades, significant advances have emerged in our understanding of the clinical conditions associated with the syndrome and the pathophysiological changes affecting the alveolar-capillary membrane responsible for the characteristic non-cardiogenic pulmonary edema. Recent data have reaffirmed the notion that...

  5. A comparative study of supine lying, side lying and prone positioning on oxygen saturation, in mechanically ventilated patients, in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Prajakta S. Patil

    2015-07-01

    Methods: Total 33 subjects aged between 15-73 years, 21 male and 12 female patients were selected for study from ICU, Neurological trauma unit Pune. Inclusion criteria: All subjects with respiratory failure due to different pathologies like ARDS, Pulmonary edema, pneumonia, tuberculosis, collection of fluid in pleural cavity with underlying lung collapse. Exclusion criteria: Unstable cardiac conditions, unstable fractures, unstable hemodynamic, recently operated cardiac subjects. The patients were kept in supine position, lateral and prone and vitals like BP, HR, RR and oxygen saturation with help of pulse oximeter noted just before position. Thorough ET or tracheostomy suction was done. Before turning patient if any intercostal drain present was clamped. Results: Paired t-test was used. p values for prone and bilateral side lying positions was < 0.05 showing its significance for above mentioned 3-positions. p value for supine was not < 0.05 showing its non-significance. Conclusion: The study concluded that oxygen saturation improves in prone lying and side lying position as compared to supine lying. But this improvement is quiet significant in prone position as compared to side lying. [Int J Res Med Sci 2015; 3(7.000: 1627-1631

  6. Predictive Factors of Respiratory Failure in Children with Guillain-Barre Syndrome

    Directory of Open Access Journals (Sweden)

    Nemat Bilan

    2015-03-01

    Full Text Available Introduction:Guillain-Barre Syndrome(GBS is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients.moreover,60% of those who are intubated develop major complications including pnemonia,sepsis,GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. the aim of this study was to determine clinical predictors of respiratory failure to avoid respiratory distress and aspiration.Methods and materials: in a cross sectional and analytical study 140 patients with clinically diagnosis of Guillain-Barre Syndrome were enrolled in study,from october 2008 to october 2014. .demographic data,nerologic examination,cranial nerve and autonomic nervous system involvement, and respiratory failure were recorded prospectively.Results:15 out of 140 patients(10,7% developed respiratory failure and underwent mechanical ventilation.the male/female ratio in patients with respiratory failure and patients without respiratory involvement were (53%/(47% and (54%/(46% respectively(p-value:0.4.the mean age in these two groups were 2,7±1,9 and 5,5±3,2(p-value:0,003.cranial nerve involvement (7,9,10 was recorded in patients with respiratory failure and without respiratory failure54% and25% respectively (p-value:0,03.absent upper limb deep tendon reflexes in these two groups were 70% and 44% respectively.(p-value:0,03 and autonomic nervous system involvement 24% vs. 14%(p-value:0,3.conclusion : our study suggests that younger age , cranial nerve involvement and absent upper limb deep tendon reflexes are predictive factors of respiratory failure in patients with Guillain-Barre Syndrome(GBS.

  7. Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects

    OpenAIRE

    Carrasco Loza, R; Villamizar Rodríguez, G; Medel Fernández, N

    2015-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically...

  8. Insuficiência respiratória aguda após exposição a conservantes de alimentos Acute respiratory failure after occupational exposure to food preservatives

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Carmo Moreira

    2005-10-01

    Full Text Available Este é um relato de caso de exposição ocupacional a conservantes de alimentos que resultou em insuficiência respiratória aguda em três trabalhadores. A análise toxicológica demonstrou que a mistura dos conservantes, por eles realizada, produziu NO2 que inalado causou quadro compatível com edema pulmonar e insuficiência respiratória aguda. Na evolução, o dano pulmonar regrediu de forma completa nos três indivíduos. Faz-se uma breve revisão sobre dano pulmonar agudo relacionado a exposição ocupacional. Enfatiza-se a importância do treinamento dos trabalhadores que manipulam substâncias químicas bem com da utilização de equipamentos de proteção adequados.Herein, we report an instance of occupational exposure to food preservatives and resultant acute respiratory failure in three workers. The toxicological analysis revealed that mixing the particular food preservatives involved, a procedure that was performed by the three workers involved, produced NO2, the inhalation of which caused the pulmonary edema and respiratory failure. With time, the pulmonary damage was completely reversed in all three individuals. Accompanying this case report is a brief review of the literature regarding acute pulmonary injury resulting from occupational exposure to chemicals. We emphasize the importance of training, as well as of the use of protective gear, for workers who handle chemical substances.

  9. Application of Percutaneous Dilatational Tracheostomy in Patients with Acute Respiratory Failure in Intensive Care Units%经皮气管切开术在重症监护病房呼吸衰竭患者中的应用

    Institute of Scientific and Technical Information of China (English)

    王霞(综述); 张恒(审校)

    2015-01-01

    Patients with acute respiratory failure account for the majority of critically ill patients in the intensive care unit.Initial intubation with an endotracheal tube through the larynx resolves acute respiratory failure.However, if long-term ventilator dependence is required, the tracheostomy is necessary.With the development of medical technology with regards to patient safety,research has continued on more effective and simple methods.One such method is percutaneous tracheostomy,which can be performed directly at the patient′s bedside which greatly improves efficiency with lower complication and mortality rate .Here is to make a review of the development, steps, indications, contraindications, and complications of percutaneous dilatational tracheostomy,and comparison to the traditional tracheostomy.%重症患者中,急性呼吸衰竭者比例高,初期可经喉插管置入气管保证换气,如需要长期使用呼吸器,推荐行气管切开术。随着医疗技术的发展与进步,为了患者的安全及保证医疗效率,经皮气管切开术得到发展。研究表明,与传统外科气管切开术相比,经皮气管切开术的并发症及手术相关病死率低。经皮气管切开术可直接在患者床边进行,提高效率。现就经皮气管切开术的发展史,执行步骤、适应证、禁忌证、相关并发症及与传统气管切开术的比较等进行综述。

  10. [Acute cardiac failure in pheochromocytoma.

    DEFF Research Database (Denmark)

    Jønler, Morten; Munk, Kim

    2008-01-01

    Pheochromocytoma (P) is an endocrine catecholamine-secreting tumor. Classical symptoms like hypertension, attacks of sweating, palpitations, headache and palor are related to catecholamine discharge. We provide a case of P in a 71 year-old man presenting with acute cardiac failure, severe reduction...... in left ventricular function and elevated myocardial enzymes. No coronary stenoses were found. The myocardium regained nearly normal systolic function in one and a half month. A renal P was laparoscopicaly removed. We discuss the pathophysiology of catecholamine cardiomyopathy. Udgivelsesdato: 2008-Jun-2...

  11. Cuirass respirator treatment of chronic respiratory failure in scoliotic patients.

    Science.gov (United States)

    Wiers, P W; Le Coultre, R; Dallinga, O T; van Dijl, W; Meinesz, A F; Sluiter, H J

    1977-04-01

    The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.

  12. 呼吸护理对急性左心力衰竭患者预防院内呼吸道感染的影响分析%Analysis of the Effect of Respiratory Nursing in the Prevention of Nosocomial Respiratory Tract Infection in Patients With Acute Left Heart Failure

    Institute of Scientific and Technical Information of China (English)

    廉幼军

    2015-01-01

    Objective To investigate the treatment of acute left knee pads power failure were the effect of prevention of nosocomial respiratory infection effect. Methods 50 patients of acute heart failure were randomly divided into a control group and observation group in our hospital. The control group received routine care approach, the observation group respiratory care approach. Comparison of the two groups were respiratory infections and nursing job satisfaction situation. Results There were upper respiratory tract infection rate was 16.00%, the control group was 44.00%, higher than the observation group, and P<0.05, satisfaction of observation group was 96.00%, the control group was 76.00%, higher than the observation group, and P<0.05. Conclusion The use of left heart failure patients in acute respiratory care can effectively reduce nosocomial respiratory infections, help patients successfully for rehabilitation process.%目的:探讨呼吸护理对急性左心力衰竭患者预防院内呼吸道感染的效果。方法将我院接受急性左心力衰竭治疗的50例患者随机分成对照组和观察组。对照组采用常规护理方式,观察组采用呼吸护理方式。比较两组患者的呼吸道感染率以及对护理工作的满意度。结果观察组呼吸道感染率为16.00%,对照组为44.00%,观察组高于对照组,且P<0.05;观察组满意度为96.00%,对照组为76.00%,观察组高于对照组,且P<0.05。结论在急性左心力衰竭患者中运用呼吸护理能有效降低院内呼吸道感染,帮助患者康复。

  13. Shrinking the room for invasive mechanical ventilation in acute chronic hypercapnic respiratory failure: yes, but must be sure to have opened windows for noninvasive ventilation

    OpenAIRE

    Esquinas, Antonio M.

    2013-01-01

    Antonio M Esquinas Rodriguez,1 Rafaelle Scala,2 Nicolino Ambrosino31International Fellow AARC, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain; 2Respiratory Ward and Respiratory Intensive Care Unit, S, Donato Hospital, Arezzo, Italy; 3Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Department, University Hospital Pisa, Pisa, ItalyIn the last decade, the treatment and prognosis of chronic obstructive pulmonary disease (COPD) patients have been improved by noninvasi...

  14. Severe respiratory failure following ventriculopleural shunt

    Directory of Open Access Journals (Sweden)

    Shahzad Alam

    2015-01-01

    Full Text Available Cerebrospinal fluid (CSF diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura. Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS. Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6-year-old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life-threatening condition, which could easily be missed if proper history is not available.

  15. Cytokines and organ failure in acute pancreatitis

    DEFF Research Database (Denmark)

    Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller;

    2012-01-01

    We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP).......We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP)....

  16. Mesenchymal stem cells - a promising therapy for Acute Respiratory Distress Syndrome.

    OpenAIRE

    Hayes M; Curley G; Laffey JG.

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) constitutes a spectrum of severe acute respiratory failure in response to a variety of inciting stimuli that is the leading cause of death and disability in the critically ill. Despite decades of research, there are no therapies for ARDS, and management remains supportive. A growing understanding of the complexity of the pathophysiology of ARDS, coupled with advances in stem cell biology, has lead to a renewed interest in the therapeutic potential of...

  17. Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome

    OpenAIRE

    Dushianthan, Ahilanandan; Goss, Victoria; Cusack, Rebecca; Grocott, Michael P. W.; Postle, Anthony D

    2014-01-01

    Background Acute respiratory distress syndrome (ARDS) is a life-threatening critical illness, characterised by qualitative and quantitative surfactant compositional changes associated with premature airway collapse, gas-exchange abnormalities and acute hypoxic respiratory failure. The underlying mechanisms for this dysregulation in surfactant metabolisms are not fully explored. Lack of therapeutic benefits from clinical trials, highlight the importance of detailed in-vivo analysis and charact...

  18. Emergency nursing of acute respiratory failure caused by lung cancer combined with diabetes%肺癌合并糖尿病发生急性呼吸衰竭的急救护理

    Institute of Scientific and Technical Information of China (English)

    朱玲玲

    2014-01-01

    目的:探讨肺癌合并糖尿病发生急性呼吸衰竭的急救护理方法。方法选择患者80例,分为两组,各40例。观察组采用针对性护理,对照组仅对患者实施鼻导管给氧及胰岛素控制血糖,比较两组护理干预后的血气分析及血糖结果。结果观察组干预后的pH、PaCO2高于对照组(P<0.05),PaO2低于对照组(P<0.05);观察组干预后的空腹血糖、餐后2 h血糖均显著低于对照组(P<0.05)。结论针对肺癌合并糖尿病发生呼吸衰竭的患者实施针对性护理能显著改善患者的血气分析结果,维持血糖稳定,值得临床重视。%Objective To investigate the emergency nursing method of acute respiratory failure caused by lung cancer combined with diabetes. Methods 80 patients were selected and divided into the two groups,and there were 40 cases in each group.The observation group was given the targeted nursing,the control group was given nasal catheter oxygen in-halation and insulin to control the blood sugar,blood gas analysis and blood sugar of the two groups after nursing in-trevention were compared. Results After intervention,the pH and PaCO2 of the observation group were higher than those of the control group,PaO2 was lower than that of the control group (P<0.05);the fasting plasma glucose and 2 hours post-prandial glucose of the observation group after intervention were lower than those of the control group (P<0.05). Con-clusion For patients with acute respiratory failure caused by lung cancer combined with diabetes,conducting the target-ed nursing can significantly improve blood gas analysis results of patients,maintain stable blood sugar,so it is worthy of attention in clinic.

  19. Adult-onset nemaline myopathy presenting as respiratory failure.

    LENUS (Irish Health Repository)

    Kelly, Emer

    2008-11-01

    Nemaline myopathy is a rare congenital myopathy that generally presents in childhood. We report a case of a 44-year-old man who presented with severe hypoxic hypercapnic respiratory failure as the initial manifestation of nemaline myopathy. After starting noninvasive ventilation, his pulmonary function test results improved substantially, and over the 4 years since diagnosis his respiratory function remained stable. There are few reported cases of respiratory failure in patients with adult-onset nemaline myopathy, and the insidious onset in this case is even more unusual. This case highlights the varied presenting features of adult-onset nemaline myopathy and that noninvasive ventilation improves respiratory function.

  20. Acute Respiratory Distress Due to Methane Inhalation

    OpenAIRE

    Jo, Jun Yeon; Kwon, Yong Sik; Lee, Jin Wook; Park, Jae Seok; Rho, Byung Hak; Choi, Won-Il

    2013-01-01

    Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest rad...

  1. Analysis of the incidence and risk factors of acute kidney injury in respiratory failure patients%呼吸衰竭患者中急性肾损伤的发生情况及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杨钱华; 严玉澄; 车妙琳; 张伟明; 王琴; 陆任华; 朱铭力; 倪兆慧; 钱家麒

    2012-01-01

    Objective To determine the incidence and risk factors of acute kidney injury (AKI) in respiratory failure patients.Method Clinical data of 235 patients diagnosed as respiratory failure admitted in respiratory division and internal medicine intensive care unit in Renji Hospital from January 2006 to December 2008 were analyzed retrospectively.Patients'demographics,clinical data and laboratory examinations before and after respiratory failure were collected.The incidence,clinical risk factors and hospital mortality of AKI in the respiratory failure patients were analyzed.Multivariate Logistic regression analysis was used to investigate the independent risk factors of AKI in these patients.Results Of the total 235 patients,the average age was (70.05±12.85) years old,the ratio of male to female was 1.90:1.Seventy-seven patients developed AKI and the incidence was 32.8%.The incidence of AKI in those with hypertension (44.4% vs 26.6%,P<0.01) or chronic kidney disease(66.7% vs 31.3%,P<0.01) was significantly higher.The incidence of AKI in patients with mechanical ventilation was much higher than those without mechanical ventilation(44.8% vs 13.3%,P<0.01).The incidence of multi-organ system failure (33.8% vs 5.7%,P<0.01),the failure of weaning from mechanical ventilation(69.2%vs 32.5%,P<0.01) and the mortality (51.9% vs 13.3%,P<0.01) in AK1 patients were higher than those without AKI.Multivariate Logistic regression analysis showed that age (OR=1.668),anemia (OR=0.980),baseline serum creatinine (OR=1.071) and mechanical ventilation (OR=3.222) were independent risk factors of AKI.Conclusions Incidence and mortality of AKI are quite high in respiratory failure patients.Age,baseline serum creatinine,anemia and mechanical ventilation are independent risk factors of AKI.%目的 了解呼吸衰竭患者中急性肾损伤(AKI)的发生情况,筛选与AKI发生相关的临床危险因素.方法 选择2006年1月至2008年12月于上海交通

  2. Acute airway failure secondary to thyroid metastasis from renal carcinoma

    Directory of Open Access Journals (Sweden)

    Lastilla Gaetano

    2008-02-01

    Full Text Available Abstract Background Secondary involvement of the thyroid gland by malignant metastases is uncommon. Acute respiratory crisis due to infiltration of the upper airways is a recognised complication of anaplastic thyroid carcinoma or thyroid lymphoma. Renal cell carcinoma is a tumour that metastasizes diffusely and in an unpredictable manner. Case presentation We report a case of a 73-year-old man with a painful neck mass, dyspnoea, stridor and dysphonia that was evaluated in emergency. A right radical nephrectomy for renal cell carcinoma was performed 8 years previously. An emergency endotracheal intubation was followed by total thyroidectomy. Histological examination confirmed the diagnosis of thyroid metastasis from renal cell carcinoma. Conclusion A literature review regarding emergency treatment for acute respiratory compromise resulting from secondary thyroid tumours was undertaken. Only two cases of metastatic colon cancer and one case of metastatic meningioma requiring emergency thyroidectomy for acute respiratory failure are reported in the literature. This appears to be the first case of emergency surgery performed for acute respiratory compromise due to thyroid metastasis from renal cell carcinoma.

  3. "Smoking wet": respiratory failure related to smoking tainted marijuana cigarettes.

    Science.gov (United States)

    Gilbert, Christopher R; Baram, Michael; Cavarocchi, Nicholas C

    2013-01-01

    Reports have suggested that the use of a dangerously tainted form of marijuana, referred to in the vernacular as "wet" or "fry," has increased. Marijuana cigarettes are dipped into or laced with other substances, typically formaldehyde, phencyclidine, or both. Inhaling smoke from these cigarettes can cause lung injuries. We report the cases of 2 young adults who presented at our hospital with respiratory failure soon after they had smoked "wet" marijuana cigarettes. In both patients, progressive hypoxemic respiratory failure necessitated rescue therapy with extracorporeal membrane oxygenation. After lengthy hospitalizations, both patients recovered with only mild pulmonary function abnormalities. To our knowledge, this is the first 2-patient report of severe respiratory failure and rescue therapy with extracorporeal oxygenation after the smoking of marijuana cigarettes thus tainted. We believe that, in young adults with an unexplained presentation of severe respiratory failure, the possibility of exposure to tainted marijuana cigarettes should be considered. PMID:23466531

  4. Genetics Home Reference: hereditary myopathy with early respiratory failure

    Science.gov (United States)

    ... list from the University of Kansas Medical Center: Muscular Dystrophy / Atrophy GeneReviews (1 link) Hereditary Myopathy with Early Respiratory Failure (HMERF) Genetic Testing Registry (1 link) Hereditary myopathy with early ...

  5. Organ failure associated with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ai-Jun Zhu; Jing-Sen Shi; Xue-Jun Sun

    2003-01-01

    AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure.METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology,extent of necrosis, infection of necrosis and mortality was analyzed.RESULTS: A total of 47 patients (63.5 %) showed organ failure, 20 patients (27.0 %) multiple organ failure, whereas 27 patients (36.5 %) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0 %) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P>0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P>0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P<0.05). The death of SAP was associated with multiple organ failure (P<0.005), pulmonary failure (P<0.005), cardiovascular dysfunction (P<0.05) and gastrointestinal dysfunction (P<0.05).CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.

  6. The successful treatment of hypercapnic respiratory failure with oral modafinil

    OpenAIRE

    Varney, Veronica

    2014-01-01

    Helen Parnell,1 Ginny Quirke,1 Sally Farmer,1 Sumbo Adeyemo,2 Veronica Varney11Respiratory Department, 2Pharmacy Department, St Helier Hospital, Carshalton, Surrey, UKAbstract: Hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease and is usually treated by nasal ventilation. Not all patients requiring such ventilation can tolerate it, with anxiety and phobia influencing their reaction, along with treatment failure. We report the case histories of six pati...

  7. Leptospirosis with acute renal failure and paraparesis

    OpenAIRE

    Ramakrishna, P.; Sai Naresh, V. V.; Chakrapani, B.; B.Vengamma; Kumar, V. Siva

    2008-01-01

    Leptospirosis is an important zoonosis with a worldwide distribution that is characterized by a broad spectrum of clinical manifestations ranging from inapparent infection to fulminant disease. The presentation of paraparesis in combination with acute renal failure is rare.

  8. Acute lung injury and acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Ragaller Maximillian

    2010-01-01

    Full Text Available Every year, more information accumulates about the possibility of treating patients with acute lung injury or acute respiratory distress syndrome with specially designed mechanical ventilation strategies. Ventilator modes, positive end-expiratory pressure settings, and recruitment maneuvers play a major role in these strategies. However, what can we take from these experimental and clinical data to the clinical practice? In this article, we discuss substantial options of mechanical ventilation together with some adjunctive therapeutic measures, such as prone positioning and inhalation of nitric oxide.

  9. Acute liver failure and self-medication

    OpenAIRE

    de OLIVEIRA, André Vitorio Câmara; ROCHA, Frederico Theobaldo Ramos; ABREU, Sílvio Romero de Oliveira

    2014-01-01

    Introduction Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure. Aim To warn about how the practice of self-medication can be responsible for acute liver failure. Method Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute live...

  10. [Ventilation strategies in the child with severe hypoxemic respiratory failure].

    Science.gov (United States)

    Donoso F, Alejandro; Arriagada S, Daniela; Díaz R, Franco; Cruces R, Pablo

    2015-01-01

    In this review, we assemble the fundamental concepts of the use of mechanical ventilation (MV) in children with acute respiratory failure (ARDS) and refractory hypoxemia. We also discusses topics of protective ventilation and recruitment potential, and specifically examine the options of ventilation and/or maneuvers designed to optimize the non-aerated lung tissue: alveolar recruitment maneuvers, positive end-expiratory pressure (PEEP) titulation, high frequency oscillatory ventilation (HFOV), airway pressure release ventilation (APRV), aimed at correcting the mismatch ventilation/perfusion (V/Q): use of prone position. The only pharmacological intervention analyzed is the use of neuromuscular blockers. In clinical practice, the protective MV concept involves using an individual adjustment of the PEEP and volume tidal (V(T)). Use of recruitment maneuvers and PEEP downward titration can improve lung function in patients with ARDS and severe hypoxemia. We must keep in mind HFOV instauration as early as possible in response to failure of MV. The use of early and prolonged prone can improve gas exchange in hopes of a better control of what caused the use of MV. PMID:25739487

  11. Acute Decompensated Heart Failure: Contemporary Medical Management

    OpenAIRE

    Joseph, Susan M.; Cedars, Ari M.; Ewald, Gregory A.; Geltman, Edward M.; Mann, Douglas L.

    2009-01-01

    Hospitalizations for acute decompensated heart failure are increasing in the United States. Moreover, the prevalence of heart failure is increasing consequent to an increased number of older individuals, as well as to improvement in therapies for coronary artery disease and sudden cardiac death that have enabled patients to live longer with cardiovascular disease. The main treatment goals in the hospitalized patient with heart failure are to restore euvolemia and to minimize adverse events. C...

  12. Ventilatory support in critically ill hematology patients with respiratory failure

    OpenAIRE

    Molina Lobo, Rosario; Bernal del Castillo, Teresa; Borges, Marcio; Zaragoza Crespo, Rafael; Bonastre Mora, Juan; Granada Vicente, Rosa María; Rodríguez-Borregán, Juan Carlos; Nuñez, Karla; Seijas Betolaza, Iratxe; Ayestaran, Ignacio; Muñiz Albaiceta, Guillermo; EMEHU Study Investigators

    2012-01-01

    Introduction Hematology patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Noninvasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks. Methods To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicenter, observational study were analyzed. All hematology patients admitted to one of the 34 participating ICUs in a 17-month period...

  13. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives.

    Science.gov (United States)

    Sen, Ayan; Callisen, Hannelisa E; Alwardt, Cory M; Larson, Joel S; Lowell, Amelia A; Libricz, Stacy L; Tarwade, Pritee; Patel, Bhavesh M; Ramakrishna, Harish

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration. PMID:26750681

  14. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives

    Directory of Open Access Journals (Sweden)

    Ayan Sen

    2016-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.

  15. [Current approaches to the treatment of severe hypoxic respiratory insufficiency (acute lung injury; acute respiratory distress syndrome)].

    Science.gov (United States)

    Kluge, S; Müller, T; Pfeifer, M

    2011-02-01

    Lung-protective ventilation with a low tidal volume, plateau pressure 90% and permissive hypercapnia results in reduction of the mortality rate in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The level of the positive end-expiratory pressure (PEEP) must be chosen in relation to oxygen requirement. High frequency oscillatory ventilation and neurally adjusted ventilatory assist are promising methods. However, further studies with firm end-points have to be awaited before a final judgment is possible. Veno-venous extracorporeal membrane oxygenation (ECMO) can ensure life-sustaining gas exchange in patients with severe vitally compromised pulmonary failure, to provide time for lung tissue to heal and reduce ventilatory stress. The latest guidelines for analgesia and sedation in intensive care medicine demand consistent monitoring of the level of sedation and the intensity of pain. The sedation should be interrupted daily, with phases of awakenings and, if possible, spontaneous breathing. Methods of supportive treatment: Positional treatment (prone position) and inhalation of vasodilators can improve ventilation/perfusion mismatch and thus oxygenation. However, administration of surfactant is currently not advised in adult respiratory failure. PMID:21271478

  16. [Continuously alternating prone and supine positioning in acute lung failure].

    Science.gov (United States)

    Walz, M; Muhr, G

    1992-11-01

    Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. Furthermore different studies have shown the effects of supine and lateral decubitus posture in patients with acute respiratory failure. There are only rare reports on using the prone position, which doesn't require two-lung ventilation in difference to lateral position. We have studied 16 patients with acute respiratory failure by using continuous changing between prone and supine position under mechanical ventilation. All were male, aged 41.3 years in the middle and showed an average "Injury Severity Score" of 30 (13-50). 15 were trauma patients with blunt chest trauma in 11 cases. We have used prone position on threatening or manifest ARDS. In all patients we observed an increment of PaO2 during prone position on to 48 mmHg so that FiO2 could be reduced on an average of 0.2 within the first 48 h since changing patient's position. Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1458988

  17. Candidate genes and pathogenesis investigation for sepsis-related acute respiratory distress syndrome based on gene expression profile

    OpenAIRE

    WANG Min; Yan, Jingjun; He, Xingxing; Zhong, Qiang; Zhan, Chengye; Li, Shusheng

    2016-01-01

    Background Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury as well as a major cause of acute respiratory failure. Although researchers have made significant progresses in elucidating the pathophysiology of this complex syndrome over the years, the absence of a universal detail disease mechanism up until now has led to a series of practical problems for a definitive treatment. This study aimed to predict some genes or pathways asso...

  18. Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome.

    Directory of Open Access Journals (Sweden)

    Kumar Dharmarajan

    Full Text Available BACKGROUND: Heart failure as recognized and treated in typical practice may represent a complex condition that defies discrete categorizations. To illuminate this complexity, we examined treatment strategies for patients hospitalized and treated for decompensated heart failure. We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease. METHODS AND RESULTS: Using Premier Perspective(®, we studied adults hospitalized with a principal discharge diagnosis of heart failure and evidence of acute heart failure treatment from 2009-2010 at 370 US hospitals. We determined treatment with acute respiratory therapies during the initial 2 days of hospitalization and daily during hospital days 3-5. We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2. Among 164,494 heart failure hospitalizations, 53% received acute respiratory therapies during the first 2 hospital days: 37% received short-acting inhaled bronchodilators, 33% received antibiotics, and 10% received high-dose corticosteroids. Of these 87,319 hospitalizations, over 60% continued receiving respiratory therapies after hospital day 2. Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease. Treatment with acute respiratory therapy during the first 2 hospital days was associated with higher adjusted odds of all adverse outcomes. CONCLUSIONS: Acute respiratory therapy is administered to more than half of patients hospitalized with and treated for decompensated heart failure. Heart failure is therefore regularly treated as a broader cardiopulmonary syndrome rather than as a singular cardiac condition.

  19. The Clinical Research on Patients with Acute Respiratory Failure Treated by Noninvasive Positive Pressure Ventilation%无创正压通气治疗急性呼吸衰竭临床研究

    Institute of Scientific and Technical Information of China (English)

    何忠红; 邓上安; 池琦

    2015-01-01

    Objective:To explore the clinical research on patients with acute respiratory failure treated by noninvasive positive pressure ventilation(NIPPV) and provide the clinical basis.Method:72 patients with acute respiratory failure were selected randomly from July 2012 to December 2013 in our hospital. According to the application of ventilation, they were divided into invasive mechanical ventilation group(the control group) and noninvasive positive pressure ventilation group (the observation group), which were 36 cases in each groups respectively. The main assessment indexes of two groups were PaO2, PaCO2 and SaO2 after 4 h and 24 h ventilation; mechanical ventilation, VAP occurrence rate.Result:In the observation group,4 h PaO2, PaCO2 ventilation and SaO2 were (82.77±1.68)mm Hg, (57.80±1.13)mm Hg,(77.19±5.46)%;24 h PaO2, ventilation PaCO2 and SaO2 were (92.48±1.41)mm Hg, (49.85±1.02)mm Hg,(93.83±6.07)%.In the control group,PaO2, PaCO2 4 h ventilation and SaO2 were (91.43±1.92)mm Hg,(52.37±0.81)mm Hg,(81.31±6.68)%,24 h PaO2,PaCO2 ventilation and SaO2 were (94.55±1.30)mm Hg,(50.34±0.89)mm Hg,(94.02±7.96)%,there was a statistically significant difference in ventilation 4 hours between the two groups(P<0.05), there was no significant differences in ventilation 24 hours.The incidence of VAP in the observation group was 8.33%, which was lower than 27.78% in the control group, the difference was statistically significant(P<0.05).Hospital stay in the observation group was (17.19±0.46)d, which was lower than (21.31±0.68)d in the control group, the difference was statistically significant(P<0.05).Conclusion:NIPPV could effectively improve the gas exchange of the patients with acute respiratory failure, without the need for tracheotomy, effectively avoid various complications occurred.%目的:探讨无创正压通气(NIPPV)治疗急性呼吸衰竭患者的临床效果,为临床治疗提供依据。方法:随机选择本院2012年7月-2013年12

  20. Acute Respiratory Distress Syndrome is a TH17-like and Treg immune disease

    OpenAIRE

    Hu, Wan-Chung

    2013-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a very severe syndrome leading to respiratory failure and subsequent mortality. Sepsis is one of the leading causes of ARDS. Thus, extracellular bacteria play an important role in the pathophysiology of ARDS. Overactivated neutrophils are the major effector cells in ARDS. Thus, extracellular bacteria triggered TH17-like innate immunity with neutrophil activation might accounts for the etiology of ARDS. Here, microarray analysis was employed to des...

  1. An unusual cause of type 2 respiratory failure

    Directory of Open Access Journals (Sweden)

    Srinivas Rajagopala

    2015-01-01

    Full Text Available We present a female patient who was referred for management of respiratory failure. She was being evaluated and managed as worsening chronic inflammatory demyelinating polyneuropathy with type 2 respiratory failure. Initial examination showed hypertrichosis, clubbing and papilledema along with severe distal and proximal motor-predominant weakness with impending respiratory failure. She was managed with noninvasive ventilation (NIV and plasmapheresis awaiting diagnostic investigations. Immunofixation showed an "M band" and free lambda chain levels were elevated. Radiographs showed the classic osteosclerotic lesions of POEMS (polyradiculoneuropathy, organomegaly, endocrinopathy, M-protein and Skin abnormalities syndrome. Six weeks after commencing radiotherapy to the osteosclerotic lesions, the patient responded favorably and remains off nocturnal NIV support.

  2. [The challenge of home care for respiratory failure].

    Science.gov (United States)

    Huchon, G

    2001-05-31

    In France, 65,000 patients with chronic respiratory failure are managed at home. This is made possible by the collaboration between prescribing physicians and other medical and social agents in the community. It consists in various medical, technical and social interventions, all aimed at improving both survival and quality of life. Patient and family education is a key-factor to increase the success of the various therapeutic interventions that are rehabilitation, long term oxygen therapy and home mechanical ventilation. Rehabilitation programmes include optimisation of pharmacological treatments, help in smoking cessation, social and psychological support, and exercise training. National alert procedure for medical devices, and evaluation of medical devices is part of the management of respiratory failure at home. Care networks facilitate the various interventions necessary to maintain the patient with chronic respiratory failure at home. PMID:11468910

  3. Clustering of acute respiratory infection hospitalizations in childcare facilities

    DEFF Research Database (Denmark)

    Kamper-Jørgensen, Mads; Benn, Christine Stabell; Simonsen, Jacob;

    2010-01-01

    To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics.......To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics....

  4. Chinese herbal medicine for severe acute respiratory syndrome

    DEFF Research Database (Denmark)

    Liu, Jianping; Manheimer, Eric; Shi, Yi;

    2004-01-01

    To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

  5. Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study

    Directory of Open Access Journals (Sweden)

    Alexandre de Matos Soeiro

    2008-02-01

    patients with acute respiratory failure (ARF and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns. METHODS: Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. RESULTS: The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD, pulmonary edema, lymphocytic interstitial pneumonia (LIP and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI, cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age > 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema. CONCLUSION: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.

  6. Clinical heterogeneity in autoimmune acute liver failure

    Institute of Scientific and Technical Information of China (English)

    Norberto C Chavez-Tapia; Julio Martinez-Salgado; Julio Granados; Misael Uribe; Felix I Tellez-Avila

    2007-01-01

    AIM:To describe the outcome and prognosis in a cohort of patients with acute liver failure due to autoimmune hepatitis without liver transplantation.METHODS:A retrospective trial was conducted in 11 patients with acute liver failure due to autoimmune hepatitis who attended the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Demographic,biochemical and severity indexes,and treatment and outcome were assessed.RESULTS: Among the 11 patients, with a median age of 31 years, 72% had inflammatory response syndrome, and six patients received corticosteroids.The mortality rate within four weeks was 56%, and the one-year survival was 27%. In the survivors, severity indexes were lower and 83% received corticosteroids.CONCLUSION:We observed a relatively high survival rate in patients with acute liver failure due to autoimmune hepatitis. This survival rate could be influenced by severity of the disease and/or use of corticosteroids.

  7. Steroid use in acute liver failure

    DEFF Research Database (Denmark)

    Karkhanis, Jamuna; Verna, Elizabeth C; Chang, Matthew S;

    2014-01-01

    UNLABELLED: Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indete......UNLABELLED: Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug......-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS...

  8. Volumetric diffusive respirator use in neonatal respiratory failure.

    Science.gov (United States)

    Campbell, P J; Chilton, H W; Garvey, P A; Gupta, J M

    1991-02-01

    Six very low birthweight neonates with terminal respiratory failure due to severe hyaline membrane disease who failed to respond to conventional ventilation were offered a trial of high frequency jet ventilation using the volumetric diffusive respirator (VDR). All neonates showed improvement in pulmonary function. Two neonates were weaned successfully from high frequency ventilation. The results of this initial trial suggest that the volumetric diffusive respirator is a safe and effective method of ventilation in neonates with respiratory failure and that the survival rate in such neonates might be enhanced if treatment is introduced earlier in the disease.

  9. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  10. Cerebral edema associated with acute hepatic failure.

    OpenAIRE

    Fujiwara, Masachika; Watanabe,Akiharu; Yamauchi,Yasuhiko; Hashimoto, Makoto; Nakatsukasa, Harushige; Kobayashi, Michio; Higashi,Toshihiro; Nagashima,Hideo

    1985-01-01

    The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64%) of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more fre...

  11. Acute respiratory infections in young Ethiopian children

    Directory of Open Access Journals (Sweden)

    Harris RA

    2015-07-01

    Full Text Available Rebecca Arden HarrisDepartment of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USAThe identification of risk factors for acute respiratory infections (ARI is crucial for designing interventions to both minimize transmission and augment the immune response, particularly in Sub-Saharan Africa where poverty-related ARI is still a major cause of preventable death in young children.1 I therefore read with interest Geberetsadik et al’s recent study of the factors associated with ARI in Ethiopian children.2 Their study uses nationally representative data on households and individuals to build a model of the social, demographic, and anthropometric determinants of ARI. A precise understanding of their model, however, requires clarification of several items in their paper.View original paper by Geberetsadik et al.

  12. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    DEFF Research Database (Denmark)

    von Linstow, Marie-Louise; Henrik Larsen, Hans; Koch, Anders;

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection...

  13. Acute otitis media and respiratory viruses.

    Science.gov (United States)

    Bulut, Yunus; Güven, Mehmet; Otlu, Bariş; Yenişehirli, Gülgün; Aladağ, Ibrahim; Eyibilen, Ahmet; Doğru, Salim

    2007-03-01

    The present study was performed to elucidate the clinical outcome, and etiology of acute otitis media (AOM) in children based on virologic and bacteriologic tests. The study group consisted of 120 children aged 6 to 144 months with AOM. Middle ear fluid (MEF) was tested for viral pathogens by reverse transcriptase polymerase chain reaction (RT-PCR) and for bacteria by gram-staining and culture. Clinical response was assessed on day 2 to 4, 11 to 13, 26 to 28. Respiratory viruses were isolated in 39 patients (32.5%). Respiratory syncytial virus (RSV) (46.5%) was the most common virus identified in MEF samples, followed by human rhinovirus (HRV) (25.6%), human coronavirus (HCV) (11.6%), influenza (IV) type A (9.3%), adenovirus type sub type A (AV) (4%), and parainfluenza (PIV) type -3 (2%) by RT-PCR. In total 69 bacterial species were isolated from 65 (54.8%) of 120 patients. Streptococcus pneumoniae (S. pneumoniae) was the most frequently isolated bacteria. Viral RNA was detected in 31 (56.3%) of 55 bacteria-negative specimens and in 8 (12.3%) of 65 bacteria-positive MEF samples. No significant differences were found between children representing viral infection alone, combined viral and bacterial infection, bacterial infection alone, and neither viral nor bacterial infection, regarding clinical cure, relapse and reinfection rates. A significantly higher rate of secretory otitis media (SOM) was observed in alone or combined RSV infection with S. pneumonia or Haemophilus influenzae (H. influenzae) than in other viruses infection. Conclusion. This study provides information about etiologic agents and diagnosis of AOM in Turkish children. The findings highlight the importance of common respiratory viruses and bacterial pathogens, particularly RSV, HRV, S. pneumoniae and H. influenzae, in predisposing to and causing AOM in children.

  14. Noninvasive ventilation in acute respiratory failure

    OpenAIRE

    Masip, Josep

    2014-01-01

    Arantxa Mas, Josep MasipCritical Care Department, Consorci Sanitari Integral (CSI), Hospital Sant Joan Despí Moisès Broggi and Hospital General de l’Hospitalet, University of Barcelona, Barcelona, SpainAbstract: After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support v...

  15. Pathogenesis of severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ding-mei; LU Jia-hai; ZHONG Nan-shan

    2008-01-01

    Severe acute respiratory syndrome (SARS) first emerged in Guangdong province,China in November2002.During the following 3 months,it spread rapidly across the world,resulting in approximately 800 deaths.In 2004,subsequent sporadic cases emerged in Singapore and China.A novel coronavims,SARS-CoV,was identified as the etiological agent of SARS.1,2 This virus belongs to a family of large,positive,single-stranded RNA viruses.Nevertheless,genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses,SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract.The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins,and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003.The predominant pathological finding in these cases was diffuse alveolar damage (DAD).This severe pulmonary injury of SARS patients is caused both by direct viral effects and immunopathogenetic factors.5 Many important aspects of the pathogenesis of SARS have not yet been fully clarified.In this article,we summarize the most important mechanisms involved in the complex pathogenesis of SARS,including clinical characters,host and receptors,immune system response and genetic factors.

  16. Use of Noninvasive Positive Pressure Ventilation in Acute Respiratory Insufficiency after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Mohamed Abdel Rahman Salem

    2004-06-01

    Full Text Available Background: Non-invasive positive pressure ventilation (NIPPV using bilevel positive airway pressure (BiPAP ventilation is a safe and effective mean of improving gas exchange in many types of respiratory failure. The results of application of NIPPV to patients who had cardiac surgery and developed respiratory failure after extubation still to be investigated. Aim of work: To compare the efficacy of NIPPV delivered through a face mask with the efficacy of conventional mechanical ventilation (CV delivered through an endotracheal tube and investigates its hemodynamic effects in this group of patients. Materials and Methods: NIPPV and CV were applied to twenty four patients in two groups who had open heart surgery and suffered from severe respiratory deterioration after tracheal extubation. Respiratory and invasive hemodynamic parameters were measured before starting ventilation, 1, 6, 12 hours, and before and after weaning of ventilation and incidence of ventilatory complications were recorded. Results: Respiratory parameters improved significantly in patients in both groups after one hour but one patient was intubated in NIPPV group. There were no significant differences between the two groups as regards the hemodynamics and respiratory parameters. Respiratory complications and infection were not noticed in NIPPV group during the study. Conclusion: NIPPV is considered an effective method of treating patients with acute respiratory insufficiency after cardiac surgery with minimal effects on respiratory and hemodynamic parameters. It reduces the respiratory complications and infection during mechanical ventilation.

  17. Respiratory failure caused by intrathoracic amoebiasis

    Directory of Open Access Journals (Sweden)

    Toshinobu Yokoyama

    2010-03-01

    Full Text Available Toshinobu Yokoyama1, Masashi Hirokawa1, Yutaka Imamura2, Hisamichi Aizawa11Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University, Japan; 2Department of Hematology, St. Mary’s Hospital, Kurume, JapanAbstract: A 41-year-old male was admitted to the hospital with symptoms of diarrhea, fever and rapidly progressive respiratory distress. A chest radiograph and computed tomography (CT of the chest and the abdomen showed a large amount of right pleural effusion and a large liver abscess. The patient was thus diagnosed to have amoebic colitis, amoebic liver abscess and amoebic empyema complicated with an HIV infection. The patient demonstrated agranulocytosis caused by the administration of trimethoprim-sulfamethoxazole. However, the administration of granulocyte colony-stimulating factor made it possible for the patient to successfully recover from agranulocytosis, and he thereafter demonstrated a good clinical course.Keywords: amebiasis, amoebic empyema, HIV, agranulocytosis, trimethoprim-sulfamethoxazole

  18. Acute respiratory distress in a silversmith

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    Jignesh Mukeshkumar Parikh

    2014-01-01

    Full Text Available A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO 2 /FiO 2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS. He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air.

  19. Cytokines and Organ Failure in Acute Pancreatitis

    DEFF Research Database (Denmark)

    Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller;

    2012-01-01

    Objectives: We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP). Methods: Interleukin (IL) 6, IL-8, IL-18, and tumor necrosis factor > were measured on admission...

  20. The management of acute heart failure

    NARCIS (Netherlands)

    Milo-Cotter, O.; Bettari, L.; Kleijn, L.; Bugatti, S.; Lombardi, C.; Rund, M.; Metra, M.; Voors, A. A.; Cotter, G.; Kaluski, E.; Weatherley, B. D.

    2010-01-01

    Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21(st) century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the heteroge

  1. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick

    2012-02-03

    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  2. Weaning from the ventilator in patients with respiratory failure

    NARCIS (Netherlands)

    B.W. van den Berg (Bart)

    1994-01-01

    textabstractWeaning from the ventilator is the gradual withdrawal of mechanical ventilatory support. Mechanical ventilation is well-accepted as rescue therapy in patients with life-threatening respiratory failure. As this treatment is associated with substantial morbidity and mortality, ventilatory

  3. Respiratory failure following anti-lung serum: study on mechanisms associated with surfactant system damage

    International Nuclear Information System (INIS)

    Within 2 minutes intravenous anti-lung serum (ALS) into guinea pig induces a respiratory failure that is fatal within 30 min. The relationship between surfactant, alveolar-capillary permeability and respiratory failure was studied. Within two minutes ALS induced a leak in the alveolar-capillary barrier. Within 30 minutes 28.3% (controls, given normal rabbit serum: 0.7%) of iv 131I-albumin, and 0.5% (controls 0.02%) of iv surfactant phospholipid tracer were recovered in bronchoalveolar lavage. Furthermore, 57% (controls 32%) of the endotracheally administered surfactant phospholipid became associated with lung tissue and only less than 0.5% left the lung. The distribution of proteins and phospholipids between the in vivo small volume bronchoalveolar lavages and the ex vivo bronchoalveolar lavages were dissimilar: 84% (controls 20%) of intravenously injected, lavageable 131I-albumin and 23% (controls 18%) of total lavageable phospholipid were recovered in the in vivo small volume bronchoalveolar lavages. ALS also decreased lavageable surfactant phospholipid by 41%. After ALS the minimum surface tension increased. The supernatant of the lavage increased the minimum surface tension of normal surfactant. In addition, the sediment fraction of the lavage had slow surface adsorption, and a marked reduction in 35,000 and 10,000 MW peptides. Exogenous surfactant ameliorated the ALS-induced respiratory failure. We propose that inhibition, altered intrapulmonary distribution, and dissociation of protein and phospholipid components of surfactant are important in early pathogenesis of acute respiratory failure

  4. [Acute heart failure: acute cardiogenic pulmonary edema and cardiogenic shock].

    Science.gov (United States)

    Sánchez Marteles, Marta; Urrutia, Agustín

    2014-03-01

    Acute cardiogenic pulmonary edema and cardiogenic shock are two of the main forms of presentation of acute heart failure. Both entities are serious, with high mortality, and require early diagnosis and prompt and aggressive management. Acute pulmonary edema is due to the passage of fluid through the alveolarcapillary membrane and is usually the result of an acute cardiac episode. Correct evaluation and clinical identification of the process is essential in the management of acute pulmonary edema. The initial aim of treatment is to ensure hemodynamic stability and to correct hypoxemia. Other measures that can be used are vasodilators such as nitroglycerin, loop diuretics and, in specific instances, opioids. Cardiogenic shock is characterized by sustained hypoperfusion, pulmonary wedge pressure > 18 mmHg and a cardiac index 30 mmHg) and absent or reduced diuresis (shock associated with ischaemic heart disease.

  5. Always Consider the Possibility of Opioid Induced Respiratory Depression in Patients Presenting with Hypercapnic Respiratory Failure Who Fail to Improve as Expected with Appropriate Therapy

    Science.gov (United States)

    Steynor, Martin; MacDuff, Andrew

    2015-01-01

    Hypercapnic respiratory failure is a frequently encountered medical emergency. Two common causes are acute exacerbations of chronic obstructive pulmonary disease (COPD) and as a side effect of opioids. The two causes may coexist leading to diagnostic confusion and consequent delay in optimal management. We report a case of what was initially thought to be an exacerbation of COPD. The patient failed to improve with treatment as expected which led to the empirical administration of naloxone resulting in a dramatic reversal of her respiratory failure. The patient was subsequently discovered to be taking regular dihydrocodeine for chronic back pain. PMID:25893118

  6. Always Consider the Possibility of Opioid Induced Respiratory Depression in Patients Presenting with Hypercapnic Respiratory Failure Who Fail to Improve as Expected with Appropriate Therapy

    Directory of Open Access Journals (Sweden)

    Martin Steynor

    2015-01-01

    Full Text Available Hypercapnic respiratory failure is a frequently encountered medical emergency. Two common causes are acute exacerbations of chronic obstructive pulmonary disease (COPD and as a side effect of opioids. The two causes may coexist leading to diagnostic confusion and consequent delay in optimal management. We report a case of what was initially thought to be an exacerbation of COPD. The patient failed to improve with treatment as expected which led to the empirical administration of naloxone resulting in a dramatic reversal of her respiratory failure. The patient was subsequently discovered to be taking regular dihydrocodeine for chronic back pain.

  7. Respiratory sleep disorders in patients with congestive heart failure.

    Science.gov (United States)

    Naughton, Matthew T

    2015-08-01

    Respiratory sleep disorders (RSD) occur in about 40-50% of patients with symptomatic congestive heart failure (CHF). Obstructive sleep apnea (OSA) is considered a cause of CHF, whereas central sleep apnea (CSA) is considered a response to heart failure, perhaps even compensatory. In the setting of heart failure, continuous positive airway pressure (CPAP) has a definite role in treating OSA with improvements in cardiac parameters expected. However in CSA, CPAP is an adjunctive therapy to other standard therapies directed towards the heart failure (pharmacological, device and surgical options). Whether adaptive servo controlled ventilatory support, a variant of CPAP, is beneficial is yet to be proven. Supplemental oxygen therapy should be used with caution in heart failure, in particular, by avoiding hyperoxia as indicated by SpO2 values >95%.

  8. Activation and Regulation of Hemostasis in Acute Liver Failure and Acute Pancreatitis

    NARCIS (Netherlands)

    Lisman, Ton; Porte, Robert J.

    2010-01-01

    Acute liver failure and acute pancreatitis are accompanied by substantial changes in the hemostatic system. In acute liver failure, defective synthesis of coagulation factors and intravascular activation of coagulation results in thrombocytopenia and reduced levels of proteins involved in coagulatio

  9. Acute liver failure and acute kidney injury: Definitions, prognosis, and outcome

    OpenAIRE

    Włodzimirow, K.A.

    2013-01-01

    The objective of this thesis was to investigate definitions, prognostic indicators and their association with adverse events, mainly mortality for acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and acute kidney injury (AKI).

  10. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    NARCIS (Netherlands)

    Kneyber, Martin C. J.; van Heerde, Marc; Twisk, Jos W. R.; Plotz, Frans B.; Markhors, Dick G.

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechan

  11. Acute Liver Failure Secondary to Niacin Toxicity

    Directory of Open Access Journals (Sweden)

    Marc A. Ellsworth

    2014-01-01

    Full Text Available A 17-year-old male was transferred to the pediatric intensive care unit for evaluation of acute liver failure. He was recently released from an alcohol treatment center with acute onset of chest pain. Cardiac workup was negative but he was found to have abnormal coagulation studies and elevated liver transaminases. Other evaluations included a normal toxicology screen and negative acetaminophen level. Autoimmune and infectious workups were normal providing no identifiable cause of his acute liver failure. He initially denied any ingestions or illicit drug use but on further query he admitted taking niacin in an attempt to obscure the results of an upcoming drug test. Niacin has been touted on the Internet as an aid to help pass urine drug tests though there is no evidence to support this practice. Niacin toxicity has been associated with serious multisystem organ failure and fulminant hepatic failure requiring liver transplantation. Pediatric providers should be aware of the risks associated with niacin toxicity and other experimental medical therapies that may be described on the Internet or other nonreputable sources.

  12. Acute respiratory distress syndrome: epidemiology and management approaches

    Directory of Open Access Journals (Sweden)

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  13. 不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值探析%Clinical Value of Noninvasive Bi-level Positive Airway Pressure Ventilation in Patients With Acute Respiratory Failure Caused by Different Causes

    Institute of Scientific and Technical Information of China (English)

    李晓理

    2016-01-01

    目的:对不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值进行评价分析。方法对68例急性呼吸衰竭患者依据病因的不同分成心源性肺水肿组和重症肺炎组,接受无创双水平气道正压通气治疗,对比分析治疗效果。结果心源性肺水肿组患者治疗后动脉血气指标、症状缓解时间、治疗时间、住院时间与对照组比较差异有统计学意义(P <0.05)。结论无创双水平气道正压通气对不同病因引起的急性呼吸衰竭具有良好的治疗效果。%Objective The different causes in patients with acute respiratory failure and clinical value of noninvasive bi-level positive airway pressure ventilation in the treatment of evaluation and analysis. Methods 68 patients with acute respiratory failure were divided according to different causes of cardiogenic pulmonary edema and severe pneumonia group, accepted non-invasive bi-level positive airway pressure therapy, comparative analysis of the treatment effect. Results Cardiogenic pulmonary edema patients arterial blood gas treatment, remission time, treatment time, duration of hospitalization with the control group was significantly different (P<0.05). Conclusion Noninvasive bi-level positive airway pressure ventilation in acute respiratory failure caused by different causes have a good therapeutic effect.

  14. Pathological study on severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    郎振为; 张立洁; 张世杰; 孟忻; 李俊强; 宋晨朝; 孙琳; 周育森

    2003-01-01

    Objective To study the pathological characteristics of severe acute respiratory syndrome (SARS) and its relationship to clinical manifestation. Methods Tissue specimens from 3 autopsies of probable SARS cases were studied by microscope, and the clinical data was reviewed.Results The typical pathological changes of lungs were diffuse hemorrhaging on the surface. A combination of serous, fibrinous and hemorrhagic inflammation was seen in most of the pulmonary alveoli with the engorgement of capillaries and detection of micro-thrombosis in some of these capillaries. Pulmonary alveoli thickened with interstitial mononuclear inflammatory infiltrates, suffered diffuse alveolar damage, experienced desquamation of pneumocytes and had hyaline-membrane formation, fibrinoid materials, and erythrocytes in alveolar spaces. There were thromboembolisms in some bronchial arteries. Furthermore, hemorrhagic necrosis was also evident in lymph nodes and spleen with the attenuation of lymphocytes. Other atypical pathological changes, such as hydropic degeneration, fatty degeneration, interstitial cell proliferation and lesions having existed before hospitalization were observed in the liver, heart, kidney and pancreas.Conclusion Severe damage to the pulmonary and immunological systems is responsible for the clinical features of SARS and may lead to the death of patients.

  15. Cerebral edema associated with acute hepatic failure.

    Directory of Open Access Journals (Sweden)

    Fujiwara,Masachika

    1985-02-01

    Full Text Available The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64% of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more frequently in patients later found to have cerebral edema. Moreover, the length of time from deep coma to death was much shorter in the brain edema cases with cerebral herniation than without herniation.

  16. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  17. ACUTE RESPIRATORY DISEASE AS THE DEBUT OF SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    A. Yu. Ischenko

    2015-01-01

    Full Text Available Systemic lupus erythematosus — a chronic autoimmune disease that is often associated with infectious processes. The paper presents two clinical cases of systemic lupus erythematosus , debuted with acute respiratory infection.

  18. Fibromyalgia after severe acute respiratory syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    TIAN Xin-ping; ZENG Xiao-feng; XU Wen-bin

    2006-01-01

    @@ Since November 2002, an infectious disease with unknown cause occurred in China and many countries had been involved. Cases were reported in 28 countries and more than 5050 individuals had been infected.1 Lung is the most frequently involved organ and can be fatal in severe cases. At the end of February 2003, it was defined as Severe Acute Respiratory Syndrome (SARS) by World Health Organization. China had a SARS epidemic in the spring of 2003. More than 1000 patients were infected and some patients died of respiratory failure.Finally, a new variant of coronavirus was suspected to be the pathogen although the pathogenesis was still unclear. Since it is a new disease and we have very limited knowledge about its clinical sequela, we followed the survived patients closely in order to understand it in depth. During the follow up, we discovered an interesting patient who was finally diagnosed as fibromyalgia. We report this case herein to share our experience with clinicians who may see patients with SARS or fibromyalgia.

  19. [Assessment of chronic glucose metabolism disorders coexisting with respiratory failure in non-critical ill patients hospitalized with lower respiratory tract infections].

    Science.gov (United States)

    Sobocińska, Magdalena Barbara; Loba, Jerzy

    2015-01-01

    Lungs are the target organ in chronic hyperglycemia, but its large reserves causes a subclinical course of these changes. Given the results of other researchers indicating reduced active surface of gas exchange and pulmonary capillary damage, it can be assumed that diabetes and other hyperglycemic states diminish these reserves and impair effectiveness of respiratory gas exchange during pneumonia. So it is plausible to observe coexistence of glucose metabolism disorders and respiratory failure in patients hospitalized with lower respiratory tract infection. An observational study was conducted on 130 patients hospitalized with bacteriologically confirmed pneumonia. 63 patients suffering from chronic glucose metabolism disorders (A) and 67 randomly selected patients in control group (B) were observed on laboratory and clinical findings. There was no significant difference in prevalence of acute respiratory failure, although in the study group a slightly greater number of patients diagnosed with acute respiratory failure was observed. There was a significantly greater number of patients with previously confirmed chronic respiratory failure using long-term oxygen theraphy in A group (p = 0.029). The B patients with average blood glucose level > 108 mg/dl had significantly lower partial pressure of oxygen (PaO2)(gIc ≤ 108: 58.6 +/- 9.8; glc > 108: 51.7 +/- 11.1; p = 0.042). There was a statistically significant negative correlation of the average blood glucose level and PaO2 in the control group (p = 0.0152) and a significant inverse association between the average blood glucose level and the partial pressure of oxygen in patients without COPD belonging to the control group (p = 0.049). Respiratory failure is frequent in patients hospitalized with pneumonia. In patients without chronic glucose metabolism disorders with blood glucose level rising the oxygen tension decreases The association is stronger in patients without COPD.

  20. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far.......Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  1. Acute effects of winter air pollution on respiratory health

    NARCIS (Netherlands)

    Zee, van der S.

    1999-01-01

    In this thesis, acute respiratory health effects of exposure to winter air pollution are investigated in panels of children (7-11 yr) and adults (50-70 yr) with and without chronic respiratory symptoms, living in urban and non-urban areas in the Netherlands. The study was performed during three cons

  2. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    OpenAIRE

    Kneijber, M.C.J.; Heerde, van, H.J.W; Twisk, J W R; Plotz, F.; Markhorst, D.G.

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus convent...

  3. Surfactant therapy for acute respiratory distress in infants

    Directory of Open Access Journals (Sweden)

    Corrado Moretti

    2014-06-01

    Full Text Available Acute respiratory distress syndrome (ARDS remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Data indicate that adoption of a lung protective ventilation with low tidal volumes and of an open-lung ventilation strategy, characterized by sufficient positive end-expiratory pressure (PEEP to avoid atelectasis, provides the greatest likelihood of survival and minimizes lung injury. The relative benefits of strategies such as high frequency oscillatory ventilation (HFOV, inhaled nitric oxide (iNO, recruiting manoeuvres and prone position are also considered. Moreover this article examines exogenous lung surfactant replacement therapy and its efficacy in the treatment of paediatric ARDS. In infants and children with acute lung injury the endogenous surfactant system is not only deficient, as observed in preterm infants, but altered via a variety of other mechanisms like inhibition and dysfunction. All factors contribute to the altered physiology seen in ARDS. The role of exogenous surfactant in lung injury beyond the neonatal period is therefore more complex and its limited efficacy may be related to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution or, simply, an inability of the drug to counteract the underlying pathophysiology of ARDS. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS, however some studies have shown that this therapy can improve oxygenation and decrease mortality in some specific

  4. Weaning from the ventilator in patients with respiratory failure

    OpenAIRE

    Berg, Bart

    1994-01-01

    textabstractWeaning from the ventilator is the gradual withdrawal of mechanical ventilatory support. Mechanical ventilation is well-accepted as rescue therapy in patients with life-threatening respiratory failure. As this treatment is associated with substantial morbidity and mortality, ventilatory support is only considered beneficial when applied during a limited period. In many patients however weaning from the ventilator is a cumbersome process. In this chapter the issues related to the w...

  5. Surfactant alteration and replacement in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Walmrath Dieter

    2001-10-01

    Full Text Available Abstract The acute respiratory distress syndrome (ARDS is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactant phospholipids and apoproteins into polymerizing fibrin, and damage/inhibition of surfactant compounds by inflammatory mediators. There is now good evidence that these surfactant abnormalities promote alveolar instability and collapse and, consequently, loss of compliance and the profound gas exchange abnormalities seen in ARDS. An acute improvement of gas exchange properties together with a far-reaching restoration of surfactant properties was encountered in recently performed pilot studies. Here we summarize what is known about the kind and severity of surfactant changes occuring in ARDS, the contribution of these changes to lung failure, and the role of surfactant administration for therapy of ARDS.

  6. Air pollution and multiple acute respiratory outcomes.

    Science.gov (United States)

    Faustini, Annunziata; Stafoggia, Massimo; Colais, Paola; Berti, Giovanna; Bisanti, Luigi; Cadum, Ennio; Cernigliaro, Achille; Mallone, Sandra; Scarnato, Corrado; Forastiere, Francesco

    2013-08-01

    Short-term effects of air pollutants on respiratory mortality and morbidity have been consistently reported but usually studied separately. To more completely assess air pollution effects, we studied hospitalisations for respiratory diseases together with out-of-hospital respiratory deaths. A time-stratified case-crossover study was carried out in six Italian cities from 2001 to 2005. Daily particulate matter (particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10)) and nitrogen dioxide (NO2) associations with hospitalisations for respiratory diseases (n = 100 690), chronic obstructive pulmonary disease (COPD) (n = 38 577), lower respiratory tract infections (LRTI) among COPD patients (n = 9886) and out-of-hospital respiratory deaths (n = 5490) were estimated for residents aged ≥35 years. For an increase of 10 μg·m(-3) in PM10, we found an immediate 0.59% (lag 0-1 days) increase in hospitalisations for respiratory diseases and a 0.67% increase for COPD; the 1.91% increase in LRTI hospitalisations lasted longer (lag 0-3 days) and the 3.95% increase in respiratory mortality lasted 6 days. Effects of NO2 were stronger and lasted longer (lag 0-5 days). Age, sex and previous ischaemic heart disease acted as effect modifiers for different outcomes. Analysing multiple rather than single respiratory events shows stronger air pollution effects. The temporal relationship between the pollutant increases and hospitalisations or mortality for respiratory diseases differs.

  7. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    OpenAIRE

    Milani, M

    2003-01-01

    Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinic...

  8. Acute respiratory distress syndrome: the Berlin Definition.

    Science.gov (United States)

    Ranieri, V Marco; Rubenfeld, Gordon D; Thompson, B Taylor; Ferguson, Niall D; Caldwell, Ellen; Fan, Eddy; Camporota, Luigi; Slutsky, Arthur S

    2012-06-20

    The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.

  9. Tsutsugamushi infection-associated acute rhabdomyolysis and acute renal failure.

    Science.gov (United States)

    Young, Park Chi; Hae, Chung Choon; Lee, Kim Hyun; Hoon, Chung Jong

    2003-12-01

    Rhabdomyolysis is a rare complication that emerges in a variety of infectious diseases, such as tsutsugamushi infection. In this study, we report a 71-year-old female patient with tsutsugamushi infection who exhibiting rhabdomyolysis and acute renal failure. On admission, an eschar, which is characteristic of tsutsugamushi infection, was found on her right flank area. Moreover, her tsutsugamushi antibody titer was 1:40960. The elevated values of serum creatinine phosphokinase (CPK), aldolase, creatinine and dark brown urine secondary to myoglobinuria are consistent with indications of rhabdomyolysis and acute renal failure due to tsutsugamushi infection. Her health improved without any residual effects after treatment with doxycyclin and hydration with normal saline. PMID:14717236

  10. Effect Assessment of Noninvasive Ventilator Applied in Acute Left Heart Failure with Type II Respiratory Failure at Different Timing%急性左心衰伴II型呼吸衰竭无创呼吸机不同应用时机的效果评价

    Institute of Scientific and Technical Information of China (English)

    陈礼刚; 李勇; 张艳霞

    2016-01-01

    目的::剖析比较不同时机应用无创通气治疗急性左心衰伴Ⅱ型呼吸衰竭的临床效果。方法:对照组先行常规处置与低流量吸氧,不改善再实施无创通气,实验组在常规处置的同时即应用无创通气,观察比较两组治疗前后各观察指标变化、疗效及住院时间。结果:两组治疗前心率、呼吸、平均动脉压及动脉氧分压等指标比较均无明显差异(P>0.05),治疗后各指标均有所改善(P0.05),and all the inde-xes were changed after treatment of the two groups(P<0.05),and the improvement rate of the experimental group was significantly higher than that in the control group (P<0.05).The effective rate in the experimen-tal group(84.9%)was significantly better than that in the control group (P<62.3%),while the rate of con-version and hospital stay were significantly less than those in the control group (P<0.05).Conclusion:The early application of noninvasive treatment in acute left heart failure with type II respiratory failure has exact results.

  11. Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome and Acute Lung Injury in Adults and Children: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2011-01-01

    data demonstrated a statistically insignificant effect of iNO on duration of ventilation, ventilator-free days, and length of stay in the intensive care unit and hospital. We found a statistically significant but transient improvement in oxygenation in the first 24 hours, expressed as the ratio of Po2......BACKGROUND: Acute hypoxemic respiratory failure, defined as acute lung injury and acute respiratory distress syndrome, are critical conditions associated with frequent mortality and morbidity in all ages. Inhaled nitric oxide (iNO) has been used to improve oxygenation, but its role remains...... be recommended for patients with acute hypoxemic respiratory failure. iNO results in a transient improvement in oxygenation but does not reduce mortality and may be harmful....

  12. Acute respiratory distress syndrome in an alpaca cria

    OpenAIRE

    Simpson, Katharine M.; Streeter, Robert N.; Genova, Suzanne G.

    2011-01-01

    A 7-hour-old alpaca was presented for lethargy and depression. The cria responded favorably to initial treatment but developed acute-onset dyspnea 48 hours later. Acute respiratory distress syndrome was diagnosed by thoracic imaging and blood gas analysis. The cria was successfully treated with corticosteroids and discharged from the hospital.

  13. Acute renal failure in Yemeni patients

    Directory of Open Access Journals (Sweden)

    Muhamed Al Rohani

    2011-01-01

    Full Text Available Acute renal failure (ARF is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days. The Science and Technology University Hospital, Sana′a, is a referral hospital that caters to patients from all parts of Yemen. The aim of this study is to have a deeper overview about the epidemiological status of ARF in Yemeni patients and to identify the major causes of ARF in this country. We studied 203 patients with ARF over a period of 24 months. We found that tropical infectious diseases constituted the major causes of ARF, seen in 45.3% of the patients. Malaria was the most important and dominant infectious disease causing ARF. Hypotension secondary to infection or cardiac failure was seen in 28.6% of the patients. Obstructive nephropathy due to urolithiasis or prostate enlargement was the cause of ARF in a small number of patients. ARF was a part of multi-organ failure in 19.7% of the patients, and was accompanied by a high mortality rate. Majority of the patients were managed conservatively, and only 39.9% required dialysis. Our study suggests that early detection of renal failure helps improve the outcome and return of renal function to normal. Mortality was high in patients with malaria and in those with associated hepatocellular failure.

  14. Emergency treatment and nursing of children with severe pneumonia complicated by heart failure and respiratory failure: 10 case reports

    Science.gov (United States)

    Li, Wanli; An, Xinjiang; Fu, Mingyu; Li, Chunli

    2016-01-01

    Pneumonia refers to lung inflammation caused by different pathogens or other factors, and is a common pediatric disease occurring in infants and young children. It is closely related to the anatomical and physiological characteristics of infants and young children and is more frequent during winter and spring, or sudden changes in temperature. Pneumonia is a serious disease that poses a threat to children's health and its morbidity and mortality rank first, accounting for 24.5–65.2% of pediatric inpatients. Due to juvenile age, severe illness and rapid changes, children often suffer acute heart failure, respiratory failure and even toxic encephalopathy at the same time. The concurrence in different stages of the process of emergency treatment tends to relapse, which directly places the lives of these children at risk. Severe pneumonia constitutes one of the main causes of infant mortality. In the process of nursing children with severe pneumonia, intensive care was provided, including condition assessment and diagnosis, close observation of disease, keeping the airway unblocked, rational oxygen therapy, prevention and treatment of respiratory and circulatory failure, support of vital organs, complications, and health education. The inflammatory response was proactively controlled, to prevent suffocation and reduce mortality. In summary, positive and effective nursing can promote the rehabilitation of children patients, which can be reinforced with adequate communication with the parents and/or caretakers.

  15. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    DEFF Research Database (Denmark)

    von Linstow, Marie-Louise; Larsen, Hans Henrik; Eugen-Olsen, Jesper;

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection...... children 1-6 months of age. Asthmatic bronchitis was diagnosed in 66.7% of hMPV and 10.6% of RSV-infected children (p respiratory support. hMPV is present in young...

  16. 强离子隙在急性呼吸衰竭中的应用研究%Evaluation of Strong Ion Gap in Patients with Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    张忠源; 章涛

    2015-01-01

    目的 评估强离子隙( SIG)作为急性呼吸衰竭( ARF)患者死亡风险预测因子的临床价值. 方法 在测定血气、血pH值、电解质结果基础上,应用Stewart-Figge方法学的方程式计算SIG. 结果 (1) ARF发生率最高的基础疾病是急性呼吸窘迫综合征(占26%)和心源性肺水肿(占26%). (2)ARF组T1 与对照组相比,除Na+和PO4-无差别外,其余各指标差异均有统计学意义(P<0.01);但恢复组T2 与对照组相比,各指标差异均无统计学意义.(3)发生ARF的患者中,恢复组T1 与死亡组T1检测各指标比较:两组间只有AG、SIG差异有统计学意义(P<0.01).(4)AG和SIG相关ROC曲线参数比较:SIG曲线下面积更大达到0.904,诊断准确性高;以15.4mmol/L作为AG的cut-off值,以6.77mmol/L作为SIG的cut-off值,计算相关ROC曲线参数,SIG的敏感度、Youden指数、阴性预测值、阴性似然比等参数优于AG.结论 (1)在发生ARF之初,AG和SIG就可以较敏感地体现患者的复合酸碱紊乱状态,且AG和SIG有可能作为预测ARF患者死亡风险的预测因子,提示预后不良. (2)作为ARF患者死亡风险的预测因子,SIG优于AG.(3)当cut-off值设为6.77mmol/L时,SIG的检测结果低于cut-off值,SIG的阴性似然比为0,敏感度高达1.000,如果诊断结果为阴性,能立刻排除患者死亡风险.%Objective To evaluate the probability that strong ion gap was selected as predictive factor of mortality in patients with a -cute respiratory failure.Methods SIG was calculated with the Stewart -Figge model, after determination of blood gas ,blood pH,serum electrolytes.Results ①The incidence of acute respiratory distress syndrome and source pulmonary edema was 26% respectively in pa-tients with ARF.②There was a significant difference in the values of K +、Cl-、HCO3-、AG、pH、ALB、SIG、Cr,lactic acid,PaCO2 and PaO2 between group T 1 and control .However , there was no significant difference between recovery group T 2 and control .

  17. Phagocyte respiratory burst activates macrophage erythropoietin signalling to promote acute inflammation resolution

    Science.gov (United States)

    Luo, Bangwei; Wang, Jinsong; Liu, Zongwei; Shen, Zigang; Shi, Rongchen; Liu, Yu-Qi; Liu, Yu; Jiang, Man; Wu, Yuzhang; Zhang, Zhiren

    2016-01-01

    Inflammation resolution is an active process, the failure of which causes uncontrolled inflammation which underlies many chronic diseases. Therefore, endogenous pathways that regulate inflammation resolution are fundamental and of wide interest. Here, we demonstrate that phagocyte respiratory burst-induced hypoxia activates macrophage erythropoietin signalling to promote acute inflammation resolution. This signalling is activated following acute but not chronic inflammation. Pharmacological or genetical inhibition of the respiratory burst suppresses hypoxia and macrophage erythropoietin signalling. Macrophage-specific erythropoietin receptor-deficient mice and chronic granulomatous disease (CGD) mice, which lack the capacity for respiratory burst, display impaired inflammation resolution, and exogenous erythropoietin enhances this resolution in WT and CGD mice. Mechanistically, erythropoietin increases macrophage engulfment of apoptotic neutrophils via PPARγ, promotes macrophage removal of debris and enhances macrophage migration to draining lymph nodes. Together, our results provide evidences of an endogenous pathway that regulates inflammation resolution, with important implications for treating inflammatory conditions. PMID:27397585

  18. Phagocyte respiratory burst activates macrophage erythropoietin signalling to promote acute inflammation resolution.

    Science.gov (United States)

    Luo, Bangwei; Wang, Jinsong; Liu, Zongwei; Shen, Zigang; Shi, Rongchen; Liu, Yu-Qi; Liu, Yu; Jiang, Man; Wu, Yuzhang; Zhang, Zhiren

    2016-01-01

    Inflammation resolution is an active process, the failure of which causes uncontrolled inflammation which underlies many chronic diseases. Therefore, endogenous pathways that regulate inflammation resolution are fundamental and of wide interest. Here, we demonstrate that phagocyte respiratory burst-induced hypoxia activates macrophage erythropoietin signalling to promote acute inflammation resolution. This signalling is activated following acute but not chronic inflammation. Pharmacological or genetical inhibition of the respiratory burst suppresses hypoxia and macrophage erythropoietin signalling. Macrophage-specific erythropoietin receptor-deficient mice and chronic granulomatous disease (CGD) mice, which lack the capacity for respiratory burst, display impaired inflammation resolution, and exogenous erythropoietin enhances this resolution in WT and CGD mice. Mechanistically, erythropoietin increases macrophage engulfment of apoptotic neutrophils via PPARγ, promotes macrophage removal of debris and enhances macrophage migration to draining lymph nodes. Together, our results provide evidences of an endogenous pathway that regulates inflammation resolution, with important implications for treating inflammatory conditions. PMID:27397585

  19. Disseminated Cryptococcal Infection Resulting in Acute Respiratory Distress Syndrome (ARDS) as the Initial Clinical Presentation of AIDS.

    Science.gov (United States)

    Orsini, Jose; Blaak, Christa; Tam, Eric; Rajayer, Salil; Morante, Joaquin

    2016-01-01

    Cryptococcosis is a cosmopolitan but rare opportunistic mycosis which is usually caused by Cryptococcus neoformans. Although the most common and worrisome disease manifestation is meningoencephalitis, pulmonary cryptococcosis has the potential to be lethal. The diagnosis of cryptococcal pneumonia is challenging, given its non-specific clinical and radiographic features. Respiratory failure leading to acute respiratory distress syndrome as a consequence of cryptococcal disease has been infrequently addressed in the literature. We herein present a case of disseminated cryptococcal infection leading to acute respiratory distress syndrome, refractory shock, and multiorgan dysfunction as the initial clinical manifestation in a patient who was newly diagnosed with acquired immunodeficiency syndrome. PMID:27086819

  20. Rhabdomyolysis and Acute Renal Failure after Gardening

    Directory of Open Access Journals (Sweden)

    Zeljko Vucicevic

    2015-01-01

    Full Text Available Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed.

  1. Rhabdomyolysis and acute renal failure after gardening.

    Science.gov (United States)

    Vucicevic, Zeljko

    2015-01-01

    Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed. PMID:25954536

  2. Cardiorenal biomarkers in acute heart failure

    Institute of Scientific and Technical Information of China (English)

    Rajiv Choudhary; Dipika Gopal; Ben A. Kipper; Alejandro De La Parra Landa; Hermineh Aramin

    2012-01-01

    Managing patients with heart failure (HF) is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient's bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.

  3. Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment.

    Science.gov (United States)

    Paschoal, Ilma Aparecida; Villalba, Wander de Oliveira; Pereira, Mônica Corso

    2007-01-01

    Neuromuscular diseases affect alveolar air exchange and therefore cause chronic respiratory failure. The onset of respiratory failure can be acute, as in traumas, or progressive (slow or rapid), as in amyotrophic lateral sclerosis, muscular dystrophies, diseases of the myoneural junction, etc. Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthopedic braces and prostheses used to aid respiration since the end of the 19th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine); pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed.

  4. Analysis of respirator treatment on acute respiratory failure after cervical spinal injury%呼吸机治疗急性颈髓损伤后急性呼吸衰竭的临床体会

    Institute of Scientific and Technical Information of China (English)

    杜志军; 洪云飞; 康智

    2008-01-01

    目的 观察颈髓损伤后用呼吸机治疗急性呼吸衰竭的临床疗效.方法 2005年10月至2007年1月55由椎骨折并脊髓损伤患者,应用药物、手术固定、呼吸机综合治疗.结果 55例病例中,16例出现呼吸衰竭,其中11台情稳定,3例呼吸衰竭死亡,1例因肺部严重感染家属放弃治疗,1例出现心肌梗死转院.结论 对急性颈髓损伤,早期应用呼吸机治疗有较好的疗效.%Objective To study the elinieal effeets of the comprehensive treatments on aeute respiratory failure after eervieal spinal injury. Methods Totally 55 eases of fracture of cervical spine and spinal injury from November 2005 to January 2007 were reviewed and analyzed, while the symptoms of dyspnea commonly existing. The eomprehensive treatments of drugs, surgical fixation and respirator were applied. Results 16cases of aeute respiratory failure resulted that 3 eases be taken worse to death, 1 ease with subsequent severe pulmonary infeetion and 1 case with myoeardial infarction, 11 eases turned out for the best. Conclusion Early intervention with respirator has the better result.

  5. Therapeutic hypothermia for acute liver failure

    DEFF Research Database (Denmark)

    Stravitz, R.T.; Larsen, Finn Stolze

    2009-01-01

    Cerebral edema is a potentially life-threatening complication of acute liver failure, the syndrome of abrupt loss of liver function in a patient with a previously healthy liver. Although the prevalence of cerebral edema appears to be decreasing, patients with rapidly progressive (hyperacute) liver...... liver failure often can be temporarily controlled by manipulating body position, increasing the degree of sedation, and increasing blood osmolarity through pharmacologic means. However, these maneuvers often postpone, but do not eliminate, the risk of brainstem herniation unless orthotopic liver...... transplantation or spontaneous liver regeneration follows in short order. To buy time, the induction of therapeutic hypothermia (core temperature 32 degrees C-35 degrees C) has been shown to effectively bridge patients to transplant. Similar to the experience in patients with cerebral edema after other neurologic...

  6. Dengue fever with acute liver failure

    OpenAIRE

    Vinodh B; Bammigatti C; Kumar Ashok; Mittal V

    2005-01-01

    A virus belonging to the Flaviviridae group causes dengue haemorrhagic fever. Dengue presenting as acute liver failure is rare. Dengue is endemic in India. The last epidemic of dengue occurred in Delhi in 2003. During this epidemic, 2185 confirmed cases of dengue were reported. Dengue virus serotypes 2 and 3 were responsible for this epidemic. A 19-yr-old male presented to our hospital with the complaints of fever for 12 days, during this epidemic. He was diagnosed as having dengue shock synd...

  7. The Pathology of Acute Liver Failure.

    Science.gov (United States)

    Lefkowitch, Jay H

    2016-05-01

    Acute liver failure (ALF) is a rare and severe liver disease that usually develops in 8 weeks or less in individuals without preexisting liver disease. Its chief causes worldwide are hepatitis virus infections (hepatitis A, B, and E) and drug hepatotoxicity (particularly intentional or unintentional acetaminophen toxicity). Massive hepatic necrosis is often seen in liver specimens in ALF and features marked loss of hepatocytes, variable degrees of inflammation, and a stereotypic proliferation of bile ductular structures (neocholangioles) derived from activated periportal hepatic progenitor cells. This paper reviews the liver pathology in ALF, including forms of zonal necrosis and their etiologies. PMID:27058243

  8. Diagnosis and management of acute heart failure.

    Science.gov (United States)

    Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet Birhan; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem

    2015-11-01

    Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge. PMID:26574757

  9. Portal hypertension in acute liver failure.

    OpenAIRE

    3.M. Navasa; Garcia-Pagán, J C; Bosch, J; Riera, J R; R. Bañares; Mas, A.; Bruguera, M; Rodés, J

    1992-01-01

    Twenty five patients with acute liver failure were measured for hepatic venous pressure gradient as an index of portal pressure during the course of a transjugular liver biopsy. Hepatic venous pressure gradient ranged from 4 to 24.5 mm Hg with a mean of 12.8 (5.3) mm Hg (normal values less than 5 mm Hg). All patients but one had increased portal pressure gradient. Portal hypertension correlated with the degree of architectural distortion of the liver, as suggested by a direct correlation betw...

  10. The role of invasive ventilation in exacerbations of chronic obstructive pulmonary disease causing respiratory failure.

    Science.gov (United States)

    Kosky, Christopher; Turton, Charles

    2006-01-01

    Acute hypercapnic respiratory failure in chronic obstructive pulmonary disease can usually be managed initially with medical treatment and non- invasive ventilation. In circumstances where non- invasive ventilation cannot be used or has failed, intubation and invasive ventilation may be lifesaving. The outcome of patients with an exacerbation of COPD requiring invasive ventilation is better than often thought, with a hospital survival of 70-89%. Decisions regarding invasive ventilation made by physicians and patients with COPD are unpredictable and vary with the individual. This article reviews the role of invasive ventilation in exacerbations of COPD to assist decision making.

  11. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex

    OpenAIRE

    Moreno, A. M.; R.R.T. de Castro; Silva, B. M.; Villacorta, H; M. Sant'Anna Junior; Nóbrega, A.C.L.

    2014-01-01

    The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66±12 years; left ventricle ejection fraction, 34±3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as th...

  12. [Nasal Highflow (NHF): A New Therapeutic Option for the Treatment of Respiratory Failure].

    Science.gov (United States)

    Bräunlich, J; Nilius, G

    2016-01-01

    The therapy of choice in hypoxemic respiratory failure (type 1) is the application of supplemental oxygen at flow rates of 1 to 15 l/min via nasal prongs or mask. Non-invasive or invasive positive pressure ventilation will be initiated when the oxygen therapy effects are not sufficient or if hypercapnic respiratory failure (type 2) is the underlying problem. Recently, an alternative therapy option is available, from the pathophysiology it can be classified between oxygen therapy and positive pressure ventilation. The therapy called Nasal High Flow (NHF) is based on the nasal application of a heated and humidified air oxygen mixture with a flow range of up to 60 l/min. The precise pathophysiological principles of NHF are only partly understood, yet various aspects are well studied already: it is possible to deliver high oxygen concentrations, airway dryness can be avoided, dead space ventilation reduced and clearance of nasal dead space is achieved. Additionally, an end expiratory positive pressure is built up, which helps to prevent airway collapse, thus resulting in an improvement of respiratory efficiency and reduction of breathing work. Current studies demonstrate improvement in gas exchange and reduction of reintubation rate when applying the NHF treatment in acute respiratory failure. Thus the NHF therapy attracts attention in intensive care medicine. The application in other fields like chronic respiratory insufficiency is less well clarified. The objectives of this review are to present the pathophysiological effects and mechanisms of NHF, as far as understood, and to give an overview over the current state of relevant studies. PMID:26789432

  13. Always Consider the Possibility of Opioid Induced Respiratory Depression in Patients Presenting with Hypercapnic Respiratory Failure Who Fail to Improve as Expected with Appropriate Therapy

    OpenAIRE

    Martin Steynor; Andrew MacDuff

    2015-01-01

    Hypercapnic respiratory failure is a frequently encountered medical emergency. Two common causes are acute exacerbations of chronic obstructive pulmonary disease (COPD) and as a side effect of opioids. The two causes may coexist leading to diagnostic confusion and consequent delay in optimal management. We report a case of what was initially thought to be an exacerbation of COPD. The patient failed to improve with treatment as expected which led to the empirical administration of naloxone res...

  14. Analysis of the Effect of Non-invasive Positive Pressure Ventilation in the Treatment of Acute StrokeComplicated with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease%无创正压通气治疗急性脑卒中合并慢性阻塞性肺疾病呼吸衰竭的疗效

    Institute of Scientific and Technical Information of China (English)

    刘梅; 蔡振林; 邓星奇; 李响; 凌美蓉; 周健

    2012-01-01

    Aim: To study the effect of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute stroke complicated with respiratory failure due to chronic obstructive pulmonary disease(COPD). Methods: Analysis of 67 patients with acute stroke complicated with respiratory failure due to chronic obstructive pulmonary disease(COPD) (acute stroke+COPDRF group), 59 patients with acute stroke complicated with central respiratory failure(acute stroke+CRF group), 65 patients with COPD complicated with respiratory failure (control group) were treated by BiPAP. During six hours before and after the treatment, the changes of vital signs and arterial blood gas, mortality rate, average effective ventilation time, and average mechanical ventilation time of dead or survivor in the three groups were analyzed statistically. Results: The therapeutic efficiency of acute stroke+COPDRF group, acute stroke+CRF group and the control group was 71.64%, 30.50%, 72.30%, respectively. There was no statistical significance between the acute stroke+COPDRF group and the control group (P>0.05). There were statistical significances between the acute stroke+CRF group and the other two groups(F0.05). There were statistical significances between the acute stroke+CRF group and the other two groups(p<0.01). There were statistical significances between the acute stroke+COPDRF group and the control group in average effective ventilation time, and between the acute stroke +CRF group and the other two groups(p<0.05). There were statistical significances between the average mechanical ventilation time of dead or survivor with acute stroke+COPDRF group and the control group and the other two groups(p<0.05). Conclusion: It was confirmed that non-invasive positive pressure ventilation on acute stroke complicated with respiratory failure due to COPD had clinical effect.%目的:观察无创正压通气(NIPPV)治疗急性脑卒中合并慢性阻塞性肺疾病(COPD)呼吸衰

  15. A review of pulmonary coagulopathy in acute lung injury, acute respiratory distress syndrome and pneumonia

    NARCIS (Netherlands)

    Nieuwenhuizen, Laurens; de Groot, Philip G.; Grutters, Jan C.; Biesma, Douwe H.

    2009-01-01

    Enhanced bronchoalveolar coagulation is a hallmark of many acute inflammatory lung diseases such as acute lung injury, acute respiratory distress syndrome and pneumonia. Intervention with natural anticoagulants in these diseases has therefore become a topic of interest. Recently, new data on the rol

  16. Prognostic models for acute liver failure

    Institute of Scientific and Technical Information of China (English)

    Wei-Bo Du; Xiao-Ping Pan; Lan-Juan Li

    2010-01-01

    BACKGROUND: Acute liver failure (ALF) remains a dramatic and unpredictable disease with high morbidity and mortality. Early and accurate prognostic assessment of patients with ALF is critically important for optimum clinical pathway. DATA SOURCES: Five English-language medical databases, MEDLINE, ScienceDirect, OVID, Springer Link and Wiley Interscience were searched for articles on"acute liver failure","prognosis", and related topics. RESULTS: Multi-variable prognostic models including the King's College Hospital criteria and the model for end-stage liver disease score have been widely used in determination of the prognosis of ALF, but the results are far from satisfactory. Other prognostic indicators including serum Gc-globulin, arterial blood lactate, serum phosphate, arterial blood ammonia, and serum alpha-fetoprotein are promising but await further assessement. CONCLUSIONS: A reliable prognostic model to be developed in the future should not only have predictive value for poor outcome but also help to predict the survival of patients without a liver transplantation. Further studies are necessary to assess the prognostic accuracy of any new models.

  17. Plasma osteopontin in acute liver failure

    DEFF Research Database (Denmark)

    Srungaram, Praveen; Rule, Jody A; Yuan, He Jun;

    2015-01-01

    BACKGROUND: Osteopontin (OPN) is a novel phosphoglycoprotein expressed in Kupffer cells that plays a pivotal role in activating natural killer cells, neutrophils and macrophages. Measuring plasma OPN levels in patients with acute liver failure (ALF) might provide insights into OPN function...... in the setting of massive hepatocyte injury. METHODS: OPN levels were measured using a Quantikine® ELISA assay on plasma from 105 consecutive ALF patients enrolled by the US Acute Liver Failure Study Group, as well as controls including 40 with rheumatoid arthritis (RA) and 35 healthy subjects both before, and 1....../mL; range 2.6-86.4). RA and SF post op patients had elevated OPN levels (37ng/mL and 198ng/mL respectively), well below those of the ALF patients. Median OPN levels were highest in acetaminophen (3603ng/mL) and ischemia-related ALF (4102ng/mL) as opposed to viral hepatitis (706ng/mL), drug-induced liver...

  18. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Respiratory failure Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Insuficiencia respiratoria

    OpenAIRE

    T. Grau Carmona; López Martínez, J.; B. Vila García

    2011-01-01

    Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanic...

  19. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    OpenAIRE

    Wasem, Jürgen; Caspary, Wolfgang; Siebert, Uwe; Schnell-Inderst, Petra; Grabein, Kristin; Hessel, Franz

    2006-01-01

    Background: Conventional diagnostic procedures and therapy of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can onl...

  20. Pulmonary hypertension due to acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  1. Fluid in the management of the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  2. the Pathogenesis of acute on Chronic Hepatitis B liver Failure

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    Acute-on-chronic liver failure is a characteristic clinical liver syndrome, which should be differentiated from acute liver failure, acute decompensated liver cirrhosis and chronic liver failure. The pathogenesis of ACLF is not fully understood yet. Viral factors and immune injury have been reported to be the two major pathogenesis. This paper reviewed the researches on the pathogenesis of acute on chronic hepatitis B liver failure in recent years, to provide theoretical basis for prompt and accurate diagnosis and treatment of this syndrome. This would beneift for the prognosis and raise the survival rate of patients.

  3. "ACUTE LIVER FAILURE" : THE HEART MAY BE THE MATTER

    NARCIS (Netherlands)

    de Leeuw, K.; van der Horst, I. C. C.; van der Berg, A. P.; Ligtenberg, J. J. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John H. J. M.

    2011-01-01

    Hypoxic hepatitis secondary to heart failure is a known and treatable cause of liver failure. The diagnosis may be difficult, especially when symptoms of heart failure are absent. We present two patients who were transferred to our hospital with the diagnosis of acute liver failure to be screened fo

  4. Acute Renal Failure in Liver Transplant Patients: Indian Study

    OpenAIRE

    Naik, Pradeep; Premsagar, B.; Mallikarjuna, M.

    2013-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tac...

  5. Respirator management of sepsis-related respiratory failure.

    Science.gov (United States)

    Chiumello, Davide; Cressoni, Massimo

    2009-09-01

    The first description of acute respiratory distress syndrome (ARDS) in adults appeared in 1967 and was characterized by dyspnea, hypoxemia, diffuse alveolar infiltrates, and reduced respiratory system compliance. ARDS and acute lung injury (ALI) syndrome have no specific treatment, only supportive care: treating the underlying cause, when possible, and using mechanical ventilation. Historically, mechanical ventilation applied normal/large tidal volumes and low levels of positive end-expiratory pressure (PEEP). Experimental data showed that a high-volume, high-pressure ventilation strategy may lead to lung lesions indistinguishable from ARDS. Subsequent randomized clinical trials showed improved survival using low tidal volumes (6 vs 12 mL/kg ideal body weight) and limiting plateau pressure to 30 cm H(2)O, although the optimal level of PEEP remains controversial. Prone positioning should be reserved for severely ill patients. Inhaled nitric oxide, which is a pulmonary vasodilator with anti-inflammatory properties, is associated with limited improvement in oxygenation without improvement in survival.

  6. O papel da ventilação líquida no tratamento da insuficiência respiratória aguda em crianças - uma revisão sistemática The role of liquid ventilation in the treatment of acute respiratory failure in children - a systematic review

    Directory of Open Access Journals (Sweden)

    Patrícia Freitas Góes

    2006-04-01

    Full Text Available OBJETIVO: A ventilação líquida consiste no preenchimento total ou parcial dos pulmões por líquido (perfluorocarbono, eliminando a interface ar-líquido da membrana alveolar e reduzindo a tensão superficial em pulmões com deficiência de surfactante. Este trabalho tem como objetivo avaliar o papel da ventilação líquida no tratamento da insuficiência respiratória aguda em crianças. MÉTODOS: A técnica empregada foi uma revisão sistemática da literatura sobre ventilação líquida. O levantamento bibliográfico utilizou os bancos de dados MEDLINE, LILACS, COCHRANE LIBRARY e referências de artigos. Os termos utilizados para pesquisa foram: liquid ventilation, respiratory distress syndrome, meconium aspiration syndrome, congenital diaphragmatic hernia e acute respiratory distress syndrome. Foram procurados ensaios clínicos randômicos, estudos de coorte, caso-controle e série de casos. Os desfechos avaliados foram resposta sobre a oxigenação sangüínea, mecânica respiratória e a sobrevida dos pacientes. RESULTADOS: Foram selecionadas 284 publicações relacionadas à ventilação líquida durante o período de estudo. Destas, 22 (7,7% eram ensaios clínicos, e apenas seis referiam-se à utilização da ventilação líquida em crianças. Todas as seis publicações foram caracterizadas como série de casos e analisadas separadamente. CONCLUSÃO: A partir da análise dos estudos clínicos, pôde-se concluir que, pela falta de estudos clínicos randômicos e controlados, a ventilação líquida não pode ser recomendada como terapia para insuficiência respiratória aguda em pediatria.BACKGROUND: Liquid Ventilation consists of partially or completely filling the lungs with a fluid (perfluorcarbon. This brings about elimination of the air-liquid interface and reduction of the surface tension in lungs with surfactant deficiency. This article focuses on the role of liquid ventilation in the treatment of acute respiratory failure in

  7. Acute respiratory distress following the inhalation of an aerosol upholstery cleaner: the importance of reporting from the Emergency Department

    OpenAIRE

    Mistry, Dipak; Meredith, Carolyn

    2009-01-01

    Aerosols are commonplace in the home and in industry as they provide a quick and controlled way of distributing chemicals or perfumes. It is well known that deliberating concentrating and inhaling vapours may result in dizziness, euphoria, blackouts, respiratory distress, cardiac and renal failure. However, in the most part, warnings and guidance on use are sparse. Here, a proven case of acute respiratory distress is presented and a reporting mechanism via the UK National Poisons Information ...

  8. Clinical research of noninvasive mechanical ventilation in patients with conscious disturbance due to acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure%无创机械通气治疗伴意识障碍AECOPD呼吸衰竭患者的临床研究

    Institute of Scientific and Technical Information of China (English)

    徐丽娜; 孙开宇; 曹洁; 陈宝元

    2013-01-01

    目的 探讨无创机械通气救治伴有意识障碍慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭患者成功的相关因素.方法 AECOPD伴有意识障碍的重症呼吸衰竭患者54例,接受BiPAP呼吸机治疗.按照治疗效果分为成功组和失败组,比较两组患者各项指标及变化,进行Logistic回归分析,寻找无创通气成功的相关因素.结果 NIPPV失败组患者稳定期FEV1%pred较高,PaCO2值较低,治疗后GCS评分较低,pH值较低,PaCO2较高,均较NIPPV成功组明显.Logistic回归分析提示,治疗后GCS评分NIPPV后期失败有显著影响.结论 治疗后GCS评分是NIPPV治疗伴有意识障碍AECOPD呼吸衰竭患者成功的相关因素.%Objective To investigate the factors related to the success of noninvasive ventilation in the treatment of conscious disturbance due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure.Methods Fifty-four patients with conscious disturbance due to AECOPD complicated with respiratory failure were selected in the study,that treated by BiPAP ventilation.They were divided into effective group and failure group according to the curative effect,clinical and physiological parameters were analyzed comparatively between two groups,multi-variable logistic regression analysis was used to find the predictive factors of the success in noninvasive ventilation.Results In stable phase,FEV1 % predicted was higher,PaCO2 values was lower significantly in patients in NIPPV failure group who also had a lower GCS compared with NIPPV success group.Multi-variable logistic analysis suggests statistical significance in GCS after 2 h ventilation.Conclusions The failure of NIPPV in patients with conscious disturbance due to AECOPD complicated with respiratory failure was influenced by GCS after 2 h ventilation.

  9. Venovenous extracorporeal membrane oxygenation in adult respiratory failure: Scores for mortality prediction.

    Science.gov (United States)

    Hsin, Chun-Hsien; Wu, Meng-Yu; Huang, Chung-Chi; Kao, Kuo-Chin; Lin, Pyng-Jing

    2016-06-01

    Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and the ECMOnet score, which allow users to predict hospital mortality for candidates with their pre-ECMO presentations. This study was aimed to test the predictive powers of these published scores in a medium-sized cohort enrolling adults treated with VV-ECMO for acute respiratory failure, and develop an institutional prediction model under the framework of the 3 scores if a superior predictive power could be achieved. This retrospective study included 107 adults who received VV-ECMO for severe acute respiratory failure (a PaO2/FiO2 ratio failure assessment (SOFA) score before VV-ECMO. The predictive power of hospital mortality of each score was presented as the area under receiver-operating characteristic curve (AUROC). The multivariate logistic regression was used to develop an institutional prediction model. The surviving to discharge rate was 55% (n = 59). All of the 3 published scores had a real but poor predictive power of hospital mortality in this study. The AUROCs of RESP score, ECMOnet score, and SOFA score were 0.662 (P = 0.004), 0.616 (P = 0.04), and 0.667 (P = 0.003), respectively. An institutional prediction model was established from these score parameters and presented as follows: hospital mortality (Y) = -3.173 + 0.208 × (pre-ECMO SOFA score) + 0.148 × (pre-ECMO mechanical ventilation day) + 1.021 × (immunocompromised status). Compared with the 3 scores, the institutional model had a significantly higher AUROC (0.779; P failure. PMID:27336901

  10. Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever

    OpenAIRE

    Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

    2011-01-01

    Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated wi...

  11. Acute respiratory viral infections in pediatric cancer patients undergoing chemotherapy

    Directory of Open Access Journals (Sweden)

    Eliana C.A. Benites

    2014-07-01

    Full Text Available OBJECTIVE: to estimate the prevalence of infection by respiratory viruses in pediatric patients with cancer and acute respiratory infection (ARI and/or fever. METHODS: cross-sectional study, from January 2011 to December 2012. The secretions of nasopharyngeal aspirates were analyzed in children younger than 21 years with acute respiratory infections. Patients were treated at the Grupo em Defesa da Criança Com Câncer (Grendacc and University Hospital (HU, Jundiaí, SP. The rapid test was used for detection of influenza virus (Kit Biotrin, Inc. Ireland, and real-time multiplex polymerase chain reaction (FTD, Respiratory pathogens, multiplex Fast Trade Kit, Malta for detection of influenza virus (H1N1, B, rhinovirus, parainfluenza virus, adenovirus, respiratory syncytial virus, human parechovirus, bocavirus, metapneumovirus, and human coronavirus. The prevalence of viral infection was estimated and association tests were used (χ2 or Fisher's exact test. RESULTS: 104 samples of nasopharyngeal aspirate and blood were analyzed. The median age was 12 ± 5.2 years, 51% males, 68% whites, 32% had repeated ARIs, 32% prior antibiotic use, 19.8% cough, and 8% contact with ARIs. A total of 94.3% were in good general status. Acute lymphocytic leukemia (42.3% was the most prevalent neoplasia. Respiratory viruses were detected in 50 samples: rhinoviruses (23.1%, respiratory syncytial virus AB (8.7%, and coronavirus (6.8%. Co-detection occurred in 19% of cases with 2 viruses and in 3% of those with 3 viruses, and was more frequent between rhinovirus and coronavirus 43. Fever in neutropenic patients was observed in 13%, of which four (30.7 were positive for viruses. There were no deaths. CONCLUSIONS: the prevalence of respiratory viruses was relevant in the infectious episode, with no increase in morbidity and mortality. Viral co-detection was frequent in patients with cancer and ARIs.

  12. Respiratory sound energy and its distribution patterns following clinical improvement of congestive heart failure: a pilot study

    Directory of Open Access Journals (Sweden)

    Gruber Karen N

    2010-01-01

    Full Text Available Abstract Background Although congestive heart failure (CHF patients typically present with abnormal auscultatory findings on lung examination, respiratory sounds are not normally subjected to additional analysis. The aim of this pilot study was to examine respiratory sound patterns of CHF patients using acoustic-based imaging technology. Lung vibration energy was examined during acute exacerbation and after clinical improvement. Methods Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Twenty-three consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created (a larger image represents more homogeneously distributed vibration energy of respiratory sound. Geographical area of the images and respiratory sound patterns were quantitatively analyzed. Data from the CHF patients were also compared to healthy volunteers. Results The median (interquartile range geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were 66.9 (9.0 and 64.1(9.0 kilo-pixels, respectively (p p p Conclusions With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image.

  13. Effect of Bi-level positive airway pressure combined with vibration spu-tum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation complicated with respiratory failure%BiPAP联合振动排痰治疗AECOPD合并呼吸衰竭的效果评价

    Institute of Scientific and Technical Information of China (English)

    李海泉; 赵杰; 王海清; 徐俊马; 杜永亮; 李慧婷

    2014-01-01

    目的:探讨无创双水平气道正压通气联合振动排痰治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果。方法将40例患者随机分为A组与B组各20例。 A组患者采用无创双水平正压通气联合振动排痰进行治疗,B组患者仅使用无创双水平正压通气治疗,观察两组的治疗效果。结果 A组患者的PaCO2较B组下降快(P<0.05),呼吸支持时间及住院时间亦明显缩短(P<0.05),气管插管率较B组低(P<0.05)。结论无创正压通气联合振动排痰对治疗慢性阻塞性肺疾病合并呼衰的患者具有明显优势,值得临床推广。%Objective To evaluate the efficacy of Bi-level positive airway pressure (BiPAP) combined with vibration sputum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation (AECOPD) com-plicated with respiratory failure. Methods 40 cases of patients with respiratory failure were randomly divided into group A (20 cases) and group B (20 cases).The patients in group A were received noninvasive BiPAP ventilation and vibration sputum elimination.The patients in group B were treated with BiPAP ventilation only.Clinical effect in two groups were observed. Results After treatment,PaCO2 changed more significantly in group A than that in group B .The patients in group A had a significantly shorter duration of respiratory support than group B (P<0.05).The respiratory support time and hospital stay of group A was shorter than that of group B (P<0.05).The rate of endotracheal intubation of group A was lower than that of group B (P<0.05). Conclusion BiPAP combined with vibration sputum elimination in treatment of AECOPD complicated with respiratory failure has good curative effect and it is worth promoting.

  14. Radiocontrast-induced acute renal failure.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2005-01-01

    The intravascular administration of iodinated radiocontrast media can lead to acute renal dysfunction. Even small changes in renal function have been associated with increased morbidity and mortality, making the prevention of radiocontrast nephropathy of paramount importance. This review summarizes the principal risk factors for radiocontrast nephropathy and evidence-based preventive strategies that should be used to limit its occurrence. Risk factors for radiocontrast nephropathy include preexistent kidney disease, diabetes mellitus, dose of radiocontrast used, advanced congestive heart failure, and intravascular volume depletion. Proven preventive measures include volume expansion with intravenous saline or sodium bicarbonate and the use of low-osmolar or iso-osmolar radiocontrast media. Studies evaluating N-acetylcysteine have been conflicting, with meta-analyses suggesting a small beneficial effect. Studies of other pharmacologic agents have not demonstrated clinical benefit.

  15. Acute renal failure secondary to rhabdomyolysis

    International Nuclear Information System (INIS)

    MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.)

  16. Retrospective analysis on acute respiratory distress syndrome in ICU

    Institute of Scientific and Technical Information of China (English)

    LI Jin-bao; ZHANG Liang; ZHU Ke-ming; DENG Xiao-ming

    2007-01-01

    Objective:To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).Methods: A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference ( AECC ). Acute physiology and chronic health evaluation Ⅲ ( APACHE in), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.Results:Totally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was (11. 27±7. 24) days and APACHE in score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE ( base excess). The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS≥2.76.Conclusions: ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is

  17. Consensus for the manaegment of severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    Chinese Medical Association,China Association of C

    2003-01-01

    @@ INTRODUCTION Since recognition of the first case of sever acute respiratory syndrome (SARS) in Guangdong Province in November 2002,health care worker engaged in basic medicine,clinical medicine and preventive progress in the understanding of the etiology,epidemiology,diagnosis,treatment and prevention of SARS.

  18. The severe acute respiratory syndrome epidemic in mainland China dissected

    NARCIS (Netherlands)

    W.C. Cao (Wu Chun); S.J. de Vlas (Sake); J.H. Richardus (Jan Hendrik)

    2011-01-01

    textabstractThis paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS) epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large ge

  19. Imatinib-induced fatal acute liver failure

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Imatinib mesylate is a drug that has been approved for treatment of chronic myeloid leukemia (CML) in blast crisis, accelerated or chronic phase, and also for advanced gastrointestinal stromal tumors. Severe hepatic toxicity and three deaths from hepatic failure have been reported. We report the case of a 51-year-old woman who was admitted to our institution with severe acute hepatitis. She was diagnosed with CML and began treatment with imatinib mesylate at a dose of 400 mg/d.Five months after beginning treatment, she developed severe hepatitis associated with coagulopathy, and was admitted to our institution. She had been consuming acetaminophen 500-1000 mg/d after the onset of symptoms. She had a progressive increase in bilirubin level and a marked decrease of clotting factor Ⅴ. Five days after admission, grade Ⅱ encephalopathy developed and she was referred for liver transplantation. Her clinical condition progressively deteriorated, and 48 h after being referred for transplantation she suffered a cardiac arrest and died. This report adds concern about the possibility of imatinib-mesylate-induced hepatotoxicity and liver failure, particularly in the case of concomitant use with acetaminophen. Liver function tests should be carefully monitored during treatment and, with the appearance of any elevation of liver function tests, treatment should be discontinued.

  20. New Combined Scoring System for Predicting Respiratory Failure in Iraqi Patients with Guillain-Barré Syndrome

    Directory of Open Access Journals (Sweden)

    Zaki Noah Hasan

    2010-09-01

    Full Text Available The Guillain-Barré syndrome (GBS is an acute post-infective autoimmune polyradiculoneuropathy, it is the commonest peripheral neuropathy causing respiratory failure. The aim of the study is to use the New Combined Scoring System in anticipating respiratory failure in order to perform elective measures without waiting for emergency situations to occur.
    Patients and methods: Fifty patients with GBS were studied. Eight clinical parameters (including progression of patients to maximum weakness, respiratory rate/minute, breath holding
    count (the number of digits the patient can count in holding his breath, presence of facial muscle weakness (unilateral or bilateral, presence of weakness of the bulbar muscle, weakness of the neck flexor muscle, and limbs weakness were assessed for each patient and a certain score was given to
    each parameter, a designed combined score being constructed by taking into consideration all the above mentioned clinical parameters. Results and discussion: Fifteen patients (30% that were enrolled in our study developed respiratory failure. There was a highly significant statistical association between the development of respiratory failure and the lower grades of (bulbar muscle weakness score, breath holding count scores, neck muscle weakness score, lower limbs and upper limbs weakness score , respiratory rate score and the total sum score above 16 out of 30 (p-value=0.000 . No significant statistical difference was found regarding the progression to maximum weakness (p-value=0.675 and facial muscle weakness (p-value=0.482.
    Conclusion: The patients who obtained a combined score (above 16’30 are at great risk of having respiratory failure.

  1. Extra-corporeal membrane oxygenation in the management of 2009 influenza A (H1N1) refractory respiratory failure.

    LENUS (Irish Health Repository)

    Das, J P

    2012-02-01

    Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.

  2. Extra-corporeal membrane oxygenation in the management of 2009 influenza A (H1N1) refractory respiratory failure.

    LENUS (Irish Health Repository)

    Das, J P

    2011-03-01

    Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.

  3. Acute Renal Failure and the Critically Ill Surgical Patient

    OpenAIRE

    Sykes, Eliot; Cosgrove, Joseph F

    2007-01-01

    Acute renal failure can occur following major surgery. Predisposing factors include massive haemorrhage, sepsis, diabetes, hypertension, cardiac disease, peripheral vascular disease, chronic renal impairment and age. Understanding epidemiology, aetiology and pathophysiology can aid effective diagnosis and management. A consensus definition for acute renal failure has recently been developed. It relates to deteriorating urine output, serum creatinine and glomerular filtration rate. In the surg...

  4. Noninvasive ventilation for hypercapnic respiratory failure in COPD and initial post-support deterioration of pH and PaCO2 may not predict failure

    Directory of Open Access Journals (Sweden)

    Mani Raj

    2005-01-01

    Full Text Available Objectives: To correlate the degree of encephalopathy, baseline values of PaCO2 and pH, and their early response to NIV with eventual in-hospital outcome in patients of severe acute-on-chronic hypercapnic respiratory failure in COPD. Design: Retrospective review. Setting: Intensive care unit. Material and methods: 24 episodes of acute exacerbation of COPD in 17 patients (10 females, 7 males with a mean age of 59.5 years (range 48 - 82 where NIV was initiated. Data collected: encephalopathy score at baseline and at 24 hours, respiratory rate, breathing pattern, serial arterial blood gases, duration of NIV support per day and hospital days. Results: All patients had severe hypercapnia (mean peak PaCO2 89.0 mm Hg ± 21; range 66-143, respiratory acidosis (mean nadir pH 7.24 ± 0.058, range 7.14 - 7.33 and tachypnoea (mean respiratory rate 29.5 ± 4.69/mt; range 24 - 40. In 17 episodes, altered mental state was present (encephalopathy score 1.92 ± 1.32, median 2.5. Clinically stable condition occurred over several days (mean 13± 9.6 days; range 5 - 40. Intubation was avoided in 22 out of 24 episodes (91.6% despite significant initial worsening of PaCO2 and pH. Two patients died. The mean time on NIV was16.5 hours/day (range 4 - 22. Conclusions: In selected patients of COPD with acute hypercapnic failure on NIV worsening PaCO2 and pH in the initial hours may not predict failure provided the level of consciousness and respiratory distress improve.

  5. Acute pulmonary injury: high-resolution CT and histopathological spectrum

    OpenAIRE

    Obadina, E T; Torrealba, J M; Kanne, J P

    2013-01-01

    Acute lung injury usually causes hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is the hallmark of ARDS, other histopathological patterns of injury, such as acute and fibrinoid organising pneumonia, can be associated with acute respiratory failure. Acute eosinophilic pneumonia can also cause acute hypoxaemic respiratory failure and mimic ARDS. This pictorial essay reviews the high-resolution CT findings of acute lung injury and ...

  6. Respiratory virus infection as a cause of prolonged symptoms in acute otitis media.

    Science.gov (United States)

    Arola, M; Ziegler, T; Ruuskanen, O

    1990-05-01

    We studied respiratory viruses in 22 children with acute otitis media who had failed to improve after at least 48 hours of antimicrobial therapy. The mean duration of preenrollment antimicrobial therapy was 4.8 days. For comparison we studied 66 children with newly diagnosed acute otitis media. Respiratory viruses were isolated from middle ear fluid or from the nasopharynx, or both, significantly more often in the patients unresponsive to initial antimicrobial therapy than in the comparison patients (68% vs 41%, p less than 0.05). Viruses were recovered from the middle ear fluid in 32% of the study patients and from 15% of the comparison group. Bacteria were isolated from the middle ear fluid of four (18%) children in the study group; one child had an isolate resistant to initial antimicrobial therapy. All four children with bacteria in the middle ear fluid had evidence of concomitant respiratory virus infection. Our results indicate that respiratory virus infection is often present in patients with acute otitis media unresponsive to initial antimicrobial therapy, and may explain the prolongation of symptoms of infection. Resistant bacteria seem to be a less common cause of failure of the initial treatment.

  7. Serum biomarkers in Acute Respiratory Distress Syndrome an ailing prognosticator

    Directory of Open Access Journals (Sweden)

    Pneumatikos Ioannis

    2005-06-01

    Full Text Available Abstract The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions. New research and novel understanding of the molecular basis of the disease reveals an abundance of exciting new biomarkers who present a promise for use in the everyday clinical practice. The past fifteen years have seen the emergence of numerous clinical applications of several new molecules as biologic markers in the research field relevant to acute respiratory distress syndrome (translational research. The scope of this review is to summarize the current state of knowledge about serum biomarkers in acute lung injury and acute respiratory distress syndrome and their potential value as prognostic tools and present some of the future perspectives and challenges.

  8. Proteomic study of acute respiratory distress syndrome: current knowledge and implications for drug development.

    Science.gov (United States)

    Levitt, Joseph E; Rogers, Angela J

    2016-05-01

    The acute respiratory distress syndrome (ARDS) is a common cause of acute respiratory failure, and is associated with substantial mortality and morbidity. Dozens of clinical trials targeting ARDS have failed, with no drug specifically targeting lung injury in widespread clinical use. Thus, the need for drug development in ARDS is great. Targeted proteomic studies in ARDS have identified many key pathways in the disease, including inflammation, epithelial injury, endothelial injury or activation, and disordered coagulation and repair. Recent studies reveal the potential for proteomic changes to identify novel subphenotypes of ARDS patients who may be most likely to respond to therapy and could thus be targeted for enrollment in clinical trials. Nontargeted studies of proteomics in ARDS are just beginning and have the potential to identify novel drug targets and key pathways in the disease. Proteomics will play an important role in phenotyping of patients and developing novel therapies for ARDS in the future. PMID:27031735

  9. Acute respiratory distress syndrome in a woman with heroin and methamphetamine misuse.

    Science.gov (United States)

    Yeh, P S; Yuan, A; Yu, C J; Kuo, S H; Luh, K T; Yang, P C

    2001-08-01

    Methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in Asia. In Taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea. PMID:11678007

  10. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults

    DEFF Research Database (Denmark)

    Gebistorf, Fabienne; Karam, Oliver; Wetterslev, Jørn;

    2016-01-01

    BACKGROUND: Acute hypoxaemic respiratory failure (AHRF) and mostly acute respiratory distress syndrome (ARDS) are critical conditions. AHRF results from several systemic conditions and is associated with high mortality and morbidity in individuals of all ages. Inhaled nitric oxide (INO) has been...... on mortality at 28 days: 202/587 deaths (34.4%) in the INO group compared with 166/518 deaths (32.0%) in the control group (RR 1.08, 95% CI 0.92 to 1.27; I² statistic = 0%; moderate quality of evidence). In children, there was no statistically significant effects of INO on mortality: 25/89 deaths (28...... = 0%; five trials, 368 participants; moderate quality of evidence). For ventilator-free days, the difference was not statistically significant (MD -0.57, 95% CI -1.82 to 0.69; I² statistic = 0%; five trials, 804 participants; high quality of evidence). There was a statistically significant increase...

  11. Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure.

    Science.gov (United States)

    Argamany, Jacqueline R; Reveles, Kelly R; Duhon, Bryson

    2016-04-01

    Synthetic cannabinoid usage has increased in the past decade. Concurrently, emergency management of associated adverse effects due to synthetic cannabinoid usage has also risen. Reported toxicities include psychosis, seizures, cardiotoxicity, acute kidney injury, and death. While cannabis was first described as a cause of acute hyperemesis in 2004, a more recent case series also describes the association between cannabinoid hyperemesis and risk of acute renal failure. Synthetic cannabinoids have also been reported to cause acute hyperemesis and acute renal failure; however, the risk of rhabdomyolysis-induced renal failure has yet to be elucidated. In this article, we report the first known case of synthetic cannabinoid hyperemesis leading to rhabdomyolysis and acute renal failure. PMID:26422191

  12. Activated protein C in the treatment of acute lung injury and acute respiratory distress syndrome

    NARCIS (Netherlands)

    A.D. Cornet; G.P. van Nieuw Amerongen; A. Beishuizen; M.J. Schultz; A.R.J. Girbes; A.B.J. Groeneveld

    2009-01-01

    Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) frequently necessitate mechanical ventilation in the intensive care unit. The syndromes have a high mortality rate and there is at present no treatment specifically directed at the underlying pathogenesis. Central in

  13. Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands : A survey

    NARCIS (Netherlands)

    Wind, Jan; Versteegt, Jens; Twisk, Jos; van der Werf, Tjip S.; Bindels, Alexander J. G. H.; Spijkstra, Jan-Jaap; Girbes, Armand R. J.; Groeneveld, A. B. Johan

    2007-01-01

    Background: The characteristics, incidence and risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) may depend on definitions and geography. Methods: A prospective, 3-day point-prevalence study was performed by a survey of all intensive care units (ICU) in the Neth

  14. Acute renal failure in premature neonates

    Directory of Open Access Journals (Sweden)

    Doronjski Aleksandra

    2009-01-01

    Full Text Available Background/Aim. Hemodynamic stress is the leading cause of acute renal failure (ARF in premature neonates. Incidence of ARF in this population is between 8 and 24%. The aim of this study was to determine the frequency of presence of ARF in premature neonates, as well as its impact on their survival. Methods. A retrospective study of 114 premature neonates [(gestational age, GA less than 37 gestation weeks (gw] admitted to the Intensive Care Unit (ICU at the Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina in 2007 was conducted. Serum creatinine, urea and bilirubine were determined on the 3rd day of life in 65 newborns who met inclusion criteria. ARF was diagnosed in 16 newborns (n=16/65; 25%. Results. The premature neonates with ARF had significantly lower GA [<28 gw - 8/16 (50% vs. 5/49 (10%; p < 0.05], birth weight (BW (1 265 g vs. 1615 g; p < 0.05 and systolic blood pressure (43.37 mm Hg vs. 52.7 mmHg; p < 0.05 than ones without ARF. Non-olyguric ARF was diagnosed in 62% of newborns with ARF (n=10/16, while the rest had the olyguric type (n = 6/16; 38%. Twenty-five percent of premature neonates with ARF (n = 4/16 died in contrast to 10% of premature neonates without ARF (n = 5/49. ARF was treated conservatively in all but 3 cases when peritoneal dialysis was performed. Renal function has recovered completely in all of the survivors. In order to determine their predictivity in relation to ARF, following parameters were analyzed: GA, BW < 1 500 g, presence of concomitant sepsis and intracranial hemorrhage grade III/IV. BW < 1 500 g demonstrated the highest sensitivity (se 0.75, while GA < 28 gw, sepsis and intracranial hemorrhage grade III/IV showed high specificity (sp = 0.90, 0.89 0.88, respectively. Conclusion. Acute renal failure frequently occurs in population of premature neonates and requires meticulous fluid and electrolyte balance, especially in the case of low birth weight and extreme immaturity.

  15. Importance of respiratory viruses in acute otitis media.

    Science.gov (United States)

    Heikkinen, Terho; Chonmaitree, Tasnee

    2003-04-01

    Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media.

  16. AECOPD呼吸衰竭患者无创正压通气治疗效果的相关因素分析%Analysis on relevant factors of the result of noninvasive positive pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease and respiratory failure

    Institute of Scientific and Technical Information of China (English)

    徐丽娜; 曹洁; 陈宝元

    2010-01-01

    Objective To investigate the factors related to the failure of noninvasive positive pressure ventilation(NIPPV) in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and typeⅡ respiratory failure. Methods One hundred and seventy six AECOPD patients with hypercapnia respiratory failure treated by BiPAP ventilation were enrolled and were divided into effective group and failure group according to the curative effect ,clinical and physiological parameters were analyzed comparatively between two groups, multi-variable logistic regression analysis was used to find the predictive factors of the failure in noninvasive ventilation. Results In stable phase, FEV1%predicted was higher,PaCO2 values was lower significantly in patients in NIPPV failure group who also had a lower GCS, lower albumin and BMI, higher APACHE Ⅱ on admission compared with NIPPV success group. Multi-variable logistic analysis suggests statistical significance in GCS and APACHE Ⅱ on admission. Conclusions The failure of NIPPV in patients with AECOPD and type Ⅱ respiratory faliure was influenced by GCS and APACHEⅡ on admission.%目的 探讨应用无创正压通气(noninvasive positive pressure ventilation,NIPPV)救治慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)并Ⅱ型呼吸衰竭失败的相关因素.方法 选取176例AECOPD并Ⅱ型呼吸衰竭的患者接受无创双水平气道内正压呼吸机治疗.按照治疗效果分为成功组和失败组,比较两组患者各项指标及变化,进行Logistic回归分析,寻找无创通气失败的相关因素.结果 NIPPV失败组患者稳定期FEV1%预计值较高,PaCO2值较低,治疗之前GCS评分较低,白蛋白及体质量指数较低,急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)较高,与NIPPV成功组比较差异有显著性意义.Logistic回归分析提示,治疗前格拉斯哥昏迷评分(GCS)及APACHE Ⅱ评分对NIPPV后期

  17. An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure.

    Science.gov (United States)

    Mayes, Theresa; Gottschlich, Michele M; Kagan, Richard J

    2008-01-01

    Respiratory failure is associated with a high mortality rate in burned children. Recently, a specialized pulmonary enteral formula (SPEF) was commercially introduced as an adjunct intervention in acute lung injury management. SPEF contains condition-specific nutrients to modulate the inflammatory response. The study examined SPEF impact in critically ill, pediatric burn patients with respiratory failure. Medical records of acute burn patients admitted December 1997 to October 2006 were reviewed for SPEF treatment. Respiratory and renal indices were compared on the first and final days of SPEF use. Nineteen patients with respiratory failure received SPEF for a mean of 10.8 +/- 0.9 days during their acute burn course. Mean age was 5.3 +/- 1.5 years. Mean total body surface area burn was 44.3 +/- 5.4% with 32.5 +/- 6.4% full thickness. Patients were admitted 2.3 +/- 0.9 days postburn. Significant improvements in peak pressure, PEEP, FiO2, P:F ratio, Pco2, Po2, and ETco2 were noted. Seventeen of the 19 patients survived despite the fact that 9 of the 19 patients developed severe barotrauma requiring multiple tube thoracotomies, and all 19 had extremely poor prognoses at SPEF initiation. Adult SPEF formula for critically ill, pediatric burn patients with respiratory failure is safe and well tolerated. SPEF seems to facilitate recovery from acute lung injury as evidenced by improvements in oxygenation and pulmonary compliance.

  18. Parvovirus B19-Induced Constellation of Acute Renal Failure, Elevated Aminotransferases and Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Iain W McAuley

    1997-01-01

    Full Text Available This report details a case of acute renal failure and elevated aminotransferases with subsequent development of congestive heart failure in a patient with history of exposure to parvovirus B19 and serological evidence of acute infection with this agent. This constellation of organ involvement has not been previously reported in the literature.

  19. Respiratory failure associated with hypoventilation in a patient with severe hypothyroidism

    OpenAIRE

    Fukusumi, Munehisa; Iidaka, Toshiko; Mouri, Atsuto; Hamamoto, Yoichiro; Kamimura, Mitsuhiro

    2014-01-01

    A 70-year-old Japanese man was admitted to hospital because of decreased consciousness due to type II respiratory failure. Severe hypothyroidism was diagnosed and considered to be associated with hypoventilation due to respiratory muscle dysfunction and sleep apnea syndrome. His status was improved partially by replacement of thyroid hormone. Despite maintaining a euthyroid state, improvement of respiratory muscle dysfunction was incomplete.

  20. Acute liver failure and liver transplantation.

    Science.gov (United States)

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Kokudo, Norihiro

    2013-08-01

    Acute liver failure (ALF) is defined by the presence of coagulopathy (International Normalized Ratio ≥ 1.5) and hepatic encephalopathy due to severe liver damage in patients without pre-existing liver disease. Although the mortality due to ALF without liver transplantation is over 80%, the survival rates of patients have considerably improved with the advent of liver transplantation, up to 60% to 90% in the last two decades. Recent large studies in Western countries reported 1, 5, and 10-year patient survival rates after liver transplantation for ALF of approximately 80%, 70%, and 65%, respectively. Living donor liver transplantation (LDLT), which has mainly evolved in Asian countries where organ availability from deceased donors is extremely scarce, has also improved the survival rate of ALF patients in these regions. According to recent reports, the overall survival rate of adult ALF patients who underwent LDLT ranges from 60% to 90%. Although there is still controversy regarding the graft type, optimal graft volume, and ethical issues, LDLT has become an established treatment option for ALF in areas where the use of deceased donor organs is severely restricted. PMID:25343108

  1. [Acute renal failure caused by phenazopyridine].

    Science.gov (United States)

    Vega, Jorge

    2003-05-01

    A 27 years old woman was admitted due to abdominal cramps, jaundice and oligoanuria, starting 48 hours after eating Chinese food. Hepatic biochemical tests, abdominal ultrasound and retrograde pyelography were normal. The urine was intensely orange colored and microscopic analysis was normal. The serum creatinine and urea nitrogen on admission were 4.59 and 42.5 mg/dl and rose to 13.5 and 72.4 mg/dl, respectively, at the 6th hospital day. Oliguria lasted only 48 hours. Dialysis was not used, since the patient was in good general condition and uremic symptoms were absent. On the 7th day, azotemia began to subside and at the 14th day, serum creatinine was 1.0 mg/dl. Before hospital discharge, she confessed the ingestion of 2.000 mg of phenazopyridine, during a nervous breakdown, aiming to sleep deeply. Remarkable was the persistence of the orange color of her urine during several days and the dissociation between the rate of increase of serum creatinine with respect to urea nitrogen. This is an unusual case of acute renal failure caused by an overdose of a drug, commonly prescribed for urinary tract infections. PMID:12879816

  2. Acute effects of urban air pollution on respiratory health of children with and without chronic respiratory symptoms

    NARCIS (Netherlands)

    van der Zee, S; Hoek, G; Boezen, H M; Schouten, J P; van Wijnen, J H; Brunekreef, B

    1999-01-01

    OBJECTIVES: To investigate to what extent different components of air pollution are associated with acute respiratory health effects in children with and without chronic respiratory symptoms. METHODS: During three consecutive winters starting in 1992-3, peak expiratory flow (PEF) and respiratory sym

  3. Treatment of acute upper respiratory tract infections in children

    Directory of Open Access Journals (Sweden)

    Rončević-Babin Nevenka P.

    2002-01-01

    Full Text Available Introduction Acute respiratory tract infections are the most common diseases of childhood. A preschool child suffers up to 5-7 infections of upper airways during a year. Upper airway infections make 80 - 90% of all respiratory infections. Etiology and treatment In 75% of all cases respiratory infections are of viral etiology, 15% of bacterial and 10% are caused by mycoplasma, rickettsiae, fungi, parasites. The treatment of respiratory infections includes antimicrobial therapy (causal, relief of symptoms (symptomatic and application of general principles of child treatment. The choice of antimicrobial drug is based on the evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where adequate specimen cannot be obtained for microbiologic tests, when these tests do not reveal the agent, or therapy must start before evidence of the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can be modified later, according to the isolated agent and its sensitivity to the drug. Considering the incidence and importance of respiratory infections in morbidity and mortality of children, the aim of this article was to present guidelines in treatment of respiratory infections. The main point remains that the treatment should take into consideration the individual patient before all.

  4. Acute renal failure from rhabdomyolysis by heroin use: nursing approach

    Directory of Open Access Journals (Sweden)

    Evangelia Prevyzi

    2013-04-01

    Full Text Available Rhabdomyolysis is caused by muscle breakdown resulting in the release of myoglobin into the systemic circulation. Acute renal failure results from the nephrotoxicity of myoglobin. Heroin use is one of the causes of rhabdomyolysis and acute renal failure. Aim: The aim of this literature review was highlight the importance of early recognition and treatment by a nurse of acute renal failure from rhabdomyolysis after heroin. Method: The method followed in this review was based on retrospective studies and research, conducted during the period 2000-2012 and retracted from the international databases Medline, Pubmed, Cinahl and the Greek database Iatrotek on acute renal failure from rhabdomyolysis after heroin use. Key-words were used: acute renal failure, rhabdomyolysis, heroin, international guidelines, based-evidence nursing care. Results: The clinical presentation occurs with muscle pain, muscle weakness, and brown-redish urine. High values of CPK and myoglobin make the diagnosis. Toxicology tests confirm heroin use. For the treatment is required naloxone administration, the rapid hydration of the patient, alkalinization of urine, good diuresis, regulation of electrolyte disturbances and dialysis if necessary. Conclusions: Early recognition and treatment of acute renal failure from rhabdomyolysis after heroin use is vital for the survival of the patient. It is necessary to educate nurses on specific issues such as acute renal failure from rhabdomyolysis after heroin use and the implementation of protocols for the treatment and cure.

  5. Evaluation of radioimmunoassay for renal functions in senile patients with cor pulmonale without respiratory failure

    International Nuclear Information System (INIS)

    The results of RIA about serum β2-MG and urine β2-MG, Alb, IgG in the senile patients with cor pulmonale are reported. The contents of sβ2-MG, uβ2-MG, uAlb in non-respiratory failure group are higher than that of the control group. The contents of sβ2-MG, uβ2-MG, uAlb and uIgG in the respiratory failure group are higher than that of the non-respiratory failure group. The results show that the renal glamorous and renal tubules functions are slightly damaged in non-respiratory failure group, while functions of the respiratory failure group become worse

  6. Message concerning Severe Acute Respiratory Syndrome ("SARS")

    CERN Multimedia

    2003-01-01

    IMPORTANT REMINDER If you have just come back from one of the regions identified by the WHO as being infected with SARS, it is essential to monitor your state of health for ten days after your return. The syndrome manifests itself in the rapid onset of a high fever combined with respiratory problems (coughing, breathlessness, breathing difficulty). Should these signs appear, you must contact the CERN Medical Service as quickly as possible on number 73802 or 73186 during normal working hours, and the fire brigade at all other times on number 74444, indicating that you have just returned from one of the WHO-identified areas with recent local transmission.China: Beijing, Hong Kong (Special Administrative Region), Guangdong Province, Inner Mongolia, Shanxi Province, Tianjin ProvinceTaiwan:TaipeiMoreover, until further notice the CERN Management requests that all trips to these various regions of the world be reduced to a strict minimum and then only with the consent of the Division Leader concerned. Anyone comin...

  7. Inconsequence of membrane choice in acute renal failure?

    Science.gov (United States)

    Mujais, S K; Ivanavich, P

    1996-05-01

    The choice of hemodialysis membrane in acute renal failure has caused a heated debate, principally because of the dogmatism with which the results of preliminary clinical studies have been translated into prescription dictum. The issue, however, is not merely the limitations of these two studies, but rather the shift in emphasis they may have engendered in the approach to dialytic therapy in acute renal failure. Dogmatism based on limited or flawed data does not serve the interests of our patients, and the issue of hemodialysis in acute renal failure is far more complex than the exaggerated importance of membrane choice. PMID:8725627

  8. [Acute respiratory distress syndrome after near-drowning (author's transl)].

    Science.gov (United States)

    Tempel, G; Jelen, S; Forster, B; Gullotta, U; Daum, S

    1977-08-01

    After successful rescue from drowning there may develop a situation which is called secondary drowning, resulting in acute respiratory distress characterized by interstitial pulmonary oedema, hypoxaemia, hypercapnia and acidosis during drowning, direct alteration of the alveolar membrane by aspirated water and particulate matters and a volume overloading by adsorption and--not seldom--inept therapy. This situation requires mechanical ventilation and forced diuresis, combined with high doses of steroids, antibiotics and digitalis. We present the case of an eleven year old patient whose clinical course demonstrate the necessity of exact clinical observation after rescue from drowning. After development of acute respiratory distress only the immediate utilization of the therapeutic modalities of an intensive care may result in a satisfactory outcome. Four months later our patient had normal pulmonary function except for a moderate reduction of compliance.

  9. TCM Therapeutic Strategy on Acute Lung Injury Caused by Infectious Atypical Pneumonia and Acute Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    唐光华

    2003-01-01

    @@ Infectious atypical pneumonia (IAP) is also called severe acute respiratory syndrome (SARS) by WHO. In its development, around 20% of SARS can develop into the stage of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), active and effective treatment of it constitutes the important basis for lowering mortality and reducing secondary pulmonary function impairment and pulmonary fibrosis.

  10. The Effects of Surfactant on Oxygenation in Term Infants with Respiratory Failure

    OpenAIRE

    Serdar Beken; Canan Turkyilmaz; Esin Koc; Ibrahim Hirfanoglu; Nilgun Altuntas

    2013-01-01

    Objective: The objective of the study was to evaluate the effects of exogenous surfactant on respiratory indices in term infants with respiratory failure.Methods: Consecutive 18 mechanically ventilated term infants, who received a single dose of exogenous surfactant were retrospectively included into the study. The respiratory outcome of surfactant rescue therapy was evaluated by comparing respiratory indices before and six hours after surfactant administration.Findings: Median oxygenation i...

  11. Severe Acute Respiratory Syndrome: Clinical and Laboratory Manifestations

    OpenAIRE

    Lam, Christopher W.K.; Chan, Michael H M; Wong, Chun K.

    2004-01-01

    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase...

  12. Surfactant alteration and replacement in acute respiratory distress syndrome

    OpenAIRE

    Walmrath Dieter; Grimminger Friedrich; Markart Philipp; Schmidt Reinhold; Ruppert Clemens; Günther Andreas; Seeger Werner

    2001-01-01

    Abstract The acute respiratory distress syndrome (ARDS) is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactan...

  13. Anti-infectious treatment in acute respiratory distress syndrome

    OpenAIRE

    Gao, Min; Xiao, Zhen-Liang; Fu-xiang LI

    2013-01-01

    Acute respiratory distress syndrome (ARDS) is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP) is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI) is different from hospital acquired infection (HAI) in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, ...

  14. The Current Care for Acute Respiratory Distress Syndrome

    OpenAIRE

    Kawamae, Kaneyuki; Iseki, Ken

    2003-01-01

    The mortality rate of acute respiratory distress syndrome (ARDS) has been still high. A many kinds of strategies for ARDS are being tried in the world. The important factors which influence for pathological-physiology of ARDS during the mechanical ventilation are gravity consolidation, atelectasis, and ventilator induced lung injury (VILI). VILI is caused by shear stress that is induced by the repeated collapse and recruit of alveolus. Alveolar over-distention caused by large tidal volume als...

  15. Respiratory Complications from Acute Corrosive Poisonings in Adults

    OpenAIRE

    Chibishev, Andon; Simonovska, Natasa; Bozinovska, Cvetanka; Pereska, Zanina; Smokovski, Ivica; Glasnovic, Marija

    2014-01-01

    Introduction: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. ...

  16. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  17. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    Directory of Open Access Journals (Sweden)

    M. Milani

    2003-08-01

    Full Text Available Respiratory syncytial virus (RSV is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinical signs, diagnosis and hospital admissions were documented. During this study period, 365 young infants (51.5% male, 48.5% female with respiratory tract infection were visited in 6 hospitals. The median age of patients was 24 months (range: 1 month to 5 years.RSV infection was found in 70 out of 365 patients (19.18%.Among the 70 children with RSV infection, 29 patients (41.42% were under 12 months of age.The main clinical manifestations of RSV infection were cough (88.57% and coryza (78.57%. There were no significant differences between patients who were tested positive for RSV and those who were tested negative with regard to demographic variables and clinical diagnoses. This study indicates that RSV is an important cause of respiratory tract infection in infants and young children .Distinguishing RSV from other respiratory infection is difficult because of the similarity in clinical presentation among children.

  18. Postinfectious diffuse proliferative glomerulonephritis and acute renal failure in an HIV patient.

    Science.gov (United States)

    Enríquez, R; Cabezuelo, J B; Escolano, C; Pérez, M; Amorós, F; Gutiérrez-Rodero, F; Reyes, A

    2004-04-01

    Postinfectious proliferative glomerulonephritis may occur in HIV-infected patients, although it is not a common cause of severe acute renal failure in them. We report a woman with HIV infection, who developed hypocomplementemic acute nephritic syndrome 10 days after an upper respiratory infection. Systemic diseases were excluded. The serum creatinine level increased to 6.6 mg/dl. Renal biopsy showed diffuse endocapillary proliferative glomerulonephritis, with mesangial and capillary walls, granular deposits of IgG and C3 by immunofluorescence. She was given corticosteroids with progressive normalization of her renal function. No opportunistic infections have occurred during 1-year follow-up.

  19. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS

    Directory of Open Access Journals (Sweden)

    2004-03-01

    Full Text Available Severe acute respiratory syndrome (SARS is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20–30% required intensive care unit (ICU or high dependency care, and 13–26% developed acute respiratory distress syndrome (ARDS. In some of these patients, the clinical course can progress relentlessly to septic shock and/or multiple organ dysfunction syndrome (MODS. The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation. Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Subcutaneous emphysema, pneumothoraces and pneumomediastinum may arise spontaneously or as a result of positive ventilatory assistance. Older age is a consistently a poor prognostic factor. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation. Physicians and scientists all over the world should collaborate to study this condition which may potentially threaten human existence.

  20. 无创正压机械通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的研究%Clinical study of noninvasive positive pressure ventilation in the treatment of acute exacerbation of chronic ob-structive pulmonary disease combined with type Ⅱ respiratory failure

    Institute of Scientific and Technical Information of China (English)

    林飞克; 陈丰

    2015-01-01

    Objective To investigate the curative effect of noninvasive positive pressure ventilation (NIPPV) on treating patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with type Ⅱ respiratory failure. Methods A total of 86 cases of AECOPD combined with type Ⅱ respiratory failure were randomly divided into the NIPPV group and the control group according to whether accept NIPPV therapy or not. The curative effect,the parame-ters of PaO2, PaCO2 and RR and HR before and after treatment were compared between the two groups. The average length of stay,expenses for medicine, examination fee and the total of hospitalization costs were also compared between the two groups. Results The total effective rate of NIPPV group was significantly higher than that of the control group (χ2=5.94, P0.05). The average length of stay of NIPPV groups was shorter than that of control group(t=5.23,P0.05). NIPPV组平均住院天数短与对照组,药费、检查费及住院总费用低于对照组,差异均有统计学意义(t分别=5.23、16.42、2.64、11.36,P均<0.05). 结论 NIPPV在治疗AECOPD合并呼吸衰竭患者有十分明显的治疗效果,并且可以减低患者住院天数、药费、检查费及总住院费用.

  1. Repeated bedside echocardiography in children with respiratory failure

    Directory of Open Access Journals (Sweden)

    Jehlicka Petr

    2011-04-01

    Full Text Available Abstract Background The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods A total of 235 children, average age 3.21 (SD 1.32 years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS, return of spontaneous circulation after cardiopulmonary resuscitation (ROSC, bronchopulmonary dysplasia (BPD, cardiomyopathy (CMP and cardiopulmonary disease (CPD. Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI, left ventricle shortening fraction (SF, cardiac output (CO, and the mitral valve ratio of peak velocity of early wave (E to the peak velocity of active wave (A as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1 and after 72 hours of comprehensive treatment (time-2. The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests. Results A total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p Conclusion Echocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

  2. Treatment of acute lower respiratory tract infections in children

    Directory of Open Access Journals (Sweden)

    Rončević-Babin Nevenka P.

    2002-01-01

    Full Text Available Introduction Acute respiratory tract infections are the most common childhood diseases. A preschool child suffers up to 5-7 infections of upper airways during a year. Lower airway infections make 5-20% of all respiratory infections. Etiologic factors In developed countries, 75% of pneumonias in childhood are of viral etiology, in 15% of bacterial, and in 10% of some other causative agent (mycoplasma, rickettsiae, fungi, parasites. In developing countries, bacterial pneumonias are present in much higher percentages. Treatment Treatment of respiratory infections includes antimicrobial therapy (causal, relief of symptoms (symptomatic and conduction of general principles in child treatment. The choice of antimicrobial drug is based on evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where we cannot provide adequate specimen for microbiologic testing, when these tests do not reveal the agent, or when therapy must be started before the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can later be modified according to the isolated agent and its sensitivity to the drug. Conclusion Having in mind the incidence and importance of respiratory infections in morbidity and mortality of children the aim of this article was to show guidelines in treatment of respiratory infections in children. The main point remains that we should take in consideration the individual patient before all.

  3. [Review of the knowledge on acute kidney failure in the critical patient].

    Science.gov (United States)

    Romero García, M; Delgado Hito, P; de la Cueva Ariza, L

    2013-01-01

    Acute renal failure affects from 1% to 25% of patients admitted to intensive care units. These figures vary depending on the population studied and criteria. The complications of acute renal failure (fluid overload, metabolic acidosis, hyperkalemia, bleeding) are treated. However, mortality remains high despite the technological advances of recent years because acute renal failure is usually associated with sepsis, respiratory failure, serious injury, surgical complications or consumption coagulopathy. Mortality ranges from 30% to 90%. Although there is no universally accepted definition, the RIFLE classification gives us an operational tool to define the degree of acute renal failure and to standardize the initiation of renal replacement techniques as well as to evaluate the results. Therefore, nurses working within the intensive care unit must be familiar with this disease, with its treatment (drug or alternative) and with the prevention of possible complications. Equally, they must be capable of detecting the manifestations of dependency each one of the basic needs and to be able to identify the collaboration problems in order to achieve an individualized care plan.

  4. A Rare Case of Propofol-Induced Acute Liver Failure and Literature Review

    Directory of Open Access Journals (Sweden)

    G. Kneiseler

    2010-02-01

    Full Text Available The incidence of drug-induced acute liver failure is increasing. A number of drugs can inhibit mitochondrial functions, alter β-oxidation and cause accumulation of free fatty acids within the hepatocytes. This may result in hepatic steatosis, cell death and liver injury. In our case, propofol, an anesthetic drug commonly used in adults and children, is suspected to have induced disturbance of the mitochondrial respiratory chain, which in consequence led to insufficient energy supply and finally liver failure. We report the case of a 35-year-old Caucasian woman with acute liver failure after anesthesia for stripping of varicose veins. Liver histology, imaging and laboratory data indicate drug-induced acute liver failure, presumably due to propofol. Hepatocyte death and microvesicular fatty degeneration of 90% of the liver parenchyma were observed before treatment with steroids. Six months later, a second biopsy was performed, which revealed only minimal steatosis and minimal periportal hepatitis. We suggest that propofol led to impaired fatty acid oxidation possibly due to a genetic susceptibility. This caused free fatty acid accumulation within hepatocytes, which presented as hepatocellular fatty degeneration and cell death. Large scale hepatocyte death was followed by impaired liver function and, consecutively, progressed to acute liver failure.

  5. Management of severe respiratory failure following influenza A H1N1 pneumonia

    Directory of Open Access Journals (Sweden)

    Michela Vivarelli

    2013-12-01

    Full Text Available The use of non-invasive ventilation (NIV in severe hypoxemic respiratory failure (PaO2/FIO2 ≤250 due to H1H1 virus pneumonia is controversial. In this prospective study, we aimed to assess the efficacy of NIV in avoiding endotracheal intubation and to identify predictors of success or failure. Nineteen patients with H1N1 viral pneumonia had severe respiratory failure (PaO2/FIO2 ratio ≤250. Five patients with PaO2/FIO2 lower than 150 and simplified acute physiology score (SAPS II lower than 34 underwent NIV and were admitted to the Intensive Care Unit and received NIV as first-line therapy. NIV failed in 2 of the 14 patients but had a good outcome in 12. None of the patients treated with NIV died. The duration of NIV was 5.0±1.9 days and the hospital stay was 11.3±1.2 days. The average PaO2/FIO2 ratio after 1 h of NIV was 239.1+38.7. No patient had multi-organ failure. PaO2/FIO2 ratio after 1 h and SAPS II at admission were independent variables correlated with the success of NIV. In our study, NIV was successful in 12 of the 14 patients (85.7% and this is one of the highest success rates in the literature. In our opinion, the reason for these results is the strict selection of patients with severe respiratory failure (PaO2/FIO2 ratio ≥150 and the strict following of predictors of success for NIV such as SAPS II of 34 or lower and PaO2/FIO2 ratio of 175 or lower after 1 h of NIV. Clinicians should be aware of pulmonary complications of influenza A H1N1 and strictly select the patients to undergo NIV. NIV could have an effective and safe role in reducing the high demand for critical care beds, particularly during the pandemic.

  6. Aldosterone blockade in post-acute myocardial infarction heart failure

    NARCIS (Netherlands)

    Pitt, Bertram; Ferrari, Roberto; Gheorghiade, Mihai; van Veldhuisen, Dirk J.; Krum, Henry; McMurray, John; Lopez-Sendon, Jose

    2006-01-01

    Development of heart failure (HF) or left ventricular systolic dysfunction (LVSD) significantly increases mortality post acute myocardial infarction (AMI). Aldosterone contributes to the development and progression of HF post AMI, and major guidelines now recommend aldosterone blockade in this setti

  7. Nutrición artificial en la insuficiencia respiratoria Artificial nutrition in respiratory failure

    Directory of Open Access Journals (Sweden)

    J. López Martínez

    2005-06-01

    Full Text Available Los pacientes con insuficiencia respiratoria crónica presentan con frecuencia alteraciones nutricionales que hacen necesario el soporte nutricional. Ello es más importante en presencia de episodios de descompensación aguda, dado que en esta situación se incrementa el riesgo de desnutrición y puede comprometerse la recuperación. Con el fin de evitar la sobrecarga ventilatoria, el soporte nutricional debe ser normocalórico o discretamente hipocalórico (recurriendo a la calorimetría indirecta, si es posible y contener una proporción de grasa cercana al 50% del aporte calórico. El aporte de micronutrientes debe ser considerado debido a los efectos de algunos de ellos (P, Mg, Se sobre la función ventilatoria. El objetivo del soporte nutricional en los pacientes con insuficiencia respiratoria aguda (SDRA es el de aportar los requerimientos al mismo tiempo que se procede a la modulación de la respuesta inflamatoria y a la estimulación de los mecanismos de recuperación ante la agresión aguda. La modificación cualitativa del aporte lipídico (disminuyendo el aporte de ácido linoleico e incrementando el de otros lípidos precursores de eicosanoides con menor capacidad proinflamatoria y el empleo de antioxidantes, parecen ser los mecanismos más importantes en este sentido.Patients with chronic respiratory failure frequently have nutritional impairments that prompt nutritional support. This is more important during acute exacerbation episodes since, in this situation, the risk for hyponutrition is increased and recovery may be compromised. In order to prevent ventilatory overload, nutritional support should be normocaloric or mildly hypocaloric (using indirect calorimetry, if possible with a fat content ratio of around 50% of the caloric intake. Micronutrients supply should be considered due to the effects of some of them (P, Mg, Se on respiratory function. The aim of nutritional support in patients with acute respiratory failure (ARDS is

  8. Total Liquid Ventilation Provides Superior Respiratory Support to Conventional Mechanical Ventilation in a Large Animal Model of Severe Respiratory Failure

    OpenAIRE

    Pohlmann, Joshua R.; Brant, David O; Daul, Morgan A; Reoma, Junewai L; Kim, Anne C; Osterholzer, Kathryn R.; Johnson, Kent J.; Bartlett, Robert H.; Cook, Keith E.; Hirschl, Ronald B.

    2011-01-01

    Total liquid ventilation (TLV) has the potential to provide respiratory support superior to conventional mechanical ventilation (CMV) in the acute respiratory distress syndrome (ARDS). However, laboratory studies are limited to trials in small animals for no longer than 4 hours. The objective of this study was to compare TLV and CMV in a large animal model of ARDS for 24 hours. Ten sheep weighing 53 ± 4 (SD) kg were anesthetized and ventilated with 100% oxygen. Oleic acid was injected into th...

  9. 无创正压通气治疗AECOPD并呼吸衰竭160例疗效观察%Observation of curative effect of non-invasive positive pressure ventilation in the treatment of AECOPD pa-tients complicated with acute respiratory failure

    Institute of Scientific and Technical Information of China (English)

    刘彦同; 高秀玲; 张会英

    2014-01-01

    目的:总结无创正压机械通气( NIPPV)在AECOPD合并呼吸衰竭治疗中的经验。方法160例AECOPD合并呼吸衰竭的患者,采用经口鼻面罩双水平正压通气,吸气峰压为13~25 cmH2 O;呼气末压4~6 cmH2 O。 NIPPV无效者改为有创通气。观察指标包括:临床症状和动脉血气改善情况,根据动脉血气和临床症状的改善情况进行疗效评价。结果①NIPPV总有效率为85%。有效率与病情严重程度、年龄相关:NIPPV有效者,上机前动脉血气状况明显好于无效病例( P <0.05),有效者年龄平均值小于无效者( P <0.05)。②24例NIPPV无效者中,22例改为有创通气,成功率为81.8%。结论①NIPPV对AECOPD合并呼吸衰竭患者的治疗有重要意义,可减少患者气管插管的痛苦和并发症,减少住院费用。②早期上机有利于提高治疗成功率。%Objective To sum up the experience of non-invasive positive pressure ventilation ( NIPPV) in the treatment of AECOPD patients complicated with acute respiratory failure. Methods 160 AECOPD patients com-plicated with acute respiratory failure received NIPPV via full face-mask were enrolled in the study. 13~25 cmH2 O of inspiratory peak airway pressure ( IPAP) and 4~6 cmH2 O of expiratory peak airway pressure ( EPAP) were deliv-ered. Invasive positive pressure ventilation was delivered when NIPPV failed. Their clinical status, changes of artery blood gases and ventilator application were observed. Results ①The total effective rate of NIPPV was 85%, which was related with the state of illness and age. NIPPV benefited patients were shown to produce significant improve-ments in arterial blood gases (P<0. 05), and they were younger than those ineffective patients (P<0. 05). ②22 patients, who failed NIPPV, received invasive positive pressure ventilation, and the effective rate was 81. 8%. Con-clusion ① NIPPV is important in the treatment of AECOPD patients complicated with acute respiratory failure

  10. Therapeutic Modulation of Coagulation and Fibrinolysis in Acute Lung Injury and the Acute Respiratory Distress Syndrome

    OpenAIRE

    Sebag, Sara C.; Bastarache, Julie A.; Ware, Lorraine B.

    2011-01-01

    Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are characterized by excessive intra-alveolar fibrin deposition, driven, at least in part by inflammation. The imbalance between activation of coagulation and inhibition of fibrinolysis in patients with ALI/ARDS favors fibrin formation and appears to occur both systemically and in the lung and airspace. Tissue factor (TF), a key mediator of the activation of coagulation in the lung, has been implicated in the pathogenesis ...

  11. Role of Ventilation in Cases of Acute Respiratory Distress Syndrome /Acute Lung injury

    OpenAIRE

    Hemant M Shah; Shilpa B Sutariya; Parul M Bhatt; Nishil Shah; Shweta Gamit

    2014-01-01

    Introduction: Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are characterized by refractory hypoxemia that develops secondary to high-permeability pulmonary edema. These syndromes are gaining more attention as a means of better comprehending the pathophysiology of ARDS and possiblyfor modifying ventilatory management. In this context a study was done to compare role of invasive and non-invasive ventilation in cases of ARDS/ALI. Methods: in this study patients of AR...

  12. Acute renal failure in pregnancy: our experience.

    Science.gov (United States)

    Aggarwal, Rohina S; Mishra, Vineet V; Jasani, Anil F; Gumber, Manoj

    2014-03-01

    Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6

  13. Acute renal failure in pregnancy: Our experience

    Directory of Open Access Journals (Sweden)

    Rohina S Aggarwal

    2014-01-01

    Full Text Available Acute renal failure (ARF is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during preg-nancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH, post-partum hemorrhage (PPH, septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8. The first trimester, second trimester and puerperal groups comprised of four (8%, 25 (50% and 21 patients (42%, respectively. Hemorrhage was the etiology for ARF in 15 (30%, APH in ten (20% and PPH in five (10% patients. Eleven (22% patients had lower segment cesarian section (LSCS while 36 (78% patients had normal vaginal delivery. In 20 (40% patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36% patients. Two (4% patients had dissemi-nated intravascular coagulation on presentation while one (2% patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n

  14. Factors Associated with Death Due to 2009 Influenza A (H1N1) Virus Infection and Acute Respiratory Distress Syndrome in Beijing, 2009-2011

    Institute of Scientific and Technical Information of China (English)

    Jin-qian; Zhang; Li-cheng; Zhang; Na; Ren; Ming; Zhang; Li-min; Guo; Xing-wang; Li; Jun; Cheng

    2012-01-01

    Objective Patients with H1N1 virus infection were hospitalized and quarantined, and some of them developed into acute respiratory failure, and were transfered to the medical intensive care unit of Beijing Ditan Hospital, Capital Medical University in Beijing, China. Methods The clinical features and preliminary epidemiologic findings among 30 patients with confirmed H1N1 virus infection who developed into acute respiratory failure for ventilatory support were investigated. Results A total of 30 patients(37.43 ± 18.80 years old) with 2009 influenza A(H1N1) related acute respiratory distress syndrome(ARDS) received treatment with mechanical ventilation, 15 cases of whom were male and 17 cases died of ARDS. Fatal cases were significantly associated with an APACHE Ⅱ score(P = 0.016), but not with PaO 2 /FIO 2(P = 0.912) and chest radiograph(P = 0.333). The most common complication was acute renal failure(n = 9). Five patients received extracorporeal membrane oxygenation(ECMO), 3 of whom died and the others survived. The major causes of death were multiple organ dysfunction syndrome(MODS)(39%), intractable respiratory failure(27%) and sepsis(20%). Conclusions Most patients with respiratory failure due to influenza A(H1N1) virus infection were young, with a high mortality, particularly associated with APACHE Ⅱ score, secondary infection of lung or type 2 diabetes mellitus.

  15. Insuficiência respiratória aguda causada por pneumonia em organização secundária à terapia antineoplásica para linfoma não Hodgkin Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

    Directory of Open Access Journals (Sweden)

    Adriell Ramalho Santana

    2012-12-01

    Full Text Available Doenças difusas do parênquima pulmonar pertencem a um grupo de doenças de evolução geralmente subaguda ou crônica, mas que podem determinar insuficiência respiratória aguda. Paciente masculino, 37 anos, em terapia para linfoma não Hodgkin, admitido com tosse seca, febre, dispneia e insuficiência respiratória aguda hipoxêmica. Iniciadas ventilação mecânica e antibioticoterapia, porém houve evolução desfavorável. Tomografia computadorizada de tórax mostrava opacidades pulmonares em "vidro fosco" bilaterais. Devido ao paciente ter feito uso de três drogas relacionadas à pneumonia em organização (ciclofosfamida, doxorrubicina e rituximabe e quadros clínico e radiológico serem sugestivos, iniciou-se pulsoterapia com metilprednisolona com boa resposta. Pneumonia em organização pode ser idiopática ou associada a colagenoses, drogas e neoplasias, e geralmente responde bem a corticoterapia. O diagnóstico é anatomopatológico, mas condições clínicas do paciente não permitiam a realização de biópsia pulmonar. Pneumonia em organização deve ser diagnóstico diferencial em pacientes com aparente pneumonia de evolução desfavorável ao tratamento antimicrobiano.Interstitial lung diseases belong to a group of diseases that typically exhibit a subacute or chronic progression but that may cause acute respiratory failure. The male patient, who was 37 years of age and undergoing therapy for non-Hodgkin's lymphoma, was admitted with cough, fever, dyspnea and acute hypoxemic respiratory failure. Mechanical ventilation and antibiotic therapy were initiated but were associated with unfavorable progression. Thoracic computed tomography showed bilateral pulmonary "ground glass" opacities. Methylprednisolone pulse therapy was initiated with satisfactory response because the patient had used three drugs related to organizing pneumonia (cyclophosphamide, doxorubicin and rituximab, and the clinical and radiological symptoms were

  16. Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings

    Directory of Open Access Journals (Sweden)

    Bambery Pradeep

    2006-11-01

    Full Text Available Abstract Background Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis. Case presentation We describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis. He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids. Conclusion Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal function

  17. Acute liver failure associated with Garcinia cambogia use.

    Science.gov (United States)

    Corey, Rebecca; Werner, K Tuesday; Singer, Andrew; Moss, Adyr; Smith, Maxwell; Noelting, Jessica; Rakela, Jorge

    2016-01-01

    Millions of Americans regularly use herbal supplements, but many are unaware of the potential hidden dangers. Numerous supplements have been associated with hepatotoxicity and, indeed dietary/herbal supplements represent an increasingly common source of acute liver injury. We report a case of acute liver failure requiring liver transplantation associated with the use of Garcinia cambogia, a supplement widely promoted for weight loss. When patients present with acute hepatitis or liver failure from an unknown etiology, a careful history of supplement use should be performed. PMID:26626648

  18. Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty.

    Science.gov (United States)

    Daner Iii, William E; Boardman Iii, Norman D

    2016-01-01

    Glenoid loosening is the most common cause of failure in primary total shoulder arthroplasty (TSA) and often occurs years after the initial surgery. It is rare for a glenoid component to fail acutely. Several case reports of complete glenoid dissociation appear in the literature. It is important to report these failures to identify technical errors or component design flaws to improve outcomes in TSA. In this case report, we present an unrecognized acute failure of a cemented hybrid glenoid component at the time of surgery. PMID:27555976

  19. Acute anuric renal failure following jering bean ingestion.

    Science.gov (United States)

    Wong, Jin Shyan; Ong, Teng-Aik; Chua, Hock-Hin; Tan, Clare

    2007-01-01

    Djenkol beans or jering (Pithecellobium jeringa) is a traditional delicacy consumed by the local population in Malaysia. Jering poisoning or djenkolism is characterized by spasmodic pain, urinary obstruction and acute renal failure. The underlying pathology is an obstructive nephropathy, which is usually responsive to aggressive hydration and diuretic therapy. We present a case of djenkolism following ingestion of jering. The patient required urgent bilateral ureteric stenting following the failure of conservative therapy. Healthcare providers need to recognize djenkolism as a cause of acute renal failure and the public educated on this potential health hazard.

  20. Acute Systolic Heart Failure Associated with Complement-Mediated Hemolytic Uremic Syndrome

    Directory of Open Access Journals (Sweden)

    John L. Vaughn

    2015-01-01

    Full Text Available Complement-mediated hemolytic uremic syndrome (otherwise known as atypical HUS is a rare disorder of uncontrolled complement activation that may be associated with heart failure. We report the case of a 49-year-old female with no history of heart disease who presented with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given her normal ADAMSTS13 activity, evidence of increased complement activation, and renal biopsy showing evidence of thrombotic microangiopathy, she was diagnosed with complement-mediated HUS. She subsequently developed acute hypoxemic respiratory failure secondary to pulmonary edema requiring intubation and mechanical ventilation. A transthoracic echocardiogram showed evidence of a Takotsubo cardiomyopathy with an estimated left ventricular ejection fraction of 20%, though ischemic cardiomyopathy could not be ruled out. Treatment was initiated with eculizumab. After several failed attempts at extubation, she eventually underwent tracheotomy. She also required hemodialysis to improve her uremia and hypervolemia. After seven weeks of hospitalization and five doses of eculizumab, her renal function and respiratory status improved, and she was discharged in stable condition on room air and independent of hemodialysis. Our case illustrates a rare association between acute systolic heart failure and complement-mediated HUS and highlights the potential of eculizumab in stabilizing even the most critically-ill patients with complement-mediated disease.

  1. Acute renal failure and severe thrombocytopenia associated with metamizole

    Directory of Open Access Journals (Sweden)

    Maria Dolores Redondo-Pachon

    2014-01-01

    Full Text Available Metamizole or dipyrone is a pyrazolone derivative that belongs to the non-steroidal anti-inflammatory drugs. Its main side-effect is hematological toxicity. Thrombocytopenia due to metamizole is rare and is usually associated with the involvement of the two other blood series. Drug-induced thrombocytopenia is more frequently related to immune mechanisms, and the diag-nosis is still largely made by exclusion of other causes and by correlation of timing of thrombocytopenia with the administration of drug. Metamizole may cause acute renal failure due to hemodynamic renal failure/acute tubular necrosis and/or acute tubulointerstitial nephritis. We report a case of acute renal failure and severe thrombocytopenia after metamizole. As far as we know, this combination of adverse effects from this drug has not been reported previously.

  2. Antibiotic use in acute upper respiratory tract infections.

    Science.gov (United States)

    Zoorob, Roger; Sidani, Mohamad A; Fremont, Richard D; Kihlberg, Courtney

    2012-11-01

    Upper respiratory tract infections account for millions of visits to family physicians each year in the United States. Although warranted in some cases, antibiotics are greatly overused. This article outlines the guidelines and indications for appropriate antibiotic use for common upper respiratory infections. Early antibiotic treatment may be indicated in patients with acute otitis media, group A beta-hemolytic streptococcal pharyngitis, epiglottitis, or bronchitis caused by pertussis. Persistent cases of rhinosinusitis may necessitate the use of antibiotics if symptoms persist beyond a period of observation. Antibiotics should not be considered in patients with the common cold or laryngitis. Judicious, evidence-based use of antibiotics will help contain costs and prevent adverse effects and drug resistance.

  3. Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction.

    Science.gov (United States)

    Morgan, Sherwin E; Vukin, Kirissa; Mosakowski, Steve; Solano, Patti; Stanton, Lolita; Lester, Lucille; Lavani, Romeen; Hall, Jesse B; Tung, Avery

    2014-11-01

    Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation.

  4. Azathioprine associated acute respiratory distress syndrome: case report and literature review

    Directory of Open Access Journals (Sweden)

    Scherbak D

    2014-08-01

    Full Text Available A 58-year-old Caucasian man treated with azathioprine to prevent rejection of an orthotopic liver transplant, presented to the Carl Hayden VA Medical Center with rapid respiratory decline and appeared septic. He required urgent intubation, mechanical ventilator support and empiric antibiotics. His clinical picture and imaging studies were consistent with acute respiratory distress syndrome; however, extensive infectious work up failed to reveal an offending organism. Review of his current medications implicated azathioprine and upon discontinuation of this agent, the patient made a rapid recovery. He was subsequently extubated, transferred out of the ICU and soon discharged home in good health. Prescribed for organ transplant rejection and a wide array of autoimmune diseases, azathioprine has been rarely correlated with pneumonitis and rapid respiratory failure. No reported cases were found in which azathioprine was used to treat liver transplant rejection and associated with development of the adult respiratory distress syndrome (ARDS. However, there have been ARDS cases in which azathioprine was used for other purposes. We review all the available cases of azathioprine associated ARDS. The patients in these reports had similar clinical symptoms on presentation as our patient: hypoxia, febrile episodes and rapid development of ARDS with no infectious etiology. Most notable is the rapid resolution of ARDS after discontinuation of azathioprine. Although azathioprine toxicity related respiratory failure is rare, this correlation should still be considered in the differential for immunosuppressed patients presenting with rapid pulmonary decline. Further studies are needed and warranted to better correlate this connection, but it is imperative to recognize that the relationship exists.

  5. Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003.

    Science.gov (United States)

    2003-03-28

    CDC continues to support the World Health Organization (WHO) in the investigation of a multicountry outbreak of unexplained atypical pneumonia referred to as severe acute respiratory syndrome (SARS). This report includes summaries of the epidemiologic investigations and public health responses in several affected locations where CDC is collaborating with international and national health authorities. This report also describes an unusual cluster of cases associated with a hotel in Hong Kong and identifies the potential etiologic agent of SARS. Epidemiologic and laboratory investigations of SAPS are ongoing. PMID:12680518

  6. Control dynamics of severe acute respiratory syndrome transmission

    Institute of Scientific and Technical Information of China (English)

    WANG Haiying; RONG Feng; KE Fujiu; BAI Yilong

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a serious disease with many puzzling features. We present a simple, dynamic model to assess the epidemic potential of SARS and the effectiveness of control measures. With this model, we analysed the SARS epidemic data in Beijing. The data fitting gives the basic case reproduction number of 2.16 leading to the outbreak, and the variation of the effective reproduction number reflecting the control effect. Noticeably, our study shows that the response time and the strength of control measures have significant effects on the scale of the outbreak and the lasting time of the epidemic.

  7. Observation on therapeutic effect of BiPAP respirator in treatment of cases of acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure.%BiPAP呼吸机治疗AECOPD合并II型呼吸衰竭的疗效观察

    Institute of Scientific and Technical Information of China (English)

    马继扬; 高健; 梁民勇

    2011-01-01

    Objective To explore the clinical efficacy of bilevel positive airway pressure ( BIPAP ) respirator assisted ventilation in treatment of cases of acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) with type Ⅱ respiratory failure.Methods A total of 62 patients of acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure were randomly allocated into two groups: trial group ( 32 cases ) and control group ( 30 cases ).The routine treatment including anti - infectious medication, cleaning airway and continuous inhalation of low concentration oxygen, and pneumatic analeptics was only given to patients of control group, but both BIPAP assisted ventilation and routine treatment were given to patients of trial group.Patients in these two groups were monitored for arterial blood gas parameters and changes of basic vital signs.Results Findings of heart rate, respiration rate, blood pH, PaO2 and PaCO2 in patients of two groups before treatment were compared with those after treatment, these parameters were obviously improved, their difference was significant ( P < 0.05 ).There was significant difference ( P < 0.05 ) in these findings between patients in trial group after treatment in comparison with those of patients in control group after treatment.Conclusion BIPAP assisted ventilation is certainly an effective measure for treatment of patients with AECOPD with type Ⅱ respiratory failure.%目的 探讨双水平气道正压无创通气(BIPAP)呼吸机在慢性阻塞性肺疾病急性加重期(AECOPD)并发Ⅱ型呼吸衰竭的临床应用.方法 62例AECOPD并发Ⅱ型呼吸衰竭患者随机分为治疗组(32例)和对照组(30例),治疗组除常规治疗外加用BiPAP呼吸机辅助通气治疗,对照组则予抗感染、通畅气道、持续低流量吸氧及应用呼吸兴奋剂等治疗,监测两组治疗前后血气参数和生命体征变化.结果 两组与治疗前相比心率、呼吸频率、pH、氧

  8. Application of Bi-level Positive Airway Pressure Ventilation in Elderly Do-not-intubate Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease and Respiratory Failure%双水平正压通气在拒绝插管的老年慢性阻塞性肺病急性加重呼吸衰竭病人的应用

    Institute of Scientific and Technical Information of China (English)

    王长捷

    2012-01-01

    Objective To determine the effect of bi- level positive airway pressure ventilation (Bi- PAP) in elderly do- not- intubate patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure. Methods 65 elderly patients who were admitted to intensive care unit from September 2006 to December 2010 with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure were randomly divided into 2 groups standard group (re =32) and Bi-PAP group (re =33) . The changes of consciousness, physiological parameters, hospital mortality and adverse events in patients were compared between the two groups. Results The baseline characters of patients were similar in both the Bi- PAP and standard therapy groups. After 2 hour of treatment, GCS scores of patients in Bi-PAP group (P<0.01) and median (5th-95th percentile) PaO2/FIO2 ratios were significantly higher [182 (77-384) vs 165 (70-358), P<0.0l] , and PaCO2 was lower than standard group [55 (31~86) mmHg vs 82 (47 - 107) mmHg, P<0.0l]. Treatment with Bi-PAP successfully reduced the hospital mortality [11 (33%) vs 24 (75%), P< 0.01]. It looked similar with adverse events occurred both Bi-PAP and standard treatment. Conclusion For elderly do-not-intubate patients with AECOPD and respiratory failure, treatment with Bi- PAP not only can improve the patient's physiological parameters, but also improve the patient's outcomes.%目的 观察双水平正压通气(Bi-PAP)在拒绝插管(Do-not-intubate)的老年慢件阻塞性肺病急性加重(AECOPD)呼吸衰竭病人的疗效.方法 2006年9月至2010年12月65名入住重症监护病房的老年慢性阻塞性肺病急性加重呼吸衰竭病人纳入研究.将病人随机分为普通治疗组(n=32)和Bi-PAP(n=33)组.比较2组病人研究期间的意识变化、生理学参数的变化、院内死亡率及不良事件发生率.结果 老年慢性阻塞性肺病急性加重呼吸衰竭无创通气组与普通治疗

  9. ACUTE RESPIRATORY DISTRESS SYNDROME DAN ACUTE PNEUMONIA PADA NEAR DROWNING:SEBUAH LAPORAN KASUS

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    Michelle Prinka Adyana

    2014-02-01

    Full Text Available Near drowning is a condition in which the victim survived the first 24 hours. The WorldHealth Organization (WHO , recorded worldwide in 2000 there were 400,000 incidentdrowned accidentally . That is, this figure ranks second only to traffic accidents.Aspiration pneumonia is a complication of near drwoning which occurred in 80 % ofcases of near drowning, while 50 % of patients sink into acute respiratory distresssyndrome ( ARDS . This case report discusses the acute respiratory distress syndromeand acute pneumonia in near drowning 24 years old , who had drowned at the beach for± 15 minutes , the chest x - ray obtained pulmonary edema dd / lung pnuemonia therepneuomothorax . Examination of multislice spiral computed tomography ( MSCT bilateral pneumothorax Thorax obtained major and minor fisuura right and left majorfissure , pneumomediastinum , pulmonary pneumonia contusio / suspected aspirationpneumonia , emphysema subcutis . In intensive care patients conducted for 9 days andreturn to akitivitas everyday

  10. Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano Acute respiratory failure as a manifestation of eosinophilia-myalgia syndrome associated with L-tryptophan intake

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    Tiago de Araujo Guerra Grangeia

    2007-12-01

    Full Text Available A síndrome da eosinofilia-mialgia foi descrita em 1989 em pacientes que apresentavam mialgia progressiva e incapacitante e eosinofilia sérica, nos líquidos e secreções. A maioria dos pacientes relatava uso prévio de L-triptofano. Sintomas respiratórios são relatados em até 80% dos casos, eventualmente como manifestação única. O tratamento inclui suspensão da droga e corticoterapia. Relatamos o caso de uma mulher de 61 anos com insuficiência respiratória aguda após uso de L-triptofano, hidroxitriptofano e outras drogas. A paciente apresentava eosinofilia no sangue, lavado broncoalveolar e derrame pleural. Após a suspensão da medicação e corticoterapia, houve melhora clínica e radiológica em poucos dias.Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80% of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.

  11. Diaphragmatic Amyloidosis Causing Respiratory Failure: A Case Report and Review of Literature

    OpenAIRE

    Aleksey Novikov; Horatio Holzer; DeSimone, Robert A.; Ghaith Abu-Zeinah; Pisapia, David J.; Mark, Tomer M.; Pastore, Raymond D.

    2015-01-01

    Neuromuscular respiratory failure is a rare complication of systemic immunoglobulin light chain amyloidosis. We describe a case of a 70-year-old Caucasian man with multiple myeloma who presented with worsening dyspnea. The patient was diagnosed with and treated for congestive heart failure but continued to suffer from hypercapnic respiratory insufficiency. He had restrictive physiology on pulmonary function tests and abnormal phrenic nerve conduction studies, consistent with neuromuscular res...

  12. Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma

    OpenAIRE

    Masafumi Oto; Kyoko Inadomi; Toshiyuki Chosa; Shima Uneda; Soichi Uekihara; Minoru Yoshida

    2014-01-01

    Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and t...

  13. Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

    OpenAIRE

    Tateno, Fuyuki; Sakakibara, Ryuji; Kawashima, Kengo; Kishi, Masahiko; Tsuyusaki, Yohei; Aiba, Yosuke; Ogata, Tsuyoshi

    2014-01-01

    It is rare that amyotrophic lateral sclerosis (ALS) presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.

  14. Pre-Operative Risk Factors Predict Post-Operative Respiratory Failure after Liver Transplantation

    OpenAIRE

    Huang, Ching-Tzu; Lin, Horng-Chyuan; Chang, Shi-Chuan; Lee, Wei-Chen

    2011-01-01

    Objective Post-operative pulmonary complications significantly affect patient survival rates, but there is still no conclusive evidence regarding the effect of post-operative respiratory failure after liver transplantation on patient prognosis. This study aimed to predict the risk factors for post-operative respiratory failure (PRF) after liver transplantation and the impact on short-term survival rates. Design The retrospective observational cohort study was conducted in a twelve-bed adult s...

  15. Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

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    Fuyuki Tateno

    2014-08-01

    Full Text Available It is rare that amyotrophic lateral sclerosis (ALS presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.

  16. Negative extrathoracic pressure in treatment of respiratory failure in infants and young children.

    OpenAIRE

    Samuels, M P; Southall, D P

    1989-01-01

    OBJECTIVE--To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN--Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING--Paediatric and neonatal intensive care units and paediatric wards. PATIENTS--88 Infants and young children aged 1 day to 2 years with respiratory failure due to bronchopulmonary dysplasia, the ...

  17. Extracorporeal support for patients with acute and acute on chronic liver failure.

    Science.gov (United States)

    Aron, Jonathan; Agarwal, Banwari; Davenport, Andrew

    2016-01-01

    The number of patients developing liver failure; acute on chronic liver failure and acute liver failure continues to increase, along with the demand for donor livers for transplantation. As such there is a clinical need to develop effective extracorporeal devices to support patients with acute liver failure or acute-on-chronic liver failure to allow time for hepatocyte regeneration, and so avoiding the need for liver transplantation, or to bridge the patient to liver transplantation, and also potentially to provide symptomatic relief for patients with cirrhosis not suitable for transplantation. Currently devices can be divided into those designed to remove toxins, including plasma exchange, high permeability dialyzers and adsorption columns or membranes, coupled with replacement of plasma proteins; albumin dialysis systems; and bioartificial devices which may provide some of the biological functions of the liver. In the future we expect combinations of these devices in clinical practice, due to the developments in bioartificial scaffolds.

  18. Ventilação mecânica não-invasiva aplicada em pacientes com insuficiência respiratória aguda após extubação traqueal Noninvasive positive pressure ventilation in patients with acute respiratory failure after tracheal extubation

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    Anderson José

    2006-12-01

    -intubação.BACKGROUND AND OBJECTIVES: Noninvasive positive pressure ventilation (NPPV has been routinely used to assist the weaning of the mechanical ventilation. One of the applications most common is in patients who had acute respiratory failure after extubation, even the scientific evidences for this indication still controversy. The aims of this study were to evaluate the index of patients that evolve for respiratory failure after extubation and evaluated the effectiveness of NPPV to avoid the need for reintubation and to promote increase in success index of weaning. METHODS: We conducted a transversal and prospective study. It was applied to NPPV in the patients who presented respiratory failure after extubation, independent of its etiology. NPPV was applied in to pressure support ventilation, with Vte for 6 to 8 mL/kg, PEEP and FiO2 adjusted to reach SaO2 > 95%. The NPPV was accomplished of a continuous mould even interrupt the signs of respiratory failure presented initially. The success of weaning and the NPPV was defined when the clinical events were reverted by a period greater than 48 hours in spontaneous breathing, avoid thus reintubation. RESULTS: We included 103 patients. Noted that 32% (33 evolved with signals of respiratory failure after extubation and were submitted to NPPV. The time of NPPV was on mean 8 ± 5 hours, PSV of 12 ± 2 cmH2O, PEEP of 7 ± 2 cmH2O, FiO2 of 40% ± 20%, Vte of 462 ± 100 mL, RR of 26 ± 5 rpm. Among patients who accomplished NPPV (33, 76% (25 attended with success and them afterwards let the ICU. Of the patients assigned to NPPV, 24% (8 did not tolerate the procedure and were reintubated. CONCLUSIONS: We conclude that NPPV is safe and effective in averting the need for reintubation in patients with respiratory failure after extubation.

  19. 慢性呼吸衰竭急性加重期患者呼吸道分泌物细菌学结果与病程和预后的关系%Bacteriological culture of airway secretions in acute onset of chronic respiratory failure and its relationship with clinical prognosis

    Institute of Scientific and Technical Information of China (English)

    何慕芝; 蔡闯; 李志斌; 池丽庄; 邹霞英

    2008-01-01

    Objecfive To investigate the association between bacteriology of airway secretions in acute onset chronic respiratory failure (ACRF) and its clinical prognosis.Methods The bacterial flora and antibiotic resistance in the airway secretions from 44 patients with 49 cases of ACRF were studied,the associations between bacteriology,antibiotic resistance and annual ACRF hospital admission frequency (ACRF≥2 or ACRF2次/年组致病菌阳性率是ACRF<2次/年组的2倍(P<0.01).致病菌中耐药菌占61.3%,耐药菌阳性患者机械通气时间、住院天数较阴性者显著延长,病死率显著增高(P<0.05). 结论 ACRF患者主要致病菌为铜绿假单胞茵等非传统病原体,致病菌阳性率、非传统病原体比率随慢性呼吸衰竭的加重而增高,耐药菌感染导致ACRF病死率增高.

  20. Extracorporeal membrane oxygenation for pediatric respiratory failure: History, development and current status.

    Science.gov (United States)

    Maslach-Hubbard, Anna; Bratton, Susan L

    2013-11-01

    Extracorporeal membrane oxygenation (ECMO) is currently used to support patients of all ages with acute severe respiratory failure non-responsive to conventional treatments, and although initial use was almost exclusively in neonates, use for this age group is decreasing while use in older children remains stable (300-500 cases annually) and support for adults is increasing. Recent advances in technology include: refinement of double lumen veno-venous (VV) cannulas to support a large range of patient size, pumps with lower prime volumes, more efficient oxygenators, changes in circuit configuration to decrease turbulent flow and hemolysis. Veno-arterial (VA) mode of support remains the predominant type used; however, VV support has lower risk of central nervous injury and mortality. Key to successful survival is implementation of ECMO before irreversible organ injury develops, unless support with ECMO is used as a bridge to transplant. Among pediatric patients treated with ECMO mortality varies by pulmonary diagnosis, underlying condition, other non-pulmonary organ dysfunction as well as patient age, but has remained relatively unchanged overall (43%) over the past several decades. Additional risk factors associated with death include prolonged use of mechanical ventilation (> 2 wk) prior to ECMO, use of VA ECMO, older patient age, prolonged ECMO support as well as complications during ECMO. Medical evidence regarding daily patient management specifically related to ECMO is scant, it usually mirrors care recommended for similar patients treated without ECMO. Linkage of the Extracorporeal Life Support Organization dataset with other databases and collaborative research networks will be required to address this knowledge deficit as most centers treat only a few pediatric respiratory failure patients each year. PMID:24701414

  1. Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up

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    Adıgüzel Nalan

    2012-09-01

    Full Text Available Abstract Background We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure. Methods A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF, ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed. Results Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20% patients were intubated, and the majority had sepsis and septic shock (p  Conclusions We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.

  2. Severe acute respiratory syndrome (SARS): a year in review.

    Science.gov (United States)

    Skowronski, Danuta M; Astell, Caroline; Brunham, Robert C; Low, Donald E; Petric, Martin; Roper, Rachel L; Talbot, Pierre J; Tam, Theresa; Babiuk, Lorne

    2005-01-01

    Severe acute respiratory syndrome (SARS) emerged from China as an untreatable and rapidly spreading respiratory illness of unknown etiology. Following point source exposure in February 2003, more than a dozen guests infected at a Hong Kong hotel seeded multi-country outbreaks that persisted through the spring of 2003. The World Health Organization responded by invoking traditional public health measures and advanced technologies to control the illness and contain the cause. A novel coronavirus was implicated and its entire genome was sequenced by mid-April 2003. The urgency of responding to this threat focused scientific endeavor and stimulated global collaboration. Through real-time application of accumulating knowledge, the world proved capable of arresting the first pandemic threat of the twenty-first century, despite early respiratory-borne spread and global susceptibility. This review synthesizes lessons learned from this remarkable achievement. These lessons can be applied to re-emergence of SARS or to the next pandemic threat to arise. PMID:15660517

  3. A MODEL FOR PROGNOSIS OF ACUTE LEFT VENTRICULAR FAILURE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS CONSIDERING TENASCIN C CONTENT.

    Science.gov (United States)

    Koteliukh, M

    2016-05-01

    The role of tenascin C in patients with acute myocardial infarction and type 2 diabetes mellitus still remains disputable today. The purpose of the study is to elaborate a model for the prediction of left ventricular failure in patients with acute myocardial infarction and type 2 diabetes taking into account the level of tenascin C, as well as to evaluate the prognostic value of this indicator in the development of acute myocardial infarction. The study showed that over time the content of tenascin C decreased on the 10th-12th day in patients with acute myocardial infarction and type 2 diabetes mellitus compared to patients with acute myocardial infarction without type 2 diabetes. The results demonstrated predictive properties of tenascin C in the development of acute myocardial infarction in patients with type 2 diabetes. The study allowed the authors to elaborate a model for the prognosis of acute left ventricular failure, taking into account the level of tenascin C. Combination of tenascin C dynamics and frequency of respiratory movements increased prognostic properties of the model, particularly its sensitivity (84%) and specificity (83%). Thus, the study proved the expediency of the model based on tenascin C indices for prognosis of acute left ventricular failure in patients with acute myocardial infarction and type 2 diabetes mellitus.

  4. Acute liver failure associated with occupational exposure to tetrachloroethylene.

    Science.gov (United States)

    Shen, Chuan; Zhao, Cai-Yan; Liu, Fang; Wang, Ya-Dong; Wang, Wei

    2011-01-01

    Tetrachloroethylene is a chlorinated solvent that is primarily used in dry cleaning and degreasing operations. Although the hepatotoxicity caused by tetrachloroethylene has been well documented in literature, it is rarely considered as a cause of acute liver failure. We report a case of a 39-yr-old man who was admitted to our hospital for acute liver failure due to tetrachloroethylene exposure. Histological examination of the liver revealed massive hepatic necrosis, prominently, in zone 3 of the hepatic lobules. The patient underwent supportive treatment along with 3 sessions of plasmapheresis, and consequently, he presented a favorable outcome. Repeat liver biopsy performed 6 months after the patient's discharge showed architectural distortion with postnecrotic cirrhosis. Physicians should be aware of the possibility of acute liver failure induced by tetrachloroethylene. Early plasmapheresis can be effective for individuals with sufficient capacity for hepatocyte regeneration.

  5. Successful treatment of Chlamydophila pneumoniae acute respiratory distress syndrome with extracorporeal membrane oxygenator: a case report and diagnostic review

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    De Bels David

    2012-01-01

    Full Text Available Abstract Introduction Chlamydophila pneumoniae is a respiratory pathogen known to infect the upper and lower respiratory tracts. Infection severity can range from sub-clinical pulmonary infection to acute respiratory distress syndrome. Case presentation A previously healthy 62-year-old Caucasian man was admitted to our hospital for acute respiratory failure. Serum samples obtained every week starting from the day of admission showed clear-cut seroconversion for C. pneumoniae antibodies. All other cultures obtained during the first days of hospitalization were negative. Despite maximal ventilatory support (high positive end expiratory pressure, fraction of inspired oxygen of 1.0, nitric oxide inhalation, neuromuscular blocking agents and prone positioning, our patient remained severely hypoxemic, which led us to initiate an extracorporeal membrane oxygenation treatment. Extracorporeal membrane oxygenation and hemodiafiltration were withdrawn on day 12. Our patient was extubated on day 18 and discharged from our Intensive Care Unit on day 20. He went home a month later. Conclusion We describe the first published case of acute respiratory distress syndrome due to C. pneumoniae infection successfully treated by extracorporeal membrane oxygenation, a very useful tool in this syndrome. A quick and specific method for the definite diagnosis of Chlamydophila infection should be developed.

  6. EXPERIENCE WITH NON - INVASIVE VENTILATION IN TYPE II RESPIRATORY FAILURE AT DEPARTMENT OF PULMONARY MEDICINE, KURNOOL MEDICAL COLLEGE, KURNOOL

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    Sailaja

    2015-07-01

    Full Text Available BACKGROUND : Non - invasive ventilation (NIV is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIV is becoming common with the increasing recognition of its benefits. OBJECTIVES: This study was done to evaluate the feasibility and outcome of NIV (BiPAP in Type II Respiratory Failu re in Department of Pulmonary Medicine, Kurnool Medical College. Materials and Methods: An observational study conducted over a period of 18 months in Department of pulmonary medicine, Kurnool Medical C ollege in 40 patients who were treated by NIV (BiPaP. Patients were stratified on basis of set of exclusion and inclusion criteria. NIV was given in accordance with the arterial blood gas (ABG parameters defining Type II respiratory failure. RESULTS: In the present study NIPPV was successful in 34(85% and failed in 6(15% patients . The most common indication of NIV in our hospital was acute exacerbation of chronic obstructive pulmonary disease (AE - COPD 90% and 88% of AE - COPD patients were improved by NIV. Application of NIV resulted in significant improvem ent of pH and blood gases in COPD patients. Kyphoscoliosis, Obstructive Sleep Apnea (OSA patients with Type II Respirato r y failure also showed significant improvement in partial pressure of oxygen and carbon dioxide. CONCLUSION: This study demonstrates and encourages the use of NIV as the first - line ventilator treatment in AE - COPD patients with Type II respiratory failure. It also supports NIV usage in other causes of type II Respiratory failure as a promising step toward prevention of mechanical ventila tion.

  7. Postvaccination Influenza 2009 H1N1 Respiratory Failure Requiring Extracorporeal Membrane Oxygenation

    OpenAIRE

    Mangino, Julie E.; Danielle Blais; Juan Crestanello; Firstenberg, Michael S.; Erik Abel

    2011-01-01

    The spread of pandemic Influenza A (H1N1-2009) was believed to have been attenuated by the effectiveness of worldwide vaccination initiatives. Despite the immunogenicity of a safe vaccine, we report a case of vaccine failure resulting in catastrophic influenza-associated respiratory failure.

  8. Intervention with flexible bronchoscopy in patiens with respiratory failure caused by tracheal stenosis

    Institute of Scientific and Technical Information of China (English)

    王继旺

    2013-01-01

    Objective To investigate the efficiency and safety of intervention with flexible bronchoscope under general anesthesia by using laryngeal mask in patients with severe tracheal stenosis induced respirtory failure.Methods A total of 16 in-patients with respiratory failure caused by

  9. Acute Liver Failure and Hepatic Encephalopathy After Cleft Palate Repair.

    Science.gov (United States)

    Kocaaslan, Nihal Durmuş; Tuncer, Fatma Betul; Tutar, Engin; Celebiler, Ozhan

    2015-09-01

    Paracetamol is the most commonly used analgesic after cleft palate repair. It has rarely caused acute hepatic failure at therapeutic or supratherapeutic doses. Only one case of therapeutic paracetamol toxicity after cleft palate repair had been reported previously. Here, we present a similar patient who developed acute liver failure and hepatic encephalopathy after an uncomplicated cleft palate surgery. Lack of large prospective trials in young children due to ethical concerns increases the value of the case reports of acetaminophen toxicity at therapeutic doses. The dosing recommendations of paracetamol may need to be reconsidered after cleft palate surgery.

  10. Acute Renal Failure due to Non-Traumatic Rhabdomyolysis

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    Nagehan Aslan

    2016-04-01

    Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.

  11. Clostridium difficile causing acute renal failure: Case presentation and review

    Institute of Scientific and Technical Information of China (English)

    Jasmin Arrich; Gottfried H. Sodeck; Gürkan Seng(o)lge; Christoforos Konnaris; Marcus Müllner; Anton N. Laggner; Hans Domanovits

    2005-01-01

    AIM: Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population.Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium difficile-associated diarrhea.METHODS: In this case report, we describe the course of Clostridium difficile-associated diarrhea in an 82-yearold patient developing acute renal failure. Stopping the offending agent and symptomatic therapy brought a rapid improvement of diarrhea and acute renal failure, full recovery was gained 18 d after admission. In a systematic review we looked for links between the two conditions.RESULTS: The link between Clostridium difficilr-associated diarrhea and acute renal failure in our patient was most likely volume depletion. However, in experimental studies a direct influence of Clostridium difficile toxins on renal duct cells could be shown.CONCLUSION: Rapid diagnosis, nonspecific supportive treatment and specific antibiotic treatment, especially in the elderly, may lower excess mortality Clostridium difficile-associated diarrhea and renal failure being possible complications.

  12. Acute renal failure in liver transplant patients: Indian study.

    Science.gov (United States)

    Naik, Pradeep; Premsagar, B; Mallikarjuna, M

    2015-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

  13. Heparin-induced thrombocytopenia associated with acute liver graft failure

    OpenAIRE

    Pannicke, Nadine; Pollok, Joerg-Matthias; Kluge, Stefan; Petzoldt, Martin

    2012-01-01

    An orthotopic liver transplantation (OLT) is of a proven benefit in an acute liver failure (ALF). Heparin-induced thrombocytopenia (HIT) is strongly associated with thromboembolic complications. We present the case of a 56-year-old patient who underwent an OLT owing to an ALF of unknown aetiology. HIT type II with consecutive hepatic and portal vein thrombosis caused progressive graft failure. Total hepatectomy and porto-caval shunt were performed to reduce the toxic effects of liver cell nec...

  14. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair

    Directory of Open Access Journals (Sweden)

    Daniel eIm

    2016-03-01

    Full Text Available Clinical and basic experimental approaches to pediatric acute lung injury (ALI, including acute respiratory distress syndrome (ARDS, have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within seven days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9-9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation and surfactant regulation, have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute and long term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis.

  15. 呼气峰流速测定对急性呼吸衰竭患儿撤机结果的预测价值%Value of peak expiratory flow determination for the prediction of machine withdrawal in children with acute respiratory failure

    Institute of Scientific and Technical Information of China (English)

    叶建兰; 张宣东; 金芳

    2015-01-01

    Objective To investigate the value of cough peak expiratory flow rate ( PEF) for the prediction of machine with-drawal in children with acute respiratory failure.Methods Eighty-five severe cases of acute respiratory failure in children were admit-ted into our hospital from September, 2010 to September, 2012, including 48 male and 37 female cases, with an age range of 2-6 years.In accordance with the necessity of endotracheal intubation 48 hours after removal of the ventilator, the patients were designated as the success group (71 cases) and the failure group (14 cases) .Differences in general clinical data, pulmonary function, blood-gas analysis results and PEF values before removal of the ventilator were compared between the 2 groups.The ROC curve was used to calcu-late Az value and evaluate the predicative value of PEF in the removal of the ventilator.Results With respect to the general medical data of the success and failure groups before removal of the ventilator, there was no statistical significance in age, gender, pediatric ill-ness scores, causes of illness, rate of lower respiratory tract infection and mechanical ventilation time, when comparisons were made be-tween the 2 groups(P>0.05).No statistical significance could be noted in respiratory rate (RR), heart rate (HR), tidal volume ( Vt) , minute ventilation( MV) , mean airway pressure( MAP) , pH value, PaO2 , PaCO2 and PaO2/FiO2 , before removal of the venti-lator, when comparisons were made between the 2 group(P>0.05).Before removal of the ventilator, PEF value of the success group was(46.3 ±8.2)L/min, which was significantly higher than that of the failure group(37.6 ±7.4)L/min, with statistical significance (P and could be used as a clinical evidence for ventilator removal.%目的:探讨咳嗽时呼气峰流速( PEF)值对预测急性呼吸衰竭患儿撤除呼吸机结果的价值。方法2010年9月至2012年9月本市某三甲医院收治的85例重症呼吸衰竭机械通气患儿,男48

  16. The relationships between oxygenation index and prognosis in acute respiratory failure patients treated by invasive mechanical ventilation%有创机械通气治疗的急性呼吸衰竭患者氧合指数与预后关系探讨

    Institute of Scientific and Technical Information of China (English)

    刘杜姣; 薛庆亮; 王鹿杰; 陈卫强; 陈伟; 于梅

    2012-01-01

    目的 通过对有创机械通气治疗急性呼吸衰竭(呼衰)患者监测指标的分析,探讨氧合指数(PaO2/FiO2)对预后的影响.方法 回顾性分析2006年11月至2011年8月兰州军区兰州总医院呼吸内科重症监护病房(ICU)91例急性呼衰行有创机械通气治疗患者的病例资料,根据患者预后分为存活组(55例)和死亡组(36例),比较两组患者通气前病情严重程度评分以及通气过程中血气分析指标的变化,并分析其与患者预后的关系.结果 存活组与死亡组患者在通气前急性生理学与慢性健康状况评分系统Ⅲ(APACHEⅢ)评分、多器官功能障碍综合征(MODS)评分、急性肺损伤(ALI)评分比较差异均无统计学意义(分:62.77±22.92比74.62±25.77,6.46±2.45比6.62±3.03,1.90±0.57比2.10±0.73,均P>0.05).存活组与死亡组患者机械通气ld时PaO2/FiO2(mm Hg,1 mm Hg=0.133 kPa)差异无统计学意义(132.18±67.29比139.24±78.36,P>0.05);存活组机械通气3d和7d时PaO2/FiO2均较死亡组显著升高(3 d:205.47±74.71比149.76±70.38,7d:225.37±67.20比120.94±85.58,P<0.05和P<0.01).结论 PaO2/FiO2与急性呼衰行有创机械通气患者的预后相关,连续监测其变化可能作为判断危重病患者预后的参考指标之一.%Objective To investigate the effect of oxygenation index (PaO2/FiO2) on patients' prognosis through comparative analyzing the monitoring indicators of acute respiratory failure patients treated by invasive mechanical ventilation.Methods Data from 91 acute respiratory failure patients treated by invasive mechanical ventilation in respiration intensive care unit (ICU) of the General Hospital of PLA of Lanzhou from November 2006 to August 2011 were retrospectively analyzed.Patients were divided into survival group (n =55 ) and death group (n =36)by the outcome,the critical severity scores of the diseases and changes in blood gas analysis during ventilation were compared,and their correlation with

  17. Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    LAN Mei-juan; HE Xiao-di

    2009-01-01

    Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care work-ers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxy-genation without use of expensive, invasive and experimen-tal procedures.

  18. Preventing acute renal failure is crucial during acute tumor lysis syndrome

    Directory of Open Access Journals (Sweden)

    Darmon Michael

    2007-01-01

    Full Text Available Tumour Lysis syndrome (TLS is characterized by the massive destruction of tumoral cells and the release in the extracellular space of their content. While TLS may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms and cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. Moreover, TLS may lead to an acute renal failure (ARF. In addition to the hospital mortality induced by the acute renal failure itself, development of an ARF may preclude optimal cancer treatment. Therefore, prevention of the acute renal failure during acute tumor lysis syndrome is mandatory. The objective of this review is to describe pathophysiological mechanisms leading to acute tumor lysis syndrome, clinical and biological consequences of this syndrome and to provide up-to-date guidelines to ensure prevention and prompt management of this syndrome.

  19. Acute respiratory infections in elderly people: the role of micronutrients and lifestyle

    NARCIS (Netherlands)

    Graat, J.M.

    2003-01-01

    Acute respiratory infections are the most frequent of all infectious diseases. In popular speech common cold, flu (influenza), and pneumonia all denote acute respiratory infections. Elderly people show an increased risk of these infections and their complications. In The Netherlands about 2.000 elde

  20. Acute effects of ambient air pollution episodes on respiratory health of children.

    NARCIS (Netherlands)

    Hoek, G.

    1992-01-01

    In this thesis the acute effects of air pollution episodes on respiratory health of seven to eleven year old children living in non-urban communities in the Netherlands are discussed. Repeated measurements of pulmonary function (spirometry) and the occurrence of acute respiratory symptoms using a da

  1. Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure.

    Directory of Open Access Journals (Sweden)

    Jonas Tydén

    Full Text Available Heparin-binding protein (HBP is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU would be associated with decreased oxygenation or circulatory failure.This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS 3 was recorded on admission. Sequential organ failure assessment (SOFA scores were recorded daily for three days.Median SAPS 3 was 58.8 (48-70 and 30-day mortality 64/278 (23%. There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001 as well as with circulatory failure (p<0.001, after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002. ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality.A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it's predictive value at the individual patient level is low.

  2. Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome.

    Science.gov (United States)

    Rocco, Patricia R M; Pelosi, Paolo; de Abreu, Marcelo Gama

    2010-08-01

    In patients with acute lung injury and acute respiratory distress syndrome, a protective mechanical ventilation strategy characterized by low tidal volumes has been associated with reduced mortality. However, such a strategy may result in alveolar collapse, leading to cyclic opening and closing of atelectatic alveoli and distal airways. Thus, recruitment maneuvers (RMs) have been used to open up collapsed lungs, while adequate positive end-expiratory pressure (PEEP) levels may counteract alveolar derecruitment during low tidal volume ventilation, improving respiratory function and minimizing ventilator-associated lung injury. Nevertheless, considerable uncertainty remains regarding the appropriateness of RMs. The most commonly used RM is conventional sustained inflation, associated with respiratory and cardiovascular side effects, which may be minimized by newly proposed strategies: prolonged or incremental PEEP elevation; pressure-controlled ventilation with fixed PEEP and increased driving pressure; pressure-controlled ventilation applied with escalating PEEP and constant driving pressure; and long and slow increase in pressure. The efficiency of RMs may be affected by different factors, including the nature and extent of lung injury, capability of increasing inspiratory transpulmonary pressures, patient positioning and cardiac preload. Current evidence suggests that RMs can be used before setting PEEP, after ventilator circuit disconnection or as a rescue maneuver to overcome severe hypoxemia; however, their routine use does not seem to be justified at present. The development of new lung recruitment strategies that have fewer hemodynamic and biological effects on the lungs, as well as randomized clinical trials analyzing the impact of RMs on morbidity and mortality of acute lung injury/acute respiratory distress syndrome patients, are warranted. PMID:20658909

  3. Propylthiouracil-Induced Acute Liver Failure: Role of Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Andres F. Carrion

    2010-01-01

    Full Text Available Propylthiouracil- (PTU- induced hepatotoxicity is rare but potentially lethal with a spectrum of liver injury ranging from asymptomatic elevation of transaminases to fulminant hepatic failure and death. We describe two cases of acute hepatic failure due to PTU that required liver transplantation. Differences in the clinical presentation, histological characteristics, and posttransplant management are described as well as alternative therapeutic options. Frequent monitoring for PTU-induced hepatic dysfunction is strongly advised because timely discontinuation of this drug and implementation of noninvasive therapeutic interventions may prevent progression to liver failure or even death.

  4. Renal blood flow in experimental septic acute renal failure

    NARCIS (Netherlands)

    Langenberg, C.; Wan, L.; Egi, M.; May, C. N.; Bellomo, R.

    2006-01-01

    Reduced renal blood flow (RBF) is considered central to the pathogenesis of septic acute renal failure (ARF). However, no controlled experimental studies have continuously assessed RBF during the development of severe septic ARF. We conducted a sequential animal study in seven female Merino sheep. F

  5. Treatment modalities in experimentally induced acute liver failure

    NARCIS (Netherlands)

    P.T. Ernst

    1988-01-01

    textabstractThe findings made in the presented study suggest that one or more still unknown factors inherent in the experimental models currently in use are of critical importance and that only a certain limited type of model of acute hepatic failure is suitable for the evaluation of the effectivene

  6. Overview of emerging pharmacologic agents for acute heart failure syndromes

    NARCIS (Netherlands)

    De Luca, Leonardo; Mebazaa, Alexandre; Filippatos, Gerasimos; Parissis, John T.; Bohm, Michael; Voors, Adriaan A.; Nieminen, Markku; Zannad, Faiez; Rhodes, Andrew; El-Banayosy, Ali; Dickstein, Kenneth; Gheorghiade, Mihai

    2008-01-01

    Background: Several therapies commonly used for the treatment of acute heart failure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of

  7. Acute Renal Failure Induced by Chinese Herbal Medication in Nigeria

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    Effiong Ekong Akpan

    2015-01-01

    Full Text Available Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30–35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes “holy water” green water leaves, bark of Mangifera indica (mango, shoot of Anacardium occidentale (cashew, Carica papaya (paw-paw leaves, lime water, Solanum erianthum (Potato tree, and Azadirachta indica (Neem trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for “body cleansing” and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission.

  8. Effects of acute oligohydramnios on respiratory system of fetal sheep.

    Science.gov (United States)

    Savich, R D; Guerra, F A; Lee, C C; Padbury, J F; Kitterman, J A

    1992-08-01

    Prolonged oligohydramnios, or a lack of amniotic fluid, is associated with pulmonary hypoplasia and subsequent perinatal morbidity, but it is unclear whether short-term or acute oligohydramnios has any effect on the fetal respiratory system. To investigate the acute effects of removal of amniotic fluid, we studied nine chronically catheterized fetal sheep at 122-127 days gestation. During a control period, we measured the volume of fluid in the fetal potential airways and air spaces (VL), production rate of that fluid, incidence and amplitude of fetal breathing movements, tracheal pressures, and fetal plasma concentrations of cortisol, epinephrine, and norepinephrine. We then drained the amniotic fluid for a short period of time [24-48 h, 30.0 +/- 4.0 (SE) h] and repeated the above measurements. The volume of fluid drained for the initial studies was 1,004 +/- 236 ml. Acute oligohydramnios decreased VL from 35.4 +/- 2.9 ml/kg during control to 22.0 +/- 1.6 after oligohydramnios (P less than 0.004). Acute oligohydramnios did not affect the fetal lung fluid production rate, fetal breathing movements, or any of the other measured variables. Seven repeat studies were performed in six of the fetuses after reaccumulation of the amniotic fluid at 130-138 days, and in four of these studies the lung volume also decreased, although the overall mean for the repeat studies was not significantly different (27.0 +/- 5.2 ml/kg for control vs. 25.5 +/- 5.5 ml/kg for oligohydramnios). Again, none of the other measured variables were altered by oligohydramnios in the repeat studies.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1399988

  9. Anti-infectious treatment in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Min GAO

    2013-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI is different from hospital acquired infection (HAI in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, atypical pathogens and Klebsiella pneumoniae. However, HAI is mainly caused by Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant Staphylococcus aureus(MRSA, and other drug-resistant bacteria. The drug-resistant bacterial infection not only makes treatment difficult, but also leads to an increase in mechanical ventilation time, length of ICU stay, mortality rate, and medical costs. The present paper has reviewed the relationship between ARDS and infection, therapeutic principles and measures of ARDS related infection, and introduced the optimal strategy of anti-infectious treatment of ARDS.

  10. Bronchoalveolar hemostasis in lung injury and acute respiratory distress syndrome.

    Science.gov (United States)

    Glas, G J; Van Der Sluijs, K F; Schultz, M J; Hofstra, J-J H; Van Der Poll, T; Levi, M

    2013-01-01

    Enhanced intrapulmonary fibrin deposition as a result of abnormal broncho-alveolar fibrin turnover is a hallmark of acute respiratory distress syndrome (ARDS), pneumonia and ventilator-induced lung injury (VILI), and is important to the pathogenesis of these conditions. The mechanisms that contribute to alveolar coagulopathy are localized tissue factor-mediated thrombin generation, impaired activity of natural coagulation inhibitors and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. There is an intense and bidirectional interaction between coagulation and inflammatory pathways in the bronchoalveolar compartment. Systemic or local administration of anticoagulant agents (including activated protein C, antithrombin and heparin) and profibrinolytic agents (such as plasminogen activators) attenuate pulmonary coagulopathy. Several preclinical studies show additional anti-inflammatory effects of these therapies in ARDS and pneumonia. PMID:23114008

  11. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    Directory of Open Access Journals (Sweden)

    Mugford Miranda

    2006-12-01

    Full Text Available Abstract Background An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. Methods/Design The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress' by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18–65 years with severe, but potentially reversible, respiratory failure (Murray score ≥ 3.0 or hypercapnea with pH Discussion Analysis will be based on intention to treat. A concurrent economic evaluation will also be performed to compare the costs and outcomes of both treatments.

  12. [Genetic predisposition and Pediatric Acute Respiratory Distress Syndrome: New tools for genetic study].

    Science.gov (United States)

    Erranz, M Benjamín; Wilhelm, B Jan; Riquelme, V Raquel; Cruces, R Pablo

    2015-01-01

    Acute respiratory distress syndrome (ARDS) is the most severe form of respiratory failure. Theoretically, any acute lung condition can lead to ARDS, but only a small percentage of individuals actually develop the disease. On this basis, genetic factors have been implicated in the risk of developing ARDS. Based on the pathophysiology of this disease, many candidate genes have been evaluated as potential modifiers in patient, as well as in animal models, of ARDS. Recent experimental data and clinical studies suggest that variations of genes involved in key processes of tissue, cellular and molecular lung damage may influence susceptibility and prognosis of ARDS. However, the pathogenesis of pediatric ARDS is complex, and therefore, it can be expected that many genes might contribute. Genetic variations such as single nucleotide polymorphisms and copy-number variations are likely associated with susceptibility to ARDS in children with primary lung injury. Genome-wide association (GWA) studies can objectively examine these variations, and help identify important new genes and pathogenetic pathways for future analysis. This approach might also have diagnostic and therapeutic implications, such as predicting patient risk or developing a personalized therapeutic approach to this serious syndrome.

  13. Submersion and early-onset acute respiratory distress syndrome: a case report.

    Science.gov (United States)

    Diamond, Wayde; MacDonald, Russell D

    2011-01-01

    Drowning is a common cause of accidental death, particularly in younger people, and acute respiratory failure is common in these patients. This case report describes a healthy 18-year-old man who suffered a cardiorespiratory arrest due to submersion while swimming in a freshwater lake. First-responder cardiopulmonary resuscitation and defibrillation using an automated external defibrillator resulted in a return of spontaneous circulation. The patient was evacuated to a tertiary care center by a rotor-wing air medical crew. The crew experienced difficulties in oxygenating and ventilating the patient because of early-onset acute respiratory distress syndrome (ARDS). This case report describes the pathophysiology and prehospital management of a patient with suspected early-onset ARDS secondary to drowning. This case report is unique because it describes the oxygenation and ventilation difficulties encountered in managing this patient in the transport setting, and possible strategies to deal with these difficulties. Finally, this case report highlights the prehospital bypass decision-making process for patients requiring specialized medical care.

  14. Lung Postmortem Autopsy Revealing Extramedullary Involvement in Multiple Myeloma Causing Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Aurélie Ravinet

    2014-01-01

    Full Text Available Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14 translocation. Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.

  15. Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

    Science.gov (United States)

    Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

    2015-01-01

    The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

  16. Clinical features of probable severe acute respiratory syndrome in Beijing

    Institute of Scientific and Technical Information of China (English)

    Hai-Ying Lu; Xiao-Yuan Xu; Yu Lei; Yang-Feng Wu; Bo-Wen Chen; Feng Xiao; Gao-Qiang Xie; De-Min Han

    2005-01-01

    AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing.METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type.The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%)and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positiveT cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality.CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

  17. Respiratory Failure Secondary to Human Metapneumovirus Requiring Extracorporeal Membrane Oxygenation in a 32-Month-Old Child

    OpenAIRE

    Abha Gupta; Melania Bembea; Anna Brown; Courtney Robertson; Lewis Romer; Cohn, Ronald D.

    2012-01-01

    Human metapneumovirus (HMPV) is a common virus that can cause respiratory problems ranging from mild upper respiratory tract disease to respiratory failure requiring mechanical support. Here, we report a case of a 32-month-old male with a previous history of asthma, who developed respiratory failure two weeks after onset of cough and rhinorrhea and required extracorporeal membrane oxygenation (ECMO) for 9 days after failing high-frequency oscillatory ventilation (HFOV). To our knowledge, this...

  18. Epidemiology of severe acute respiratory syndrome (SARS): adults and children.

    Science.gov (United States)

    Zhong, Nan-Shan; Wong, Gary W K

    2004-12-01

    Severe acute respiratory syndrome (SARS) is a newly described respiratory infection with pandemic potential. The causative agent is a new strain of coronavirus most likely originating from wild animals. This disease first emerged in November 2002 in Guangdong Province, China. Early in the outbreak the infection had been transmitted primarily via household contacts and healthcare settings. In late February 2003 the infection was transmitted to Hong Kong when an infected doctor from the mainland visited there. During his stay in Hong Kong at least 17 guests and visitors were infected at the hotel at which he stayed. By modern day air travel, the infection was rapidly spread to other countries including Vietnam, Singapore and Canada by these infected guests. With the implementation of effective control strategies including early isolation of suspected cases, strict infection control measures in the hospital setting, meticulous contact tracing and quarantine, the outbreak was finally brought under control by July 2003. In addition, there were another two events of SARS in China between the end of December 2003 and January 2004 and from March to May 2004; both were readily controlled without significant patient spread. PMID:15531250

  19. Acute respiratory infections in Pakistan: Have we made any progress?

    International Nuclear Information System (INIS)

    Acute respiratory infections (ARI) are the leading cause of death in young children in Pakistan, responsible for 20-30% of child deaths under age 5 years. This paper summarizes the research and technical development efforts over the last 15 years which have contributed to improving the effectiveness of the case management strategy to reduce mortality from 5' pneumonia in children in Pakistan. Community intervention is viable, effective and practical. Rising antimicrobial resistance among commonly used and A low-cost oral agent is of significant concern. Appropriate monitoring and evaluation of the impact of the ARI control programme is lacking. Lack of funding for programmatic activities, lack of coordination with other child survival programs, inadequate training for community health workers and general practitioners in the private sector, lack of public awareness about seeking timely and appropriate care and insufficient planning and support for ARI in the programmatic activities at provincial and district levels are major hindrances in decreasing the burden of ARI in the country. The recent introduction of the community-based Lady Health Worker (LHW) Programme and WHO and UNICEF-sponsored integrated management of childhood illness initiative present ideal opportunities for re-emphasizing early case detection and appropriate case management of ARI. Ultimately, focusing on preventive strategies such as improving nutrition, reducing indoor pollution, improving mass vaccination, as well as introduction of new vaccines effective against important respiratory pathogens will likely have the most impact on reducing severe ARI and deaths from severe disease. (author)

  20. Acute renal failure following binge drinking and nonsteroidal antiinflammatory drugs.

    Science.gov (United States)

    Wen, S F; Parthasarathy, R; Iliopoulos, O; Oberley, T D

    1992-09-01

    Two college students who developed reversible acute deterioration in renal function following binge drinking of beer and the use of nonsteroidal antiinflammatory drugs (NSAIDs) are reported. Both patients presented with back and flank pain with muscle tenderness, but showed no evidence of overt rhabdomyolysis. The first case had marked renal failure, with a peak serum creatinine reaching 575 mumol/L (6.5 mg/dL), and acute tubular necrosis was documented by renal biopsy. The second case had only modest elevation in serum creatinine, and renal function rapidly improved on rehydration. The contribution of the potential muscle damage associated with alcohol ingestion to the changes in renal function in these two cases is not clear. However, the major mechanism for the acute renal failure was thought to be related to inhibition of renal prostaglandin synthesis in the face of compromised renal hemodynamics secondary to alcohol-induced volume depletion. PMID:1519610

  1. Watershed Cerebral Infarction in a Patient with Acute Renal Failure

    Directory of Open Access Journals (Sweden)

    Ruya Ozelsancak

    2016-02-01

    Full Text Available Acute renal failure can cause neurologic manifestations such as mood swings, impaired concentration, tremor, stupor, coma, asterixis, dysarthria. Those findings can also be a sign of cerebral infarct. Here, we report a case of watershed cerebral infarction in a 70-year-old female patient with acute renal failure secondary to contrast administration and use of angiotensin converting enzyme inhibitor. Patient was evaluated with magnetic resonance imaging because of dysarthria. Magnetic resonance imaging revealed milimmetric acute ischemic lesion in the frontal and parietal deep white matter region of both cerebral hemisphere which clearly demonstrated watershed cerebral infarction affecting internal border zone. Her renal function returned to normal levels on fifth day of admission (BUN 32 mg/dl, creatinine 1.36 mg/dl and she was discharged. Dysarthria continued for 20 days.

  2. Fulminant hepatic failure (FHF) due to acute hepatitis C.

    Science.gov (United States)

    Younis, Bilal Bin; Arshad, Rozina; Khurhsid, Saima; Masood, Junaid; Nazir, Farhan; Tahira, Maham

    2015-01-01

    Acute hepatitis C (HCV) infection has been identified as an important cause of fulminant hepatic failure (FHF), characterized by rapid deterioration of liver function from massive hepatic necrosis leading to encephalopathy and multi-organ failure. We admitted a female patient at Shalamar Hospital with jaundice, fever, encephalopathy and coagulopathy of short duration with no history of any comorbidity. Her hepatitis viral screen revealed positive anti HCV. Her viral loads were also high. A diagnosis of FHF due to acute HCV infection was made. Patient was treated conservatively and improved gradually. In summary, acute HCV can cause FHF and should be ruled out in patients with FHF of unknown cause in an endemic country for HCV like Pakistan.

  3. [Hyperhydration and dialysis in acute kidney failure].

    Science.gov (United States)

    Saner, Fuat H; Bienholz, Anja; Tyczynski, Bartosz; Kribben, Andreas; Feldkamp, Thorsten

    2015-05-01

    Despite the advances in critical care medicine, the hospital mortality in patients with acute kidney injury (AKI) requiring dialysis remains high. Depending on the underlying disease the in-house mortality is reported to be up to 80%. Several observational studies demonstrated an association between mortality and fluid overload. A primary mechanism of interest is that fluid overload causes tissue edema and subsequent reduction of perfusion, oxygenation and nutrient delivery. This results in further renal damage. In addition, fluid overload-related dilution within the extracellular space causes artificially low serum creatinine, which masks AKI diagnosis. As a consequence, renal protective management strategies are deferred, which further aggravates kidney injury. This aggravation of renal damage subsequently increases the mortality. This review discusses the role of fluid overload for outcomes in critically ill patients as described in the current literature and assesses criteria for the initiation of renal replacement therapy in this critically ill population. PMID:25970415

  4. [Acute liver failure after ingestion of death cap mushrooms].

    Science.gov (United States)

    Zuliani, Anna-Maria; Kabar, Iyad; Mitchell, Todd; Heinzow, Hauke Sebastian

    2016-07-01

    Amatoxins, which are mainly found in Amanita phalloides, Amanita virosa, and Galerina autumnalis, are responsible for the majority of fatal intoxication with green death cap. The intoxication is associated with acute liver failure, which explains the poor prognosis. Acute liver injury is generally preceeded by a gastrointestinal phase with nausea, vomiting and diarrhea. In the course, pre-renal kidney failure due to the associated fluid deficit and fulminant liver failure may occur. General guidelines for the treatment of amatoxin poisoning are yet not available. We report on three patients who suffered from amatoxin mushroom poisoning after ingestion of green death cap mushrooms. Based on the pathophysiology of amatoxin poisoning, we discuss a potential therapeutic approach. PMID:27359312

  5. Association of alveolar recruitment maneuvers and prone position in acute respiratory disease syndrome patients.

    Science.gov (United States)

    Costa, Daniela Caetano; Rocha, Eduardo; Ribeiro, Tatiane Flores

    2009-06-01

    The acute respiratory distress syndrome is the clinical presentation of acute lung injury characterized by diffuse alveolar damage and development of non-cardiogenic pulmonary edema due to increased pulmonary alveolar-capillary membrane permeability. Alveolar recruitment maneuvers and prone position can be used in the treatment of acute respiratory distress syndrome. The objective of this review of literature was to identify possible benefits, indications, complications and care of the associated recruitment maneuvers and prone position for treatment of the acute respiratory distress syndrome. This national and international scientific literature review was developed according to the established criteria for searching the databases MedLine, LILACS, SciElo, PubMed, Cochrane, from 1994 to 2008 in Portuguese and English, with the key words: acute respiratory distress syndrome, alveolar recruitment maneuver and prone position. Despite advances in the understanding of acute respiratory distress syndrome pathophysiology, mortality is still expressive. Alveolar recruitment maneuvers and prone position significantly contribute to treatment of acute respiratory distress syndrome patient aiming to improve oxygenation and minimizing complications of refractory hypoxemia and reduction of pulmonary compliance. However,as there are few studies in literature associating alveolar recruitment maneuvers and prone position for treatment of acute respiratory distress syndrome, additional research and evidences of clinical application are required. PMID:25303351

  6. BiPAP plus vibrating sputum-ejection for acute exacerbation of chronic obstructive pulmonary disease with type Ⅱ respiratory failure%双水平气道正压通气联合振动排痰在AECOPD并Ⅱ型呼吸衰竭的应用

    Institute of Scientific and Technical Information of China (English)

    林增锐; 黄泽宽; 林武强

    2011-01-01

    目的 探讨双水平气道正压通气(BiPAP)结合振动排痰在慢性阻塞性肺疾病急性加重期(AECOPD)并Ⅱ型呼吸衰竭的临床应用价值.方法 30例AECOPD患者随机分为对照组和联合组,对照组予双水平气道正压通气辅助呼吸治疗;联合组在对照组治疗基础上联合 振动排痰.结果两组患者治疗后的HR、RR、pH、PaO2、PACO2有明显改善,有统计学意义(P<0.01).治疗1天后,联合组有8例患者的PaCO2降至50mmHg以下,对照组无一例;治疗3天后,联合组有10例患者PaCO2降至50 mmHg以下,对照组有6例,联合组的例数仍较多,联合组的患者其HR、RR、pH、PaO2、PaCO2的改善显著优于对照组(P<0.05).结论 双水平气道正压通气结合振动排痰治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭患者疗效肯定,有临床应用价值.%Objective To explore the values of bilevel positive airway pressure ventilation (BiPAP)combined with vibrating sputum-ejection for acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with type Ⅱ respiratory failure.Methods 30 patients were randomly assigned to receive BiPAP alone(control group),or BiPAP plus vibrating sputum-ejection(combination group).Results HR,RR,pH,PaO2,and PaCO2 were obviously improved in the two groups after treatment,with statistical significances(P<0.01). PaCO2 decreased below 50 mmHg in 8 patients in the combination group ore clay after treatment while stayed still in the control group; and it dropped below 50 mmHg in 10 patients in the combination group three days after treatment but stayed unchanged in 6 patients in the control group.the improvement of HR,RR,pH,PaO2,and PaCO2 in the combination group was obviously superior to that in the control group(P<0.05).Conclusions Bilevel positive airway pressure ventilation combined with vibrating sputum-ejection is more effeetive in the treatment of acute exacerbation of chronic obstructive pulmonary disease with type

  7. Pulmonary Alveolar Proteinosis: A Rare Cause of Respiratory Failure.

    Science.gov (United States)

    Munir, Zeeshan; Khosa, Muhammad Zeeshan; Qazi, Muhammad Yaqoob

    2015-07-01

    Pulmonary Alveolar Proteinosis (PAP) is a rare syndrome in the paediatric age group and characterized by intra-alveolar accumulation of proteinaceous phospholipid-laden material called surfactant. The diagnosis is made by High Resolution Computed Tomography (HRCT) chest which shows characteristic crazy paving appearance and diagnosis confirmed by Bronchoalveolar Lavage (BAL). We report two cases. First was a 9-month old infant who presented with respiratory distress and peripheral cyanosis since birth. He was diagnosed on High Resolution Computed Tomography (HRCT) chest as a case of pulmonary alveolar proteinosis and broncho-alveolar lavage confirmed his diagnosis. Second case was a 10-year old female child who had a history of repeated chest infections for 5 years and now presented with cough and respiratory distress for 45 days. She was also diagnosed on HRCT chest but unfortunately she died before bronchoalveolar lavage. PMID:26208564

  8. Respiratory protection and emerging infectious diseases: lessons from severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    John H. Lange

    2005-01-01

    @@ The severe acute respiratory syndrome (SARS) that emerged 2002-2003 and apparently again 2004 (reported by the news media on December 27, 2003) as the first confirmed case by the World Health Organization (WHO)1,2 raised awareness of emerging infectious diseases.3 Every year there are both new and old infectious diseases emerging as potential pandemic agents.4-6 However, few of these diseases receive the public attention and concern expressed as occurred during the emergence of SARS. Much of this concern was a result of the rapid spread of the novel coronavirus (CoV) to different regions of the world and its high infectivity, especially for health care workers (HCW).3 In many ways, the high percent of HCW infected is a warning of the potential hazards of old and emerging infectious diseases.6 However, SARS was not the only disease (e.g. Monkeypox) that emerged in 2003,3 rather it received the greatest attention.

  9. Factors associated with acute respiratory illness in day care children.

    Science.gov (United States)

    Hatakka, Katja; Piirainen, Laura; Pohjavuori, Sara; Poussa, Tuija; Savilahti, Erkki; Korpela, Riitta

    2010-09-01

    The aim of this study was to investigate the relationship between child characteristics, parental and environmental factors and the occurrence of acute respiratory illness (ARI) and acute otitis media (AOM) among Finnish children attending day care centres (DCCs). The study was a cross-sectional questionnaire of 594 children aged 1-6 y from 18 DCCs in Helsinki, Finland. Recurrent (> or =4 diseases/y) ARI was present in 44% of the 1-3-y-olds and 23% of the 4-6-y-olds, and recurrent AOM in 15% and 2.5%, respectively. Parent atopic disease (odds ratio (OR) 1.53, p = 0.033), mother's academic education (OR 1.77, p = 0.008) and a medium length of DCC attendance compared to a short period (OR 1.67, p = 0.049) increased, while furry pets (OR 0.44, p = 0.003) and older child age (OR 0.38, p or =6 months (OR 0.20, p = 0.002) and older child age (OR 0.05, p < 0.001) reduced the risk of recurrent AOM. Parental and environmental factors had a significant impact on recurrent ARI and AOM episodes in children attending DCCs. These risk factors should be considered in future studies intending to reduce DCC infections.

  10. Chronic heart failure modifies respiratory mechanics in rats: a randomized controlled trial

    OpenAIRE

    Deise M. Pacheco; Viviane D. Silveira; Alex Thomaz; Ramiro B Nunes; Viviane R. Elsner; Pedro Dal Lago

    2016-01-01

    ABSTRACT Objective To analyze respiratory mechanics and hemodynamic alterations in an experimental model of chronic heart failure (CHF) following myocardial infarction. Method Twenty-seven male adult Wistar rats were randomized to CHF group (n=12) or Sham group (n=15). Ten weeks after coronary ligation or sham surgery, the animals were anesthetized and submitted to respiratory mechanics and hemodynamic measurements. Pulmonary edema as well as cardiac remodeling were measured. Results The C...

  11. Long-term prognosis for transplant-free survivors of paracetamol-induced acute liver failure

    DEFF Research Database (Denmark)

    Jepsen, P; Schmidt, L E; Larsen, F S;

    2010-01-01

    The prognosis for transplant-free survivors of paracetamol-induced acute liver failure remains unknown.......The prognosis for transplant-free survivors of paracetamol-induced acute liver failure remains unknown....

  12. End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

    Directory of Open Access Journals (Sweden)

    Dagmar Elfriede Rinnenburger

    2012-01-01

    Full Text Available INTRODUCTION: The transition from paternalistic medicine to a healthcare culture centred on the patient's decision making autonomy presents problems of communication and understanding. Chronic respiratory failure challenges patients, their families and caregivers with important choices, such as invasive and non-invasive mechanical ventilation and tracheostomy, which, especially in the case of neuromuscular diseases, can significantly postpone the end of life. MATERIAL AND METHODS: A 7-item questionnaire was administered to 100 patients with advanced COPD, neuromuscular diseases and pulmonary fibrosis, all of them on oxygen therapy and receiving day-hospital treatment for respiratory failure. The objective was to find out whether or not patients, if faced with a deterioration of their health condition, would want to take part in the decision making process and, if so, how and with whom. RESULTS. Results showed that: 90% of patients wanted to be interviewed, 10% preferred not to be interviewed, 82% wanted to be regularly updated on their clinical situation, 75% wanted to be intubated, if necessary, and 56% would also agree to have a tracheostomy. These choices have been confirmed one year later, with 93% of respondents accepting the questionnaire and considering it useful. CONCLUSIONS: It is possible to conclude that a simple questionnaire can be a useful tool contributing to therapeutic decision making in respiratory failure.

  13. [Bowel obstruction-induced cholinergic crisis with progressive respiratory failure following distigmine bromide treatment].

    Science.gov (United States)

    Kobayashi, Kazuki; Sekiguchi, Hiroshi; Sato, Nobuhiro; Hirose, Yasuo

    2016-03-01

    A 54-year-old female experienced rapid respiratory failure while being transported in an ambulance to our emergency department for evaluation and management of constipation and abdominal pain. The patient was on treatment with distigmine bromide for postoperative urination disorder and magnesium oxide for constipation. Increased salivary secretions, diminished respiratory excursion, type 2 respiratory failure (PaCO2 : 65 mmHg), low serum cholinesterase, and hypermagnesemia were detected. Imaging studies revealed that the patient had bilateral aspiration pneumonia, fecal impaction in the rectum, and a distended colon causing ileus. The patient was mechanically ventilated and was weaned off the ventilator on day 3. Therapeutic drug monitoring after discharge revealed that the serum level of distigmine bromide on admission was markedly elevated (377.8 ng/mL vs. the normal therapeutic level of 5-10 ng/mL). Distigmine bromide induced a cholinergic crisis with a resultant increase in airway secretions and respiratory failure. In this particular case, orally administered distigmine bromide was excessively absorbed because of prolonged intestinal transit time secondary to fecal impaction and sluggish bowel movement; this caused a cholinergic crisis and hypermagnesemia contributing to respiratory failure. Clinicians should be aware that bowel obstruction in a patient treated with distigmine bromide can increase the risk of a cholinergic crisis. PMID:27255021

  14. Progression from respiratory dysfunction to failure in late-onset Pompe disease.

    Science.gov (United States)

    Berger, Kenneth I; Chan, Yinny; Rom, William N; Oppenheimer, Beno W; Goldring, Roberta M

    2016-08-01

    To identify determinants of respiratory disease progression in late-onset Pompe disease (LOPD), we studied relationships between pulmonary function, respiratory muscle strength, gas exchange, and respiratory control. Longitudinal evaluation of 22 LOPD patients (mean age 38 years) was performed at 6-month intervals for 6-24 months. Measurements included vital capacity (VC), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (VT), dead space (VD), and ventilatory response to CO2. Although reduction in VC correlated with MIP and MEP (p respiratory failure, is tightly linked to the degree of respiratory muscle weakness and severity of pulmonary dysfunction in LOPD patients. Reductions in CO2 clearance efficiency and ventilatory responsiveness may contribute to the development of chronic daytime hypercapnia.

  15. Acute-on-chronic liver failure: a review

    Directory of Open Access Journals (Sweden)

    Zamora Nava LE

    2014-04-01

    Full Text Available Luis Eduardo Zamora Nava,1 Jonathan Aguirre Valadez,2 Norberto C Chávez-Tapia,3 Aldo Torre21Department of Endoscopy, 2Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, 3Obesity and Digestive Diseases Unit, Medica Sur Clinic and Foundation, Mexico City, MexicoAbstract: There is no universally accepted definition of acute-on-chronic liver failure; however, it is recognized as an entity characterized by decompensation from an underlying chronic liver disease associated with organ failure that conveys high short-term mortality, with alcoholism and infection being the most frequent precipitating events. The pathophysiology involves inflammatory processes associated with a trigger factor in susceptible individuals (related to altered immunity in the cirrhotic population. This review addresses the different definitions developed by leading research groups, epidemiological and pathophysiological aspects, and the latest treatments for this entity.Keywords: acute-on-chronic liver failure, cirrhosis, organ failure, acute kidney injury, infection

  16. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS): the mechanism, present strategies and future perspectives of therapies

    OpenAIRE

    Luh, Shi-Ping; Chiang, Chi-huei

    2006-01-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS), which manifests as non-cardiogenic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/AR...

  17. Respiratory failure as the presenting manifestation of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Srivali, Narat; Ryu, Jay H; Rabatin, Jeffrey T

    2016-07-01

    Although amyotrophic lateral sclerosis (ALS) does not directly affect the lung parenchyma, it can jeopardize the mechanical function of the respiratory system. About one-quarter of ALS patients have had at least one prior misdiagnosis. Therefore, a high clinical suspicion, and careful correlation of physical examination and electromyography (EMG) are needed to reach the correct diagnosis. We report a 65-year-old man who presented with a progressive exertional dyspnea. He was subsequently found to have a diaphragmatic paralysis that was felt to be secondary to spinal cord stenosis. However, his subsequent EMG showed evidence of muscle fasciculation and he was ultimately diagnosed with ALS. PMID:26899358

  18. Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure

    NARCIS (Netherlands)

    C.A. den Uil; W.K. Lagrand; P.E. Spronk; M. van der Ent; L.S.D. Jewbali; J.J. Brugts; C. Ince; M.L. Simoons

    2009-01-01

    Impaired tissue perfusion is often observed in patients with acute heart failure. We tested whether low-dose nitroglycerin (NTG) improves microcirculatory perfusion in patients admitted for acute heart failure. In 20 acute heart failure patients, NTG was given as intravenous infusion at a fixed dose

  19. Evaluation of Fiber Bundle Rotation for Enhancing Gas Exchange in a Respiratory Assist Catheter

    OpenAIRE

    Eash, Heide J.; Mihelc, Kevin M.; Frankowski, Brain J.; Hattler, Brack G.; Federspiel, William J.

    2007-01-01

    Supplemental oxygenation and carbon dioxide removal through an intravenous respiratory assist catheter can be used as a means of treating patients with acute respiratory failure. We are beginning development efforts toward a new respiratory assist catheter with an insertional size

  20. Lipopolysaccharide-induced acute renal failure in conscious rats

    DEFF Research Database (Denmark)

    Jonassen, Thomas E N; Graebe, Martin; Promeneur, Dominique;

    2002-01-01

    In conscious, chronically instrumented rats we examined 1) renal tubular functional changes involved in lipopolysaccharide (LPS)-induced acute renal failure; 2) the effects of LPS on the expression of selected renal tubular water and sodium transporters; and 3) effects of milrinone......, a phosphodiesterase type 3 (PDE3) inhibitor, and Ro-20-1724, a PDE4 inhibitor, on LPS-induced changes in renal function. Intravenous infusion of LPS (4 mg/kg b.wt. over 1 h) caused an immediate decrease in glomerular filtration rate (GFR) and proximal tubular outflow without changes in mean arterial pressure (MAP......-alpha and lactate, inhibited the LPS-induced tachycardia, and exacerbated the acute LPS-induced fall in GFR. Furthermore, Ro-20-1724-treated rats were unable to maintain MAP. We conclude 1) PDE3 or PDE4 inhibition exacerbates LPS-induced renal failure in conscious rats; and 2) LPS treated rats develop an escape...

  1. Dengue fever presenting as acute liver failure- a case report

    Institute of Scientific and Technical Information of China (English)

    Rajat Jhamb; Bineeta Kashyap; Ranga GS; Kumar A

    2011-01-01

    Dengue fever(DF) and dengue haemorrhagic fever(DHF) are important mosquito-borne viral diseases of humans and recognized as important emerging infectious diseases in the tropics and subtropics. Compared to nine reporting countries in the 1950s, today the geographic distribution includes more than100 countries worldwide. Dengue viral infections are known to present a diverse clinical spectrum, ranging from asymptomatic illness to fatal dengue shock syndrome. Mild hepatic dysfunction in dengue haemorrhagic fever is usual. However, its presentation as acute liver failure(ALF)is unusual. We report a patient with dengue shock syndrome who presented with acute liver failure and hepatic encephalopathy in a recent outbreak of dengue fever in Delhi, India.

  2. Hepatic encephalopathy in acute-on-chronic liver failure.

    Science.gov (United States)

    Lee, Guan-Huei

    2015-10-01

    The presence of hepatic encephalopathy (HE) within 4 weeks is part of the criteria for defining acute-on-chronic liver failure (ACLF). The pathophysiology of HE is complex, and hyperammonemia and cerebral hemodynamic dysfunction appear to be central in the pathogenesis of encephalopathy. Recent data also suggest that inflammatory mediators may have a significant role in modulating the cerebral effect of ammonia. Multiple prospective and retrospective studies have shown that hepatic encephalopathy in ACLF patients is associated with higher mortality, especially in those with grade III-IV encephalopathy, similar to that of acute liver failure (ALF). Although significant cerebral edema detected by CT in ACLF patients appeared to be less common, specialized MRI imaging was able to detect cerebral edema even in low grade HE. Ammonia-focused therapy constitutes the basis of current therapy, as in the treatment of ALF. Emerging treatment strategies focusing on modulating the gut-liver-circulation-brain axis are discussed.

  3. Prediction of Acute Respiratory Disease in Current and Former Smokers With and Without COPD

    Science.gov (United States)

    Kim, Victor; Regan, Elizabeth; Williams, André A. A.; Santorico, Stephanie A.; Make, Barry J.; Lynch, David A.; Hokanson, John E.; Washko, George R.; Bercz, Peter; Soler, Xavier; Marchetti, Nathaniel; Criner, Gerard J.; Ramsdell, Joe; Han, MeiLan K.; Demeo, Dawn; Anzueto, Antonio; Comellas, Alejandro; Crapo, James D.; Dransfield, Mark; Wells, J. Michael; Hersh, Craig P.; MacIntyre, Neil; Martinez, Fernando; Nath, Hrudaya P.; Niewoehner, Dennis; Sciurba, Frank; Sharafkhaneh, Amir; Silverman, Edwin K.; van Beek, Edwin J. R.; Wilson, Carla; Wendt, Christine; Wise, Robert A.; Curtis, Jeffrey; Kazerooni, Ella; Hanania, Nicola; Alapat, Philip; Bandi, Venkata; Guntupalli, Kalpalatha; Guy, Elizabeth; Lunn, William; Mallampalli, Antara; Trinh, Charles; Atik, Mustafa; DeMeo, Dawn; Hersh, Craig; Jacobson, Francine; Graham Barr, R.; Thomashow, Byron; Austin, John; MacIntyre, Neil; Washington, Lacey; Page McAdams, H.; Rosiello, Richard; Bresnahan, Timothy; McEvoy, Charlene; Tashjian, Joseph; Wise, Robert; Hansel, Nadia; Brown, Robert; Casaburi, Richard; Porszasz, Janos; Fischer, Hans; Budoff, Matt; Sharafkhaneh, Amir; Niewoehner, Dennis; Allen, Tadashi; Rice, Kathryn; Foreman, Marilyn; Westney, Gloria; Berkowitz, Eugene; Bowler, Russell; Friedlander, Adam; Meoni, Eleonora; Criner, Gerard; Kim, Victor; Marchetti, Nathaniel; Satti, Aditi; James Mamary, A.; Steiner, Robert; Dass, Chandra; Bailey, William; Dransfield, Mark; Gerald, Lynn; Nath, Hrudaya; Ramsdell, Joe; Ferguson, Paul; Friedman, Paul; McLennan, Geoffrey; van Beek, Edwin JR; Martinez, Fernando; Han, MeiLan; Thompson, Deborah; Kazerooni, Ella; Wendt, Christine; Allen, Tadashi; Sciurba, Frank; Weissfeld, Joel; Fuhrman, Carl; Bon, Jessica; Anzueto, Antonio; Adams, Sandra; Orozco, Carlos; Santiago Restrepo, C.; Mumbower, Amy; Crapo, James; Silverman, Edwin; Make, Barry; Regan, Elizabeth; Samet, Jonathan; Willis, Amy; Stinson, Douglas; Beaty, Terri; Klanderman, Barbara; Laird, Nan; Lange, Christoph; Ionita, Iuliana; Santorico, Stephanie; Silverman, Edwin; Lynch, David; Schroeder, Joyce; Newell, John; Reilly, John; Coxson, Harvey; Judy, Philip; Hoffman, Eric; San Jose Estepar, Raul; Washko, George; Leek, Rebecca; Zach, Jordan; Kluiber, Alex; Rodionova, Anastasia; Mann, Tanya; Crapo, Robert; Jensen, Robert; Farzadegan, Homayoon; Murphy, James; Everett, Douglas; Wilson, Carla; Hokanson, John

    2014-01-01

    BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown. METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score. RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George’s Respiratory Questionnaire score). Risks were similar for those with and without COPD. CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD. PMID:24945159

  4. Liver transplantation for acute liver failure accompanied by severe acute pancreatitis.

    Science.gov (United States)

    Kirino, Izumi; Fujimoto, Yasuhiro; Hata, Koichiro; Uemoto, Shinji

    2016-01-01

    The role of liver transplantation (LT) in acute liver failure (ALF) complicated by severe acute pancreatitis is still unclear. We here report a case of deceased-donor LT for idiopathic ALF accompanied by severe acute pancreatitis. A 58-year-old man with no history of liver disease presented with idiopathic ALF and acute pancreatitis. After careful consideration, he received a liver from a deceased donor. Following surgery, the patient's liver function rapidly reverted to normal level and the acute pancreatitis simultaneously subsided. The patient later developed a pancreatic pseudocyst, which was treated successfully with combination interventional radiology. LT can be considered for ALF associated with severe acute pancreatitis if there is no clinical evidence of an absolute contraindication for organ transplantation, such as systemic or local infection. Moreover, we recommend a close follow-up by ultrasonography to allow early detection and treatment of pancreatic pseudocysts following surgery. PMID:27600056

  5. Disseminated lymphoma presenting as acute thigh pain and renal failure.

    LENUS (Irish Health Repository)

    Brown, Catherine

    2009-01-01

    A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.

  6. Acute Respiratory Failure in 3 Children With Juvenile Myelomonocytic Leukemia

    DEFF Research Database (Denmark)

    Gustafsson, Britt; Hellebostad, Marit; Ifversen, Marianne;

    2011-01-01

    Juvenile myelomonocytic leukemia is a rare hematopoietic stem cell disease in children with features of both myelodysplasia and myeloproliferation. Extramedullary involvement has been reported and pulmonary involvement secondary to leukemic infiltration is an initial manifestation, which may resu...

  7. Lessons from an unusual case : malignancy associated hypercalcemia, pancreatitis and respiratory failure due to ARDS

    NARCIS (Netherlands)

    Wymenga, ANM; van der Werf, TS; van der Graaf, WTA; Tulleken, JE; Zijlstra, JG; Ligtenberg, JJM

    1999-01-01

    A 37-year old woman, presenting with severe hypercalcaemia-associated pancreatitis with pseudocyst formation, was admitted to intensive care because she developed ARDS with respiratory failure. Skeletal metastasis from non-small cell bronchial carcinoma were subsequently diagnosed. After she develop

  8. Severe respiratory failure due to co-infection with human metapneumovirus and Streptococcus pneumoniae

    OpenAIRE

    Masafumi Seki; Hisao Yoshida; Kazuyoshi Gotoh; Nobuyuki Hamada; Daisuke Motooka; Shota Nakamura; Norihisa Yamamoto; Shigeto Hamaguchi; Yukihiro Akeda; Hiroshi Watanabe; Tetsuya Iida; Kazunori Tomono

    2014-01-01

    A 64-year-old male patient was admitted with respiratory failure, although chest X-rays revealed only mild bronchiolitis. Streptococcus pneumoniae, which usually presents as massive lobular pneumonia, was isolated from sputum, however, pan-pathogen screening using a next-generation sequencer also detected human metapneumovirus genome fragments.

  9. Mechanisms of improvement of respiratory failure in patients with restrictive thoracic disease treated with non-invasive ventilation

    OpenAIRE

    Nickol, A; Hart, N.; Hopkinson, N; Moxham, J.; Simonds, A; Polkey, M.

    2005-01-01

    Background: Nocturnal non-invasive ventilation (NIV) is an effective treatment for hypercapnic respiratory failure in patients with restrictive thoracic disease. We hypothesised that NIV may reverse respiratory failure by increasing the ventilatory response to carbon dioxide, reducing inspiratory muscle fatigue, or enhancing pulmonary mechanics.

  10. Acute alcoholic myopathy, rhabdomyolysis and acute renal failure : a case report.

    Directory of Open Access Journals (Sweden)

    Singh S

    2000-01-01

    Full Text Available A case of middle aged male who developed swelling and weakness of muscles in the lower limbs following a heavy binge of alcohol is being reported. He had myoglobinuria and developed acute renal failure for which he was dialyzed. Acute alcoholic myopathy is not a well recognized condition and should be considered in any intoxicated patient who presents with muscle tenderness and weakness.

  11. Acute respiratory distress syndrome in the global context.

    Science.gov (United States)

    Buregeya, Egide; Fowler, Robert A; Talmor, Daniel S; Twagirumugabe, Theogene; Kiviri, Willy; Riviello, Elisabeth D

    2014-09-01

    Acute respiratory distress syndrome (ARDS) is a clinically defined syndrome of hypoxia and bilateral pulmonary infiltrates due to inflammatory pathways triggered by pulmonary and nonpulmonary insults, and ARDS is pathologically correlated with diffuse alveolar damage. Estimates of ARDS's impact in the developed world vary widely, with some of the discrepancies attributed to marked differences in the availability of intensive care beds and mechanical ventilation. Almost nothing is known about the epidemiology of ARDS in the developing world, in part due to a clinical definition requiring positive pressure ventilation, arterial blood gases, and chest radiography. Current frameworks for comparing the epidemiology of death and disability across the world including the GBD (Global Burden of Disease Study) 2010 are ill-suited to quantifying critical illness syndromes including ARDS. Modifications to the definition of ARDS to allow a provision for environments without the capacity for positive pressure ventilation, and to allow for alternate diagnostic techniques including pulse oximetry and ultrasound, may make it possible to quantify and describe the impact of ARDS in the global context. PMID:25667180

  12. Severe acute respiratory syndrome: vaccine on the way

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ding-mei; WANG Guo-ling; LU Jia-hai

    2005-01-01

    @@ In November 2002, a new disease-severe acute respiratory syndrome, or SARS-first emerged in Guangdong Province, China. Subsequently, it spread to more than 30 countries worldwide.1 The causative agent was identified to be a previously unknown member of the coronaviridae family, and was named SARS coronavirus (SARS-CoV). SARS coronavirus is a large, enveloped, positive-sense RNA virus. The genome is about 30 kb, which is predicted to contain 14 functional open reading frames (ORFs). Two large 5'-terminal ORFs (1a and 1b) encode the polymerases that are required for viral RNA synthesis. The remaining twelve ORFs encode four structural proteins [spike protein (S), envelope protein (E), membrane protein (M) and nucleocapsid protein (N)] and eight accessory proteins.2 Though the SARS-CoV genome is clear, a great deal more work will be required to develop an efficient vaccine and effective drugs. Neutralizing antibodies were detectable in the convalescent sera of SARS patients, and sera from recovered patients could be used to treat newly infected individuals.3 The data suggest that protective humoral immunity is achievable and that vaccines can be developed for prevention of SARS. In this article, we review and discuss progress towards development of a SARS vaccine.

  13. Current status of severe acute respiratory syndrome in China

    Institute of Scientific and Technical Information of China (English)

    Qing-He Nie; Xin-Dong Luo; Jian-Zhong Zhang; Qin Su

    2003-01-01

    Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality.SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an acumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARSCoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy,antiviralagents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals,SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research.Otherstudies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.

  14. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Cho, Young-Jae; Moon, Jae Young; Shin, Ein-Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jaemin; Lee, Seok Jeong; Lee, Won-Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo

    2016-01-01

    There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

  15. Acute respiratory distress syndrome (ARDS): HRCT findings in survivors

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jung Im; Park, Seog Hee; Lee, Jae Mun; Song, Jeong Sup; Lee, Kyo Young [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this report is to describe the high-resolution computed tomography (HRCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one year, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hyperoxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.

  16. Lung tissue remodeling in the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Souza Alba Barros de

    2003-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibropro­liferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient?s prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.

  17. Hyperlactatemia in patients with non-acetaminophen-related acute liver failure

    Institute of Scientific and Technical Information of China (English)

    Pilar Taurá; Graciela Martinez-Palli; Julia Martinez-Ocon; Joan Beltran; Gerard Sanchez-Etayo; Jaume Balust; Teresa Anglada; Antoni Mas; Juan-Carlos Garcia-Valdecasas

    2006-01-01

    AIM: To characterize hyperlactatemia in patients with non-acetaminophen acute liver failure (ALF) in an attempt to clarify the mechanisms implicated and the role as a prognosis factor.METHODS: In the setting of liver transplantation, 63 consecutive patients with non-acetaminophen acute liver failure were studied in relation to tissue oxygenation,hemodynamic and metabolic parameters. Before and after transplantation, the number of infected patients and outcome were registered.RESULTS: Acute ALF showed higher levels of lactate than subacute ALF (5.4±1 mmol/L versus 2.2 ± 0.6 mmol/L, P=0.01). Oxygenation parameters were within the normal range. Lactate levels showed good correlation with respiratory quotient (r= 0.759, P< 0.005), mean glucose administration (r=0.664, P=0.01) and encephalopathy (r=0.698, P= 0.02), but not with splanchnic arteriovenous difference in PCO2, pH and the presence of infection (P=0.1). Portal vein lactate was higher (P< 0.05) than arterial and mixed venous lactate,suggesting its production of hyperlactatemia in the intestine and spleen. The presence of infection was an independent predictor of survival. CONCLUSION: Hyperlactatemia is not a prognosis factor due to byproduct of the overall acceleration in glycolysis.

  18. Outcome of Severe Dengue Viral Infection-caused Acute Liver Failure in Thai Children.

    Science.gov (United States)

    Laoprasopwattana, Kamolwish; Jundee, Puthachat; Pruekprasert, Pornpimol; Geater, Alan

    2016-06-01

    To determine clinical course and outcomes of liver functions in children with dengue viral infection-caused acute liver failure (ALF), the records of patients aged dengue hemorrhagic fever grade II, III and IV, respectively. Multiorgan failure including respiratory failure, massive bleeding and acute kidney injury occurred in 80.0%, 96.0% and 84.0% of the ALF cases, respectively, with an overall fatality rate of 68.3%. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were highest on the day that the patient developed ALF. Lactate dehydrogenase levels had positive correlations with AST (r = 0.95) and ALT (r = 0.87) (all p < 0.01). The median (interquartile range) days before the AST and ALT levels returned to lower than 200 U/L after the ALF were 10.5 (8.8, 12.8) and 10.5 (7.8, 14.0) days, respectively. PMID:26851434

  19. Possible role of mtDNA depletion and respiratory chain defects in aristolochic acid I-induced acute nephrotoxicity

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Zhenzhou, E-mail: jiangcpu@yahoo.com.cn; Bao, Qingli, E-mail: bao_ql@126.com; Sun, Lixin, E-mail: slxcpu@126.com; Huang, Xin, E-mail: huangxinhx66@sohu.com; Wang, Tao, E-mail: wangtao1331@126.com; Zhang, Shuang, E-mail: cat921@sina.com; Li, Han, E-mail: hapo1101@163.com; Zhang, Luyong, E-mail: lyzhang@cpu.edu.cn

    2013-01-15

    This report describes an investigation of the pathological mechanism of acute renal failure caused by toxic tubular necrosis after treatment with aristolochic acid I (AAI) in Sprague–Dawley (SD) rats. The rats were gavaged with AAI at 0, 5, 20, or 80 mg/kg/day for 7 days. The pathologic examination of the kidneys showed severe acute tubular degenerative changes primarily affecting the proximal tubules. Supporting these results, we detected significantly increased concentrations of blood urea nitrogen (BUN) and creatinine (Cr) in the rats treated with AAI, indicating damage to the kidneys. Ultrastructural examination showed that proximal tubular mitochondria were extremely enlarged and dysmorphic with loss and disorientation of their cristae. Mitochondrial function analysis revealed that the two indicators for mitochondrial energy metabolism, the respiratory control ratio (RCR) and ATP content, were reduced in a dose-dependent manner after AAI treatment. The RCR in the presence of substrates for complex I was reduced more significantly than in the presence of substrates for complex II. In additional experiments, the activity of respiratory complex I, which is partly encoded by mitochondrial DNA (mtDNA), was more significantly impaired than that of respiratory complex II, which is completely encoded by nuclear DNA (nDNA). A real-time PCR assay revealed a marked reduction of mtDNA in the kidneys treated with AAI. Taken together, these results suggested that mtDNA depletion and respiratory chain defects play critical roles in the pathogenesis of kidney injury induced by AAI, and that the same processes might contribute to aristolochic acid-induced nephrotoxicity in humans. -- Highlights: ► AAI-induced acute renal failure in rats and the proximal tubule was the target. ► Tubular mitochondria were morphologically aberrant in ultrastructural examination. ► AAI impair mitochondrial bioenergetic function and mtDNA replication.

  20. Possible role of mtDNA depletion and respiratory chain defects in aristolochic acid I-induced acute nephrotoxicity

    International Nuclear Information System (INIS)

    This report describes an investigation of the pathological mechanism of acute renal failure caused by toxic tubular necrosis after treatment with aristolochic acid I (AAI) in Sprague–Dawley (SD) rats. The rats were gavaged with AAI at 0, 5, 20, or 80 mg/kg/day for 7 days. The pathologic examination of the kidneys showed severe acute tubular degenerative changes primarily affecting the proximal tubules. Supporting these results, we detected significantly increased concentrations of blood urea nitrogen (BUN) and creatinine (Cr) in the rats treated with AAI, indicating damage to the kidneys. Ultrastructural examination showed that proximal tubular mitochondria were extremely enlarged and dysmorphic with loss and disorientation of their cristae. Mitochondrial function analysis revealed that the two indicators for mitochondrial energy metabolism, the respiratory control ratio (RCR) and ATP content, were reduced in a dose-dependent manner after AAI treatment. The RCR in the presence of substrates for complex I was reduced more significantly than in the presence of substrates for complex II. In additional experiments, the activity of respiratory complex I, which is partly encoded by mitochondrial DNA (mtDNA), was more significantly impaired than that of respiratory complex II, which is completely encoded by nuclear DNA (nDNA). A real-time PCR assay revealed a marked reduction of mtDNA in the kidneys treated with AAI. Taken together, these results suggested that mtDNA depletion and respiratory chain defects play critical roles in the pathogenesis of kidney injury induced by AAI, and that the same processes might contribute to aristolochic acid-induced nephrotoxicity in humans. -- Highlights: ► AAI-induced acute renal failure in rats and the proximal tubule was the target. ► Tubular mitochondria were morphologically aberrant in ultrastructural examination. ► AAI impair mitochondrial bioenergetic function and mtDNA replication.

  1. Guidelines to rational use of antibiotics in acute upper respiratory tract infections in Chinese children

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Acute respiratory tract infections (ARTIs) is the most common disease afflicting Chinese children and ranks first in numbers of outpatients, hospitalization and fatality rate. ARTI is also the most frequent reason that antibiotics are prescribed.

  2. A case of lung cancer associated with acute respiratory distress syndrome after thoracic radiotherapy

    International Nuclear Information System (INIS)

    A 73-year-old man presented with dyspnea, cough, fever, appetite loss and stridor due to bronchial stenosis. Fiber-optic bronchoscopy revealed an endobronchial lesion in the right main bronchus and biopsy specimens showed poorly differentiated squamous cell carcinoma. The clinical stage of lung cancer was IIIB (T4N2M0). The patient received 60 Gy in 30 fractions over 43 days to a field including the right hilum and mediastinum. The tumor decreased in size and stenosis of the bronchus disappeared. A week after completion of radiation the patient began to have high grade fever and dyspnea, and progressive hypoxia developed. A chest radiograph showed diffuse bilateral interstitial infiltrates. Despite mechanical ventilation with PEEP and the administration of steroids, he died of respiratory failure three weeks after completion of radiation. Necropsy specimens obtained from the left lung revealed massive deposition of fibrin in the alveolar airspaces associated with hyaline membranes and hyperplasia of type II cells indicating diffuse alveolar damage. The patient had mild pulmonary fibrosis on a CT scan taken before the start of radiotherapy. We conclude that care should be taken if the case has pulmonary fibrosis because radiation therapy can precipitate severe radiation pneumonitis and acute respiratory distress syndrome in such cases. (author)

  3. Recent insights: mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome

    Science.gov (United States)

    Horie, Shahd; Laffey, John G.

    2016-01-01

    Acute respiratory distress syndrome (ARDS) causes respiratory failure, which is associated with severe inflammation and lung damage and has a high mortality and for which there is no therapy. Mesenchymal stromal/stem cells (MSCs) are adult multi-progenitor cells that can modulate the immune response and enhance repair of damaged tissue and thus may provide a therapeutic option for ARDS. MSCs demonstrate efficacy in diverse in vivo models of ARDS, decreasing bacterial pneumonia and ischemia-reperfusion-induced injury while enhancing repair following ventilator-induced lung injury. MSCs reduce the pro-inflammatory response to injury while augmenting the host response to bacterial infection. MSCs appear to exert their effects via multiple mechanisms—some are cell interaction dependent whereas others are paracrine dependent resulting from both soluble secreted products and microvesicles/exosomes derived from the cells. Strategies to further enhance the efficacy of MSCs, such as by overexpressing anti-inflammatory or pro-repair molecules, are also being investigated. Encouragingly, early phase clinical trials of MSCs in patients with ARDS are under way, and experience with these cells in trials for other diseases suggests that the cells are well tolerated. Although considerable translational challenges, such as concerns regarding cell manufacture scale-up and issues regarding cell potency and batch variability, must be overcome, MSCs constitute a highly promising potential therapy for ARDS.

  4. 8th International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

    OpenAIRE

    Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

    2015-01-01

    This paper summarizes the Part 3 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 3) presents a section regarding Moving Across the Spectrum of Care for Long-Term Ventilati...

  5. Pre-operative risk factors predict post-operative respiratory failure after liver transplantation.

    Directory of Open Access Journals (Sweden)

    Ching-Tzu Huang

    Full Text Available OBJECTIVE: Post-operative pulmonary complications significantly affect patient survival rates, but there is still no conclusive evidence regarding the effect of post-operative respiratory failure after liver transplantation on patient prognosis. This study aimed to predict the risk factors for post-operative respiratory failure (PRF after liver transplantation and the impact on short-term survival rates. DESIGN: The retrospective observational cohort study was conducted in a twelve-bed adult surgical intensive care unit in northern Taiwan. The medical records of 147 liver transplant patients were reviewed from September 2002 to July 2007. Sixty-two experienced post-operative respiratory failure while the remaining 85 patients did not. MEASUREMENTS AND MAIN RESULTS: Gender, age, etiology, disease history, pre-operative ventilator use, molecular adsorbent re-circulating system (MARS use, source of organ transplantation, model for end-stage liver disease score (MELD and Child-Turcotte-Pugh score calculated immediately before surgery were assessed for the two groups. The length of the intensive care unit stay, admission duration, and mortality within 30 days, 3 months, and 1 year were also evaluated. Using a logistic regression model, post-operative respiratory failure correlated with diabetes mellitus prior to liver transplantation, pre-operative impaired renal function, pre-operative ventilator use, pre-operative MARS use and deceased donor source of organ transplantation (p<0.05. Once liver transplant patients developed PRF, their length of ICU stay and admission duration were prolonged, significantly increasing their mortality and morbidity (p<0.001. CONCLUSIONS: The predictive pre-operative risk factors significantly influenced the occurrence of post-operative respiratory failure after liver transplantation.

  6. [Learning from failure - implications for respiratory and intensive care medicine: a conceptual review].

    Science.gov (United States)

    Kabitz, H-J

    2013-08-01

    The clinical, social and economical impact of failure in medicine [i. e., adverse health care events (AHCE)] is overwhelming. Respiratory and intensive care medicine are strongly relevant to AHCE, particularly in cases associated with respiratory failure, mechanical ventilation and pharmacotherapy. In spite of the obvious necessity to learn from AHCE, its realisation in health-care organisations is still rare. This conceptual review therefore aims to (i) clarify the most relevant terminology, (ii) identify obstacles related to this health-care topic, and (iii) present possible strategies for solving the problems, thereby enabling respiratory and intensive care medicine to systematically and effectively learn from failure. A review of the literature (effective as of June 2013) derived from the electronic databases Medline via PubMed, EMBASE, ERIC and Google Scholar identified the following relevant obstacles (ii): a so-called blame culture associated with concealing failure, missing system analyses (vs. individual breakdown), and (economically) misdirected incentives. Possible strategies to overcome these obstacles (iii) include acknowledging the importance of leadership, a safe environment, open reporting, an effective feedback culture, and detection (e. g., trigger-tools), analysis and discussion (e. g., double loop learning) of failure. The underlying reasons for the occurrence of AHCE are based on structural, organisational and human shortcomings, and affect all categories of caregivers. Approaches to solving the problem should therefore focus primarily on the entire system, rather than on the individual alone. PMID:23846430

  7. Acute Respiratory Distress following Intravenous Injection of an Oil-Steroid Solution

    OpenAIRE

    Michael Russell; Aric Storck; Martha Ainslie

    2011-01-01

    Several case reports have described acute lung injury and respiratory distress following the intravascular injection of oil. Although biochemical and mechanical theories explaining the pathological mechanism of pulmonary oil embolism have been proposed, the phenomenon is not completely understood. This report describes a case of acute respiratory distress and hypoxemia involving a 21-year-old bodybuilder who self-administered an injection of anabolic steroids suspended in oil. The ensuing bri...

  8. Evaluation of physiological parameters before and after respiratory physiotherapy in newborns with acute viral bronchiolitis

    OpenAIRE

    S Gonçalves, Rodrigo A; Feitosa, Sérgio; de Castro Selestrin, Cláudia; Vitor E. Valenti; de Sousa, Fernando H; F Siqueira, Arnaldo A; Petenusso, Márcio; de Abreu, Luiz Carlos

    2014-01-01

    Background Acute viral bronchiolitis is a respiratory disease with high morbidity that affects newborn in the first two years of life. Its treatment with physiotherapy has been highlighted as an important tool, however, there is no consensus regarding its effects on patients improvement. We aimed to evaluate the physiological parameters before and after the procedure respiratory therapy in newborn with acute viral bronchiolitis. Method This was a cross sectional observational study in 30 newb...

  9. Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome

    OpenAIRE

    Grissom, CK; Hirshberg, EL; Dickerson, JB; Brown, SM; Lanspa, MJ; Liu, KD; Schoenfeld, D; Hite, RD; Miller, RR; Morris, AH; Hudson, L; Gundel, S; Hough, C.; Neff, M.; Sims, K.

    2015-01-01

    © 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Objectives: In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protoco...

  10. A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

    OpenAIRE

    Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R. Joan H.; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q. Sue; Gross, Diane

    2015-01-01

    Background The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity s...

  11. Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report.

    Science.gov (United States)

    Pothuri, Pallavi; Ahuja, Keerat; Kumar, Viki; Lal, Sham; Tumarinson, Taisiya; Mahmood, Khalid

    2016-01-01

    BACKGROUND Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. CONCLUSIONS As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute

  12. Obstetrical acute renal failure: a challenging medical complication

    International Nuclear Information System (INIS)

    Acute renal failure (ARF) is a syndrome characterised by rapid decline in glomerular filtration rate and retention of nitrogenous waste products such as urea and creatinine. The objective of this study was to study the prevalence, risk and outcome of women with obstetrical renal failure. Methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital, Hyderabad, Pakistan from October 2009 to September 2010. Thirty-five patients with obstetrical acute renal failure were included in the study, patients with chronic renal diseases, hypertension, diabetes mellitus and renal stones were excluded from the study. A detailed history was followed by thorough examination and investigation. Their clinical history, physical examination and intake/urine output was recorded. Routine laboratory investigations were done related to each case and specialised investigations like renal scan, renal ultrasonography and renal biopsies were performed in selected cases where recovery was delayed for more than 3 weeks. Results: Total numbers of admissions in obstetric ward were 3,285. Pregnancy related acute renal failure was found in 35 (1.065%) women. Age ranged from 18-40 years. Most of the women belonged to age group 30-35. Out of 35 women 31.42% had postpartum haemorrhage. Ante partum haemorrhage was found in 25.71%, Eclampsia in 17.14%, DIC in 14.28%, and sepsis in 11.42%. Anuria was observed in 25 patients, remaining presented with oliguria (28.57%). Haemodialysis was done in 75% of patients, others were managed conservatively. Complete recovery was observed in 53% cases. Maternal mortality was 25.71% and foetal mortality was 22.85%. Conclusion: Pregnancy related ARF is one of the most common causes of ARF, it is a dangerous complication of pregnancy which carries very high mortality and morbidity. (author)

  13. Use of Noninvasive Positive Pressure Ventilation in Acute Respiratory Insufficiency after Cardiac Surgery

    OpenAIRE

    Mohamed Abdel Rahman Salem

    2004-01-01

    Background: Non-invasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BiPAP) ventilation is a safe and effective mean of improving gas exchange in many types of respiratory failure. The results of application of NIPPV to patients who had cardiac surgery and developed respiratory failure after extubation still to be investigated. Aim of work: To compare the efficacy of NIPPV delivered through a face mask with the efficacy of conventional mechanical ventilation ...

  14. Nephroprotective effect of ethanolic extract of abutilon indicum root in gentamicin induced acute renal failure

    OpenAIRE

    Jacob Jesurun RS; Lavakumar S.

    2016-01-01

    Background: The term acute renal failure (ARF) is at present called acute kidney injury (AKI). AKI is a reversible condition in which there is a sudden decline in renal function, manifested by elevated SCr and BUN which occurs in hours to days to weeks. The present study was to evaluate the nephron protective effect of abutilon indicum root in gentamicin induced acute renal failure in wistar albino rats. Methods: Experimental evaluation was done in gentamicin induced acute renal failure. 2...

  15. Evaluation of respiratory dysfunction in a pig model of severe acute dichlorvos poisoning

    Institute of Scientific and Technical Information of China (English)

    HE Xin-hua; WU Jun-yuan; LI Chun-sheng; SU Zhi-yu; JI Xian-fei; HAN Yi; WANG Sheng-qi; ZHANG Jian

    2012-01-01

    Background Respiratory failure is the main cause of death in acute organophosphorus pesticide poisoning.In this study,a pulse-induced contour cardiac output monitor was used to evaluate the respiratory status in a pig model of acute dichlorvos poisoning.Methods Twenty female pigs were randomly allocated to dichlorvos (n=7),atropine (n=7),and control (n=6) groups.In the dichlorvos group,pigs were administered 80% emulsifiable dichlorvos (100 mg/kg) via a gastric tube.In the atropine group,pigs were similarly administered dichlorvos,and 0.5 hours later,atropine was injected to attain and maintain atropinization.The control group was administered saline solution.Arterial blood gas was measured at 0,0.5,1,2,4,and 6 hours post-injection.The extravascular lung water index and pulmonary vascular permeability index were recorded by the pulse-induced contour cardiac output monitor.At termination of the study,the animals were euthanized,the lung wet-to-dry weight ratio was determined,and histopathology was observed.Results In the dichlorvos group,the extravascular lung water index and pulmonary vascular permeability index were substantially increased from 0.5 hours and were particularly high within 1 hour.In the atropine group,these indices increased initially,but decreased from the 1-hour mark.The control group exhibited no obvious changes.In both the dichlorvos and atropine groups,the extravascular lung water index was negatively correlated with partial pressure of oxygen/fraction of inspiration oxygen (PO2/FiO2) and positively correlated with the pulmonary vascular permeability index.Compared with the control group,the lung wet-to-dry weight ratio markedly increased and the histopathological findings obviously changed in the dichlorvos group,but only mildly increased and changed,respectively,in the atropine group.Conclusion The extravascular lung water index is an appropriate and valuable parameter for assessment of respiratory function in acute dichlorvos poisoning.

  16. Demographics, Clinical Characteristics, Management, and Outcomes of Acute Heart Failure Patients: Observations from the Oman Acute Heart Failure Registry

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    Prashanth Panduranga

    2016-05-01

    Full Text Available Objectives: We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF as part of the Gulf aCute heArt failuRe rEgistry (CARE project. Methods: Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012. Results: The mean age of our patients was 63±12 years. Over half (57% were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%, coronary artery disease (55%, and diabetes mellitus (53%. Ischemic heart disease (IHD, hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27–45% with 56% of the patients having heart failure with reduced ejection fraction (< 40%. Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge. Conclusions: Oman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical

  17. Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography

    NARCIS (Netherlands)

    Stravitz, R. Todd; Lisman, Ton; Luketic, Velimir A.; Sterling, Richard K.; Puri, Puneet; Fuchs, Michael; Ibrahim, Ashraf; Lee, William M.; Sanyal, Arun J.

    2012-01-01

    Background & Aims: Patients with acute liver injury/failure (ALI/ALF) are assumed to have a bleeding diathesis on the basis of elevated INR; however, clinically significant bleeding is rare. We hypothesized that patients with ALI/ALF have normal hemostasis despite elevated INR. Methods: Fifty-one pa

  18. Adiponectin gene polymorphisms and acute respiratory distress syndrome susceptibility and mortality.

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    Amy M Ahasic

    Full Text Available RATIONALE: Adiponectin is an anti-inflammatory adipokine that is the most abundant gene product of adipose tissue. Lower levels have been observed in obesity, insulin resistance, and in critical illness. However, elevated levels early in acute respiratory failure have been associated with mortality. Polymorphisms in adiponectin-related genes (ADIPOQ, ADIPOR1, ADIPOR2 have been examined for relationships with obesity, insulin resistance and diabetes, cardiovascular disease, and to circulating adipokine levels, but many gaps in knowledge remain. The current study aims to assess the association between potentially functional polymorphisms in adiponectin-related genes with acute respiratory distress syndrome (ARDS risk and mortality. METHODS: Consecutive patients with risk factors for ARDS admitted to the ICU were enrolled and followed prospectively for development of ARDS. ARDS cases were followed through day 60 for all-cause mortality. 2067 patients were successfully genotyped using the Illumina CVD BeadChip high-density platform. Of these, 567 patients developed ARDS. Forty-four single nucleotide polymorphisms (SNPs on ADIPOQ, ADIPOR1 and ADIPOR2 were successfully genotyped. Of these, 9 SNPs were hypothesized to be functional based on their location (promoter, exon, or 3' untranslated region. These 9 SNPs were analyzed for association with ARDS case status and mortality among ARDS cases. RESULTS: After multivariable analysis and adjustment for multiple comparisons, no SNPs were significantly associated with ARDS case status. Among ARDS cases, homozygotes for the minor allele of rs2082940 (ADIPOQ had increased mortality (hazard ratio 2.61, 95% confidence interval 1.36-5.00, p = 0.0039 after adjustment for significant covariates. The significance of this association persisted after adjustment for multiple comparisons (FDR_q = 0.029. CONCLUSIONS: A common and potentially functional polymorphism in ADIPOQ may impact survival in ARDS. Further

  19. Paroxysmal nocturnal hemoglobinuria: rare cause of acute renal failure

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    Vilma Takayasu

    2012-12-01

    Full Text Available Paroxysmal nocturnal hemoglobinuria is a rare acquired disease, characterized by hemolytic anemia, recurrent infections, cytopenias, and vascular thrombosis. It occurs by non-malignant clonal expansion of one or more hematopoietic stem cells that acquired somatic mutations in PIG-A gene linked to chromosome X. This mutation results in lower erythrocyte expression of CD55 and CD59 surface proteins and consequently increased susceptibility to the complement system. The renal involvement is generally benign, resulting in mild impairment in urinary concentration. Acute renal failure requiring hemodialytic support accompanying PNH is rarely observed. The authors report a case of a 37-year-old male who presented with bicytopenia (hemolytic anemia and thrombocytopenia associated with acute renal failure requiring dialysis. Diagnosis was challenging because of the rarity and unfamiliarity with this entity, but was confirmed by flow cytometry. In the course of the disease, acute pyelonephritis with multiple renal abscesses was diagnosed requiring prolonged antibiotic therapy. Patient outcome was favorable after the control of hemolysis and the infection treatment.

  20. Acute renal failure in patients with tumour lysis sindrome

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    Poskurica Mileta

    2016-01-01

    Full Text Available Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al., as well as solid tumours (renal, liver, lung, ovarian, etc., can lead to acute or chronic renal failure. The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS. It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat significantly reduce the risk of developing TLS. If prevention of renal impairment isn’t possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase. Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.