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Sample records for chronic respiratory failure

  1. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970318 A study on evoked potentials in cor pul-monale patients with chronic respiratory failure.QIAO Hui(乔慧), et al. Beijing Neurosurg Instit,Beijing, 100050. Chin J Geriatr 1997; 16(1): 43-45. Objective: Evoked protential was used to detect thechange of brain function in cor pulmonale patients with

  2. Health-related quality of life in COPD patients with chronic respiratory failure

    NARCIS (Netherlands)

    Duiverman, M. L.; Wempe, J. B.; Bladder, G.; Kerstjens, H. A. M.; Wijkstra, P. J.

    2008-01-01

    The Maugeri Respiratory Failure (MRF-28) and Severe Respiratory Insufficiency (SRI) questionnaires were recently developed to assess health-related quality of life (HRQoL) in patients with chronic respiratory failure, although not exclusively in chronic obstructive pulmonary disease (COPD) patients.

  3. 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-

  4. 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

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    Angela Maria Grazia Pacilli

    2014-01-01

    Full Text Available 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 functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.

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

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    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.

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

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    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.

  7. End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

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    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.

  8. Base excess, a marker of chronic hypercapnic respiratory failure and predictor of survival in COPD

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    Stephan Budweiser

    2006-12-01

    Full Text Available We studied the role of base excess (BE as marker of chronic hypercapnia and survival in patients with chronic obstructive pulmonary disease (COPD and chronic hypercapnic respiratory failure (CHRF. Moreover, it was investigated whether the effects of non-invasive positive pressure ventilation (NPPV on CHRF were reflected in BE and survival. In 240 (160 without exacerbation patients with COPD (mean±SD FEV1 30.7±9.7 %pred; PaCO2 56.9±9.9 mmHg body-mass index (BMI, lung function, respiratory muscle function, blood gases and 6-minute walking distance (6-MWD were assessed prior to initiation of NPPV. In addition, the changes of risk factors 6.3±2.9 months after initiation of NPPV were evaluated. Overall mortality during the follow-up time (26.0±24.5 months was 34.6%. Deaths resulted predominantly from respiratory causes (65.1%; among those, respiratory failure was most frequent (85.2%. Univariate analysis revealed BMI, FEV1, maximal inspiratory pressure (PImax, inspiratory load (P0.1, haemoglobin, 6-MWD, hyperinflation (IC/TLC, RV/TLC, blood gases and BE to be associated (p<0.05 each with prognosis. In multivariate analyses, however, only BMI, RV/TLC and BE turned out to be independent cross-sectional predictors (p<0.05. Kaplan-Meier analyses showed that BE had predictive value particularly in patients with BMI25 kg·m–2, RV/TLC70 % and PaCO257 mmHg. Furthermore, changes of BMI, RV/TLC and BE (p<0.01 were associated with improved prognosis in severe hypercapnic COPD. In patients with COPD and CHRF, BE was a prognostic marker for mortality, that was independent from other factors, particularly PaCO2. In addition, reversal of CHRF was reflected in BE and appeared to have an impact on prognosis.

  9. Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors

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    Bruno-Pierre Dubé; Piergiuseppe Agostoni; Pierantonio Laveneziana

    2016-01-01

    Exertional dyspnoea is among the dominant symptoms in patients with chronic heart failure and progresses relentlessly as the disease advances, leading to reduced ability to function and engage in activities of daily living. Effective management of this disabling symptom awaits a better understanding of its underlying physiology. Cardiovascular factors are believed to play a major role in dyspnoea in heart failure patients. However, despite pharmacological interventions, such as vasodilators o...

  10. 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).

  11. [Chronic respiratory insufficiency and the elderly patient].

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    Cobarzan, Daniel

    2012-01-01

    Chronic respiratory failure is a complex entity of varied etiology and physio-pathological mechanisms. It is mainly characterised by the respiratory system's difficulty in ensuring correct aeration at rest, resulting initially in insufficient oxygenation of arterial blood. Treatment is adapted to each etiology and aims to compensate for respiratory failure and to ensure the oxygenation of the organism.

  12. Treatment of respiratory failure in COPD

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    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

  13. Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis

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    Schmidbauer Kathrin

    2007-12-01

    Full Text Available Abstract Background Health-related quality of life (HRQL is considered as an important outcome parameter in patients with chronic diseases. This study aimed to assess the role of disease-specific HRQL for long-term survival in patients of different diagnoses with chronic hypercapnic respiratory failure (CHRF. Methods In a cohort of 231 stable patients (chronic obstructive pulmonary disease (COPD, n = 98; non-COPD (obesity-hypoventilation syndrome, restrictive disorders, neuromuscular disorders, n = 133 with CHRF and current home mechanical ventilation (HMV, HRQL was assessed by the disease-specific Severe Respiratory Insufficiency (SRI questionnaire and its prognostic value was prospectively evaluated during a follow-up of 2–4 years, using univariate and multivariate regression analysis. Results HRQL was more impaired in COPD (mean ± SD SRI-summary score (SRI-SS 52.5 ± 15.6 than non-COPD patients (67.6 ± 16.4; p 1 turned out to be independent predictors (p Conclusion In patients with CHRF and HMV, the disease-specific SRI was an overall predictor of long-term survival in addition to established risk factors. However, the SRI predominantly beared information regarding long-term survival in non-COPD patients, while in COPD patients objective measures of the disease state were superior. This on one hand highlights the significance of HRQL in the long-term course of patients with CHRF, on the other hand it suggests that the predictive value of HRQL depends on the underlying disease.

  14. Acute respiratory failure in scrub typhus patients

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    Jyoti Narayan Sahoo

    2016-01-01

    Full Text Available Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU. Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49% had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score. At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group.

  15. 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.

  16. Supine changes in lung function correlate with chronic respiratory failure in myotonic dystrophy patients.

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    Poussel, Mathias; Kaminsky, Pierre; Renaud, Pierre; Laroppe, Julien; Pruna, Lelia; Chenuel, Bruno

    2014-03-01

    Quality of life and prognosis of patients with myotonic dystrophy type 1 (MD1) often depend on the degree of lung function impairment. This study was designed to assess the respective prevalence of ventilatory restriction, hypoxaemia and hypercapnia in MD1 patients and to determine whether postural changes in lung function could contribute to the early diagnosis of poor respiratory outcome. Fifty-eight patients (42.6±12.9 years) with MD1 were prospectively evaluated from April 2008 to June 2010 to determine their supine and upright lung function and arterial blood gases. The prevalence of ventilatory restriction was 36% and increased with the severity of muscular disability (from 7.7% to 70.6%). The prevalence of hypoxaemia and hypercapnia was 37.9% and 25.9%, respectively. Multiple regression analysis showed that the supine fall in FEV1 was the only variable associated with ventilatory restriction, hypoxaemia and hypercapnia. Our data indicate that supine evaluation of lung function could be helpful to predict poor respiratory outcome, which is closely correlated with hypoxaemia and/or hypercapnia.

  17. Understanding chronic heart failure

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    Fenton, Matthew; Burch, Michael

    2007-01-01

    The key principles of chronic heart failure and the development of clinical management strategies are described. The physiological changes in chronic heart failure and the clinical management of children with heart failure are considered, but the treatment of heart failure related to congenital heart disease or the intensive care management of heart failure are not mentioned as both topics require consideration in their own right. A greater understanding of the maladaptive responses to chroni...

  18. Empyema and Respiratory Failure Secondary to Nephropleural Fistula Caused by Chronic Urinary Tract Infection: A Case Report

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    G. H. Jones

    2012-01-01

    Full Text Available We report a case of nephropleural fistula causing empyema and respiratory failure in a 68-year-old gentleman with a long history of urological problems including recurrent nephrolithiasis and urinary tract infections. He was admitted with sepsis, a productive cough, pyuria, and reduced breath sounds over the left hemithorax. Radiological imaging revealed a fistulous connection between a left-sided perinephric abscess and the pleural space. He was commenced on broad spectrum intravenous antibiotics but developed progressive respiratory failure requiring intensive care admission. Urinary and pleural aspirates cultured facultative anaerobic pathogens with identical resistance patterns. Drainage of thoracic and perinephric collections was carried out, allowing him to be extubated after 24 hours and discharged home after 18 days on an extended course of oral antibiotics. Left nephrectomy is now planned after a period of convalescence. Empyema developing in patients with known urolithiasis should alert the treating physician to the possibility that a pathological communication has formed especially if typical urinary tract pathogens are cultured from respiratory sampling.

  19. Noninvasive ventilation in hypoxemic respiratory failure

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    Raja Dhar

    2016-01-01

    Full Text Available Noninvasive ventilation (NIV refers to positive pressure ventilation delivered through a noninvasive interface (nasal mask, facemask, or nasal plugs etc. Over the past decade its use has become more common as its benefits are increasingly recognized. This review will focus on the evidence supporting the use of NIV in various conditions resulting in acute hypoxemic respiratory failure (AHRF, that is, non-hypercapnic patients having acute respiratory failure in the absence of a cardiac origin or underlying chronic pulmonary disease. Outcomes depend on the patient's diagnosis and clinical characteristics. Patients should be monitored closely for signs of noninvasive ventilation failure and promptly intubated before a crisis develops. The application of noninvasive ventilation by a trained and experienced team, with careful patient selection, should optimize patient outcomes.

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

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    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

  1. Noninvasive ventilation in acute respiratory failure

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    Mas A

    2014-08-01

    Full Text Available 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 ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique. Keywords

  2. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study

    Institute of Scientific and Technical Information of China (English)

    Collaborating Research Group for Noninvasive Mecha

    2005-01-01

    Background Early withdraw from invasive mechanical ventilation (MV) followed by noninvasive MV is a new strategy for changing modes of treatment. This study was conducted to estimate the feasibility and the efficacy of early extubation and sequential noninvasive MV commenced at beginning of pulmonary infection control window in patients with exacerbated hypercapnic respiratory failure caused by chronic obstructive pulmonary diseases (COPD). Methods A prospective, randomized controlled study was conducted in eleven teaching hospitals' respiratory or medical intensive care units in China. Ninety intubated COPD patients with severe hypercapnic respiratory failure triggered by pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. When the pulmonary infection had been controlled by antibiotics and comprehensive therapy, the "pulmonary infection control window (PIC window)" has been reached. Each case was randomly assigned to study group (extubation and noninvasive MV via facial mask immediately) or control group (invasive MV was received continuously after PIC window by using conventional weaning technique).Results Study group (n=47) and control group (n=43) had similar clinical characteristics initially and at the time of PIC window. Compared with control group, study group had shorter duration of invasive MV [(6.4±4.4) days vs (11.3±6.2) days, P=0.000], lower rate of ventilator associated pneumonia (VAP) (3/47 vs 12/43, P=0.014), fewer days in ICU [(12±8) days vs (16±11) days, P=0.047] and lower hospital mortality (1/47 vs 7/43, P=0.025).Conclusions In COPD patients requiring intubation and invasive MV for hypercapnic respiratory failure, which is exacerbated by pulmonary infection, early extubation followed by noninvasive MV initiated at the start of PIC window may decrease significantly the duration of invasive MV, the risk of VAP and hospital mortality.

  3. Respiratory failure in elderly patients.

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    Sevransky, Jonathan E; Haponik, Edward F

    2003-02-01

    Elderly individuals comprise an increasing proportion of the population and represent a progressively expanding number of patients admitted to the ICU. Because of underlying pulmonary disease, loss of muscle mass, and other comorbid conditions, older persons are at increased risk of developing respiratory failure. Recognition of this vulnerability and the adoption of proactive measures to prevent decompensation requiring intrusive support are major priorities together with clear delineation of patients' wishes regarding the extent of support desired should clinical deterioration occur. Further, the development of coordinated approaches to identify patients at risk for respiratory failure and strategies to prevent the need for intubation, such as the use of NIV in appropriate patients, are crucial. As soon as endotracheal intubation and mechanical ventilation are implemented strategies that facilitate the liberation of elderly patients from the ventilator are especially important. The emphasis on a team approach, which characterizes geriatric medicine, is essential in coordinating the skills of multiple health care professionals in this setting. Respiratory failure can neither be effectively diagnosed nor managed in isolation. Integration with all other aspects of care is essential. Patient vulnerability to nosocomial complications and the "cascade effect" of these problems such as the effects of medications and invasive supportive procedures all impact on respiratory care of elderly patients. For example, prolonged mechanical ventilation may be required long after resolution of the underlying cause of respiratory failure because of unrecognized and untreated delirium or residual effects of small doses of sedative and/or analgesic agents or other medications in elderly patients with altered drug metabolism. The deleterious impact of the foreign and sometimes threatening ICU environment and/or sleep deprivation on the patient's course are too often overlooked because

  4. Cost-effectiveness of noninvasive ventilation for chronic obstructive pulmonary disease-related respiratory failure in Indian hospitals without ICU facilities

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    Shraddha P Patel

    2015-01-01

    Full Text Available Introduction: The majority of Indian hospitals do not provide intensive care unit (ICU care or ward-based noninvasive positive pressure ventilation (NIV. Because no mechanical ventilation or NIV is available in these hospitals, the majority of patients suffering from respiratory failure die. Objective: To perform a cost-effective analysis of two strategies (ward-based NIV with concurrent standard treatment vs standard treatment alone in chronic obstructive pulmonary disease (COPD respiratory failure patients treated in Indian hospitals without ICU care. Materials and Methods: A decision-analytical model was created to compare the cost-effectiveness for the two strategies. Estimates from the literature were used for parameters in the model. Future costs were discounted at 3%. All costs were reported in USD (2012. One-way, two-way, and probabilistic sensitivity analysis were performed. The time horizon was lifetime and perspective was societal. Results: The NIV strategy resulted in 17.7% more survival and was slightly more costly (increased cost of $101 (USD 2012 but resulted in increased quality-adjusted life-years (QALYs (1.67 QALY. The cost-effectiveness (2012 USD/QALY in the standard and NIV groups was $78/QALY ($535.02/6.82 and $75/QALY ($636.33/8.49, respectively. Incremental cost-effectiveness ratio (ICER was only $61 USD/QALY. This was substantially lower than the gross domestic product (GDP per capita for India (1489 USD, suggesting the NIV strategy was very cost effective. Using a 5% discount rate resulted in only minimally different results. Probabilistic analysis suggests that NIV strategy was preferred 100% of the time when willingness to pay was >$250 2012 USD. Conclusion: Ward-based NIV treatment is cost-effective in India, and may increase survival of patients with COPD respiratory failure when ICU is not available.

  5. 血活素对慢性呼衰血液流变学的影响%The influence of solcoseryl over hemorheology of chronic respiratory failure

    Institute of Scientific and Technical Information of China (English)

    王吉如

    2001-01-01

    Objective To discuss the influence of solcoseryl over hemorheology of chronic respiratory failure. Methods 79 cases of chronic respiratory failure were divided into 2 groups randomly: control group (34 cases) were given general treatment, including anti- inflammatory, antitussive, apophlegmatic, cardiac tonic, diuretic agents, et al; solcoseryl group received solcoseyl for 14 days besides general treatment. Hemorheologic indexes of both groups were detected before and after therapy. Results Blood viscosity, erythrocyte deformability and erythrocyte electrophoresis time of solcoseryl group were significantly different from control group. Conclusion Solcoseryl had good effects in treating chronic respiratory failure, and the effects correlated with the changes of hemorheology.%目的从细胞代谢促进剂-血活素,对心肺循环-血液流变学的影响观察评价对慢性呼衰的治疗作用。方法 79例慢阻肺、肺心病发展而来的慢性呼衰病人随机分为两组:对照组 34例,予以抗炎、止咳化痰、强心利尿、改善心肺功能(包括硝酸甘油的使用)的综合治疗;治疗组在综合治疗基础上予以血活素 15ml+生理盐水 200ml,静滴,疗程 14天,两组在治疗前后测定血液流变学指标(包括高低切全血粘度,红细胞变形指数及电泳时间,血小板粘附率等)。结果血活素治疗组在改善全血粘度、红细胞变形指数及电泳时间等方面较对照组具有显著的效果。结论细胞代谢促进剂-血活素对慢性呼衰具有良好的治疗作用,其病情好转与血液流变学的改善呈一致性。

  6. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  7. Predictors of requirement of mechanical ventilation in patients with chronic obstructive pulmonary disease with acute respiratory failure

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    S Kumar

    2013-01-01

    Full Text Available Background and Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD leads to increased morbidity, mortality and requirement of invasive mechanical ventilation (MV. The aim of this study was to identify predictors of need of MV in these patients. Materials and Methods: Clinical symptomatology, demographic profile, biochemical parameters including renal functions, liver functions and acid base parameters, and acute physiology and chronic health evaluation II (APACHE II score at the time of admission were recorded in 100 patients of COPD exacerbation. Various parameters were compared between patients in whom MV was required with those managed with medical therapy. Results: MV was required in 73% of the patients. Parameters found to be independent predictors of need of MV were: Admission APACHE-II score ≥ 11.5 {adjusted odds ratio (OR [95% confidence interval (CI]: 1.42 [1.08-1.86]; P = 0.012}, first day pH ≤ 7.28 (adjusted OR [95% CI]: 1.09 [1.02-1.15]; P = 0.008, first day PaCO 2 ≥ 68.6 mmHg (adjusted OR [95% CI]: 1.09 [1.02-1.15]; P = 0.004 and worse premorbid functional status (adjusted OR [95% CI]: 17.01 [1.95-148.68]; P = 0.01. Conclusions: Underlying disease severity as assessed by premorbid functional status and APACHE-II score, and the acuity of respiratory system decompensation as assessed by the admitting arterial pH and PaCO 2 , are independent predictors of need of MV in patients with exacerbation of COPD.

  8. Emergency thyroidectomy: Due to acute respiratory failure

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    Zulfu Bayhan

    2014-01-01

    CONCLUSION: Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.

  9. Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure.

    Science.gov (United States)

    Borghi-Silva, Audrey; Carrascosa, Cláudia; Oliveira, Cristino Carneiro; Barroco, Adriano C; Berton, Danilo C; Vilaça, Debora; Lira-Filho, Edgar B; Ribeiro, Dirceu; Nery, Luiz Eduardo; Neder, J Alberto

    2008-06-01

    Blood flow requirements of the respiratory muscles (RM) increase markedly during exercise in chronic heart failure (CHF). We reasoned that if the RM could subtract a fraction of the limited cardiac output (QT) from the peripheral muscles, RM unloading would improve locomotor muscle perfusion. Nine patients with CHF (left ventricle ejection fraction = 26 +/- 7%) undertook constant-work rate tests (70-80% peak) receiving proportional assisted ventilation (PAV) or sham ventilation. Relative changes (Delta%) in deoxy-hemoglobyn, oxi-Hb ([O2Hb]), tissue oxygenation index, and total Hb ([HbTOT], an index of local blood volume) in the vastus lateralis were measured by near infrared spectroscopy. In addition, QT was monitored by impedance cardiography and arterial O2 saturation by pulse oximetry (SpO2). There were significant improvements in exercise tolerance (Tlim) with PAV. Blood lactate, leg effort/Tlim and dyspnea/Tlim were lower with PAV compared with sham ventilation (P 0.05). Unloaded breathing, however, was related to enhanced leg muscle oxygenation and local blood volume compared with sham, i.e., higher Delta[O2Hb]% and Delta[HbTOT]%, respectively (P < 0.05). We conclude that RM unloading had beneficial effects on the oxygenation status and blood volume of the exercising muscles at similar systemic O2 delivery in patients with advanced CHF. These data suggest that blood flow was redistributed from respiratory to locomotor muscles during unloaded breathing.

  10. Energy expenditure at rest and during walking in patients with chronic respiratory failure: a prospective two-phase case-control study.

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    Ernesto Crisafulli

    Full Text Available BACKGROUND: Measurements of Energy Expenditure (EE at rest (REE and during physical activities are increasing in interest in chronic patients. In this study we aimed at evaluating the validity/reliability of the SenseWear®Armband (SWA device in terms of REE and EE during assisted walking in Chronic Respiratory Failure (CRF patients receiving long-term oxygen therapy (LTOT. METHODOLOGY/PRINCIPAL FINDINGS: In a two-phase prospective protocol we studied 40 severe patients and 35 age-matched healthy controls. In phase-1 we determined the validity and repeatability of REE measured by SWA (REEa in comparison with standard calorimetry (REEc. In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted (Aid or unassisted (No-Aid modalities. When compared with REEc, REEa was slightly lower in patients (1351±169 vs 1413±194 kcal/day respectively, p<0.05, and less repeatable than in healthy controls (0.14 and 0.43 coefficient respectively. COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked, perceived symptoms and EE. CONCLUSIONS/SIGNIFICANCE: SWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT, and it shows that aided walking results in a substantial energy saving in this population.

  11. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease.

    Science.gov (United States)

    Amri Maleh, Valiollah; Monadi, Mahmood; Heidari, Behzad; Maleh, Parviz Amri; Bijani, Ali

    2016-01-01

    Background: Application noninvasive ventilation in the patients with exacerbation of chronic obstructive pulmonary disease (COPD) reduced mortality. This case-control study was designed to compare efficiency and outcome of non-invasive (NIV) versus invasive positive pressure ventilation (IPPV) in respiratory failure due to COPD. Methods: The patients were assigned to NIV or IPPV intermittantly.The clinical parameters, including RR (respiratory rate), BP (blood pressure), HR (heart rate) and PH, PaCO2, PaO2 before and 1, 4 and 24 h after treatment were measured. Demographic information such as age, sex, severity of disease based on APACHE score, length of stay and outcome were recorded. Results: Fifty patients were enrolled in the NIV group and 50 patients in IPPV. The mean age was 70.5 in NIV and 63.9 in invasive ventilation group (p>0.05). In IPPV group, the average values of PH: PCO2: and PO2, were 7.22±0.11, 69.64 + 24.25: and 68.86±24.41 .In NIV, the respective values were 7.30±0.07, 83.94±18.95, and 60.60±19.88. In NIV group, after 1, 4 and 24 h treatment, the clinical and ventilation parameters were stable. The mean APACHE score in was IPPV, 26.46±5.45 and in NIV was 12.26±5.54 (p<0.05). The average length of hospital stay in IPPV was 15.90±10 and in NIV 8.12±6.49 days (p<0.05). The total mortality in the NIV was 4 (8%) and in IPPV, 27 patients (54%) (p<0.05). Conclusion: This study indicates that using NIPPV is a useful therapeutic mode of treatment for respiratory failure with acceptable success rate and lower mortality. The application of NIPPV reduces hospital stay, intubation and its consequent complications. PMID:27386061

  12. Shrinking the room for invasive ventilation in hypercapnic respiratory failure

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    Scarpazza P

    2013-03-01

    Full Text Available Paolo Scarpazza,1 Cristoforo Incorvaia,2 Chiara Melacini,1 Roberta Cattaneo,1 Cristiano Bonacina,1 Gian Galeazzo Riario-Sforza,2 Walter Casali1 1Pneumology Unit, Ospedale Civile, Vimercate, 2Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy Abstract: Noninvasive ventilation (NIV was introduced as an alternative to invasive mechanical ventilation for acute respiratory failure caused from exacerbations of chronic obstructive pulmonary disease in the 1980s, and its use gradually rose worldwide. Seventy-eight patients (57 males, mean age 78.3 ± 9.2 years undergoing NIV were evaluated. Of them, 48 (62.3% had acute hypercapnic respiratory failure because of a chronic obstructive pulmonary disease exacerbation, and the remaining 30 had acute hypercapnic respiratory failure from other causes, mainly cardiac failure. All patients were treated by NIV using the bi-level positive airway pressure set up at high pressure/high backup rate. NIV was successful in 67 subjects (85.9% and the patients were discharged, 57 of whom continued NIV at home and ten had spontaneous breathing. NIV was unsuccessful in eleven patients, ten of whom died and one was successfully treated by invasive mechanical ventilation. Significant differences were detected for a higher basal Glasgow Coma Scale score in successfully treated patients (P = 0.007, a higher basal Acute Physiology and Chronic Health Evaluation score in unsuccessfully treated patients (P = 0.004, and a lower pH after 1 hour in unsuccessfully treated patients (P = 0.015. These findings show a very high rate of success of NIV in patients with acute hypercapnic respiratory failure not only from chronic obstructive pulmonary disease but also from cardiac failure. This suggests that the use of invasive mechanical ventilation may be further reduced, with a decrease in its known complications as well. Keywords: invasive ventilation, noninvasive ventilation, acute respiratory failure

  13. 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

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    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.

  14. An unusual cause of type 2 respiratory failure

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    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.

  15. CPAP in chronic heart failure

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    F. Lari

    2013-05-01

    Full Text Available BACKGROUND Chronic Heart Failure (CHF represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

  16. An Unusual Suspect Causing Hypoxemic Respiratory Failure.

    Science.gov (United States)

    Aqeel, Masooma; Batdorf, Bjorn; Olteanu, Horatiu; Patel, Jayshil J

    2017-01-01

    Introduction: Antisynthetase syndrome (ASS) is characterized by the presence of anti-Jo-1 antibodies in conjunction with clinical findings of fever, polymyositis-dermatomyositis, and interstitial lung disease (ILD). Inflammatory myopathies carry a high risk of malignancy, but this association is less well outlined in ASS. We present the case of a patient with ASS who developed non-Hodgkin's lymphoma with acute hypoxemic respiratory failure. Case Presentation: A 44-year-old female with ASS presented with acute hypoxemic respiratory failure. She was empirically treated with broad-spectrum antibiotics for a health care-associated pneumonia; however, she failed to improve. Chest computed tomography revealed extensive bilateral ground glass opacities as well as extensive mediastinal and axillary lymphadenopathy. Infectious workup was negative. A surgical lung biopsy revealed peripheral T-cell lymphoma (PTCL). The patient was started on chemotherapy with complete resolution of hypoxemic respiratory failure. Conclusions: Malignancy is very rare in the setting of ASS; and our case illustrates the unique presentation of PTCL in ASS. In addition, lung involvement in PTCL is variable (incidence ranging from 8% to 20%); and in this case, bilateral multifocal consolidation was biopsied and proven to be PTCL involving the lungs. This case highlights the rare noninfectious conditions that can present as acute hypoxemic respiratory failure in the setting of ASS.

  17. Extracorporeal membrane oxygenation for adult respiratory failure.

    Science.gov (United States)

    Turner, David A; Cheifetz, Ira M

    2013-06-01

    Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that is a mainstay of therapy in neonatal and pediatric patients with life threatening respiratory and/or cardiac failure. Historically, the use of ECMO in adults has been limited, but recent reports and technological advances have increased utilization and interest in this technology in adult patients with severe respiratory failure. As ECMO is considered in this critically ill population, patient selection, indications, contraindications, comorbidities, and pre-ECMO support are all important considerations. Once the decision is made to cannulate a patient for ECMO, meticulous multi-organ-system management is required, with a priority being placed on lung rest and minimization of ventilator-induced lung injury. Close monitoring is also necessary for complications, some of which are related to ECMO and others secondary to the patient's underlying degree of illness. Despite the risks, reports demonstrate survival > 70% in some circumstances for patients requiring ECMO for refractory respiratory failure. As the utilization of ECMO in adult patients with respiratory failure continues to expand, ongoing discussion and investigation are needed to determine whether ECMO should remain a "rescue" therapy or if earlier ECMO may be beneficial as a lung-protective strategy.

  18. Periodontitis in Chronic Heart Failure.

    Science.gov (United States)

    Fröhlich, Hanna; Herrmann, Kristina; Franke, Jennifer; Karimi, Alamara; Täger, Tobias; Cebola, Rita; Katus, Hugo A; Zugck, Christian; Frankenstein, Lutz

    2016-08-01

    Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause. We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey. Gingivitis, moderate periodontitis, and severe periodontitis were present in 17 (24%), 17 (24%), and 37 (52%) patients, respectively. Severe periodontitis was more prevalent among chronic heart failure patients than in the general population. In contrast, moderate periodontitis was more prevalent in the general population (P <0.00001). The severity of periodontal disease was not associated with the cause of chronic heart failure or the severity of heart failure symptoms. Six-minute walking distance was the only independent predictor of severe periodontitis. Periodontal disease is highly prevalent in chronic heart failure patients regardless of the cause of heart failure. Prospective trials are warranted to clarify the causal relationship between both diseases.

  19. 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

  20. An Unusual Suspect Causing Hypoxemic Respiratory Failure

    OpenAIRE

    Aqeel, Masooma; Batdorf, Bjorn; Olteanu, Horatiu; Patel, Jayshil J.

    2017-01-01

    Introduction: Antisynthetase syndrome (ASS) is characterized by the presence of anti-Jo-1 antibodies in conjunction with clinical findings of fever, polymyositis-dermatomyositis, and interstitial lung disease (ILD). Inflammatory myopathies carry a high risk of malignancy, but this association is less well outlined in ASS. We present the case of a patient with ASS who developed non-Hodgkin’s lymphoma with acute hypoxemic respiratory failure. Case Presentation: A 44-year-old female with ASS pre...

  1. Myeshenia Gravis Presented with Respiratory Failure

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    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.

  2. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

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    Salturk C

    2015-11-01

    Full Text Available Cuneyt Salturk,1 Zuhal Karakurt,1 Huriye Berk Takir,1 Merih Balci,2 Feyza Kargin,1 Ozlem Yazıcıoglu Mocin,1 Gokay Gungor,1 Ipek Ozmen,1 Selahattin Oztas,1 Murat Yalcinsoy,3 Ruya Evin,1 Murat Ozturk,1 Nalan Adiguzel1 1Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 2Respiratory Intensive Care Unit, Kartal Kosuyolu Cardiovascular Disease and Surgery Teaching and Research Hospital, Istanbul, 3Respiratory Intensive Care Unit, Department of Chest Disease and Pulmonology, Inonu University Medical Faculty, Malatya, Turkey Introduction: The objective of this study was to compare the change in 6-minute walking distance (6MWD in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV due to chronic hypercapnic respiratory failure (CHRF caused by different etiologies.Methods: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD], between January 2011 and January 2012. The results of arterial blood gas (ABG analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA and multiple linear regression (MLR analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group.Results: A total of 105 patients with a mean age (± standard deviation of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical

  3. 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.

  4. Chronic Kidney Disease and Kidney Failure

    Science.gov (United States)

    ... Education Visitor Information RePORT NIH Fact Sheets Home > Chronic Kidney Disease and Kidney Failure Small Text Medium Text Large Text Chronic Kidney Disease and Kidney Failure YESTERDAY One third of diabetic ...

  5. 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.

  6. 浅析肺心病合并慢性呼吸衰竭30例临床护理%Clinical Nursing Care of 30 Cases of Pulmonary Heart Disease Complicated With Chronic Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    冯淑香

    2016-01-01

    ObjectiveStudy on clinical nursing of pulmonary heart disease complicated with chronic respiratory failure.Methods From January 2015 to January 2016,analyzed of 30 cases with chronic pulmonary heart disease respiratory failure in patients with clinical data and study effective nursing intervention.Results30 cases of patients with effective intervention to treat all patients were discharged,effective 7 cases, 21 cases,generally 2 cases,excellent recovery rate of 93.33%. This study had low incidence of adverse reactions in patients,2 patients with shock and 1 case of pulmonary cerebral hernia.Conclusion Clinic for patients with pulmonary heart disease complicated with chronic respiratory failure for targeted nursing intervention to better promote the recovery of patients, improve the excellent rate of recovery of patients, improve the prognosis of patients.%目的:研究肺心病合并慢性呼吸衰竭的临床护理措施。方法分析我院在2015年1月~2016年1月收治的30例肺心病合并慢性呼吸衰竭的患者的临床资料,研究患者的有效护理干预措施。结果30例患者经过有效的干预治疗所有患者均康复出院,所有患者当中康复显效7例,有效21例,一般2例,康复优良率为93.33%,本研究患者的不良症状发生率相对较低,出现2例休克患者和1例肺性脑病患者。结论临床上对于肺心病合并慢性呼吸衰竭的患者,配合有针对性的护理干预措施,更好地促进患者的恢复,提高患者恢复的优良率,提升患者的预后效果。

  7. Coma blisters with hypoxemic respiratory failure.

    Science.gov (United States)

    Agarwal, Abhishek; Bansal, Meghana; Conner, Kelly

    2012-03-15

    A 24-year-old woman with quadriplegia was admitted with respiratory failure because of pneumonia. She was on multiple medications including diazepam, oxycodone, and amitriptyline, known to be associated with coma blisters, though she did not overdose on any of them. On hospital day 2, she developed multiple blisters on both sides of her right forearm and hand. Skin biopsy showed eccrine gland degeneration consistent with coma blisters. It was felt that hypoxemia from her pneumonia contributed to the development of these blisters, which occurred on both pressure and non-pressure bearing areas of the arm. Coma blisters are self-limited skin lesions that occur at sites of maximal pressure, mostly in the setting of drug overdose. However, coma blisters may occur with metabolic and neurological conditions resulting in coma.

  8. Ultrasonography in chronic renal failure

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    Buturovic-Ponikvar, Jadranka E-mail: jadranka.buturovic@mf.uni-lj.si; Visnar-Perovic, Alenka

    2003-05-01

    Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option.

  9. [Nutrition and chronic renal failure].

    Science.gov (United States)

    Ayúcar Ruiz de Galarreta, A; Cordero Lorenzana, M L; Martínez-Puga y López, E; Gómez Seijo, A; Escudero Alvarez, E

    2000-01-01

    The causes of malnutrition in chronic terminal kidney failure are reviewed in the situation both before and after dialysis, as are the malnutrition rates in both circumstances and their treatment. Malnutrition has a high prevalence in terminal kidney patients, partly as a result of the therapeutic restriction on calories and proteins, but also due to the metabolic reactions typical of the disease and to anorexia. In patients subjected to dialytical methods, certain other mechanisms are added. In addition to malnutrition, there are alterations in the metabolism of calcium, phosphorus and potassium, as well as lipids, thus limiting nutritional therapy's ability to restore the nutritional status to normal. An awareness of energy expenditure in chronic terminal kidney failure and the consequences of malnutrition have led to new challenges in nutritional therapy, both in the dose and quality of the proteins, with a debate raging over the advantages of ketoanalogues, and also in the methods for providing nutrients. The ideal nutritional method for repletion is oral administration, but this can be enhanced with artificial support such as oral supplements, parenteral nutrition during dialysis or such alternatives as enteral nutrition at home in the case of chronic kidney problems in children, using percutaneous endoscopic gastrostomy (PEG), in order to nourish the patients and minimize growth disorders.

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

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    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.

  11. Functional and histopathological identification of the respiratory failure in a DMSXL transgenic mouse model of myotonic dystrophy

    OpenAIRE

    Petrica-Adrian Panaite; Thierry Kuntzer; Geneviève Gourdon; Johannes Alexander Lobrinus; Ibtissam Barakat-Walter

    2013-01-01

    SUMMARY Acute and chronic respiratory failure is one of the major and potentially life-threatening features in individuals with myotonic dystrophy type 1 (DM1). Despite several clinical demonstrations showing respiratory problems in DM1 patients, the mechanisms are still not completely understood. This study was designed to investigate whether the DMSXL transgenic mouse model for DM1 exhibits respiratory disorders and, if so, to identify the pathological changes underlying these respiratory p...

  12. Boussignac CPAP in acute respiratory failure

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    Federico Lari

    2013-03-01

    Full Text Available Introduction: The application of continuous positive airway pressure (CPAP is one of the most important therapeutic interventions used in patients with acute respiratory failure (ARF secondary to acute cardiogenic pulmonary edema (ACPE. Thanks to its positive effects on both hemodynamics and ventilation, CPAP improves clinical and blood-gas parameters. Compared with standard oxygen therapy, use of CPAP is associated with decreased mortality and reduced need for intubation in these patients. Aim of the study: This review examines the principles of CPAP, techniques and equipment used to deliver it, and clinical applications. Special emphasis is placed on CPAP delivered with the Boussignac device. Discussion and conclusions: In emergency departments, this simple, lightweight, disposable device has proved to be well tolerated and similar to Venturi-like flow generators in terms of effectiveness. These findings suggest that Boussignac CPAP might be useful for managing ARF in non-critical care areas where other more complicated CPAP equipment (Venturi-like flow generators and ventilators are not available (for example, in general medical wards.

  13. [Understanding of pneumococcal vaccination in patients with chronic respiratory diseases].

    Science.gov (United States)

    Watanuki, Yuji; Takahashi, Hiroshi; Yoshiike, Yasuhiro; Ogura, Takashi; Sato, Masamiti; Miyazawa, Naoki; Kakemizu, Nobumasa

    2005-04-01

    Pneumococcal vaccination is still rare in Japan. To evaluate understanding concerning the vaccination, we employed a questionnaire answered by patients aged over 60 with chronic respiratory diseases from August to October 2002. Only 286 (18%) of the 1595 patients already knew of the existence of the vaccine, and 999 (64%) patients wanted to be vaccinated. That season, 717 (43%) patients were actually vaccinated. Patients with chronic respiratory failure, those who had contracted pulmonary infections in the previous year, those over 70 year-old, and male patients tended to be vaccinated. Although elderly and high-risk patients are recommended to be vaccinated, the pneumococcal vaccination rates in those patients was low. Campaigns for vaccination are needed.

  14. Event-related evoked potentials in chronic respiratory encephalopathy

    Directory of Open Access Journals (Sweden)

    A R Al Tahan

    2010-02-01

    limited by the small number of tested patients. P300 latency changes correlated significantly with age as well as severity of respiratory failure. P300 was also significantly delayed whether hypoxia occurred with or without hypercapnia.Conclusion: Results show a significant delay of P300 latency in patients with severe and mild respiratory failure. This was associated with subclinical encephalopathy in most patients, evidenced by a near-normal MMSE score. Apart from confirming the importance of P300 latency measurement as a marker of respiratory encephalopathy, this study asserts the causal relationship between hypoxemia and cognitive derangement. Furthermore, it promotes the early use of oxygen therapy in a selected group of patients with mild or moderate respiratory failure, who have responsibilities which involve taking rapid critical decisions.Keywords: event-related evoked potentials, hypoxic–hypercapnic encephalopathy, respiratory failure, chronic respiratory encephalopathy

  15. 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.

  16. Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure.

    Science.gov (United States)

    Ham, P Benson; Hwang, Brice; Wise, Linda J; Walters, K Christian; Pipkin, Walter L; Howell, Charles G; Bhatia, Jatinder; Hatley, Robyn

    2016-09-01

    Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1-18) placed on ECMO in the last 15 years (1999-2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2-16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23-122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2-6). The average number of days on the ventilator was 15 (range 4-27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1-15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.

  17. High flow nasal oxygen in acute respiratory failure.

    Science.gov (United States)

    Ricard, J-D

    2012-07-01

    Use of high flow nasal cannula oxygen (HFNC) is increasingly popular in adult ICUs for patients with acute hypoxemic respiratory failure. This is the result of the successful long-term use of HFNC in the neonatal field and recent clinical data in adults indicating beneficial effects of HFNC over conventional facemask oxygen therapy. HFNC rapidly alleviates symptoms of respiratory distress and improves oxygenation by several mechanisms, including deadspace washout, reduction in oxygen dilution and in inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. Indications of HFNC are broad, encompassing most if not all causes of acute hypoxemic respiratory failure. HFNC can also provide oxygen during invasive procedures, and be used to prevent or treat post-extubation respiratory failure. HFNC may also alleviate respiratory distress in patients at a palliative stage. Although observational studies suggest that HFNC might reduce the need for intubation in acute hypoxemic respiratory failure; such a reduction has not yet been demonstrated. Beyond this potential additional effect on outcome, the evidence already published argues in favor of the large use of HFNC as first line therapy for acute respiratory failure.

  18. Pulmonary agenesis and respiratory failure in childhood.

    Science.gov (United States)

    Dinamarco, Paula Vanessa Valverde; Ponce, Cesar Cilento

    2015-01-01

    Pulmonary agenesis (PA) is a rare congenital anomaly, which may be unilateral or bilateral. Unilateral PA may be associated with nonspecific respiratory symptoms. We report the case of 5-month-old infant who presented a normal development until the age of 4 months when a respiratory infection caused an acute respiratory distress syndrome with a fatal outcome. The autopsy findings depicted the right lung agenesis without any other concomitant malformation. Although respiratory symptoms represent frequent complaints in pediatrics, the aim of this study is not only to draw attention to the unilateral pulmonary agenesis as a possible underlying malformation in children who present recurrent and severe respiratory symptoms, but also to report a case diagnosed at autopsy.

  19. Pulmonary agenesis and respiratory failure in childhood

    Directory of Open Access Journals (Sweden)

    Paula Vanessa Valverde Dinamarco

    2015-03-01

    Full Text Available Pulmonary agenesis (PA is a rare congenital anomaly, which may be unilateral or bilateral. Unilateral PA may be associated with nonspecific respiratory symptoms. We report the case of 5-month-old infant who presented a normal development until the age of 4 months when a respiratory infection caused an acute respiratory distress syndrome with a fatal outcome. The autopsy findings depicted the right lung agenesis without any other concomitant malformation. Although respiratory symptoms represent frequent complaints in pediatrics, the aim of this study is not only to draw attention to the unilateral pulmonary agenesis as a possible underlying malformation in children who present recurrent and severe respiratory symptoms, but also to report a case diagnosed at autopsy.

  20. Chronic heart failure and micronutrients.

    Science.gov (United States)

    Witte, K K; Clark, A L; Cleland, J G

    2001-06-01

    Heart failure (HF) is associated with weight loss, and cachexia is a well-recognized complication. Patients have an increased risk of osteoporosis and lose muscle bulk early in the course of the disease. Basal metabolic rate is increased in HF, but general malnutrition may play a part in the development of cachexia, particularly in an elderly population. There is evidence for a possible role for micronutrient deficiency in HF. Selective deficiency of selenium, calcium and thiamine can directly lead to the HF syndrome. Other nutrients, particularly vitamins C and E and beta-carotene, are antioxidants and may have a protective effect on the vasculature. Vitamins B6, B12 and folate all tend to reduce levels of homocysteine, which is associated with increased oxidative stress. Carnitine, co-enzyme Q10 and creatine supplementation have resulted in improved exercise capacity in patients with HF in some studies. In this article, we review the relation between micronutrients and HF. Chronic HF is characterized by high mortality and morbidity, and research effort has centered on pharmacological management, with the successful introduction of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists into routine practice. There is sufficient evidence to support a large-scale trial of dietary micronutrient supplementation in HF.

  1. 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.

  2. Central respiratory failure during acute organophosphate poisoning.

    Science.gov (United States)

    Carey, Jennifer L; Dunn, Courtney; Gaspari, Romolo J

    2013-11-01

    Organophosphate (OP) pesticide poisoning is a global health problem with over 250,000 deaths per year. OPs affect neuronal signaling through acetylcholine (Ach) neurotransmission via inhibition of acetylcholinesterase (AChE), leading to accumulation of Ach at the synaptic cleft and excessive stimulation at post-synaptic receptors. Mortality due to OP agents is attributed to respiratory dysfunction, including central apnea. Cholinergic circuits are integral to many aspects of the central control of respiration, however it is unclear which mechanisms predominate during acute OP intoxication. A more complete understanding of the cholinergic aspects of both respiratory control as well as neural modification of pulmonary function is needed to better understand OP-induced respiratory dysfunction. In this article, we review the physiologic mechanisms of acute OP exposure in the context of the known cholinergic contributions to the central control of respiration. We also discuss the potential central cholinergic contributions to the known peripheral physiologic effects of OP intoxication.

  3. 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.

  4. Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure.

    Science.gov (United States)

    Jaenisch, Rodrigo B; Hentschke, Vítor S; Quagliotto, Edson; Cavinato, Paulo R; Schmeing, Letiane A; Xavier, Léder L; Dal Lago, Pedro

    2011-12-01

    Respiratory muscle training (RMT) improves functional capacity in chronic heart-failure (HF) patients, but the basis for this improvement remains unclear. We evaluate the effects of RMT on the hemodynamic and autonomic function, arterial baroreflex sensitivity (BRS), and respiratory mechanics in rats with HF. Rats were assigned to one of four groups: sedentary sham (n = 8), trained sham (n = 8), sedentary HF (n = 8), or trained HF (n = 8). Trained animals underwent a RMT protocol (30 min/day, 5 day/wk, 6 wk of breathing through a resistor), whereas sedentary animals did not. In HF rats, RMT had significant effects on several parameters. It reduced left ventricular (LV) end-diastolic pressure (P RMT (P RMT (P RMT (P RMT protocol in HF rats promotes an improvement in hemodynamic function, sympathetic and vagal heart modulation, arterial BRS, and respiratory mechanics, all of which are benefits associated with improvements in cardiopulmonary interaction.

  5. Acute respiratory failure as a first manifestation of syringomyelia

    Directory of Open Access Journals (Sweden)

    Al Bashapshe Ali

    2010-01-01

    Full Text Available A 40 year old woman presented with a short history of acute onset of breathlessness to the ER of our hospital and after initial evaluation for acute pulmonary embolism which was ruled out after carrying out the appropriate investigations, she was diagnosed to be afflicted with syringomyelia based on her neurological symptoms and clinical findings, which was confirmed by doing an MRI scan, which was her basic diagnosis that was complicated by acute hypercapnic respiratory failure. This case is being reported to highlight syringomyelia as an unusual cause of acute respiratory failure, which manifested clinically in this patient as its first presentation and the underlying neurological diagnosis has been found to be present in very few reported cases (less than 0.01% of case reports in the available literature as the basic disease in the absence of its classical presenting features. Problems associated with acute respiratory failure in the setting of syringomyelia are discussed.

  6. RESPIRATORY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    10.1 Respiratory failure2003068 Evaluation of non-invasive ventilation in a-cute respiratory failure with chronic obstructive pulmonary disease. GU Jianyong(顾俭勇), et al. Dept E-mergen, Zhongshan Hosp, Fudan Univ, Shanghai 200032. Shanghai J Med 2002; 25 (12): 741 - 743.Objective:To observe the effect of non-invasive venti-lation(NIV) in acute respiratory failure with chronic

  7. HBV Vaccination in Chronic Renal Failure Patients

    OpenAIRE

    Mir-davood Omrani; Mohammad Hassan Khadem Ansari

    2006-01-01

    HBV infection in chronic renal failure (CRF) becomes chronic in 30 to 60% compared with less than 10% in nonuremic patients. Immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumor necrosis factor (TNF-|α|) and interleukin (IL) 6,1 by retention of renal metabolite in uremia and chronic inflammation and have a poor immunological reaction to T-cell-dependent antigens, like hepatitis B vaccination. Immunocompromised patients who are unre...

  8. 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.

  9. NT-proBNP对呼吸衰竭、慢性肺源性心脏病的预后评估价值%Prognostic evaluation value of NT-proBNP in respiratory failure and chronic cor pulmonale

    Institute of Scientific and Technical Information of China (English)

    刘艺菲; 杜道兵

    2015-01-01

    目的 观察NT-proBNP在呼吸衰竭及慢性肺源性心脏病合并呼吸衰竭患者中的水平变化,评价NT-proBNP对呼吸衰竭、呼吸衰竭并慢性肺源性心脏病的严重程度、预后评估的价值.方法 选择2012年1月至2013年12月我科收治的55例呼吸衰竭患者,50例呼吸衰竭并慢性肺心病患者,测定入院时NT-proBNP血清浓度,比较两组患者NT-proBNP数值变化,再次以NT-proBNP 2000 pg/ml为截点,分为两组(A组为浓度高者,B组为浓度低者),观察两组患者住院天数、8个月内不良事件发生数.结果 呼吸衰竭并慢性肺心病患者NT-proBNP水平显著高于呼吸衰竭患者,差异有统计学意义(P<0.05),NT-proBNP≥2000 pg/ml组8月内不良事件发生率高,差异有统计学意义(P<0.01).结论 NT-proBNP水平变化对呼吸衰竭、慢性肺源性心脏病诊断及预后有一定的临床评价意义.%Objective To observe serum NT-proBNP level in patients with respiratory failure (RF) and patients with RF combined with chronic cor pulmonale,investigate the value of NT-proBNP in evaluation of severity and prognosis in RF and RF combined with chronic cor pulmonale.Methods 55 cases of RF and 50 cases of RF combined with chronic cor pulmonale in our department from Jan.2012 to Dec.2013 were selected.Tested and compared serum NT-proBNP concentration in two groups.All patients were divided into two groups according to serum NT-proBNP concentration (group A:serum NT-proBNP concentration ≥ 2000 pg/ml; group B:serum NT-proBNP concentration < 2000 pg/ml).Hospitalization day and the incidence of adverse events within 8 months were compared between two groups.Results Serum NT-proBNP concentration in patients with RF combined with chronic cor pulmonale was significantly higher than that in patients with RF (P < 0.05).The rate of adverse events within 8 months in group A was significantly higher than that in group B (P < 0.01).Conclusion Serum NT-proBNP concentration is helpful

  10. [EFFICIENT TREATMENT OF CHRONIC RESPIRATORY INSUFFICIENCY IN PATIENTS WITH KYPHOSCOLIOSIS].

    Science.gov (United States)

    Tsvetkova, O A; Pal'man, A D; Abdulaeva, G B

    2015-01-01

    We report efficient treatment of chronic respiratory insufficiency in patients with congenital kyphoscoliosis by non-invasive auxiliary ventilation and low-flow oxygen therapy. It proved possible to effectively control severe chronic respiratory insufficiency under conditions of a pulmonological ward without application of means and measures of intensive therapy.

  11. Chronic lower respiratory diseases among demolition and cement workers

    DEFF Research Database (Denmark)

    Mølgaard, Ellen Fischer; Hannerz, Harald; Tüchsen, Finn

    2013-01-01

    To estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995-2009.......To estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995-2009....

  12. 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

  13. [Urinary tract infections and chronic renal failure].

    Science.gov (United States)

    Sobotová, D

    2011-01-01

    The paper briefly summarizes issues related to urinary tract infections in adults: predispositions and risk factors, classification, assessment of pathogenicity of bacterial agents, the role of bacteriuria and leucocyturia, interpretation of findings, treatment principles and an association with chronic renal failure. Urinary tract infections are the second most frequent infectious disease in the population. They most often affect women of childbearing potential and then seniors of both sexes who have multiple risk factors. Escherichia coli and Staphylococcus saprophyticus are the most pathogenic towards urinary tract; they are responsible for 85% and 10-15% of cases of acute uncomplicated urinary infections, respectively. Chronic pyelonephritis, a chronic interstitial nephritis, is the fourth most frequent cause of chronic renal failure. Chronic renal failure is a risk factor for the development of urinary infections due to metabolic disorders resulting in secondary immunodeficiencywith a disorder of all components of immunity. In patients with chronic renal failure, urinary tract infections occur most frequently after kidney transplantation when graft pyelonephritis is a life-threatening complication. Therefore, urinary tract infection prevention with co-trimoxazole once daily over at least 6 months is recommended in renal allograft recipients.

  14. 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

  15. 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....

  16. Facioscapulohumeral muscular dystrophy and respiratory failure; what about the diaphragm?

    NARCIS (Netherlands)

    Hazenberg, A.; Alfen, N. van; Voet, N.B.M.; Kerstjens, H.A.; Wijkstra, P.J.

    2015-01-01

    INTRODUCTION: We present a case of facioscapulohumeral muscular dystrophy (FSHD) with a diaphragm paralysis as the primary cause of ventilatory failure. FSHD is an autosomal dominant inherited disorder with a restricted pattern of weakness. Although respiratory weakness is a relatively unknown in FS

  17. Acute respiratory failure secondary to mesalamine-induced interstitial pneumonitis.

    Science.gov (United States)

    Abraham, Albin; Karakurum, Ali

    2013-08-20

    Interstitial pneumonitis as an adverse effect of mesalamine therapy is a rare but potentially serious complication. Patients typically have a mild disease course with no documented cases of respiratory failure in published literature. Given its variable latent period and non-specific signs and symptoms, it may be difficult to diagnose. We present the case of a 65-year-old man who presented with symptoms of fever, shortness of breath and a non-productive cough, 2 weeks after initiation of therapy with mesalamine. His hospital course was complicated by acute respiratory failure requiring intubation and mechanical ventilation. Radiographic studies revealed bilateral lower lobe infiltrates and bronchosopy with bronchoalveolar lavage and transbronchial biopsy were consistent with a diagnosis of drug-induced interstitial pneumonitis. The aim of this paper is to highlight the importance of considering a diagnosis of mesalamine-induced lung injury in patients presenting with respiratory symptoms while on mesalamine therapy and to review relevant literature.

  18. The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure.

    Science.gov (United States)

    Millar, Jonathan; Lutton, Stuart; O'Connor, Philip

    2014-04-01

    Hypercarbic respiratory failure, occurring secondary to chronic lung disease, is a frequently encountered problem. These patients present a significant challenge to respiratory and critical care services, as many are unsuitable for mechanical ventilation and most have multiple comorbidities. Recently, noninvasive ventilation (NIV) has become established as the primary modality for respiratory support in this group of patients. Several factors limit patient compliance with NIV, not least comfort and tolerability. A recent innovation in adult critical care is the use of high-flow nasal oxygen (HFNO) devices. These systems are capable of delivering high gas flows via nasal cannulae, with the ability to blend air and oxygen to give a controlled FiO2. Few clinical studies have been conducted in adults, although several are planned. To date the majority of available evidence addresses the use of HFNO in hypoxemic respiratory failure. Here we present a case in which a HFNO system was used to successfully manage hypercarbic respiratory failure in a patient unable to tolerate conventional NIV.

  19. Pseudomelanosis duodeni associated with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    Marcia Henriques de Magalh(a)es Costa; Maria da Gloria Fernandes Pegado; Cleber Vargas; Maria Elizabeth C Castro; Kalil Madi; Tiago Nunes; Cyrla Zaltman

    2012-01-01

    Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different drugs.We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin index.Gastroduodenal endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the moment.In addition,the duodenal mucosa presented marked signs of melanosis; later confirmed by histopathological study.Even though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.

  20. 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

  1. [Chronic renal failure secondary to uterine prolapse].

    Science.gov (United States)

    Peces, R; Canora, J; Venegas, J L

    2005-01-01

    Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.

  2. 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%.

  3. 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

  4. Insuficiência respiratória crônica nas doenças neuromusculares: diagnóstico e tratamento Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Ilma Aparecida Paschoal

    2007-02-01

    Full Text Available As doenças neuromusculares prejudicam a renovação do ar alveolar e, por esta razão, produzem insuficiência respiratória crônica. A instalação da insuficiência respiratória pode acontecer de modo agudo, como nos traumas, ou ser lenta ou rapidamente progressiva, como na esclerose lateral amiotrófica, distrofias musculares, doença da placa mioneural, etc. O comprometimento da musculatura respiratória prejudica também a eficiência da tosse e, no estado atual da terapêutica disponível no Brasil para estes doentes, pode-se dizer que a morbimortalidade nestes indivíduos está mais associada ao fato de que eles tossem mal do que de que ventilam mal. Nesta revisão, uma breve compilação histórica procura mostrar a evolução das órteses e próteses respiratórias, desde o final do século XIX até agora, com o objetivo de apresentar as opções de máquinas disponíveis para o suporte e substituição da ventilação nas doenças neuromusculares. Além disso, são enfatizados os elementos fundamentais para o diagnóstico da hipoventilação alveolar e da falência do mecanismo protetor da tosse: história clínica, determinação do pico de fluxo da tosse, medida da pressão expiratória máxima e da pressão inspiratória máxima, espirometria em dois decúbitos (sentado e supino, oximetria de pulso, capnografia e polissonografia. São apresentados os valores limites disponíveis na literatura tanto para a indicação do suporte noturno da ventilação como para a extensão do suporte para o período diurno. As manobras para incremento da eficiência da tosse são aqui também discutidas, assim como o momento adequado para sua introdução.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

  5. Ivabradine, heart failure and chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Luca Di Lullo

    2015-12-01

    Full Text Available The incidence and prevalence of congestive heart failure are actually increasing worldwide, especially in Western countries. In Europe and the United States, congestive heart failure represents a disabling clinical disease, accountable for increased hospitalization and health care costs. European guidelines have underlined the importance of pharmacological treatment to improve both patients’ outcomes and quality of life. The latest clinical trials to evaluate ivabradine’s efficacy have underlined its usefulness as a stand-alone medication and in combination with conventional congestive heart failure therapy, including in chronic kidney disease patients.

  6. Flu Shot May Curb Respiratory Infections in People with Heart Failure

    Science.gov (United States)

    ... Shot May Curb Respiratory Infections in People With Heart Failure Doctors should consider high-dose vaccine for those ... HealthDay News) -- Flu and pneumonia vaccines may reduce heart failure patients' risk of dangerous respiratory infections, a new ...

  7. Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Tai Sun Park

    2016-08-01

    Full Text Available Background: Administering extracorporeal membrane oxygenation (ECMO to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. Methods: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. Results: A total of 15 patients (9 men; median age 45 years with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding. The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56. Conclusions: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.

  8. Advanced glycation endproducts in chronic heart failure

    NARCIS (Netherlands)

    Smit, Andries J.; Hartog, Jasper W. L.; Voors, Adriaan A.; van Veldhuisen, Dirk J.; Schleicher, E; Somoza,; Shieberle, P

    2008-01-01

    Advanced glycation endproducts (AGEs) have been proposed as factors involved in the development and progression of chronic heart failure (CHF). Cross-linking by AGEs results in vascular and myocardial stiffening, which are hallmarks in the pathogenesis of CHE Additionally, stimulation of receptors b

  9. New pharmacological strategies in chronic heart failure

    NARCIS (Netherlands)

    van de Wal, RMA; Voors, AA; Plokker, HWM; van Gilst, WH; van Veldhuisen, DJ

    2004-01-01

    Diuretics, ACE inhibitors and betablockers form the cornerstone of pharmacological treatment of chronic heart failure (CHF), while angiotensin receptor blockers are gaining ground. However, despite optimal treatment CHF remains a syndrome with poor prognosis. For this reason, a large number of new a

  10. Parathyroid hormone secretion in chronic renal failure

    DEFF Research Database (Denmark)

    Madsen, J C; Rasmussen, A Q; Ladefoged, S D

    1996-01-01

    The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during....../ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure....

  11. High serum enalaprilat in chronic renal failure

    DEFF Research Database (Denmark)

    Elung-Jensen, T; Heisterberg, J; Kamper, A L

    2001-01-01

    renal failure. METHODS: Fifty nine out-patients with plasma creatinine >150 micromol/L and chronic antihypertensive treatment with enalapril were investigated, in a cross-sectional design. RESULTS: Median glomerular filtration rate (GFR) was 23(range 6-60) ml/minute/1.73 m2. The daily dose of enalapril......-68) ml/minute and correlated linearly with GFR (r=0.86, p=0.003). Intra-subject day-to-day variation in trough concentrations was 19.7%. CONCLUSION: Patients with chronic renal failure given small or moderately high doses of enalapril may thus have markedly elevated levels of serum enalaprilat. Whether......BACKGROUND: Most angiotensin-converting enzyme (ACE) inhibitors and their metabolites are excreted renally and doses should hence be reduced in renal insufficiency. We studied whether the dosage of enalapril in daily clinical practice is associated with drug accumulation of enalaprilat in chronic...

  12. 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.

  13. Community-based exercise training for people with chronic respiratory and chronic cardiac disease: a mixed-methods evaluation

    Science.gov (United States)

    McNamara, Renae J; McKeough, Zoe J; Mo, Laura R; Dallimore, Jamie T; Dennis, Sarah M

    2016-01-01

    Background Poor uptake and adherence are problematic for hospital-based pulmonary and heart failure rehabilitation programs, often because of access difficulties. The aims of this mixed-methods study were to determine the feasibility of a supervised exercise training program in a community gymnasium in people with chronic respiratory and chronic cardiac disease, to explore the experiences of participants and physiotherapists and to determine if a community venue improved access and adherence to rehabilitation. Methods Adults with chronic respiratory and/or chronic cardiac disease referred to a hospital-based pulmonary and heart failure rehabilitation program were screened to determine their suitability to exercise in a community venue. Eligible patients were offered the opportunity to attend supervised exercise training for 8 weeks in a community gymnasium. Semi-structured interviews were conducted with participants and physiotherapists at the completion of the program. Results Thirty-one people with chronic respiratory and chronic cardiac disease (34% males, mean [standard deviation] age 72 [10] years) commenced the community-based exercise training program. Twenty-two (71%) completed the program. All participants who completed the program, and the physiotherapists delivering the program, were highly satisfied, with reports of the community venue being well-equipped, convenient, and easily accessible. Using a community gymnasium promoted a sense of normality and instilled confidence in some to continue exercising at a similar venue post rehabilitation. However, factors such as cost and lack of motivation continue to be barriers. Conclusion The convenience and accessibility of a community venue for rehabilitation contributed to high levels of satisfaction and a positive experience for people with chronic respiratory and chronic cardiac disease and physiotherapists. PMID:27895476

  14. Chronic Respiratory Diseases of School-Age Children

    Science.gov (United States)

    McGovern, John P.

    1976-01-01

    The author examines the problems of chronic respiratory disease in school-age children from a medical viewpoint, including recognition and diagnosis, commonly encountered diseases, their effect on participation in physical exercise, emotional factors, medication, and emergency care. (MB)

  15. Fluoride-induced chronic renal failure.

    Science.gov (United States)

    Lantz, O; Jouvin, M H; De Vernejoul, M C; Druet, P

    1987-08-01

    Renal fluoride toxicity in human beings is difficult to assess in the literature. Although experimental studies and research on methoxyflurane toxicity have shown frank renal damage, observations of renal insufficiency related to chronic fluoride exposure are scarce. We report a case of fluoride intoxication related to potomania of Vichy water, a highly mineralized water containing 8.5 mg/L of fluoride. Features of fluoride osteosclerosis were prominent and end-stage renal failure was present. The young age of the patient, the long duration of high fluoride intake, and the absence of other cause of renal insufficiency suggest a causal relationship between fluoride intoxication and renal failure.

  16. Outcome at three months of COPD patients with acute hypercapnic respiratory failure treated with NPPV in an Acute Medicine Ward

    Directory of Open Access Journals (Sweden)

    Fabrizio Vincenti

    2011-03-01

    Full Text Available Non invasive positive pressure ventilation (NPPV is increasingly used for patients with hypercapnic respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease (COPD. NPPV has been shown to improve arterial blood gas tensions and dyspnoea and to prevent the need for intubation in patients admitted to hospital with an exacerbation of COPD associated with respiratory acidosis. Although advantages of NPPV over conventional treatment have been convincingly documented in the short period, there are fewer data as to the outcomes following hospital discharge. We have undertaken a prospective descriptive study to obtain comprehensive data on the in hospital and 3 month outcomes of a cohort of 57 COPD patients treated with NPPV for acute hypercapnic respiratory failure as a first intervention in addition to usual medical care. Patients with a COPD exacerbation had better outcomes than patients with COPD complicated by other acute conditions. Pneumonia was specifically associated with a higher inhospital risk of death. In our series about one in four patients with an indicator of previous severe respiratory disease (past admission for acute respiratory failure, previous use of NPPV, long term oxygen therapy or home NPPV was dead at three months after discharge and almost one in two was dead or had been readmitted. On the contrary, patients without indicators of previous severe respiratory disease benefited from NPPV during an acute episode of respiratory failure and had a chance of approximately 80% of being alive and free from recurrence at three months.

  17. Respiratory weakness in patients with chronic neck pain.

    Science.gov (United States)

    Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

    2013-06-01

    Respiratory muscle strength is one parameter that is currently proposed to be affected in patients with chronic neck pain. This study was aimed at examining whether patients with chronic neck pain have reduced respiratory strength and with which neck pain problems their respiratory strength is associated. In this controlled cross-sectional study, 45 patients with chronic neck pain and 45 healthy well-matched controls were recruited. Respiratory muscle strength was assessed through maximal mouth pressures. The subjects were additionally assessed for their pain intensity and disability, neck muscle strength, endurance of deep neck flexors, neck range of movement, forward head posture and psychological states. Paired t-tests showed that patients with chronic neck pain have reduced Maximal Inspiratory (MIP) (r = 0.35) and Maximal Expiratory Pressures (MEP) (r = 0.39) (P Neck muscle strength (r > 0.5), kinesiophobia (r neck pain and disability (r Neck muscle strength was the only predictor that remained as significant into the prediction models of MIP and MEP. It can be concluded that patients with chronic neck pain present weakness of their respiratory muscles. This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.

  18. Sexual dysfunction in chronic renal failure.

    Science.gov (United States)

    Soffer, O

    1980-12-01

    Sexual dysfunction in end-stage renal disease is a troublesome, multifactorial disorder. Abnormality of the hypothalamo-pituitary-gonadal axis is but one of the causes leading to the impotence and infertility commonly encountered in chronic renal failure. Short of kidney transplantation, no therapy is available. Though infertility is the rule in end-stage renal disease, successful fatherhood and deliveries have occurred on rare occasions.

  19. Isometric exercise and chronic heart failure

    Directory of Open Access Journals (Sweden)

    Efthimia Zerva

    2013-07-01

    Full Text Available The resistance exercise is an important part of all rehabilitation programs in patients with chronic heart failure. Among several kinds of resistance exercises, the one mainly applied is isotonic exercise, whereas, in the contrary, isometric is not heavily used although it affects the daily lives of patients who, trying to look after themselves (moving, walking, lifting objects, twitch in an isometric way their peripheral muscles due to reduced cardiovascular endurance. Purpose: The purpose of the present review was to present the data available so far for isometric exercise in cardiovascular patients and to examine the importance of applying this kind of exercise in rehabilitation programs in the context of, firstly, evaluation, and secondly therapeutic intervention. Material - Methods: The methodology followed included searching inquiries and reviews from international databases (Pubmed, Medline, Scopus on the effects of isometric exercise in patients with chronic heart failure. The progress and development of the studies are of particular importance to this work and, to this end, the literature refers to the entire range of time in the last three decades, from 1985 to 2012 according the key words noted. Results: In rehabilitation programs for patients with chronic heart failure, resistance exercise if applied in an isotonic way helps improve hemodynamic and functional parameters. In contrast, resistance exercise applied in an isometric way requires further investigation because most findings are related to hemodynamic disturbances. The data which is encouraging for isometric exercise programs are few and, therefore, it cannot be directly recommended as a proper way to exercise. Conclusions: Isometric exercise has an important place in the evaluation of patients with chronic heart failure, and limits should be "placed" in its application as a therapeutic tool to prevent complications.

  20. Acute-on-chronic Liver Failure.

    Science.gov (United States)

    Sarin, Shiv Kumar; Choudhury, Ashok

    2016-12-01

    Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame. ACLF is characterized by a state of deregulated inflammation. Initial cytokine burst presenting as SIRS, progression to CARS and associated immunoparalysis leads to sepsis and multi-organ failure. Early identification of the acute insult and mitigation of the same, use of nucleoside analogue in HBV-ACLF, steroid in severe alcoholic hepatitis, steroid in severe autoimmune hepatitis and/or bridging therapy lead to recovery, with a 90-day transplant-free survival rate of up to 50 %. First-week presentation is crucial concerning SIRS/sepsis, development, multiorgan failure and consideration of transplant. A protocol-based multi-disciplinary approach including critical care hepatology, early liver transplant before multi-organ involvement, or priority for organ allocation may improve the outcome. Presentation with extrahepatic organ involvement or inclusion of sepsis as an acute insult in definition restricts the therapy, i.e., liver transplant or bridging therapy, and needs serious consideration. Augmentation of regeneration, cell-based therapy, immunotherapy, and gut microbiota modulation are the emerging areas and need further research.

  1. Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: a case report and overview of the literature.

    Science.gov (United States)

    Tone, Kazuya; Kiryu, Ikumi; Yoshida, Masahiro; Tsuboi, Kazuto; Takagi, Masamichi; Kuwano, Kazuyoshi

    2014-05-01

    An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.

  2. RELIABILITY AND VALIDITY OF THE CHRONIC RESPIRATORY QUESTIONNAIRE (CRQ)

    NARCIS (Netherlands)

    WIJKSTRA, PJ; TENVERGERT, EM; VANALTENA, R; OTTEN, [No Value; POSTMA, DS; KRAAN, J; KOETER, GH

    1994-01-01

    Background - The Chronic Respiratory Questionnaire (CRQ) is frequently applied to assess quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the reliability and validity of this questionnaire have not yet been determined. This study investigates the reliability an

  3. 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.

  4. 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.

  5. 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 ...

  6. Chronic heart failure part 2: treatment and management.

    Science.gov (United States)

    Brake, Rebecca; Jones, Ian David

    2017-01-11

    Chronic heart failure is a common and complex clinical syndrome that results from impaired cardiac relaxation or contraction. There have been considerable advances in the management of chronic heart failure; however, the mortality rate remains high. Patients with chronic heart failure may experience multiple debilitating symptoms, such as fatigue, pain, and peripheral oedema. However, breathlessness may be considered the most debilitating symptom. The management of chronic heart failure aims to improve the patient's quality of life by reducing symptoms and supporting the patient to manage their condition. Treatment of patients with chronic heart failure may involve a combination of pharmacological therapy, device implantation and cardiac rehabilitation. This is the second of two articles on chronic heart failure. Part 1 discussed the pathophysiology of chronic heart failure, its causes, assessment, signs and symptoms. Part 2 outlines the treatment and management of patients with the condition, including pharmacological strategies, device implantation, lifestyle modification, cardiac rehabilitation and palliative care.

  7. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Esther Ern-Hwei Chan

    2016-01-01

    Full Text Available Hydrothorax secondary to a pancreaticopleural fistula (PPF is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up.

  8. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure

    Science.gov (United States)

    Chan, Esther Ern-Hwei

    2016-01-01

    Hydrothorax secondary to a pancreaticopleural fistula (PPF) is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up. PMID:27747128

  9. 无创呼吸机辅助通气治疗慢性阻塞性肺疾病合并呼吸衰竭临床体会%Clinical experience of non-invasive mechanical ventilation in chronic obstructive pulmonary disease with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    施红伟; 姚炳荣; 徐爱明; 刘春峰; 徐朝晖

    2015-01-01

    目的 观察无创呼吸机辅助通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果. 方法选取2013年1月至2014年6月间入住我院的52例慢性阻塞性肺病( COPD)合并呼吸衰竭患者,随机分为两组,对照组给予吸痰、通畅气道、低流量持续吸氧、呼吸兴奋剂、抗感染、补液、营养支持等常规治疗,治疗组在常规治疗基础上,加用无创呼吸机辅助通气. 比较两组患者治疗前后有效率、血气分析及肺功能变化情况. 结果 治疗组的总有效率为92.00%,显著高于对照组(χ2 =6.166,P=0.02);治疗后治疗组在PaO2、PaCO2、血pH及肺功能方面均优于对照组. 结论 无创呼吸机辅助通气治疗可显著提高COPD合并呼吸衰竭患者氧分压,改善呼吸状况及肺功能.%Objective To observe clinical results of the non-invasive mechanical ventilation in chronic obstructive pulmonary disease with respiratory failure.Methods Between January 2013 and June 2014, 52 patients admitted to our hospital with chronic obstructive pulmonary disease ( COPD) and respiratory failure were randomly divided into two groups, a control group was given suction, unobstructed airway, low flow continued oxygen, respiratory stimulants, antibiotics, rehydration, nutritional support and other conventional treatment group on the basis of conventional therapy plus noninvasive mechanical ventilation.Two groups of patients before and after treatment efficiency, blood gas analysis and pulmonary function changes.Results The total effective rate of 92.00 percent effective, significantly higher (χ2 =6.166,P=0.02); the treatment group in PaO2, PaCO2 , blood pH and lung function than the control group.Conclusions Noninvasive mechanical ventilation therapy can significantly improve COPD patients with respiratory failure, oxygen partial pressure; improve the respiratory conditions and lung function.

  10. Chronic Renal Failure, Cachexia, and Ghrelin

    Directory of Open Access Journals (Sweden)

    A. Laviano

    2010-01-01

    Full Text Available Protein energy wasting is frequently observed in patients with advanced chronic renal failure and end-stage renal disease. Anorexia and reduced food intake are critical contributing factors and negatively impact on patients' survival. Ghrelin is a prophagic peptide produced by the stomach and acting at the hypothalamic level to increase the activity of orexigenic neurons. In patients with chronic renal disease, plasma levels are increased as a likely effect of reduced renal clearance. Nevertheless, patients' food intake is significantly reduced, suggesting inflammation-mediated resistance of hypothalamic nuclei to peripheral signals. A number of forms of evidence show that ghrelin resistance could be overcome by the administration of exogenous ghrelin. Therefore, ghrelin has been proposed as a potential strategy to improve food intake in chronic renal failure patients with protein energy wasting. Preliminary data are encouraging although larger prospective clinical trials are needed to confirm the results and to identify those patients who are likely to benefit most from the administration of exogenous ghrelin.

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

    Directory of Open Access Journals (Sweden)

    Titlestad IL

    2013-04-01

    Full Text Available Ingrid L Titlestad,1 Annmarie T Lassen,2 Jørgen Vestbo1,3 1Department of Respiratory Medicine, 2Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; 3Respiratory Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK Abstract: 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 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. Method: Data from medical records were retrospectively retrieved from all patients receiving NIV for the first time after being admitted acutely to an acute medical ward and further transfer to a respiratory ward with respiratory failure and a diagnosis of COPD in the period January 1, 2005 to December 31, 2007; patients were followed until January 2012. Demographic data collected included age, sex, diagnoses at discharge, and, when present, FEV1; a “not-to-intubate” order was also registered when listed. Results: In total, 253 patients (143 female, 110 male received NIV for the first time. The median age was 72 years (range 46–91 years. The 30-day mortality rate was 29.3%. The 5-year survival rate was 23.7%. Women showed a trend towards better survival than men (25.7% vs 19.2%, P = 0.25, and the trend was even more pronounced for patients with COPD. Conclusion: The mortality rate of patients receiving NIV is high, as expected in a real-life setting, but with a 5-year survival rate

  12. Gastrointestinal Angiodysplasia in Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Kaaroud H

    2008-01-01

    Full Text Available Gastrointestinal (GI hemorrhage is a frequent and sometimes life-threatening complication of end-stage renal failure. Angiodysplasia (AD, vascular malformation, is the most common cause of recurrent lower-intestinal hemorrhage in patients with renal failure. We report four chronic hemodialysis patients with AD. All patients presented with severe anemia requiring transfusion. GI hemorrhage ceased spontaneously in three cases and after treatment with argon plasma coagulation in another. Diagnosis of AD is usually challenging, since its cause is still unknown, and its clinical presentation is variable. Lesions are multiple in 40-75% of cases, often located in the stomach and duodenum but can affect the colon and the jejunum. Diagnosis is improved by endoscopy which has a much higher sensitivity compared to angiography. Capsular endoscopy may reveal the hemorrhage site in the small intestine when regular endoscopy fails, and therapeutic intervention usually include argon plasma coagulation.

  13. 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.

  14. [Gastro-esophageal reflux and chronic respiratory diseases].

    Science.gov (United States)

    Dirou, S; Germaud, P; Bruley des Varannes, S; Magnan, A; Blanc, F-X

    2015-12-01

    Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases.

  15. Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.

    Directory of Open Access Journals (Sweden)

    Malcolm Lemyze

    Full Text Available PURPOSE: Acute respiratory failure (ARF is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS. We aimed to identify the determinants of noninvasive ventilation (NIV success or failure for this indication. METHODS: We prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital. RESULTS: NIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n = 12/13, 92% vs n = 9/63, 14%; p<0.0001, high SOFA (10 vs 5; p<0.0001 and SAPS2 score (63 vs 39; p<0.0001 at admission. These patients often experienced poor outcome despite early resort to endotracheal intubation (in-hospital mortality, 92.3% vs 17.5%; p<0.001. The only factor significantly associated with successful response to NIV was idiopathic decompensation of OHS (n = 30, 48% vs n = 0, 0%; p = 0.001. In the NIV success group (n = 63, 33 patients (53% experienced a delayed response to NIV (with persistent hypercapnic acidosis during the first 6 hours. CONCLUSIONS: Multiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS.

  16. Noninvasive Ventilation Practice Patterns for Acute Respiratory Failure in Canadian Tertiary Care Centres: A Descriptive Analysis

    Directory of Open Access Journals (Sweden)

    Geneviève C Digby

    2015-01-01

    Full Text Available BACKGROUND: The extent of noninvasive ventilation (NIV use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.

  17. Ocular findings in the chronic renal failure

    Directory of Open Access Journals (Sweden)

    P Dahal

    2015-07-01

    Full Text Available BACKGROUND The aim of the study was to evaluate the ocular signs in chronic renal failure (CRF in diabetes and hypertensive patients. MATERIALS AND METHODS Two hundred and thirty eight cases were enrolled in the study from the nephrology unit of College Of Medical Science, Bharatpur, Nepal and examined in the department of Ophthalmology. The study duration was carried out over 2 years from January 2011 to December 2012. RESULT The number of cases in each grade of CRF were mild 80 (26.67%, moderate 84 (28%, severe 75 (25%, end stage renal disease 61 (20.33%. In all the groups the commonest cause of CRF were Hypertension (HTN 123 out of 300(41% and diabetes 98(32.67%. The commonest ocular symptoms in CRF was blurring of vision 68%. CONCLUSION Many important ocular findings like vitreous haemorrage, retinal detachment, neovascular glaucoma and cataract are the presentation in chronic renal failure, which can cause marked vision loss. Hence proper awareness should be provided to the people in time to prevent these ocular complications.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12949 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2; 18-26

  18. Community-based exercise training for people with chronic respiratory and chronic cardiac disease: a mixed-methods evaluation

    Directory of Open Access Journals (Sweden)

    McNamara RJ

    2016-11-01

    Full Text Available Renae J McNamara,1,2 Zoe J McKeough,3 Laura R Mo,3 Jamie T Dallimore,4 Sarah M Dennis3 1Physiotherapy Department, 2Respiratory and Sleep Medicine Department, Prince of Wales Hospital, Randwick, 3Discipline of Physiotherapy, The University of Sydney, Lidcombe, 4Eastern Sydney Medicare Local, Rosebery, NSW, Australia Background: Poor uptake and adherence are problematic for hospital-based pulmonary and heart failure rehabilitation programs, often because of access difficulties. The aims of this mixed-methods study were to determine the feasibility of a supervised exercise training program in a community gymnasium in people with chronic respiratory and chronic cardiac disease, to explore the experiences of participants and physiotherapists and to determine if a community venue improved access and adherence to rehabilitation. Methods: Adults with chronic respiratory and/or chronic cardiac disease referred to a hospital-based pulmonary and heart failure rehabilitation program were screened to determine their suitability to exercise in a community venue. Eligible patients were offered the opportunity to attend supervised exercise training for 8 weeks in a community gymnasium. Semi-structured interviews were conducted with participants and physiotherapists at the completion of the program. Results: Thirty-one people with chronic respiratory and chronic cardiac disease (34% males, mean [standard deviation] age 72 [10] years commenced the community-based exercise training program. Twenty-two (71% completed the program. All participants who completed the program, and the physiotherapists delivering the program, were highly satisfied, with reports of the community venue being well-equipped, convenient, and easily accessible. Using a community gymnasium promoted a sense of normality and instilled confidence in some to continue exercising at a similar venue post rehabilitation. However, factors such as cost and lack of motivation continue to be barriers

  19. Importance of Social Relationships in Patients with Chronic Respiratory Diseases.

    Science.gov (United States)

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bozena

    2016-01-01

    The literature lacks reports on the role of the social relationships domain (SRD) of quality of life (QoL) in shaping care for patients with chronic respiratory diseases in primary care. In this study we examined a group of 582 patients with chronic respiratory diseases and chronic non-respiratory diseases recruited from 199 primary care centers. In the patients with chronic respiratory diseases, higher SRD correlated with more frequent patient visits due to medical issue, fewer district nurse interventions over the past 12 months, less frequent hospitalizations over the past 3 years, and fewer chronic diseases. In these patients, a high SRD was most effectively created by high QoL in the Psychological, Environmental, and Physical domains, and the satisfaction with QoL. Programs for preventing a decline in SRD should include patients with low scores in the Psychological, Environmental, and Physical domains, those who show no improvement in mental or somatic well-being in the past 12 months, those with a low level of positive mental attitudes, unhealthy eating habits, and with low levels of met needs. Such programs should include older widows and widowers without permanent relationships, with only primary education, living far from a primary care center, and those whose visits were not due to a medical issue.

  20. HBV Vaccination in Chronic Renal Failure Patients

    Directory of Open Access Journals (Sweden)

    Mir-davood Omrani

    2006-12-01

    Full Text Available HBV infection in chronic renal failure (CRF becomes chronic in 30 to 60% compared with less than 10% in nonuremic patients. Immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumor necrosis factor (TNF-|α| and interleukin (IL 6,1 by retention of renal metabolite in uremia and chronic inflammation and have a poor immunological reaction to T-cell-dependent antigens, like hepatitis B vaccination. Immunocompromised patients who are unresponsive to hepatitis B vaccination seem to be unable to enhance IL-10 synthesis for control of monokine overproduction. Moreover, human leukocyte antigen (HLA genes, which play a major role in the antigen presentation to immunocompetent cells, have also been shown to modulate this immune response. Unfortunately, seroconversion to anti-HBS has been reported to occur in only 40 to 50% of the vaccine, a significantly lower rate than that observed in healthy adults. Various methods including adjutants such as zinc, gamma interferon, thymopentine, GM-CSF and Levamisol for improving immune responses have been advised. Experience with Pres1/s2, third-generation vaccines is limited and they have not been proven more effective than intradermally (ID administered second-generation S antigen vaccines. Both intramuscular (IM and intradermal (ID vaccinations against hepatitis B have variable efficiency in hemodialysis and non-responders should be retreated by ID route.

  1. Acute respiratory failure in a rapidly enlarging benign cervical goitre.

    Science.gov (United States)

    Garingarao, Carlo Jan; Añonuevo-Cruz, Cecille; Gasacao, Ryan

    2013-07-22

    Benign goitres have the potential to reach massive sizes if neglected, but most have a protracted course that may or may not present with compressive symptoms. We report the case of a 57-year-old man who presented with a rapidly enlarging nodular goitre resulting in acute respiratory failure. Endotracheal intubation and emergency total thyroidectomy were performed, revealing massive thyroid nodules with minimal intrathoracic extension and tracheal erosion. Despite a course and clinical findings suggestive of malignant disease, histopathology was consistent with a benign multinodular goitre. Several cases of benign goitres necessitating endotracheal intubation have been reported. Airway compromise was attributed to a significant intrathoracic component, or inciting events such as thyroid haemorrhage, pregnancy, radioiodine uptake or major surgery. Obstructive symptoms may not correlate well with objective measures of upper airway obstruction such as radiographs or flow volume loops.

  2. The Phosphate Levels of Critically ill Patients with Respiratory Failure

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    Mehmet Turan İnal

    2011-04-01

    Full Text Available Objective: The incidence of hypophosphatemia is higher in critically ill patients and prolonged the length of ICU stay and duration of mechanical ventilation. This study evaluated the prognostic value of phosphate levels in critically ill patients. Materials and Methods: All patients admitted to the general and surgical intensive care unit (ICU of Trakya University Medical Faculty, with respiratory failure during 1 year period (from January 1, 2009, to December 31, 2009, were retrospectively enrolled. The phosphate levels, age, gender, length of ICU stay, duration of mechanical ventilation, APACHE II scores, medical drug usage and prognosis were recorded. Hypophosphataemia was defined as a level under 2.5 mg/dL and normophosphatemia was defined as a level between 2.5-4.7 mg/dL. Results: 139 patients were retrospectively enrolled into the study, of these, 41% had hypophosphataemia. There was no statistically significant difference in age, gender and APACHE II scores. The length of ICU stay was 20.16±16.31 days in hypophosphatemic patients and 12.62±12.43 days in normophosphatemic patients (p<0.05. The duration of mechanical ventilation was 17.54±16.27 days in hypophosphatemic patients and 9.94±11.55 days in normophosphatemic patients (p<0.05. The usage of catecholamines, beta adrenergic receptor agonists, diuretics and glucocorticoids were higher in hypophosphatemic patients (p<0.05. Conclusion: The duration of mechanical ventilation and the length of ICU stay was prolonged in hypophosphatemic patients with respiratory failure. We suggested to follow the phosphate levels tightly for early diagnosis and treatment of phosphate deficiency. (Journal of the Turkish Society of Intensive Care 2011; 9: 19-22

  3. Update on the "Dutch hypothesis" for chronic respiratory disease

    DEFF Research Database (Denmark)

    Vestbo, J; Prescott, E

    1998-01-01

    BACKGROUND: Many patients with chronic obstructive lung disease show increased airways responsiveness to histamine. We investigated the hypothesis that increased airways responsiveness predicts the development and remission of chronic respiratory symptoms. METHODS: We used data from 24-year follow......-up (1965-90) of 2684 participants in a cohort study in Vlagtwedde and Vlaardingen, Netherlands. Increased airways responsiveness was defined as a PC10 value (concentration of histamine for which challenge led to a 10% fall in forced expiratory volume in 1 s) of less than 8 mg/ml. Information on respiratory...... of the odds ratio for the development of any of the six symptoms was 1.7 (1.2-2.3). Participants with increased airways responsiveness were less likely than those without this characteristic to show remission of these respiratory symptoms. The estimate of the odds ratio for the remission of any of the six...

  4. Research Comment on the Treatment of Respiratory Failure of Acute Exacerbation of Chronic Obstructive Pulmonary Disease by Chinese Medicine%中医药治疗慢性阻塞性肺疾病急性加重期呼吸衰竭研究述评

    Institute of Scientific and Technical Information of China (English)

    蒋艳丽; 王海峰; 李建生

    2012-01-01

    Objective: To explore the research progress of treating respiratory failure of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) by Chinese medicine. Methods:TCM literatures about respiratory failure of AECOPD in recent ten years were systematically collected,concluded and analyzed. Results:Pathogenesis law,syndrome classification,diagnosis criterion and application of respiratory failure of AECOPD still showed a lack of standardization at present and design procedures of clinical research needed to be further strengthened. Evaluation index and methods of curative effect needed to be further improved. Therefore,research should be focused on the law of pathogenesis, standardization of syndrome, and so on, and improving the design level of clinical theory based on that. Clinical research with multi-center and great amount of samples should be developed to provide high-level clinical evidence so that to provide scientific basis for the clinical application of Chinese medicine. Conclusion: Traditional Chinese medicine has good clinical effect on the treatment of respiratory failure of AECOPD .which provides evidence for the clinical treatment and scientific research of respiratory failure of AECOPD.%目的:探讨中医药治疗慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)急性加重期呼吸衰竭的研究进展情况.方法:通过对近10 a来有关慢性阻塞性肺疾病急性加重(acute exacerbations of COPD,AECOPD)期呼吸衰竭的中医文献进行系统整理、归纳、分析.结果:目前AECOPD呼吸衰竭的病因病机、证候分类、诊断标准及治疗等方面尚不规范,临床研究设计方法有待进一步加强,疗效评价指标及方法有待进一步提高等.故应着眼于病机规律、证候规范等方面的研究,并在此基础上提高临床理论设计水平,开展多中心、大样本的临床研究以提供高级别的临床证据,为中医药临床应用的进一步研究提供科学依

  5. 慢性阻塞性肺疾病合并呼吸衰竭应用无创正压通气临床疗效%Clinical effect of non-invasive positive pressure ventilation for chronic obstructive pulmonary disease combined with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    刘冲; 余洁

    2015-01-01

    目的 探讨慢性阻塞性肺疾病合并呼吸衰竭应用无创正压通气治疗的临床疗效.方法 80例慢性阻塞性肺疾病合并呼吸衰竭患者, 随机分为观察组和对照组, 每组40例, 对照组患者应用常规治疗, 观察组在对照组治疗的基础上给予无创正压通气治疗, 对比分析两组患者治疗前后呼吸频率、心率、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值.结果 治疗前两组患者心率、呼吸频率、PaCO2、PaO2、pH值比较差异无统计学意义(P>0.05), 治疗后观察组患者心率、呼吸频率、PaCO2、PaO2、pH值均明显优于对照组(P0.05). After treatment, the observation group had obviously better heart rate, respiratory rate, PaCO2, PaO2, and pH than the control group (P<0.05).Conclusion Non-invasive positive pressure ventilation provides precise effect in treating chronic obstructive pulmonary disease combined with respiratory failure. It can effectively improve clinical symptoms, prevent progression of disease, and correct respiratory failure. This method is worthy of clinical promotion and application.

  6. Metabolic remodeling in chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    Jing WANG; Tao GUO

    2013-01-01

    Although the management of chronic heart failure (CHF) has made enormous progress over the past decades,CHF is still a tremendous medical and societal burden.Metabolic remodeling might play a crucial role in the pathophysiology of CHF.The characteristics and mechanisms of metabolic remodeling remained unclear,and the main hypothesis might include the changes in the availability of metabolic substrate and the decline of metabolic capability.In the early phases of the disease,metabolism shifts toward carbohydrate utilization from fatty acids (FAs) oxidation.Along with the progress of the disease,the increasing level of the hyperadrenergic state and insulin resistance cause the changes that shift back to a greater FA uptake and oxidation.In addition,a growing body of experimental and clinical evidence suggests that the improvement in the metabolic capability is likely to be more significant than the selection of the substrate.

  7. Effects of pneumococcal vaccine in patients with chronic respiratory disease

    Directory of Open Access Journals (Sweden)

    Yuji Watanuki

    2008-04-01

    Full Text Available In developed countries, it is very difficult to demonstrate the effectiveness of pneumococcal vaccines because the incidence of pneumococcal pneumonia is very low. Vaccination against pneumococci infection was advised for 1378 outpatients, over 60 years of age, with chronic respiratory disease for more than one year. Of these patients, those who responded affirmatively to the advice were vaccinated against pneumococci between August and November 2002. The effectiveness of vaccination was evaluated by means of a 2-year cohort-study, comparing the vaccinated group (647 with the non-vaccinated group (731. The variables analyzed were the frequency of onset of bacterial respiratory infection, hospitalization due to bacterial respiratory infection and onset of pneumococcal respiratory infection. The incidence of bacterial respiratory infection and the incidence of pneumococcal respiratory infection to have decreased in the following 2 years (17.4%, 0.9%, as compared to the previous year (25.9%, 3.1%, in the vaccinated group. Conversely, the frequency was higher in the following 2 years (14.4%, 0.9% as compared to the previous year (14.2%, 0.4% in the non-vaccinated group. This inter-group difference was statistically significant. Simultaneous vaccination against pneumococci and influenza virus also resulted in a significant reduction in the incidence of bacterial respiratory infection. No decrease was observed in the frequency of hospitalization. These results indicate that pneumococcal vaccine is useful for elderly patients with chronic respiratory disease and that its efficacy may be enhanced by simultaneous vaccination against influenza.

  8. Home monitoring of chronic heart failure

    Directory of Open Access Journals (Sweden)

    Bockeria O. L.

    2012-06-01

    Full Text Available Being a common syndrome chronic heart failure (CHF results in high mortality among cardiosurgical patients and requires very high expenditures for the treatment. All over the world the number of patients with CHF syndrome is about 22 millions. Heart failure is difficult to treat because of high level of hospitalization due to decompensation. Care aimed at constant home observation of patients could have been more efficient and not only symptomatic and as a response to complications induced. There are methods controlling CHF patients at home. These methods vary from increase of self-care and telephone support to telemonitoring and remote monitoring of implantable devices. Self-care includes such components as maintenance of drug intake, keeping to a diet, physical exercises and active control over edemas. Telephone calls are also a source of monitoring and treatment of heart failure at home. Meta-analysis of programs for structured phone support showed that telephone support could reduce the level of readmission of HF patients approximately by 25%. Telemonitoring implies transmission of such physiological data as blood pressure, body weight, electrocardiographic signals or oxygen saturation using phone lines, broadband and satellite or wireless networks. Having cardiac pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy devices that are placed in HF patients, it is possible to use their opportunities for the further evaluation of the patient. Some regularly controlled parameters can show the clinical state of the patient and predict the following heart failure. For example, atrial fibrillation, decrease of cardiac rhythm variability and decrease of the level of the patient`s activity (according to integrated accelerometer can predict clinical decompensation. Also, implantable hemodynamic monitors for immediate pressure measuring in the left atrium, sensor system of pressure measuring in the right atrium are

  9. Respiratory Failure in Premature Babies Born from Multiple Pregnancy

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    S. A. Perepelitsa

    2010-01-01

    Full Text Available Objective: to reveal the factors that are responsible for the development of respiratory distress syndrome (RDS and the specific features of its course in preterm twin neonates. Subjects and methods. Twenty-three patients who had had twin pregnancy, including 9 (39.1% and 14 (60% with monochorial and bichorial biamniotic twin pregnancies, respectively, were examined. Their mean age was 28.5±5.4 years. Obstetric and gynecologic histories, conditions at conception, the course of pregnancy, the type of pla-centation, and fetal presentation were considered. The placentas were morphologically examined. In all the patients, pregnancy ended in birth of 46 premature neonates, of them there were 19 (41.3% boys and 27 (58.7% girls. The gestational age of the neonates averaged 31.7±2.3 weeks. The evaluation of the efficiency of performed therapy used clinical assessment of the status of the premature neonates; measurement of partial oxygen tension (pO2 and calculation of alveolar-arterial oxygen gradient (A-a DO2, respiratory index (RI, and oxygenation index (OI; death rates were analyzed. Results. The main cause of respiratory failure (RF was RDS in premature twins. Neonatal blood aspiration-caused pneumonia occurred in one case. The course of RDS was variable. Most neonatal infants needed exogenous surfactant replacement therapy and mechanical ventilation (MV. No signs of RF were present in 7 (15.2% premature neonates. Conclusion. Premature twins are a high RDS risk group. The unfavorable factors that contribute to the development of the disease are multiple pregnancy, a past maternal obstetric history, in-vitro fertilization-induced pregnancy, severe gestosis in the second half of pregnancy, and preterm delivery. The type of placentation affects the fetal status after birth. Fatal outcome occurred in infants from the monochorial bioamniotic twins. In multiple pregnancies, there are pathological changes in the placenta, its membranes, and umbilical

  10. Analysis of the Cause of Treatment Failure by Noninvasive Positive Pressure Ventilation in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Respiratory Failure%COPD急性加重并呼吸衰竭患者无创正压通气治疗失败原因分析

    Institute of Scientific and Technical Information of China (English)

    何炜; 揭志军; 冷蓓峥; 鄢莉宏; 施劲东; 钱凌

    2012-01-01

    Objective To analyze the cause of treatment failure by noninvasive positive pressure ventilation ( NPPV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure and explore indication of contraindication and invasive mechanical ventilation. Methods 210 patients with exacerbation of COPD combined with respiratory failure during January 2008 and December 2011 were divided into 2 groups (effective group, non-effective group) according to the results of noninvasive mechanical ventilation. The basic condition, functional disturbance of organ, HPPV influencing factors, complications, the results of blood gas analysis pretherapy and 2-4 hours after NPPN of the two groups were recorded, and the differences of the two groups were compared. The causes of treatment failure of NPPV were analyzed. Results The APACHⅡscore in NPPV non-effective group was significantly higher than that of NPPV effective group ( P < 0.01); albumin levels was lower than that of effective group ( P <0.01). The incidence rates of two organ dysfunctions in NPPV non-effective group (23.0% ) was significantly lower than that of the effective group (51.7% , P<0.01 ) ; but the percentage of more than three organ dysfunctions (76.9% ) was significantly higher than that of the effective group (48.3% , P < 0.01). The incidence rates of renal insufficiency, shock, sputum disorder and vomit aspiration in non-effective group were significantly higher than those of the effective group (P < 0. 01 ). After 2-4 hours of NPPV , the pH and PaCO2 of the effective group were improve significantly than that of the useless group (P <0. 01). Conclusion The high APACH Ⅱ score, the low albumin levels, multiple organ dysfunctions and complications may be the direct cause of treatment failure of NPPV.%目的 分析经面罩无创正压通气(noninvasive positive pressure ventilation,NPPV)常见的失败原因,探讨其禁忌证和改行有创机械通气的指征.方法

  11. 无创机械通气治疗慢性阻塞性肺病合并呼吸衰竭疗效观察%Non-invasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease with respiratory failure Efficacy

    Institute of Scientific and Technical Information of China (English)

    李玉

    2010-01-01

    Objective To explore the bi-level positive airway pressure non-invasive ventilation (BI-PAP) for chronic obstructive pulmonary disease (COPD)with respiratory failure,the value of the cure.Methods COPD patients with type Ⅱ respiratory failure 47 regular bi-level positive airway pressure non-invasive ventilation(BIPAP) ,recorded the change before treatment,on the plane two hours after one day,three days PH,PaO2 ,PaCO2,SPO2 change.Results All patients through the bi-level positive airway pressure non-invasive ventilation,the clinical symptoms significantly improved after treatment,blood gas analysis The PH,PaO2,PaCO2 ,SPO2 a significant improvement compared with before treatment (P < 0.05).Conclusion The bi-level positive airway pressure non-invasive ventilation (BIPAP) for chronic obstructive pulmonary disease (COPD) with respiratory failure has a significant effect.%目的 探讨双水平气道正压无创通气(BIPAP)对慢性阻塞性肺病(COPD)合并呼吸衰竭的冶疗价值.方法 对COPD合并Ⅱ型呼吸衰竭患者47例行双水平气道正压无创通气(BIPAP),记录治疗前,上机后2 h、1 d、3 d的pH、PaO2、PaCO2、SPO2变化.结果 所有患者经过双水平气道正压无创通气后,临床症状有明显好转,治疗后血气分析中的pH、PaO2、PaCO2、SPO2较治疗前有明显改善(P<0.05).结论 双水平气道正压无创通气(BIPAP)对慢性阻塞性肺病(COPD)合并呼吸衰竭患者疗效显著.

  12. Respiratory Conditions Update: Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Karel, Daphne J

    2016-09-01

    Chronic obstructive pulmonary disease (COPD) is defined as persistent airflow limitation due to irritant-induced chronic inflammation. A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less is diagnostic in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure. Tobacco smoking is the most significant etiology, and smoking cessation is the only intervention shown to slow disease progression. Long-acting beta2-agonists and long-acting muscarinic antagonists are first-line treatments for patients with persistently symptomatic COPD with an FEV1 of 80% or less of predicted. When COPD is uncontrolled with a long-acting bronchodilator, combination therapy with a long-acting muscarinic antagonist-long-acting beta2-agonist or long-acting beta2-agonist-inhaled corticosteroid should be prescribed. Patients with COPD and reduced exercise tolerance should undergo pulmonary rehabilitation and be evaluated for supplemental oxygen therapy. Other treatment options for persistently symptomatic COPD include inhaler triple therapy (ie, long-acting muscarinic antagonist, long-acting beta2-agonist, inhaled corticosteroid), phosphodiesterase type 4 inhibitors, oxygen, and surgical interventions.

  13. 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.

  14. 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.

  15. Functional connectivity and information flow of the respiratory neural network in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Yu, Lianchun; De Mazancourt, Marine; Hess, Agathe; Ashadi, Fakhrul R; Klein, Isabelle; Mal, Hervé; Courbage, Maurice; Mangin, Laurence

    2016-08-01

    Breathing involves a complex interplay between the brainstem automatic network and cortical voluntary command. How these brain regions communicate at rest or during inspiratory loading is unknown. This issue is crucial for several reasons: (i) increased respiratory loading is a major feature of several respiratory diseases, (ii) failure of the voluntary motor and cortical sensory processing drives is among the mechanisms that precede acute respiratory failure, (iii) several cerebral structures involved in responding to inspiratory loading participate in the perception of dyspnea, a distressing symptom in many disease. We studied functional connectivity and Granger causality of the respiratory network in controls and patients with chronic obstructive pulmonary disease (COPD), at rest and during inspiratory loading. Compared with those of controls, the motor cortex area of patients exhibited decreased connectivity with their contralateral counterparts and no connectivity with the brainstem. In the patients, the information flow was reversed at rest with the source of the network shifted from the medulla towards the motor cortex. During inspiratory loading, the system was overwhelmed and the motor cortex became the sink of the network. This major finding may help to understand why some patients with COPD are prone to acute respiratory failure. Network connectivity and causality were related to lung function and illness severity. We validated our connectivity and causality results with a mathematical model of neural network. Our findings suggest a new therapeutic strategy involving the modulation of brain activity to increase motor cortex functional connectivity and improve respiratory muscles performance in patients. Hum Brain Mapp 37:2736-2754, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

  16. Functional and histopathological identification of the respiratory failure in a DMSXL transgenic mouse model of myotonic dystrophy.

    Science.gov (United States)

    Panaite, Petrica-Adrian; Kuntzer, Thierry; Gourdon, Geneviève; Lobrinus, Johannes Alexander; Barakat-Walter, Ibtissam

    2013-05-01

    Acute and chronic respiratory failure is one of the major and potentially life-threatening features in individuals with myotonic dystrophy type 1 (DM1). Despite several clinical demonstrations showing respiratory problems in DM1 patients, the mechanisms are still not completely understood. This study was designed to investigate whether the DMSXL transgenic mouse model for DM1 exhibits respiratory disorders and, if so, to identify the pathological changes underlying these respiratory problems. Using pressure plethysmography, we assessed the breathing function in control mice and DMSXL mice generated after large expansions of the CTG repeat in successive generations of DM1 transgenic mice. Statistical analysis of breathing function measurements revealed a significant decrease in the most relevant respiratory parameters in DMSXL mice, indicating impaired respiratory function. Histological and morphometric analysis showed pathological changes in diaphragmatic muscle of DMSXL mice, characterized by an increase in the percentage of type I muscle fibers, the presence of central nuclei, partial denervation of end-plates (EPs) and a significant reduction in their size, shape complexity and density of acetylcholine receptors, all of which reflect a possible breakdown in communication between the diaphragmatic muscles fibers and the nerve terminals. Diaphragm muscle abnormalities were accompanied by an accumulation of mutant DMPK RNA foci in muscle fiber nuclei. Moreover, in DMSXL mice, the unmyelinated phrenic afferents are significantly lower. Also in these mice, significant neuronopathy was not detected in either cervical phrenic motor neurons or brainstem respiratory neurons. Because EPs are involved in the transmission of action potentials and the unmyelinated phrenic afferents exert a modulating influence on the respiratory drive, the pathological alterations affecting these structures might underlie the respiratory impairment detected in DMSXL mice. Understanding

  17. Functional and histopathological identification of the respiratory failure in a DMSXL transgenic mouse model of myotonic dystrophy

    Directory of Open Access Journals (Sweden)

    Petrica-Adrian Panaite

    2013-05-01

    Acute and chronic respiratory failure is one of the major and potentially life-threatening features in individuals with myotonic dystrophy type 1 (DM1. Despite several clinical demonstrations showing respiratory problems in DM1 patients, the mechanisms are still not completely understood. This study was designed to investigate whether the DMSXL transgenic mouse model for DM1 exhibits respiratory disorders and, if so, to identify the pathological changes underlying these respiratory problems. Using pressure plethysmography, we assessed the breathing function in control mice and DMSXL mice generated after large expansions of the CTG repeat in successive generations of DM1 transgenic mice. Statistical analysis of breathing function measurements revealed a significant decrease in the most relevant respiratory parameters in DMSXL mice, indicating impaired respiratory function. Histological and morphometric analysis showed pathological changes in diaphragmatic muscle of DMSXL mice, characterized by an increase in the percentage of type I muscle fibers, the presence of central nuclei, partial denervation of end-plates (EPs and a significant reduction in their size, shape complexity and density of acetylcholine receptors, all of which reflect a possible breakdown in communication between the diaphragmatic muscles fibers and the nerve terminals. Diaphragm muscle abnormalities were accompanied by an accumulation of mutant DMPK RNA foci in muscle fiber nuclei. Moreover, in DMSXL mice, the unmyelinated phrenic afferents are significantly lower. Also in these mice, significant neuronopathy was not detected in either cervical phrenic motor neurons or brainstem respiratory neurons. Because EPs are involved in the transmission of action potentials and the unmyelinated phrenic afferents exert a modulating influence on the respiratory drive, the pathological alterations affecting these structures might underlie the respiratory impairment detected in DMSXL mice. Understanding

  18. 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.

  19. Pathogenic bacteria and drug resistance in patients with chronic heart failure and lower respiratory infections%慢性心力衰竭患者下呼吸道感染病原菌和耐药菌临床分析

    Institute of Scientific and Technical Information of China (English)

    王选琦; 聂书伟; 王小丽; 李陕区

    2012-01-01

    目的 分析慢性心力衰竭患者伴发下呼吸道感染的病原菌及耐药菌情况.方法 回顾性分析126例慢性心力衰竭患者下呼吸道感染痰培养及药敏试验的临床资料,对其病原菌分布及耐药情况进行统计分析.结果 在203次痰培养检测中,培养出病原菌182株,包括细菌139株和真菌43株.139株细菌中包括革兰阳性球菌48株(35.5%)和革兰阴性杆菌91株(65.5%).126例慢性心力衰竭患者中根据经验治疗的有41例与药敏结果相吻合,感染控制差的68例患者根据痰培养结果更换或联合用抗生素后多数控制了感染,另有17例耐药明显,最终死于严重感染,住院病死率13.5%.结论 慢性心力衰竭患者下呼吸道感染病菌多为革兰阴性菌,对常用抗生素有明显耐药性.合理使用抗生素,防止药物滥用是预防细菌耐药的关键.%Objective To investigate the information of pathogenic bacteria and drug resistance in patients with chronic heart failure and lower respiratory infections. Methods A retrospective review was adopted to analyze the results of sputum culture and susceptibility tests among 126 patients with chronic heart failure and lower respiratory infections. The pathogen distribution and drug resistance was analyzed statistically. Results Of 203 samples of sputum culture, 182 strains of pathogenic bacteria were found, including 139 strains of bacteria that consisted of 65.5% (91/139) Gram-negative bacteria and 34.5% (48/139) Gram-positive bacteria, and 43 strains of fungus. In 126 patients with chronic heart failure. 41 patients had the drug sensitivity in good agreement with empirical treatment, and 68 patients had poor infection controlled according to sputum culture or in combination with antibiotics after the replacement of the majority of infections under control, and 17 cases were dead as apparent drug resistance and infection without control, and the hospital mortality was 13.5%. Conclusion The lower

  20. 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

  1. 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

    : Retrospective cohort study including 359 patients admitted with acute pancreatitis. Information was gathered from electronic patient records. We defined respiratory failure based on the modified Marshall scoring system in the revised Atlanta criteria. Predictors of respiratory failure were evaluated......, or pneumonia may develop respiratory failure, suggests that acute lung injury, possibly associated with systemic inflammation, may be important.......BACKGROUND: The incidence of respiratory failure and other respiratory complications in the early phase of acute pancreatitis (AP) is not well investigated. OBJECTIVE: To evaluate the incidence and risk factors of respiratory failure, and its impact on mortality in the early phase AP. METHODS...

  2. Erythropoietin therapy in patients with chronic renal failure.

    OpenAIRE

    Pinevich, A J; Petersen, J.

    1992-01-01

    Symptomatic anemia is a common complication of chronic renal failure. Treatment is now possible with the availability of recombinant human erythropoietin (epoetin alfa). Previous experimental studies have suggested that correcting the anemia of chronic renal failure may be harmful in that renal failure may be accelerated. Although experience with this drug has been primarily restricted to its use in patients with end-stage renal disease, several recent trials have been reported in patients wi...

  3. Gastrointestinal function in chronic renal failure.

    Science.gov (United States)

    Ravelli, A M

    1995-12-01

    Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment. Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delayed gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia

  4. Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin.

    Science.gov (United States)

    Díaz-Lobato, Salvador; Folgado, Miguel Angel; Chapa, Angel; Mayoralas Alises, Sagrario

    2013-12-01

    The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, P(aCO2), and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy.

  5. Sympathetic nervous system and chronic renal failure.

    Science.gov (United States)

    Boero, R; Pignataro, A; Ferro, M; Quarello, F

    2001-01-01

    The aim of this work was to review evidence on the role of the sympathetic nervous system (SNS) in chronic renal failure (CRF). Three main points are discussed: 1) SNS and pathogenesis of arterial hypertension; 2) SNS and cardiovascular risk; 3) implication of SNS in arterial hypotension during hemodialysis. Several lines of evidence indicate the presence of a sympathetic hyperactivity in CRF, and its relationship with arterial hypertension. It is suggested that diseased kidneys send afferent nervous signals to central integrative sympathetic nuclei, thus contributing to the development and maintenance of arterial hypertension. The elimination of these impulses with nephrectomy could explain the concomitant reduction of blood pressure. Several experiments confirmed this hypothesis. Regarding SNS and cardiovascular risk, some data suggest that reduced heart rate variability identifies an increased risk for both all causes and sudden death, independently from other recognized risk factors. Symptomatic hypotension is a common problem during hemodialysis treatment, occurring in approximately 20-30% of all hemodialysis sessions and is accompanied by acute withdrawal of sympathetic activity, vasodilation and relative bradicardia. This reflex is thought to be evoked by vigorous contraction of a progressively empty left ventricle, activating cardiac mechanoceptors. This inhibits cardiovascular centers through vagal afferents, and overrides the stimulation by baroreceptor deactivation. Alternative explanations include cerebral ischemia and increased production of nitric oxide, which inhibit central sympathetic activity. It is hoped that therapies aimed at modulating sympathetic nerve activity in patients with CRF will ameliorate their prognosis and quality of life.

  6. Hybrid ECMO for a patient in respiratory failure developing cardiac insufficiency.

    Science.gov (United States)

    Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

    2016-04-01

    A 45-year-old patient in lung failure treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) developed subsequent right heart failure and required cardiac support.We present a method of upgrading a VV ECMO to a hybrid system for simultaneous support for respiratory and cardiac failure.

  7. 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...

  8. Increased interleukin-13 levels in patients with chronic heart failure.

    Science.gov (United States)

    Nishimura, Yuki; Inoue, Teruo; Nitto, Takeaki; Morooka, Toshifumi; Node, Koichi

    2009-01-24

    A great number of basic and clinical studies have demonstrated that inflammatory cytokines play an important role in development and progress of heart failure. However, there is limited information about allergic cytokine interleukin-13 (IL-13). The inflammatory responses mediated by allergic cytokines can cause significant morbidity and mortality when they become chronic. Therefore, we elucidated the role of IL-13 in the pathophysiology of chronic heart failure. We measured plasma IL-13 levels by enzyme-linked immunosorbent assay in 110 patients with chronic heart failure and 20 control subjects. Plasma IL-13 levels were increased in heart failure patients, compared with the controls, in association with NYHA functional class. In addition, IL-13 levels were correlated positively with plasma levels of brain natriuretic peptide and C-reactive protein, and negatively with left ventricular ejection fraction. Plasma IL-13 levels may be useful for evaluating disease severity in chronic heart failure.

  9. [Effectiveness of pneumococcal polysaccharide vaccine in older patients with chronic respiratory diseases].

    Science.gov (United States)

    Watanuki, Yuji; Takahashi, Hiroshi; Ogura, Takashi; Miyazawa, Naoki; Nakamura, Mari; Hashizume, Toshihiko; Kozawa, Satoko; Tagawa, Akihiro

    2006-04-01

    To evaluate effectiveness of pneumococcal polysaccharide vaccine, we recommended 1378 outpatients aged over 60 with chronic respiratory diseases to be vaccinated from August to October 2002, and 647 patients were vaccinated from August to November 2002. In the 1229 patients without respiratory failure, the incidence of antimicrobial treatment for bacterial respiratory infections in 547 vaccinated patients significantly decreased from 7.9% in the 2001/02 winter season to 5.7% in the 2002/03 winter season, although that in the 682 unvaccinated patients increased from 3.8% to 5.7%. The incidence of antimicrobial treatment for bacterial respiratory infections in 229 vaccinated patients with pneumococcal and influenza vaccines together significantly decreased from 10.5% in the 2001/02 winter season to 5.2% in 2002/03 winter season although that in 110 subjects vaccinated with influenza vaccine only increased from 2.7% to 7.2%. These findings suggest the effectiveness of the pneumococcal polysaccharide vaccine for the prevention of bacterial respiratory infections and the additive effectiveness of pneumococcal and influenza vaccines together.

  10. 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

  11. 高压力家庭无创通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效研究%Study of the Efficacy of High-intensity Non-invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease Patients with TypeⅡ Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    李强; 饶常红; 黄渤

    2016-01-01

    Objective:To study the efficacy of high-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type Ⅱ respiratory failure.Method:36 patients with chronic obstructive pulmonary exacerbation and type Ⅱ respiratory failure in our department from July 2013 to February 2016 were selected,after treatment,the disease was still stable with carbon dioxide retention.According to the random number table method,they were divided into the experimental group and control group,each of 18 cases.Two groups of patients were discharged from hospital at home to continue the use of noninvasive ventilation,the experimental group used the high-inspiratory pressure,the control group used the conventional inspiratory pressure,before and after treatment for 6 months,the FVC,FEV1,PaCO2,PaO2 and dyspnea scores in the two groups were compared.Result:After treatment,the two groups of PaCO2 and PaO2 compared with before treatment, the differences were statistically significant(P0.05).After treatment,between the dyspnea score of the two groups compared,there was no significant difference (P>0.05).Conclusion:To stable chronic obstructive pulmonary disease patinets with type Ⅱ respiratory failure home high-intensity non-invasive ventilation can better decrease carbon dioxide retention,but it can’t better improve lung function and exercise power.%目的:研究高压力家庭无创通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效。方法:选取2013年7月-2016年2月因慢性阻塞性肺急性加重且合并Ⅱ型呼吸衰竭在本科室住院,经治疗后病情平稳仍伴有二氧化碳潴留的患者36例。按照随机数字表法分为试验组和对照组,各18例。两组患者均出院后在家中继续使用无创通气,试验组使用高吸气压力,对照组使用常规吸气压力,比较治疗前与治疗6个月后两组患者的FVC、FEV1、PaCO2、PaO2数值及呼吸困难评分。结

  12. Fatal respiratory failure caused by pulmonary infiltration by pseudo-Gaucher cells

    NARCIS (Netherlands)

    Links, T P; Karrenbeld, A; Steensma, J T; Weits, J; van der Jagt, E J; Postmus, P E

    1992-01-01

    Pseudo-Gaucher cells are reticuloendothelial cells that are found in several diseases. We report a case of pulmonary tuberculosis in which extensive pulmonary involvement with these cells resulted in fatal respiratory failure.

  13. FATAL RESPIRATORY-FAILURE CAUSED BY PULMONARY INFILTRATION BY PSEUDOGAUCHER CELLS

    NARCIS (Netherlands)

    LINKS, TP; KARRENBELD, A; STEENSMA, JT; WEITS, J; VANDERJAGT, EJ; POSTMUS, PE

    1992-01-01

    Pseudo-Gaucher cells are reticuloendothelial cells that are found in several diseases. We report a case of pulmonary tuberculosis in which extensive pulmonary involvement with these cells resulted in fatal respiratory failure.

  14. Patchy cerebral white matter edema in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Anlar, B.; Erzen, C.; Saatci, U.

    1989-07-01

    Bilateral patchy cerebral white matter edema was observed in two children with chronic renal failure. Uremia in one case and hypertension or hyponatremia in the other appeared to be the cause of the neurological and radiological findings. (orig.).

  15. 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.

  16. 机械通气联合雾化吸入治疗COPD呼吸衰竭疗效观察%Observation of the Efficacy of mechanical ventilation combined with aerosolization inhalation to treat respiratory failure in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    姜远普

    2012-01-01

    Objective Observation of the efficacy of bi - level positive airway pressure ventilation( BiPAP ) combined with drug aerosolization inhalation to treat respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECO-PD ). Methods 52 patients were randomly divided into group A and group B with based on routine therapies, group A received BiPAP treatment. Group B were received BiPAP combined drug aerosolization inhalation treatment. Changes of clinical situation, time of mechanical ventilation and days of hospitalization in ICU were observed. Results Arterial blood gas( PaO2、PaCO2 )、PaO2/FiO2 and respiratory rate of group B had significant improvement over group A after treatment ( P < 0. 05 ) . Time of mechanical ventilation and days of hospitalization in ICU of group B were also fewer than group A. Conclusion BiPAP combined with drug aerosolization inhalation to treat respiratory failure in AECOPD is more effective.%目的 双水平无创正压通气(BiPAP)联合药物雾化吸入治疗AECOPD Ⅱ型呼吸衰竭疗效观察.方法 52例AECOPD Ⅱ型呼吸衰竭患者在常规治疗基础上随机分为A、B两组,A组BiPAP治疗.B组BiPAP联合药物雾化吸入治疗,观察两组临床情况变化及机械通气时间、住ICU天数.结果 治疗后B组血气指标、氧合指数、呼吸频率较A组改善明显(P<0.05),B组机械通气时间、住ICU天数少于A组.结论 BiPAP联合药物雾化吸入治疗AECOPD Ⅱ型呼吸衰竭疗效好.

  17. Rehabilitation effect of nocturnal noninvasive positive pressure ventilation on respiratory failure in patients with stable chronic cor pulmonale at high altitude area%夜间无创正压通气对高原地区肺心病缓解期慢性呼吸衰竭患者的康复效应

    Institute of Scientific and Technical Information of China (English)

    杨生岳; 冯恩志; 沈君礼; 张瑛; 赵丽红; 吴雪梅; 张冬天

    2005-01-01

    min步行距离:治疗组治疗后明显高于治疗前和对照组治疗后(P<0.05~0.01),动脉血二氧化碳分压:治疗组治疗后明显低于治疗前和对照组治疗后(P<0.01).结论:夜间无创正压通气治疗能显著改善高原地区肺心病缓解期慢性呼吸衰竭患者的动脉血气和肺功能,增强呼吸肌力量.%BACKGROUND: Medicine treatment of chronic respiratory failure achieved little effect. Interfering chronic respiratory failure of chronic cor pulmonale with noninvasive positive pressure ventilation (NIPPV) may be an effective measure to eliminate symptom and physical sign of patients.OBJECTIVE: To investigate the effect of nocturnal noninvasive positive pressure ventilation (NIPPV) on respiratory muscle function, pulmonary function of chronic respiratory failure patients with stable chronic cor pulmonale at high altitude area (HACCP).DESIGN: A completely randomized grouping design and randomized control trial.SETTING: Center of Respiratory Medicine, the 4th Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 60 HACCP patients with chronic respiratory failure in stable stage, 38 male and 22 female, were admitted to Department of Respiratory Disease, the 4th hospital of Chinese PLA from October 2002 to November 2004. All cases, after informed consent was obtained,were randomly divided into two groups, including treatment group and control group with 30 cases in each group.METHODS: [1] Treatment group: Fitted with ventilator with pressure support ventilation (PSV) mode or positive end-expiratory pressure (PEEP)mode from 22:00 to next 7:00 every night. Before and after 5 weeks therapeutics, pulmonary function, arterial blood gas, respiratory muscle function and 6-minute walking distance (6MWD) were measured. Control group:Those were either assessed in inpatient objects stabled at least 1 week as control group before discharged and 5 weeks thereafter. [2] 6-minute walking distance (6MWD) test: Patients

  18. 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.

  19. The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

    NARCIS (Netherlands)

    A.P.C. Top (Anke); E.A.B. Buijs (Erik ); M. van Dijk (Monique); D. Tibboel (Dick); C. Ince (Can)

    2012-01-01

    textabstractPurpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcircu- lation in neonates with severe respiratory fa

  20. Erythrocyte survival in chronic renal failure. Role of secondary hyperparathyroidism.

    OpenAIRE

    Akmal, M; Telfer, N; Ansari, A N; Massry, S G

    1985-01-01

    The human erythrocyte (RBC) is a target organ for parathyroid hormone (PTH) and the hormone increases RBC osmotic fragility and induces their hemolysis. The present study was undertaken to examine whether elevated blood levels of PTH affect RBC survival, and therefore whether PTH, being an extracorpuscular factor, is responsible for the shortened RBC survival in chronic renal failure. 51Cr-labeled RBC survival was elevated in six normal dogs, in six animals with chronic renal failure and seco...

  1. Acute respiratory failure in critically ill patients with interstitial lung disease.

    Directory of Open Access Journals (Sweden)

    Lara Zafrani

    Full Text Available Patients with chronic known or unknown interstitial lung disease (ILD may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce.Clinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF. Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression.Hospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR 4.55; 95% confidence interval (95%CI (1.20-17.33; OR, 7.68; (1.78-33.22 and OR 10.60; (2.25-49.97 respectively. Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005-0.21. In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality.Mortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival.

  2. Central Mechanisms of Abnormal Sympathoexcitation in Chronic Heart Failure

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    Takuya Kishi

    2012-01-01

    Full Text Available It has been recognized that the sympathetic nervous system is abnormally activated in chronic heart failure, and leads to further worsening chronic heart failure. In the treatment of chronic heart failure many clinical studies have already suggested that the inhibition of the abnormal sympathetic hyperactivity by beta blockers is beneficial. It has been classically considered that abnormal sympathetic hyperactivity in chronic heart failure is caused by the enhancement of excitatory inputs including changes in peripheral baroreceptor and chemoreceptor reflexes and chemical mediators that control sympathetic outflow. Recently, the abnormalities in the central regulation of sympathetic nerve activity mediated by brain renin angiotensin system-oxidative stress axis and/or proinflammatory cytokines have been focused. Central renin angiotensin system, proinflammatory cytokines, and the interaction between them have been determined as the target of the sympathoinhibitory treatment in experimental animal models with chronic heart failure. In conclusion, we must recognize that chronic heart failure is a syndrome with an abnormal sympathoexcitation, which is caused by the abnormalities in the central regulation of sympathetic nerve activity.

  3. Angiotensin II, sympathetic nerve activity and chronic heart failure.

    Science.gov (United States)

    Wang, Yutang; Seto, Sai-Wang; Golledge, Jonathan

    2014-03-01

    Sympathetic nerve activity has been reported to be increased in both humans and animals with chronic heart failure. One of the mechanisms believed to be responsible for this phenomenon is increased systemic and cerebral angiotensin II signaling. Plasma angiotensin II is increased in humans and animals with chronic heart failure. The increase in angiotensin II signaling enhances sympathetic nerve activity through actions on both central and peripheral sites during chronic heart failure. Angiotensin II signaling is enhanced in different brain sites such as the paraventricular nucleus, the rostral ventrolateral medulla and the area postrema. Blocking angiotensin II type 1 receptors decreases sympathetic nerve activity and cardiac sympathetic afferent reflex when therapy is administered to the paraventricular nucleus. Injection of an angiotensin receptor blocker into the area postrema activates the sympathoinhibitory baroreflex. In peripheral regions, angiotensin II elevates both norepinephrine release and synthesis and inhibits norepinephrine uptake at nerve endings, which may contribute to the increase in sympathetic nerve activity seen in chronic heart failure. Increased circulating angiotensin II during chronic heart failure may enhance the sympathoexcitatory chemoreflex and inhibit the sympathoinhibitory baroreflex. In addition, increased circulating angiotensin II can directly act on the central nervous system via the subfornical organ and the area postrema to increase sympathetic outflow. Inhibition of angiotensin II formation and its type 1 receptor has been shown to have beneficial effects in chronic heart failure patients.

  4. Investigating Awareness in Chronic Renal Failure Among Family Physicians

    Directory of Open Access Journals (Sweden)

    Birgül ATAMAN

    2014-05-01

    Full Text Available OBJECTIVE: The conditions underlying chronic renal failure have become epidemics in the world. The aim of this study was to reveal the degree of awareness of chronic renal failure among family physicians. MATERIAL and METHODS: Using data collected with a structured questionnaire and considering physicians’ socio-demographic features and their education on nephrology, we evaluated physicians’ awareness of the definition, frequency and clinical features of chronic renal failure. The questionnaire was filled in by volunteering family medicine specialists (FMS, family medicine assistants (FMA and family physicians (FP during a family medicine meeting. RESULTS: Out of 310 physicians, 25.2% (n=78 were FMS, 27.7% (n=86 FMA and 47.1% (n=146 FP. %35,2 of physicians (n=109 (FMS: % 62,8 (n=49, FMA: %52.3 (n=45, FP: %10.3 (n=15, p0.05. However, less than 15% of the physicians reported that they felt competent enough to follow patients with chronic renal failure. The rate of the physicians who felt the need to refer these patients to health institutions was high. However, the Fps did not like the patient care style of internal medicine specialists and thought that patients faced financial problems to access the nephrologist. CONCLUSION: Appropriate care and management of referrals are life-saving for patients with chronic renal failure. New strategies should be developed to increase awareness concerning chronic renal failure and the management of this condition.

  5. Nature and frequency of respiratory involvement in chronic progressive external ophthalmoplegia

    NARCIS (Netherlands)

    Smits, B.W.; Heijdra, Y.F.; Cuppen, F.; Engelen, B.G. van

    2011-01-01

    Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. Weakness of the extra-ocular, limb girdle and laryngeal muscles are established clinical features. Respiratory muscle involvement however has never been studied systematically, even though respiratory

  6. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2008-01-01

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of an

  7. Angiotensin II vaccine promising for patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    CHEN Yang-xin; YAO You-jie; NIE Ru-qiong; ZHOU Shu-xian; WANG Jing-feng

    2009-01-01

    @@ Chronic heart failure (CHF), as the end-stage presentation of all kinds of heart diseases, is a major public health problem as well as a pressing public policy issue. There are more than 5 million patients diagnosed with CHF in USA alone and approximately 550 000 new cases appear per year. About 0.4%-2% of the European population is affected by symptomatic heart failure. Hence heart failure is the leading cause of hospitalization especially in older people around the world.

  8. Vitamin B-12 and folate deficiency in chronic heart failure

    NARCIS (Netherlands)

    van der Wal, Haye H.; Comin-Colet, Josep; Klip, Ijsbrand T.; Enjuanes, Cristina; Grote Beverborg, Niels; Voors, Adriaan A.; Banasiak, Waldemar; van Veldhuisen, Dirk J.; Bruguera, Jordi; Ponikowski, Piotr; Jankowska, Ewa A.; van der Meer, Peter

    2015-01-01

    Objective To determine the prevalence, clinical correlates and the effects on outcome of vitamin B-12 and folic acid levels in patients with chronic heart failure (HF). Methods We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause m

  9. Iron deficiency in chronic heart failure : An international pooled analysis

    NARCIS (Netherlands)

    Klip, IJsbrand T.; Comin-Colet, Josep; Voors, Adriaan A.; Ponikowski, Piotr; Enjuanes, Cristina; Banasiak, Waldemar; Lok, Dirk J.; Rosentryt, Piotr; Torrens, Ainhoa; Polonski, Lech; van Veldhuisen, Dirk J.; van der Meer, Peter; Jankowska, Ewa A.

    2013-01-01

    Background Iron deficiency (ID) is an emerging problem in patients with chronic heart failure (HF) and can be a potential therapeutic target. However, not much is known about the prevalence, predictors, and prognosis of ID in patients with chronic HF. Methods In an international pooled cohort compri

  10. 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

  11. 高压力无创通气治疗稳定期慢性阻塞性肺疾病的疗效观察%Observation of the efficacy of High-intensity non-invasive ventilation in stable chronic obstructive pulmonary disease patients with type H respiratory failure

    Institute of Scientific and Technical Information of China (English)

    周琴; 杨力; 郭光云

    2012-01-01

    Objective TO explore efficacy of the high-intensity noninvasive positive pressure ventilation in stable chronic obstructive pulmonary disease patinets with type II respiratory failure. Methods The patients between January 2007 and December 2003 ever hospitalized in our department, 29 stable COPD patients with type II respiratory failure were divided into two groups. FEV[ ,FVC, PaO2 , PaCO2 changes were assessed between high-intensity non-invasive ventilation group( 16 cases) and low-intensity non-invasive ventilation group (13 cases) before and after the treatment of home non-invasive ventilation. Results Before the treatment of non - invasive ventilation in the two groups, FEVj , FVC, PaO2 , PaCO2 difference was not statistically significant (P > 0. 05 ). Affter treatment, the difference of these four indicators of high-intensity ventilation group and PaCO2 of low-intensity ventilation group was statistically significant compared with before treatment (P < 0. 05 ) , other wise, there were significant differences between two groups ( P < 0. 05 ). Conclusion To stable chronic obstructive pulmonary disease patinets with type II respiratory failure, high-intensity non-invasive ventilation can better improve the lung function and carbon dioxide retention, increase blood oxygen pressure more efficiently.%目的 探讨高压力无创正压通气治疗稳定期慢性阻塞性肺疾病合并Ⅱ型呼衰的疗效.方法 2007年1月~2010年12月在我科住院的29例稳定期COPD合并Ⅱ型呼衰的患者,高压力无创通气组(16例)及低压力无创通气组(13例)进行家庭无创通气,比较两组患者治疗前后FEV1、FVC、PaO2、PaCO2的变化.结果 治疗前,FEV1、FVC、PaO2、PaCO2差异无统计学意义(P>0.05);治疗后,高压力通气组上述4指标及低压力通气组PaCO2与治疗前相比差异有统计学意义(P<0.05).结论 高压力无创通气能更好地改善稳定期COPD合并Ⅱ型呼衰患者的肺功能,提高PaO2,改善二氧化碳潴留.

  12. Noninvasive ventilation for acute respiratory failure: state of the art (I 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. A lot of trials have shown improvements in clinical features (respiratory rate, neurological score, pH and arterial blood gases. Methods: In particular clinical conditions, such as Acute Cardiogenic Pulmonary Edema (ACPE and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD, systematic reviews and meta-analysis show a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. In other clinical conditions, such as acute asthma, Acute Lung Injury (ALI/Acute Respiratory Distress Syndrome (ARDS and severe pneumonia, NIV does not show significant improvements in term of avoided intubations or mortality rate. Although the first important data on NIV comes from studies performed in Intensive Care Units (ICUs, subsequently these methodologies of ventilation have been used with increasing frequency in Emergency Departments (ED and medical wards. Results: Studies developed in ICU sometimes report slightly worse outcomes compared to studies performed in general wards due to the need to treat more severe patients in ICU. Aetiology remains one of the most important factor determining prognosis: different pathological mechanisms substain different clinical conditions and not in all cases the application of positive pressures to the airways is useful. NIV for ARF due to COPD and ACPE is feasible, safe and effective also in a general medical ward if selection of patients, staff training and monitoring are appropriate: its early application improves clinical parameters, arterial blood gases, prevents endotracheal intubation, decreases mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting.

  13. 肠内营养支持治疗慢性阻塞性肺疾病并发呼吸衰竭患者的应用%Application value of enteral nutrition in the treatment of chronic obstructive pulmonary disease patients with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    邓迎丽; 杨岚

    2016-01-01

    Objective To observe the effect of enteral nutrition in the treatment of chronic obstructive pul-monary disease patients with respiratory failure. Methods 70 COPD patients complicated with respiratory failure from 2014 to 2015 were randomly divided into two groups. The control group was given regular treatment, and the study group was additionally given joint enteral nutrition support treatment. Results After 1-month treatment, their hemoglobin ( Hb) , total protein ( TP) and albumin ( ALB) increased more obviously in the study group than in the control group (P<0. 05). Plasma PH value, PaO2, PaCO2, SF-36 scores, 6min walking distance improved signifi-cantly in the study group (P<0. 05), and non-invasive ventilation time and ICU stay were obviously shorter in the study group than in the control group (P<0. 05), and the invasive ventilation rate decreased more significantly in the study group than in the control group (P<0. 05). Conclusion The proper nutrition support is important for COPD patients complicated with respiratory failure, and enteral nutrition can effectively improve the nutritional status of pa-tients to promote respiratory function recovery.%目的:探讨肠内营养支持对慢性阻塞性肺疾病(慢阻肺)合并呼吸衰竭患者治疗的影响。方法选取2014-2015年我院收治的慢阻肺合并呼吸衰竭患者70例,随机平均分为两组,分别选择常规治疗以及联合肠内营养支持治疗。结果治疗1个月后研究组患者血清血红蛋白( Hb )、总蛋白( TP )、清蛋白(ALB)均相比对照组以及治疗前明显提高(P<0.05),血浆PH值、PaO2、PaCO2、SF-36评分、6min步行距离指标明显改善(P<0.05),无创通气时间、ICU住院之间相比对照组明显缩短(P<0.05),有创通气比例明显降低(P<0.05)。结论合理的营养支持方式对慢阻肺合并呼吸衰竭患者十分重要,肠内营养支持能够有效改善患者营养状况,促进呼吸功能恢复。

  14. Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: the role of noninvasive ventilation.

    Directory of Open Access Journals (Sweden)

    Claudio Terzano

    Full Text Available BACKGROUND: Hypercapnic Chronic Obstructive Pulmonary Disease (COPD exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV when treating hypercapnic respiratory failure. METHODS: Sixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO(2 and PaCO(2 and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV. RESULTS: Nine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7% mixed respiratory acidosis-metabolic alkalosis, 10/36 (27.8% respiratory acidosis and 3/5 (60% mixed respiratory-metabolic acidosis patients (p = 0.026, with durations of 45.1 ± 9.8, 36.2 ± 8.9 and 53.3 ± 4.1 hours, respectively (p = 0.016. The duration of ventilation was associated with higher blood lactate (p<0.001, lower pH (p = 0.016, lower serum sodium (p = 0.014 and lower chloride (p = 0.038. Hyponatremia without hypervolemic hypochloremia occurred in 11 respiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis-metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder. CONCLUSIONS: Mixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated.

  15. 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

  16. 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.

  17. Respiratory Failure Associated with the Lipodystrophy Syndrome in an HIV-Positive Patient with Compromised Lung Function

    Directory of Open Access Journals (Sweden)

    Natasha Press

    2001-01-01

    Full Text Available Protease inhibitors, used as treatment in human immunodeficiency virus (HIV infection, are associated with a syndrome of peripheral lipodystrophy, central adiposity, hyperlipidemia and insulin resistance. An HIV-positive patient with chronic obstructive pulmonary disease is presented who developed the lipodystrophy syndrome that is associated with the use of protease inhibitors. It is postulated that the lipodystrophy syndrome further compromised his lung function, leading to respiratory failure. Patients who have pulmonary disease and are taking protease inhibitors require monitoring of clinical status and pulmonary function tests.

  18. EXPERIENCE WITH NON - INVASIVE VENTILATION IN TYPE II RESPIRATORY FAILURE AT DEPARTMENT OF PULMONARY MEDICINE, KURNOOL MEDICAL COLLEGE, KURNOOL

    Directory of Open Access Journals (Sweden)

    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.

  19. [CHRONIC RENAL FAILURE AND PREGNANCY--A CASE REPORT].

    Science.gov (United States)

    Amaliev, G M; Uchikova, E; Malinova, M

    2015-01-01

    Pregnancy in women with chronic renal failure is a complex therapeutic problem requiring a multidisciplinary approach. It is associated with a higher risk of many perinatal complications. The most common abnormalities are related to: progression of renal failure, development of preeclampsia development of nephrotic syndrome, anemic syndrome, IUGR and fetal death. The prognosis depends on the values of serum creatinine prior to pregnancy, the degree of deterioration of renal function, development of additional obstetric complications and the specific etiological reasons that have led to the occurrence of renal failure. Determining the optimum time for authorization birth depends on the condition of the mother, the condition of the fetus and the rate of progression of renal failure, and the deadline the pregnancy should be terminated is 35 weeks. We present a case of a patient with chronic renal failure, with favorable perinatal outcome.

  20. [Circulatory failure in chronic glomerulo- and pyelonephritis].

    Science.gov (United States)

    Kulakov, G P; Melikian, A M; Seĭsembekov, T Z

    1982-01-01

    The frequency and degree of circulatory insufficiency depending on the stage of the disease are analyzed in 404 patients with chronic glomerulonephritis and 145 patients with chronic pyelonephritis aged 15 to 74 years. When the renal function is still preserved different degrees of circulatory insufficiency are diagnosed in 29.4% of patients. Circulatory insufficiency complicates more often chronic glomerulonephritis than pyelonephritis and is more common in the aged. Latent cardiac insufficiency is more common. In the period of chronic renal insufficiency cardiac decompensation is seen in 78.1% of cases, its frequency is practically the same in glomerulonephritis and pyelonephritis. The mechanisms of development of cardiac insufficiency and the principles of treatment depending on the functional state of the kidneys are discussed.

  1. RESPIRATORY STUDIES IN CHRONIC MOUNTAIN SICKNESS:THE PERUVIAN EXPERIENCE

    Institute of Scientific and Technical Information of China (English)

    Fabiola León-Velarde

    2005-01-01

    @@ Chronic Mountain Sickness (CMS) is a multifactorial disease caused by a limited capacity to achieve complete adaptation to life under chronic hypoxic conditions. It is accompanied by excessive erythrocitosis (levels of erythrocytes above the normal value set for each altitude), and in advances cases also by pulmonary hypertension. The hypoxemia, caused by central or peripheral respiratory disorders and/or associated to diverse risk factors, produces the excessive erythrocytosis. The most common symptoms are headaches, dizziness, breathlessness, sleep disturbances, tinnitus, physical and mental fatigue, anorexia, and bone and muscle pain. The most common signs are an intermittent or permanent cyanosis, hyperemia and venous dilatation in hands or feet (Monge-M et al., 1928; Winslow and Monge-C, 1987). Aging, respiratory diseases, sleep, menopause, and overweight has proved to be additional risk factors in the development of CMS (Kryger et al., 1978; León-Velarde et al., 1993; Sime et al., 1975; León-Velarde et al., 1997; León-Velarde et al., 2001; Monge-C et al., 1992; Normand et al., 1992)

  2. Respiratory Failure Secondary to Human Metapneumovirus Requiring Extracorporeal Membrane Oxygenation in a 32-Month-Old Child

    Directory of Open Access Journals (Sweden)

    Abha Gupta

    2012-01-01

    Full Text Available 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 is the oldest reported pediatric patient with respiratory failure secondary to human metapneumovirus that did not respond to mechanical ventilation. This case highlights three critical points: the potentially fatal causative role of HMPV in respiratory failure in an older pediatric age group of immunocompetent hosts, the importance of early recognition of impending respiratory failure, and the timely utilization of ECMO.

  3. 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

  4. Market failure, policy failure and other distortions in chronic disease markets

    Directory of Open Access Journals (Sweden)

    Segal Leonie

    2009-06-01

    Full Text Available Abstract Background The increasing prevalence of chronic disease represents a significant burden on most health systems. This paper explores the market failures and policy failures that exist in the management of chronic diseases. Discussion There are many sources of market failure in health care that undermine the efficiency of chronic disease management. These include incomplete information as well as information asymmetry between providers and consumers, the effect of externalities on consumer behaviour, and the divergence between social and private time preference rates. This has seen government and policy interventions to address both market failures and distributional issues resulting from the inability of private markets to reach an efficient and equitable distribution of resources. However, these have introduced a series of policy failures such as distorted re-imbursement arrangements across modalities and delivery settings. Summary The paper concludes that market failure resulting from a preference of individuals for 'immediate gratification' in the form of health care and disease management, rather than preventative services, where the benefits are delayed, has a major impact on achieving an efficient allocation of resources in markets for the management of chronic diseases. This distortion is compounded by government health policy that tends to favour medical and pharmaceutical interventions further contributing to distortions in the allocation of resources and inefficiencies in the management of chronic disease.

  5. 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.

  6. Anemia associated with chronic heart failure: current concepts

    Directory of Open Access Journals (Sweden)

    Shah R

    2013-02-01

    Full Text Available Ravish Shah, Anil K AgarwalDivision of Nephrology, The Ohio State University, Columbus, Ohio, USAAbstract: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.Keywords: anemia, heart failure, chronic kidney disease, elderly population

  7. Acute-on-chronic and Decompensated Chronic Liver Failure: Definitions, Epidemiology, and Prognostication.

    Science.gov (United States)

    Olson, Jody C

    2016-07-01

    Chronic liver disease is the fifth leading cause of death worldwide and represents a major burden for the health care community. Cirrhosis is a progressive disease resulting in end-stage liver failure, which in the absence of liver transplantation is fatal. Acute-on-chronic liver failure carries high short-term mortality but is potentially reversible. Viral hepatitis, alcohol, and nonalcoholic fatty liver disease remain the principal causes of liver disease. Though treatments exist for hepatitis B and C, they remain unavailable to many with these diseases. This article reviews the epidemiology of advanced liver disease and the concept of acute-on-chronic liver failure.

  8. Deteriorated function of cutaneous microcirculation in chronic congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    Marie-Louise Edvinsson; Erik Uddman; Sven E Andersson

    2011-01-01

    Background Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age.In this study,we examined a group of very old patients with severe chronic heart failure to test the hypothesis that vascular function is further compromised by a combination of heart failure and aging.Methods Cutaneous forearm blood flow was measured by laser Doppler flownretry and compared among three groups:Group 1 (n=20,men±SE:85.54 years),heart failure patients with New York Heart Association class Ⅳ(NYHA IV) and with a NT-proBNP level =10,mean±SE:67.6 ± 3.0 years),healthy controls with no clinical signs of heart failure.The vasodilator response to the iontophoretic administration of acetylcholine (ACh),acting via an endothelial mechanism,and sodium nitroprusside (SNP),acting via a smooth muscle cell mechanism,were studied. Results All patients with heart failure had significantly reduced vascular reactivity independent of the mode of stimulation (ACh,SNP or heat) when compared to healthy controls.However,the responses did not differ between the two groups of heart failure patients.Conclusions Cutaneous vascular reactivity is reduced in heart failure patients and does not correlate with the severity of the condition or age of patients.

  9. Extra-aortic implantable counterpulsation pump in chronic heart failure.

    Science.gov (United States)

    Mitnovetski, Sergei; Almeida, Aubrey A; Barr, Althea; Peters, William S; Milsom, F Paget; Ho, Betty; Smith, Julian A

    2008-06-01

    Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality. The patient lived almost 7 months after the implantation of the device and died of septic complications secondary to gas line infection.

  10. Zhang Qi's Experience in Treating Chronic Renal Failure

    Institute of Scientific and Technical Information of China (English)

    LIN Qi-zhan; XU Da-ji; MA Yu-peng

    2008-01-01

    @@ Chronic renal failure is a result of the parenchymatous injury of kidney and progressive exacerbation due to many reasons.It is a svstematic clinical syndrome caused by the disturbance in excreting metabolites,adjusting water-electrolyte and acid-base balance as well as production and inactivation of active substances of endocrine.Prof Zhang Qi has rich clinical experience in treating renal failure.A report follows.

  11. Urinary Peptide Levels in Patients with Chronic Renal Failure

    OpenAIRE

    Mungli Prakash; Nagaraj M Phani; Kavya R; Supriya M

    2010-01-01

    Introduction: Peptide levels in urine are found to be decreased in renal failure. In the current study urinary peptide levels were determined in chronic renal failure (CRF) patients. Method: 86 CRF patients and 80 healthy controls were selected for the study. Urinary proteins and peptide levels were determined by spectrophotometer based Lowry and Bradford methods. Urinary creatinine levels were determined by clinical chemistry analyzer. Results: There was significant decrease in urinary pepti...

  12. Different Ways of Oxygen Effect on the Prognosis of Patients with Respiratory Failure of Chronic Obstructive Pulmonary Disease%不同给氧方式对慢性阻塞性肺病合并呼吸衰竭患者预后的影响研究

    Institute of Scientific and Technical Information of China (English)

    聂蓉晖; 吕秀花; 王兆丽

    2015-01-01

    目的:观察无创正压通气在治疗急性加重期的慢性阻塞性肺疾病合并有 II 型呼吸衰竭的治疗效果。方法选择我院收治的60例 COPD 合并Ⅱ型呼吸衰竭病患者作为研究对象,随机分为对照组和观察组,每组各30例,两组病患均给予常规治疗,观察组在给予常规治疗的同时加用无创正压通气的治疗,运用急性生理学及慢性健康状况系统评分Ⅱ( APACHE Ⅱ评分)为标准,观察两组患者在治疗前后的心率、呼吸频率、血气分析和临床指标变化。结果观察组与对照组患者在治疗后 APACHEII 评分高于治疗前 APACHEII 评分,差异有统计学意义(P <0.05)。观察组与对照组患者在治疗后 CPIS 评分低于治疗前 CPIS 评分,差异有统计学意义(P <0.05)。经过治疗后,观察组患者的 APACHEII 评分高于对照组患者的 APACHEII 评分,差异有统计学意义(P <0.05)。经过治疗后,观察组患者的 CPIS 评分低对照组患者的 CPIS 评分,差异有统计学意义(P <0.05)。观察组的患者在住院日、病死率与对照组相比较显示出明显地减少和降低,观察组与对照组相比较差异有统计学意义( P <0.05)。结论运用无创正压通气治疗急性加重期的慢性阻塞性肺疾病合并有II 型呼吸衰竭可以提高治疗疗效,降低并发症发生率、死亡率。%Objective:to observe noninvasive positive pressure ventilation with type II respiratory failure with treatment effect in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods:In our hospital 60 cases of COPD with type II respiratory failure patients were treated as the research object,and were randomly divided into control group and observation group,with 30 cases in each group,two groups of patients were given conventional treatment,in the observation group,given conventional treatment plus non - invasive positive pressure

  13. Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust

    Directory of Open Access Journals (Sweden)

    Sun Mi Choi

    2016-05-01

    Full Text Available Diffuse alveolar hemorrhage (DAH is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

  14. ESPEN guidelines on chronic intestinal failure in adults

    DEFF Research Database (Denmark)

    Pironi, Loris; Arends, Jann; Bozzetti, Federico

    2016-01-01

    : The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS......: The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC...

  15. 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

    .2,35.0) hours and 4.0 (2.0,5.0) days,which were significantly shorter than in the control group,96.0 (26.0,240.0) hours and 6.0 (4.0,9.0) days respectively,P <0.05 or P <0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury (ALl) (17 vs.0,P=0.038),fewer patients with pneumonia (2 vs.7,P <0.001) and lower acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores (16.1±2.8 vs.21.8±3.2,P <0.001).Multivariate analysis showed that pneumonia (P=-0.027) and a high APACHE Ⅱ score >20 (P=-0.002) were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score >20 might be the independent risk factors of NPPV failure in this group of patients.

  16. Clinical Study on Treatment of Chronic Renal Failure with Shenshuailing

    Institute of Scientific and Technical Information of China (English)

    鞠建伟; 郭亚玲; 梁延平; 孙世宁; 杨建华; 杨素云

    2001-01-01

    The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY肾衰灵口服液, the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY肾衰灵灌肠液, the Enema for Renal Failure) were evaluated in treatment of chronic renal failure, with coateg aldehyde oxystarch as the controls. The changes in the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%.

  17. Recovery from respiratory failure after decompression laparotorny for severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Sylvia Siebig; Igors Iesalnieks; Tanja Bruennler; Christine Dierkes; Julia Langgartner; Juergen Schoelmedch; Christian E Wrede

    2008-01-01

    We present three cases of patients (at the age of 56 years,49 years and 74 years respectively) with severe acute pancreatitis (SAP),complicated by intra-abdominal compartment syndrome (ACS) and respiratory insufficiency with limitations of mechanical ventilation.The respiratory situation of the patients was significantly improved after decompression laparotomy (DL) and lung protective ventilation was re-achieved.ACS was discussed followed by a short review of the literature.Our cases show that DL may help patients with SAP to recover from severe respiratory failure.

  18. Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study

    Science.gov (United States)

    Flores-Franco, René Agustín; Olivas-Medina, Dahyr Alberto; Pacheco-Tena, Cesar Francisco; Duque-Rodríguez, Jorge

    2015-01-01

    Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure. PMID:26273486

  19. Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication.

    Science.gov (United States)

    Lawlor, Claire M; Riley, Charles A; Hildrew, Douglas M; Guarisco, J Lindhe

    2015-07-01

    Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented. To date, there have been no published cases of respiratory failure secondary to pneumomediastinum, pneumopericardium, and bilateral pneumothoraces with associated subcutaneous emphysema after superior-based pharyngeal flap. We present the first case in the literature. Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation.

  20. 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.

  1. 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.

  2. 慢性阻塞性肺疾病急性加重期并呼吸衰竭患者实施肠内营养的护理干预%Nursing intervention of enteral nutrition to the patients with chronic obstructive pulmonary disease on acute exacerbation complicating respiratory failure

    Institute of Scientific and Technical Information of China (English)

    余金活; 伍丽霞; 赵艳婷; 周萍

    2014-01-01

    目的:观察肠内营养支持在慢性阻塞性肺疾病急性加重期并呼吸衰竭患者中的效果。方法回顾分析2012年1月~2013年12月在本科住院7d以上的慢性阻塞性肺疾病急性加重期呼吸衰竭患者,均需留置人工气道和留置胃管,住院48h内给予肠内营养支持。检测患者治疗前1d和治疗后第7天血红蛋白及血清白蛋白含量及观察相关并发症情况。结果肠内营养支持中患者血红蛋白和血清白蛋白含量均较前降低;出现腹泻24例,胃液反流5例,腹胀12例,低血糖反应2例。结论肠内营养支持是医治危重症患者的一项重要内容,特别是早期治疗,越来越受到认可和重视,所以规范流程,个性化护理是保证肠内营养顺利完成,减少并发症的必要条件。%Objective To study the effects of enteral nutrition in patients with chronic obstructive pulmonary disease on acute exacerbation complicating respiratory failure. Methods Retrospectively study about the patients with chronic obstructive pulmonary disease on acute exacerbation and respiratory failure hospitalized in ICU for more than 7 days from January 2012 to December 2013. All the patients are needed to be indwelled artificial airway and gastric tube, supported with enteral nutrition within 48 hours in hospital. Hemoglobin and serum albumin content are checked and the related complications are observed in the first day before treatment and the seventh day after treatment. Results The hemoglobin and serum albumin in patients with enteral nutrition were lower. Diarrhea 24 cases, gastric reflux 5 cases, abdominal distension 12 cases and hypoglycemia reaction 2 cases occurred. Conclusion The enterable nutrition support is an important treatment of critically ill patients, especially in early treatment. It is receiving more and more recognition and attention. Hence, standardized processes and personalized nursing are the necessary conditions to ensure

  3. Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

    Science.gov (United States)

    Koul, Parvaiz A; Mir, Hyder; Akram, Shabir; Potdar, Varsha; Chadha, Mandeep S

    2017-01-01

    Objective: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD. Methods: Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA. Results: Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization. Conclusions: We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate

  4. Heart Failure Update: Chronic Disease Management Programs.

    Science.gov (United States)

    Fountain, Lorna B

    2016-03-01

    With high mortality and readmission rates among patients with heart failure (HF), multiple disease management models have been and continue to be tested, with mixed results. Early postdischarge care improves outcomes for patients. Telemonitoring also can assist in reducing mortality and HF-related hospitalizations. Office-based team care improves patient outcomes, with important components including rapid access to physicians, partnerships with clinical pharmacists, education, monitoring, and support. Pay-for-performance measures developed for HF, primarily use of angiotensin-converting enzyme inhibitors and beta blockers, also improve patient outcomes, but the influence of adherence to other measures has been minimal. Evaluating comorbid conditions, including diabetes and hypertension, and making drug adjustments for patients with HF to include blood pressure control and use of metformin, when possible, can reduce mortality and morbidity.

  5. Bone marrow dysfunction in chronic heart failure patients

    NARCIS (Netherlands)

    Westenbrink, B. Daan; Voors, Adriaan A.; de Boer, Rudolf A.; Schuringa, Jan J.; Klinkenberg, Theo; van der Harst, Pim; Vellenga, Edo; van Veldhuisen, Dirk J.; van Gilst, Wiek H.

    2010-01-01

    To investigate whether chronic heart failure (CHF) is associated with a general dysfunction of the haematopoietic compartment. Bone marrow was obtained during coronary artery bypass graft surgery from 20 patients with CHF (age 67 +/- 6 years, 75% NYHA class >= III, LVEF 32 +/- 6%), and 20 age- and g

  6. Review of Helicobacter pylori infection and chronic renal failure.

    Science.gov (United States)

    Sugimoto, Mitsushige; Yamaoka, Yoshio

    2011-02-01

    Chronic renal failure patients receiving hemodialysis and continuous ambulatory peritoneal dialysis often encounter gastrointestinal troubles over their long treatment period. Helicobacter pylori infection has close association with development of peptic ulcer, gastric cancer and gastric lymphoma, and is thought to be one of the major risk factors for gastrointestinal troubles in dialysis patients. However, it is unclear whether H. pylori infection is directly associated with progression of renal dysfunction and prognosis of chronic renal failure patients. Recent consensus shows that the prevalence of H. pylori infection in chronic renal failure patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in hemodialysis patients, the prevalence of infection decreases as dialysis periods progressed, in particular within the first four years after the start of treatment. However, the chance of natural eradication becomes rare for patients receiving dialysis treatment for a long time. Moreover, chronic renal failure patients with H. pylori infection have a higher incidence of gastroduodenal diseases, and therefore, are recommended to receive eradication therapies, especially for those receiving treatment for a long time and with higher risks of complication. Intensive endoscopic check-ups for the prevention of gastrointestinal events and the discovery of peptic ulcer and neoplastic diseases at an early phase may be required.

  7. TREATMENT OF CHRONIC HEART FAILURE: FOCUS ON METOPROLOL SUCCINATE

    Directory of Open Access Journals (Sweden)

    O. D. Ostroumova

    2015-12-01

    Full Text Available Advantages of metoprolol succinate in patients with chronic heart failure (CHF are covered. Results of MERIT-HF study are taken as the main evidences. Patterns of the metoprolol succinate use in the treatment of different categories of patients with CHF (women, the elderly , severe CHF forms, CHF with concomitant hypertension or diabetes are considered.

  8. High prevalence of microalbuminuria in chronic heart failure patients

    NARCIS (Netherlands)

    Van De Wal, RMA; Asselbergs, FW; Plokker, HWT; Smilde, TDJ; Lok, D; Van Veldhuisen, DJ; Van Gilst, WH; Voors, AA

    2005-01-01

    Background: Microalbuminuria is associated with increased risk for cardiovascular morbidity and mortality. However, the relation between microalbuminuria and chronic heart failure has not been well described yet. In this cross-sectional study, we aim to evaluate the prevalence of microalbuminuria an

  9. Nebivolol in chronic heart failure : current evidence and future perspectives

    NARCIS (Netherlands)

    Lipsic, Erik; van Veldhuisen, Dirk J.

    2010-01-01

    Areas covered in the review: We describe the role of the sympathetic nervous system, beta-blockers and specifically nebivolol in chronic heart failure. What the reader will gain: Nebivolol is a third-generation beta-blocker, with high beta(1)/beta(2) selectivity. Moreover, it has important vasodilat

  10. Hope in elderly adults with chronic heart failure. Concept analysis.

    Science.gov (United States)

    Caboral, Meriam F; Evangelista, Lorraine S; Whetsell, Martha V

    2012-01-01

    This topic review employed Walker and Avant's method of concept analysis to explore the construct of hope in elderly adults with chronic heart failure. The articles analyzed revealed that hope, as the belief of the occurrence of a positive result without any guarantee that it will be produced, is necessary for the survival and wellbeing of the elderly adults enduring this disease.

  11. ESPEN guidelines on chronic intestinal failure in adults

    NARCIS (Netherlands)

    Pironi, L; Arends, J.; Bozzetti, F.; Cuerda, C.; Gillanders, L.; Jeppesen, P.B.; Joly, F.; Kelly, D.; Lal, S.; Staun, M.; Szczepanek, K.; Gossum, A. van; Wanten, G.J.A.; Schneider, S.M.

    2016-01-01

    BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest org

  12. [Telemedicine for patients with chronic intestinal failure].

    Science.gov (United States)

    Nauta, Sjoukje; Feibig, Doreen; Wanten, Geert

    2014-01-01

    Telemedicine is a valuable extension of the ways in which patients with chronic diseases can be contacted. Patients can easily contact their caregivers within the safe environment of the digital waiting room. Telemedicine especially offers an advantage for those forms of care where the visual aspect is important. Care should be taken with respect to its implementation into the disease management process with careful synchronisation between all involved parties, e.g. patient, caregiver, and organisation. The effectiveness of telemedicine and the savings that can be achieved should be properly established in order to justify the funding of a telemedicine project. Rather than focusing on the possible drawbacks of telemedicine, e.g. safety concerns and the user-friendliness of the system, we should highlight the possibilities that information technology offers.

  13. Paraoxonase 1 in Chronic Kidney Failure

    Directory of Open Access Journals (Sweden)

    Alejandro Gugliucci

    2012-01-01

    Full Text Available In this review we summarize the findings from the literature and our own laboratory on the decreased PON1 activity in renal failure, the mechanisms proposed and the effect of interventions. In addition to profound alterations in lipoproteins, reduced serum PON1 activity has been clearly established in the past decade and could contribute to accelerated development of atherosclerosis in ESRD and in HD. PON1 lactonase activity is lower in ESRD patients. Hemodialysis partially restores PON1 lactonase and the other activities. PON1 activity recovery after dialysis suggests that uremic toxins may play a mechanistic role in PON1 inactivation. Lower PON1 activity in CRF patients is associated with low thiol concentration, high CRP, and is beneficially enhanced with vitamin C and flavonoids. Changes in HDL subclasses, namely lower HDL3 in these patients may also play a role in PON1 lower activity. Future research should focus on: (1 mechanistic studies on causes for low PON1 activity and mass; (2 prospective studies focusing on whether there is an added predictive value in measuring PON1 activity (and PON1 activity in HDL3 in this patient population; (3 intervention studies attempting to increase PON1 activity.

  14. Acute-on-chronic liver failure: terminology, mechanisms and management.

    Science.gov (United States)

    Sarin, Shiv K; Choudhury, Ashok

    2016-03-01

    Acute-on-chronic liver failure (ACLF) is a distinct clinical entity and differs from acute liver failure and decompensated cirrhosis in timing, presence of acute precipitant, course of disease and potential for unaided recovery. The definition involves outlining the acute and chronic insults to include a homogenous patient group with liver failure and an expected outcome in a specific timeframe. The pathophysiology of ACLF relates to persistent inflammation, immune dysregulation with initial wide-spread immune activation, a state of systematic inflammatory response syndrome and subsequent sepsis due to immune paresis. The disease severity and outcome can be predicted by both hepatic and extrahepatic organ failure(s). Clinical recovery is expected with the use of nucleoside analogues for hepatitis B, and steroids for severe alcoholic hepatitis and, possibly, severe autoimmune hepatitis. Artificial liver support systems help remove toxins and metabolites and serve as a bridge therapy before liver transplantation. Hepatic regeneration during ongoing liver failure, although challenging, is possible through the use of growth factors. Liver transplantation remains the definitive treatment with a good outcome. Pre-emptive antiviral agents for hepatitis B before chemotherapy to prevent viral reactivation and caution in using potentially hepatotoxic drugs can prevent the development of ACLF.

  15. 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.

  16. 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.

  17. The role of high flow oxygen therapy in acute respiratory failure.

    Science.gov (United States)

    Masclans, J R; Pérez-Terán, P; Roca, O

    2015-11-01

    Acute respiratory failure represents one of the most common causes of intensive care unit admission and oxygen therapy remains the first-line therapy in the management of these patients. In recent years, high-flow oxygen via nasal cannula has been described as a useful alternative to conventional oxygen therapy in patients with acute respiratory failure. High-flow oxygen via nasal cannula rapidly alleviates symptoms of acute respiratory failure and improves oxygenation by several mechanisms, including dead space washout, reduction in oxygen dilution and inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. However, the experience in adults is still limited and there are no clinical guidelines to establish recommendations for their use. This article aims to review the existing evidence on the use of high-flow oxygen via nasal cannula in adults with acute respiratory failure and its possible applications, advantages and limitations.

  18. 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

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

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    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.

  20. Ventilatory management of respiratory failure in patients with severe Guillain-Barré syndrome

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    Aggarwal A

    2003-04-01

    Full Text Available Guillain-Barré syndrome (GBS is the commonest peripheral neuropathy causing ventilatory failure, and 10-30% patients may require respiratory support. Records of 11 adult patients of GBS in respiratory failure, admitted to the Respiratory Intensive Care Unit (RICU of our institute for mechanical ventilation over a four-year period, were studied. Six patients received intravenous immunoglobulin. The median duration of mechanical ventilation was 38 days. Seven patients underwent tracheostomy. Four patients were ventilated for less than 2 weeks and 3 for more than 2 months each. Seven developed ventilator-associated pneumonia and/or sepsis. Three patients died in, and two shortly after discharge from RICU; all had systemic problems or complications of hospitalization.

  1. Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure

    Institute of Scientific and Technical Information of China (English)

    王辰; 商鸣宇; 黄克武; 童朝晖; 孔维民; 姜超美; 代华平; 张洪玉; 翁心植

    2003-01-01

    Objective To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.Methods Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.Results All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1±2.9) vs (23.0±14.0) days, respectively, P<0.01. The total duration of ventilatory support was (13±7) vs (23±14) days, respectively, P<0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P<0.01. The duration of intensive care unit (ICU) stay was (13±7) vs (26±14) days, respectively, P<0.05. Conclusions In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.

  2. SERUM YKL-40 LEVELS IN CHRONIC HEART FAILURE.

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    Maria Kazakova

    2014-06-01

    Full Text Available Inflammatory processes are involved in the pathogenesis and development of chronic heart disease. The promising novel inflammatory biomarker YKL-40 is related to the degree of inflammation and pathological tissue remodeling. The aim of this study was to determine serum YKL-40 levels in patients with chronic heart failure and to evaluate the potential relationship with ultrasonography findings. Forty-three individuals were enrolled in the study – 24 patients (10 females and 14 males with chronic heart failure, aged 70±11 (mean ± standard deviation and 16 healthy people as age-matched controls (above 50 years. The serum YKL-40 levels were assessed by ELISA. Sonographic measurements such as two-dimensional, Power wave, Continuous Wave, Colour mode and M-Mode were performed using a diagnostic ultrasound system (PHILIPS Ultrasound, Washington, US with a L11-3 probe of 3-11 MHz. The six minute walk test was used to assess functional capability of patients. Our study revealed significantly higher serum YKL-40 levels in patients compared to the control group (P=0.010. No relation was found between the glycoprotein and the results from the ultrasonographic and functional examination. We suppose that increased serum YKL-40 levels in patients with chronic heart failure might reflect the inflammatory route in the development of the disease.

  3. 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.

  4. 无创呼吸机治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的临床研究%Study on the efficacy of non-invasive ventilation in the treatment of chronic obstructive pulmonary disease combined with type Ⅱ respiratory failure

    Institute of Scientific and Technical Information of China (English)

    宋毅; 李婵; 徐莉琼; 刘培曦

    2011-01-01

    Objective To probe into the efficacy of non-invasive ventilation in the treatment of chronic obstructive pulmonary disease combined with II respiratory failure. Methods Selected October 2008 ~ September 2010 in our hospital during the COPD in 76 cases patients with type II 76 cases of respiratory failure, patients were randomly divided into observe group and the control group. The two groups were given a clear diagnosis bronchodilator, antibiotics, antiasthmatic and expectorant and antiapas-modic to correct water and electrolyte disorders and acid-base balance and other conventional treatment, patients in the observation group based on the use of this non-invasive ventilation in the treatment , And the clinical efficacy of the two groups were compared and related indicators. Results Compared the 2h and 4h after treatment with control group, the observe group patients in the pH, PaO2, PaCO2 and other arterial blood gases indices were significantly improved, there were significant differences (P<0. 05). At the same time, compared with control group, the observe patients of the heart rate and respiratory rate were significantly reduced, and tends to normal, there were also significant differences ( P<0.05 ). Compared with control group t the observe patients of the patho-genetic condition improved rate were significantly increased, and the hospital day were significantly reduced, there were also significant differences ( P<0. 05 ). Conclusion Non-invasive ventilation has a very important clinical therapeutic value for the patients with COPD combined with type II respiratory failure.%目的 探讨无创呼吸机治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的临床疗效.方法 选择我院2008年10月~2010年9月期间收治的慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者76例,随机将患者分为观察组和对照组.对照组患者经相关检查后均给予祛痰、抗感染、解痉平喘和支气管扩张以及纠正水电解质紊乱和酸

  5. [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.

  6. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure.

    Science.gov (United States)

    Jakovljevic, Djordje G; Seferovic, Petar M; Nunan, David; Donovan, Gay; Trenell, Michael I; Grocott-Mason, Richard; Brodie, David A

    2012-02-01

    Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

  7. Clinical observation of BiPAP ventilation in the treatment of chronic obstructive pulmonary disease with respiratory failure%双水平无创正压通气无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床观察

    Institute of Scientific and Technical Information of China (English)

    时衍同; 潘丽; 刘丰梅; 宋旭; 吴大玮

    2011-01-01

    Objective To compare the effect of bi - level positive airway pressure ventilation in chronic obstructive pulmonary disease (COPD) with respiratory failure and the therapeutic effect of conventional method. Methods Ninety patients selected were randomly divided into treatment and control groups,45 cases in each group.The conventional treatment (including anti -infection,expectorant,asthma,symptomatic correction of electrolyte disorders and acid - base imbalance and nutritional support treatment,and when necessary given corticosteroids,etc.) was the same,treatment group were given bi -level positive airway pressure treatment,3 days for a treatment period,patients were observed for 3 days of the signs and symptoms and pH,PCO2,PO2,HR index changes,and with the control group made between the values of blood gas analysis of the statistical analysis.Results Of clinical symptoms in patients treated with BiPAP,signs and blood gas analysis after treatment than before treatment had significantly improved.Compared with the control group,there were significant differences (P < 0.05).Conclusions The effect of BiPAP ventilatory support for treating COPD with respiratory failure is good.%目的 探讨应用双水平无创正压通气(BiPAP)在慢性阻塞性肺疾病(COPD)合并呼吸衰竭与常规呼吸内科治疗的疗效对比.方法 将90例入选患者随机分为治疗与对照两组,每组45例,在常规治疗(包括抗感染、祛痰、平喘、对症纠正电解质紊乱和酸碱平衡失调以及营养支持等治疗,并酌情给予糖皮质激素等)基础上,治疗组加用双水平无创正压通气治疗,3d为1个治疗阶段,观察患者3d后的症状体征及pH值、二氧化碳分压、氧分压、心率指标变化,并与对照组在血气分析各数值间做统计学分析.结果 BiPAP治疗组患者临床症状、体征和血气指标在治疗后较治疗前有明显改善,与对照组相比差异有统计学意义(P均<0.05).结论 BiPAP通气支持

  8. Cardiovascular complications of chronic renal failure - an updated review.

    Science.gov (United States)

    Roy, G C; Sutradhar, S R; Barua, U K; Datta, N C; Debnath, C R; Hoque, M M; Hossain, A S; Haider, M S; Das, M

    2012-07-01

    Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

  9. 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; J. López Martínez; 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...

  10. Chronic Respiratory Disease: Considerations within the Public Health System

    Directory of Open Access Journals (Sweden)

    Diana Durán Palomino

    2007-09-01

    Full Text Available Chronic Respiratory Disease (CRD is a publichealth problem in Colombia. Its severity increasesby the presence of risk factors like firesmoke, which tend to prevail in young populationand that leads consequences at physical,social and mental level in the long run. The CRDincludes a series of clinical entities with theirown characteristics, caused by the suffering, socialisolation, physiological deterioration andthe associated morbidity. All these contributeto the functional limitation, the lost quality oflife and, ultimately, can turn the individual thatsuffers it in a dependent being without future.All this takes to a greater consumption of healthresources without this means one better attention,since in many opportunities the isolated efforts, the lack of clear rules, sustained proposalsand the non use of clinical guidelines amongother causes, allow that the intervention wouldbe destined to only palliate the present symptoms,but is far from including an integral, effectivehandling and that responds to individualnecessities. This article analyze the public norms and policies that cover patients with CRD, theaspects related to the rights to an integral, safeand real treatment in the affected individualalong with the obstacles for its accomplishment.

  11. Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

    Institute of Scientific and Technical Information of China (English)

    Sameer singhal; Pankaj Banode; Nitish Baisakhiya

    2009-01-01

    Objective: To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.

  12. [Secondary cystic changes in the kidneys in chronic kidney failure].

    Science.gov (United States)

    Todorov, V; Lalev, I; Monov, A; Penkova, S

    1989-01-01

    In patients with chronic renal failure the presence and frequency of acquired cystic changes in the kidneys (acquired cystic renal disease) were studied. 46 patients, 21 to 62 years of age and duration of hemodialysis treatment from 2 up to 126 months, were examined. The patients with polycystic kidneys were excluded. Cysts were found in 67.4% of the patients. They were classified into five groups. Between the duration of the hemodialysis treatment (the chronic renal failure respectively) and the development of the cystic renal disease correlation was found. The correlation between the length of the kidneys and the cystic changes is statistically significant. There is no correlation with the sex, age, basic disease, hematologic indices, diuresis and arterial pressure of the patients. In 50% of the patients examined splenomegaly was found the cause of which is not known.

  13. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

    Full Text Available The auditory sensitivity of 63 patient of chronic renal failure on hemodialysis was assessed in order to know the effect of dialysis on hearing threshold. All selected patient were non diabetic with normal tympanic membrane and with no history of ototoxic drug and any hereditary hearing problems. Pure tone audiometry was done before and after dialys is and all cases were followed for 3 month. A high incidence of high frequency sensorineural hearing loss was obtained which could not be attributed to age , noise exposure and ottotoxicity. An association between high frequency sensorineural hearing loss a nd hemodialysis is thus suggested KEYWORDS: Hemodialysis ; Pure tone audiometry ; High frequency sensorineural hearing loss ; Duration of disease ; Chronic renal failure

  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. A pharmacokinetic study of roxatidine acetate in chronic renal failure.

    Science.gov (United States)

    Lameire, N; Rosenkranz, B; Maass, L; Brockmeier, D

    1988-01-01

    The pharmacokinetics of a single oral dose of roxatidine acetate 150 mg were studied in 31 patients with varying degrees of chronic renal failure. The patients were divided into 5 groups according to their creatinine clearance (Clcr): controls (Clcr 94.5 +/- 13.9 ml/min; n = 6); mild chronic renal failure (Clcr 47 +/- 6 ml/min; n = 4); moderate chronic renal failure (Clcr 27.3 +/- 3.1 ml/min; n = 4); severe chronic renal failure (Clcr 12.8 +/- 1.4 ml/min; n = 5) and uraemia (Clcr 6.6 +/- 0.6 ml/min; n = 12). Serum and urine samples were analysed with capillary gas chromatography to measure the salt of the desacetyl metabolite of roxatidine acetate (roxatidine). The terminal half-life was 6.02 +/- 0.31 hours in controls and 7.35 +/- 0.57, 9.3 +/- 0.83, 14.6 +/- 3.7 and 18.10 +/- 2.77 hours, respectively, in the 4 other groups, with progressively decreasing creatinine clearance. Maximum serum concentration and time to maximum serum concentration rose from 816 +/- 75 ng/ml and 2.08 +/- 0.22 hours, respectively, in controls to 1364.7 +/- 156 ng/ml and 4.05 +/- 0.47 hours, respectively, in uraemic patients. Relative total clearance progressively decreased with decreasing glomerular filtration rate (GFR) [from 353.6 +/- 26 ml/min in controls to 90.31 +/- 12.2 ml/min in patients with uraemia]. Renal clearance decreased from a control of 243.9 +/- 56 ml/min to 12.32 +/- 0.18 ml/min in uraemic patients. A linear correlation between creatinine clearance and both relative total clearance and renal drug clearance was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Neurological Complications in Child with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Faruk Incecik

    2003-08-01

    Full Text Available Congenital uremic encephalopathy, progressive dialysis encephalopathy, Wernicke encefalopathy, headache, seizures because of dialysis, disequilibrium syndrome, cerebral hemorrhage and uremic neuropathy are the neurologic complications seen in child with chronic renal failure. Here it is aimed to discuss these complications with literature, and to emphasize the importance of evaluation of patients with these aspects. [Archives Medical Review Journal 2003; 12(4.000: 406-412

  17. Nutritional Status in Children with Chronic Renal Failure on Hemodialysis

    OpenAIRE

    Zaki, Moushira Erfan; Hassan, Mona Mamdouh; Bazaraa, Hafez Mahmoud; Ahmed, Hany Fathy; Mahmoud Badr, Ahmed Mohamed

    2014-01-01

    Background and Aim: Growth retardation is still an important manifestation of children with chronic renal failure (CRF). The aim of this study is to evaluate the growth in relation to nutritional status in Egyptian children with CRF on hemodialysis.Subjects and Methods: The study included 30 Egyptian children above the age of six years on regular haemodialysis at the Haemodialysis Unit of the Centre of Pediatric Nephrology and Transplantation of Cairo University. Anthropometry, biochemical pa...

  18. Growth Hormone Therapy in Children with Chronic Renal Failure

    OpenAIRE

    Cayir, Atilla; Kosan, Celalettin

    2014-01-01

    Growth is impaired in a chronic renal failure. Anemia, acidosis, reduced intake of calories and protein, decreased synthesis of vitamin D and increased parathyroid hormone levels, hyperphosphatemia, renal osteodystrophy and changes in growth hormone-insulin-like growth factor and the gonadotropin-gonadal axis are implicated in this study. Growth is adversely affected by immunosuppressives and corticosteroids after kidney transplantation. Treating metabolic disorders using the recombinant huma...

  19. [Diagnosis and management of chronic renal failure in the elderly].

    Science.gov (United States)

    Segalen, Isabelle; Le Meur, Yannick

    2016-01-01

    The incidence of chronic renal failure in the elderly is rising due to the ageing of the general population. Its management, and notably nephroprotective therapies, must be adapted to the elderly person who is often frail and with multiple pathologies. The decision to start extra-renal purification does not depend on the patient's chronological age but on their physiological age and requires dialogue between the patient and their family, the geriatrician and the nephrologist.

  20. Limbal and corneal calcification in patients with chronic renal failure.

    Science.gov (United States)

    Klaassen-Broekema, N; van Bijsterveld, O P

    1993-09-01

    In patients with chronic renal failure on regular dialysis treatment, limboconjunctival degenerations and calcifications are commonly observed. In this study three groups of patients were followed over a period of 6 years. The first group consisted of 47 patients with renal failure, the second group of 17 patients with renal failure and hyperparathyroidism not controlled by drugs, and the third group seven patients with primary hyperparathyroidism without renal failure. The aim of this study was to determine the progression of the limboconjunctival changes over time. The hypothesis that an increase in serum calcium and phosphorus concentrations, as a result of tertiary hyperparathyroidism, could possibly add a corneal component to the limbal calcification was also tested. All patients with renal failure (in as much as the degenerative limbal features were not obscured by deposits of lime salts), had a type II white limbus girdle of Vogt. This limbal degeneration was observed in only 45% of controls. In all 47 patients with renal failure conjunctival calcification was observed; 26 of them also had limbal calcification. After 6 years 41 patients had developed limbal calcification. This progression was statistically significant. In 15 out of 17 patients with tertiary hyperparathyroidism a band-shaped keratopathy developed in addition to the limboconjunctival calcification.

  1. 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.

  2. Coping with chronic renal failure in Hong Kong.

    Science.gov (United States)

    Mok, Esther; Lai, Claudia; Zhang, Zhi-Xue

    2004-02-01

    The purpose of the study was to investigate the coping behaviours of Chinese patients with chronic renal failure. The study, based on Lazarus and Folkman (Stress, Appraisal and Coping, Springer, New York, 1984) model of coping, was conducted to identify the process by which 11 chronic renal failure patients cope with their disease. The identified themes are coping with fluctuating feelings and concerns, motivation to cope, interdependent relationships between patients and their family members and modes of coping strategies. The significance of the results indicates that coping is the consequence not only of situational demands but also of life goals. Meaning in life is an important motivator in the coping process. Besides problem-focused coping and emotion-focused coping, another important element is relationship-focused coping. The interdependent influences of families on patients and patients on families are also important factors. The role of family and cultural factors is discussed as it affects how patients with chronic renal failure cope with their illness.

  3. 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

    2016-10-01

    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.

  4. Study on effect of immune enteral nutrition in patients with chronic obstructive pulmonary disease with typeⅡrespiratory failure in patients with immune recovery%免疫肠内营养对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者免疫恢复情况的疗效研究

    Institute of Scientific and Technical Information of China (English)

    杨奉民

    2014-01-01

    Objective To study the clinical effect of immune enteral nutrition for patients with chronic obstructive pulmonary disease (COPD) combined with typeⅡrespiratory failure recovery. Method Selected 104 patients with COPD combined with typeⅡrespiratory failure in our hospital from February 2010 to June 2013. Devided into control group and observation group, each group of 52 cases via the method of random grouping. Two groups were treated with anti infection and clinical treatment. Observation group used immuned enteral nutrition while control group used routine enteral nutrition support. Compared the effect of two groups. Result The pulmonary function level (FEV1 and FVC) of two groups before treatment had no significant difference (Pal >0.05). The FEV1 and FVC of observation group after treatment respectively were (1.98±0.41) L and (2.83±0.66) L, which were signiifcantly higher than that of control group [(1.69±0.44) L, (2.42±0.74) L], the differences were statistical signiifcance (P<0.05). After nutritional support, both pH and PaO2 levels of two groups were increased, but observation group increased more, the differences were statistically signiifcant (Pal <0.05). The PaCO2 leves of both groups decreased and observation group decreased more, the difference was statistically signiifcant (P < 0.05). Conclusion Immune enteral nutrition can support reasonable needs for patients with COPD complicated with respiratory failure disease type Ⅱ , it helps patients adjust the lung function and blood gas levels, increased patient immunity, better, economic security, worthy of clinical used and recommended.%目的:研究免疫肠内营养对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者免疫恢复情况的疗效。方法选取本院2010年2月至2013年6月收治的104例COPD合并Ⅱ型呼吸衰竭患者作为研究对象。以数字法随机分为观察组和对照组,每组各52例。两组患者均给予相关抗感染及临床治疗。观

  5. No-invasive positive pressure pentilation for chronic obstructive pulmonary disease at acute exacerbation period complicating respiratory failure of type Ⅱ of sixty five patients%无创正压通气治疗慢性阻塞性肺疾病急性加重期伴Ⅱ型呼吸衰竭65例

    Institute of Scientific and Technical Information of China (English)

    杨华; 周志才; 奚峰; 周伟菊; 吴浩; 唐志君

    2011-01-01

    Objective To evaluate the clinical effect of no-invasive positive-pressure ventilation ( NIPPV) in treating chronic obstructive pulmonary diseases ( COPD) at acute exacerbation period complicating type Ⅱ respiratory failure. Meth ods One hundred and twenty-seven cases with COPD at acute exacerbation period complicating type Ⅱ respiratory failure were divided into observation group(n = 65) and control group( n = 62) . The control group were given drug treatment; Based on this, NIPPV were given in observation group. The breathing frequency and heart rate before and after treatment were ob served between two groups. The arterial blood gas analysis results were collected before and 3 hours , 1 ,3, 7 days after the treat ment and then were compared between two groups. Results There were no statistic significance of heart rate and breathing fre quency before treatment between two groups( P > 0.05 ) . Compared with before treatment , the heart rate and breathing frequen cy in the two groups were improved significantly at 3 hours , 1 , 3 ,7 days after treatment( P < 0.05) . There were statistical sig nificance of heart rate and breathing frequency at 3 ,7 daya after treatment between two groups ( P < 0.05 ) . Before treatment the difference of pH , PaO2 amd PaCO2 had no statistical difference between two groups ( P > 0.05 ) . At 3 hours , 1 , 3 , 7 days after treatment , the pH , PaO2 and PaCO2 were significant improved,and the difference made statistical difference ( P < 0.05 ) . At 1 day and 3 days after treatment the pH was statistically significant difference between two groups ( P < 0.05) . At 3 hours,1 ,3 , 7 days after treatment the PaO2 and PaCO2 was statistic significance between two groups ( P <0.05) . Conclusion NIPPV has great effects to treat COPD at acute exacerbation complicating type Ⅱ respiratory failure.%目的 探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重期合并Ⅱ型呼

  6. 慢性阻塞性肺疾病合并呼吸衰竭患者机械通气撤机时机的分析%Chronic Obstructive Pulmonary Dsease Patients with Respiratory Failure with Mechanical Ventilation Weaning Timing

    Institute of Scientific and Technical Information of China (English)

    张祥标; 叶晓东; 王丽萍

    2016-01-01

    Objective To explore under the guidance of the respiratory system function score mechanical ventilation in COPD with respiratory failure in patients weaning feasibility. Methods June 2013 to February 2015, hospital receiving mechanical ventila-tion in the treatment of COPD and respiratory failure in 90 patients were randomly divided into 3 groups using traditional of weaning ( n=45), respiratory function score of 3 to 4 minutes (n = 30 )and 5 to 6 minutes (n = 15 ). Extubation respiratory function score u-sing respiratory function score guidance weaning. Dynamic observed and compared three groups of patients with mechanical ventilation and oxygenation before ventilation, respiratory function score, while receiving mechanical ventilation longer directly weaning success rate, total weaning success rate, the rate of re-intubation, ventilator-associated pneumonia (VAP) The incidence of pulmonary baro-trauma incidence. Results Compared to 3 to 4 minutes ,direct weaning success rate, the total withdrawal rate of no significant differ-ence (P>0. 05) machine success;traditional mechanical ventilation weaning unit significantly reduced (P﹤0. 05), VAP incidence was lower (P0. 05). Conclusion COPD with respiratory failure patients using mechanical ventilation weaning respiratory function score guidance weaning measures have the safety, feasibility;without affecting the success rate of weaning premise when respiratory system score 3-4 timeshare weaning can reduce the incidence of mechanical ventilation and lung complications.%目的:探讨在呼吸系统功能评分指导下,机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者撤机的可行性。方法2013年6月至2015年2月接受机械通气治疗的慢性阻塞性肺疾病呼吸衰竭患者90例,随机分成传统撤机组( n=45人),3~4分撤机组( n=30人),5~6分撤机组( n=15人),撤机组采用呼吸系统功能评分指导撤机。动态观察并比较三组患者撤机成功率、重新插管

  7. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Karla Kristine Dames da Silva

    2015-07-01

    Full Text Available OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm as well as values for the inspiration (Zi and expiration cycles (Ze at the beginning of inspiration (Zbi and expiration (Zbe, respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi and the respiratory cycle dependence (ΔZrs=Ze-Zi were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65, p90%. CONCLUSIONS: We conclude the following: (1 chronic obstructive pulmonary disease introduces higher respiratory cycle dependence, (2 this increase is proportional to airway obstruction, and (3 the within-breath forced oscillation technique may provide novel parameters that facilitate the diagnosis of respiratory abnormalities in chronic obstructive pulmonary disease.

  8. Resetting the transcription factor network reverses terminal chronic hepatic failure.

    Science.gov (United States)

    Nishikawa, Taichiro; Bell, Aaron; Brooks, Jenna M; Setoyama, Kentaro; Melis, Marta; Han, Bing; Fukumitsu, Ken; Handa, Kan; Tian, Jianmin; Kaestner, Klaus H; Vodovotz, Yoram; Locker, Joseph; Soto-Gutierrez, Alejandro; Fox, Ira J

    2015-04-01

    The cause of organ failure is enigmatic for many degenerative diseases, including end-stage liver disease. Here, using a CCl4-induced rat model of irreversible and fatal hepatic failure, which also exhibits terminal changes in the extracellular matrix, we demonstrated that chronic injury stably reprograms the critical balance of transcription factors and that diseased and dedifferentiated cells can be returned to normal function by re-expression of critical transcription factors, a process similar to the type of reprogramming that induces somatic cells to become pluripotent or to change their cell lineage. Forced re-expression of the transcription factor HNF4α induced expression of the other hepatocyte-expressed transcription factors; restored functionality in terminally diseased hepatocytes isolated from CCl4-treated rats; and rapidly reversed fatal liver failure in CCl4-treated animals by restoring diseased hepatocytes rather than replacing them with new hepatocytes or stem cells. Together, the results of our study indicate that disruption of the transcription factor network and cellular dedifferentiation likely mediate terminal liver failure and suggest reinstatement of this network has therapeutic potential for correcting organ failure without cell replacement.

  9. ST2 and patient prognosis in chronic heart failure.

    Science.gov (United States)

    Bayes-Genis, Antoni; Zhang, Yuhui; Ky, Bonnie

    2015-04-02

    Biomarkers of cardiovascular diseases are indispensable tools for diagnosis and prognosis, and the use of several biomarkers is now considered the standard of care. New markers continue to be developed, but few prove to be substantially better than established markers. Suppression of tumorigenicity 2 (ST2) is a marker of cardiomyocyte stress and fibrosis that provides incremental value to natriuretic peptides for risk stratification of patients with a wide spectrum of cardiovascular diseases. On the basis of all available data, the 2013 American College of Cardiology and American Heart Association guidelines now recommend measurement of ST2 for additive risk stratification in patients with acute or chronic ambulatory heart failure (HF). This report provides an up-to-date overview of the clinical studies that led to the endorsement of ST2 as a cardiovascular prognostic marker in chronic HF. The presented data suggest that the addition of ST2 to a model that includes established mortality risk factors, including natriuretic peptides, substantially improves the risk stratification for death and HF hospitalization in patients with HF. ST2's prognostic value remains strong even in the subset of patients with renal insufficiency and is superior to other remodeling-fibrosis biomarkers currently being evaluated. In conclusion, these results have been repeatedly validated; thus, ST2 could be rapidly incorporated into clinical practice for risk prediction. Indeed, the body of evidence supporting the use of ST2 in chronic HF stratification continues to grow, with consistent data from cohorts around the world in single-center (Barcelona, Brussels, and San Diego cohorts) and multicenter (Penn Heart Failure Study [PHFS] and Muerte Subita en Insuficiencia Cardiac [MUSIC]) studies and in post hoc studies from clinical trials (Prospective Randomized Amlodipine Survival Evaluation 2 [PRAISE-2], Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF

  10. 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.

  11. Occupational mercury vapour poisoning with a respiratory failure, pneumomediastinum and severe quadriparesis

    Science.gov (United States)

    Smiechowicz, Jakub; Skoczynska, Anna; Nieckula-Szwarc, Agata; Kulpa, Katarzyna; Kübler, Andrzej

    2017-01-01

    Objectives: Despite restrictions, mercury continues to pose a health concern. Mercury has the ability to deposit in most parts of the body and can cause a wide range of unspecific symptoms leading to diagnostic mistakes. Methods and results: We report the case of severe mercury vapour poisoning after occupational exposure in a chloralkali plant worker that resulted in life-threatening respiratory failure, pneumomediastinum and quadriparesis. Conclusions: Prolonged mechanical ventilation and treatment with penicillamine and spironolactone was used with successful outcome. PMID:28321305

  12. Urgent awake thoracoscopic treatment of retained haemothorax associated with respiratory failure

    OpenAIRE

    Pompeo, Eugenio; Cristino, Benedetto; Rogliani, Paola; Dauri, Mario

    2015-01-01

    A number of video-assisted thoracoscopic surgery (VATS) procedures are being increasingly performed by awake anesthesia in an attempt of minimizing the surgical- and anesthesia-related traumas. However, so far the usefulness of awake VATS for urgent management of retained haemothorax has been scarcely investigated. Herein we present two patients with retained haemothorax following previous thoracentesis and blunt chest trauma, respectively, who developed acute respiratory failure and underwen...

  13. A Case of Biotinidase Deficiency in an Adult with Respiratory Failure in the Intensive Care Unit

    Science.gov (United States)

    Demirtürk, Zerrin; Şentürk, Evren; Köse, Abbas; Özcan, Perihan Ergin; Telci, Lütfi

    2016-01-01

    Background: Biotinidase deficiency (BD) is a rare, inherited autosomal recessive disorder that is treatable within childhood. We present a patient with pneumonia and respiratory acidosis who was not diagnosed with any systemic disorders; the patient was finally diagnosed as BD. Case Report: A thirty-year-old woman was admitted to the emergency department with respiratory failure that had persisted for a few days and progressively weakening over the previous six months. Then, the patient was admitted to the intensive care unit with marked respiratory acidosis, respiratory failure and alterations in consciousness. At the follow-up, the patient was not diagnosed with a systematic disorder. Rather, the patient’s historical clinical findings suggested a metabolic disorder. Finally, the patient was diagnosed with biotinidase deficiency. Conclusion: Even though biotinidase deficiency is not frequently seen in the intensive care unit, metabolic syndromes such as biotinidase deficiency should be considered. Patients should be evaluated holistically with attention to medical history, family history and clinical findings. PMID:27761288

  14. Respiratory failure induced by acute organophosphate poisoning in rats: effects of vagotomy.

    Science.gov (United States)

    Gaspari, Romolo J; Paydarfar, David

    2009-03-01

    Acute organophosphate (OP) poisoning causes respiratory failure through two mechanisms: central apnea and pulmonary dysfunction. The vagus nerve is involved in both the central control of respiratory rhythm as well as the control of pulmonary vasculature, airways and secretions. We used a rat model of acute OP poisoning with and without a surgical vagotomy to explore the role of the vagus in OP-induced respiratory failure. Dichlorvos (2,2-dichlorovinyl dimethyl phosphate) injection (100mg/kg subcutaneously, 3 x LD50) resulted in progressive hypoventilation and apnea in all animals, irrespective of whether or not the vagi were intact. However, vagotomized animals exhibited a more rapidly progressive decline in ventilation and oxygenation. Artificial mechanical ventilation initiated at onset of apnea resulted in improvement in oxygenation and arterial pressure in poisoned animals with no difference between vagus intact or vagotomized animals. Our observations suggest that vagal mechanisms have a beneficial effect during the poisoning process. We speculate that vagally mediated feedback signals from the lung to the brainstem serve as a modest protective mechanism against central respiratory depressive effects of the poison and that bulbar-generated efferent vagal signals do not cause sufficient pulmonary dysfunction to impair pulmonary gas exchange.

  15. Efficacy analysis of long-term home non-invasive assisted ventilation in stable chronic obstructive pulmonary disease combined with typeⅡ respiratory failure%长期家庭无创辅助通气对稳定期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效分析

    Institute of Scientific and Technical Information of China (English)

    赵静; 古力·卡德尔; 王丽霞; 阿迪拉; 雍楠

    2013-01-01

    (COPD) combined with type Ⅱ respiratory failure.Methods Seventy-eight patients with stable COPD combined with type Ⅱ respiratory failure were divided into treatment group (26 cases) and control group (52 cases).Patients in control group were given conventional treatment,including inhaled salmeterol/fluticasone plus long-term home oxygen therapy (LTOT).Patients in treatment group on the basis of conventional treatment were given non-invasive assisted ventilation therapy for 6-8 hours a day,and the course was 12 months.Blood gas analysis index [pH,arterial blood carbon dioxide partial pressure (PaCO2),arterial blood oxygen partial pressure (PaO2)],pulmonary function index [forced expiratory volume in 1 second (FEV1),FEV1 percentage of expected value (FEV1%)],6 min walk test (6-MWT) distance,St George's respiratory questionnaire (SGRQ) and acute episodes.Results After 12 months'follow-up,there was no endotracheal intubation and dead patients in treatment group.Five patients had acute trachea intubation and invasive mechanical ventilation,and 1 case died in the control group.The index of pulmonary function (FEV1,FEV1%) in two groups after treatment was improved compared with that before treatment (P< 0.05).But FEV1 and FEV1% over the same period in treatment group after treatment was higher than that in control group (P < 0.05).The blood gas analysis indicators (pH,PaCO2,PaO2) in treatment group after treatment were improved compared with that before treatment (P <0.05).PaO2 in control group after treatment was improved,compared with that before treatment (P< 0.05),but there was no significant difference in control group in pH and PaCO2 levels before and after treatment (P >0.05).After treatment 6-MWT distance,and SGRQ scores were improved,compared with that before treatment (P < 0.05),6-MWT from the same period in treatment group after treatment was higher than that in control group,and SGRQ scores was lower than that in control group during this

  16. Spinal Fusion for Scoliosis in Rett Syndrome With an Emphasis on Respiratory Failure and Opioid Usage.

    Science.gov (United States)

    Rumbak, Dania M; Mowrey, Wenzhu; W Schwartz, Skai; Sarwahi, Vishal; Djukic, Aleksandra; Killinger, James S; Katyal, Chhavi

    2016-02-01

    Our objective was to characterize our experience with 8 patients with Rett syndrome undergoing scoliosis surgery in regard to rates of respiratory failure and rates of ventilator-acquired pneumonia in comparison to patients with neurologic scoliosis and adolescent idiopathic scoliosis. This study was a retrospective chart review of patients undergoing scoliosis surgery at a tertiary children's hospital. Patients were divided into 3 groups: (1) adolescent idiopathic scoliosis, (2) neurologic scoliosis, and (3) Rett syndrome. There were 133 patients with adolescent idiopathic scoliosis, 48 patients with neurologic scoliosis, and 8 patients with Rett syndrome. We found that patients with Rett syndrome undergoing scoliosis surgery have higher rates of respiratory failure and longer ventilation times in the postoperative period when compared with both adolescent idiopathic scoliosis and neurologic scoliosis patients. There is insufficient evidence to suggest a difference in the incidence of ventilator-acquired pneumonia between the Rett syndrome and the neurologic scoliosis group. We believe our findings are the first in the literature to show a statistically significant difference between these 3 groups in regard to incidence of respiratory failure.

  17. The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

    Directory of Open Access Journals (Sweden)

    Anke P. C. Top

    2012-01-01

    Full Text Available Purpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcirculation in neonates with severe respiratory failure. Methods. This single-center prospective observational pilot study took place in an intensive care unit of a level III university children’s hospital. Twenty-one-term neonates, who received VA-ECMO treatment, were included. The microcirculation was assessed in the buccal mucosa, using Orthogonal Polarization Spectral imaging, within 24 hours before (T1 and within the first 24 hours after initiation of ECMO treatment (T2. Data were compared to data of a ventilated control group (=7. Results. At baseline (T1, median functional capillary density (FCD, microvascular flow index (MFI, and heterogeneity index (HI did not differ between the ECMO group and the control group. At T2 the median FCD was lower in the control group (median [range]: 2.4 [1.4–4.2] versus 4.3 [2.8–7.4] cm/cm2; P value <0.001. For MFI and HI there were no differences at T2 between the two groups. Conclusion. The perfusion of the microcirculation does not change after initiation of VA-ECMO treatment in neonates with severe respiratory failure.

  18. Facial Involuntary Movements and Respiratory Failure in CANOMAD, Responsive to IVIG Therapy

    Directory of Open Access Journals (Sweden)

    Kate Johnson

    2015-01-01

    Full Text Available CANOMAD is a rare chronic neuropathy, characterized by chronic sensory ataxia and intermittent brain stem symptoms due to antidisialosyl antibodies. The disorder results in significant morbidity but is poorly understood and often misdiagnosed. We describe a unique case of CANOMAD, associated with involuntary movements of the face; patient reported exacerbations with citrus and chocolate and respiratory muscle weakness. Our patient was initially misdiagnosed with Miller Fisher Syndrome, highlighting the need for vigilance should neurological symptoms recur in patients initially diagnosed with a Guillain Barre variant. Moreover, the optimal treatment is unknown. This patient responded remarkably to intravenous immunoglobulin and has been maintained on this treatment, without further exacerbations.

  19. Re-Evaluation of Acid-Base Prediction Rules in Patients with Chronic Respiratory Acidosis

    Directory of Open Access Journals (Sweden)

    Tereza Martinu

    2003-01-01

    Full Text Available RATIONALE: The prediction rules for the evaluation of the acid-base status in patients with chronic respiratory acidosis, derived primarily from an experimental canine model, suggest that complete compensation should not occur. This appears to contradict frequent observations of normal or near-normal pH levels in patients with chronic hypercapnia.

  20. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization

    DEFF Research Database (Denmark)

    Kristensen, Kim; Hjuler, Thomas; Ravn, Henrik

    2012-01-01

    Little is known about how chronic conditions other than prematurity, heart disease, and Down syndrome affect the risk and severity of hospitalization for respiratory syncytial virus (RSV). We assess the risk and severity of RSV hospitalization in children with chronic conditions in this register...

  1. Cleistanthus collinus induces type I distal renal tubular acidosis and type II respiratory failure in rats

    Directory of Open Access Journals (Sweden)

    Maneksh Delinda

    2010-01-01

    Full Text Available Background and Purpose : A water decoction of the poisonous shrub Cleistanthus collinus is used for suicidal purposes. The mortality rate is 28%. The clinical profile includes distal renal tubular acidosis (DRTA and respiratory failure. The mechanism of toxicity is unclear. Objectives : To demonstrate features of C. collinus toxicity in a rat model and to identify its mechanism(s of action. Materials and Methods : Rats were anesthetized and the carotid artery was cannulated. Electrocardiogram and respiratory movements were recorded. Either aqueous extract of C. collinus or control solution was administered intraperitoneally. Serial measurements of blood gases, electrolytes and urinary pH were made. Isolated brush border and basolateral membranes from rat kidney were incubated with C. collinus extract and reduction in ATPase activity was assessed. Venous blood samples from human volunteers and rats were incubated with an acetone extract of C. collinus and plasma potassium was estimated as an assay for sodium-potassium pump activity. Results : The mortality was 100% in tests and 17% in controls. Terminal event in test animals was respiratory arrest. Controls had metabolic acidosis, respiratory compensation , acidic urine and hyperkalemia. Test animals showed respiratory acidosis, alkaline urine and low blood potassium as compared to controls. C. collinus extract inhibited ATPase activity in rat kidney. Plasma K + did not increase in human blood incubated with C. collinus extract. Conclusions and Implications : Active principles of C. collinus inhibit proton pumps in the renal brush border, resulting in type I DRTA in rats. There is no inhibition of sodium-potassium pump activity. Test animals develop respiratory acidosis, and the immediate cause of death is respiratory arrest.

  2. 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.

  3. 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.

  4. Acute kidney injury in acute on chronic liver failure.

    Science.gov (United States)

    Maiwall, Rakhi; Sarin, S K; Moreau, Richard

    2016-03-01

    Acute on chronic liver failure (ACLF) is a distinct clinical entity; however, there is still debate in the way it is defined in the East as compared to the West, especially with respect to incorporation of kidney dysfunction or failure in the definition of ACLF. Kidney dysfunction is defined as serum creatinine between 1.5 and 1.9 mg/dl and kidney failure as serum creatinine of more than 2 mg/dl or requirement of renal replacement therapy according to the EASL-CLIF Consortium. Kidney dysfunction or failure is universally present in patients with ACLF according to the definition by the EASL-CLIF Consortium while on the contrary the APASL definition of ACLF does not incorporate kidney dysfunction or failure in its definition. Recently, both the diagnosis and management of renal failure in patients with cirrhosis has changed with the advent of the acute kidney injury (AKI) criteria defined as an abrupt decline in renal functions, characterized by an absolute increase in serum creatinine of 0.3 mg/dl within 48 h or an increase of more than 50 % from baseline, which is known or presumed to have occurred in the previous 7 days. Further, recent studies in patients with cirrhosis have shown the utility of biomarkers for the diagnosis of AKI. The present review covers the pathogenetic mechanisms, diagnosis, prognosis as well as management of AKI in patients with ACLF from both a Western as well as an Eastern perspective. The review identifies an unmet need to diagnose AKI and prevent this ominous complication in patients with ACLF.

  5. Abnormalities of skeletal muscle in patients with chronic heart failure.

    Science.gov (United States)

    Lipkin, D P; Jones, D A; Round, J M; Poole-Wilson, P A

    1988-02-01

    We have examined muscle strength, mitochondrial enzyme activity, histochemistry and fibre size in the quadriceps muscle of 9 patients with severe chronic heart failure. A needle biopsy of the quadriceps muscle was taken with patients at rest. Maximum oxygen uptake was measured during treadmill exercise. Mean maximal oxygen consumption was 11.7 ml.kg-1.min-1. Isometric maximum voluntary contraction was reduced to 55% of the predicted value for weight. Eight biopsies were abnormal. Findings included increased acid phosphatase, increased interstitial cellularity, excess intracellular lipid accumulation, atrophy of both type I and II fibres and variation in size with hypertrophy and atrophy of fibers. Muscle fibre capillary density and the activity of mitochondrial enzymes were normal. Changes in skeletal muscle strength may play a role in the limitation of exercise capacity seen in patients with congestive heart failure.

  6. 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.

  7. Quality of life in patients with chronic congestive heart failure

    Directory of Open Access Journals (Sweden)

    Anca D. Farcaş

    2011-12-01

    Full Text Available Objective: Quality of life (QOL is severely decreased in patients with chronic heart failure (CHF. Our study aims to identify the factors affecting the evaluation of QOL. Material and Methods: Clinical, demographic, social and economic data was collected from patients with CHF in NYHA class III and IV as part of a complex workup. The Minnesota Living with Heart Failure Questionnaire (MLHFQ was used to evaluate QOL. Results: QOL decreases as the NYHA class increases. Women evaluate their QOL as more severely affected than men. Age, social and economic factors modulate the perception of QOL. Conclusion: Combining demographic, social and economic data and evaluation of QOL can provide valuable and useful information for the medical management of patients with CHF.

  8. Urinary Peptide Levels in Patients with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Mungli Prakash

    2010-10-01

    Full Text Available Introduction: Peptide levels in urine are found to be decreased in renal failure. In the current study urinary peptide levels were determined in chronic renal failure (CRF patients. Method: 86 CRF patients and 80 healthy controls were selected for the study. Urinary proteins and peptide levels were determined by spectrophotometer based Lowry and Bradford methods. Urinary creatinine levels were determined by clinical chemistry analyzer. Results: There was significant decrease in urinary peptide levels in CRF patients and Urinary % peptides were significantly decreased in CRF patients as compared to healthy controls. Urinary % peptides correlated negatively with proteinuria. Conclusion: we have found decrease in urinary peptides and % urinary peptides in CRF patients and possibly measurement of % urinary peptides may possibly serve as better indicator in early detection of impairment in renal function.

  9. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing

    DEFF Research Database (Denmark)

    Bousquet, J; Farrell, J; Crooks, G;

    2016-01-01

    Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS ...

  10. [IPPB therapy at home in chronic respiratory insufficiency in France. II. Indications. Technics and surveillance (author's transl)].

    Science.gov (United States)

    Kauffmann, F; Drouet, D; Brille, D; Hatzfeld, C; Liot, F; Kompalitch, M

    1979-01-01

    A survey has been conducted among French chest physicians and physicians involved in intensive care. 296 physicians have prescribed IPPB at home to 3 778 patients with chronic respiratory insufficiency between 1960 and 1977. Acute respiratory failure was the first criteria considered in the indications (57% of the patients); hypercapnia, hypoxemia and right heart failure episode frequency were the other criteria of severity the most often taken into account. Since 1960, the indications among those with airflow obstruction have decreased, whereas they have increased for those with restrictive insufficiencies, expressing the questions raised about the efficacy of IPPB in these two types. 18% of the patients have had IPPB through tracheostomy canula. 70% of the patients have used a pressure cycling respirator and 30% a volume or flow cycling respiratory. This second type was quite always used in the case of IPPB through canula. Oxygen was added for half of the patients. The physicians have regularly followed the patients. Great importance was accorded to home care surveillance.

  11. 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-

  12. 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

  13. Exercise training and the progression of chronic renal failure

    DEFF Research Database (Denmark)

    Eidemak, I; Haaber, A B; Feldt-Rasmussen, B

    1997-01-01

    The possible beneficial effect of regular exercise training on the progression of chronic renal failure was studied in a prospective randomized controlled study. Thirty patients with a median glomerular filtration rate (GFR) of 25 ml/(min.1.73 m2) (range 10-43) were randomized to physical training...... the rate of progression judged by the slope of GFR versus time plot was equal in the two groups. Hence, the beneficial effect of exercise training, earlier observed in rat studies, could not be reproduced in our patients. Physical exercise had no untoward effect on progression of renal disease....

  14. Acquired perforating dermatosis in a patient with chronic renal failure*

    Science.gov (United States)

    Fernandes, Karen de Almeida Pinto; Lima, Lourenço de Azevedo; Guedes, Juliana Chaves Ruiz; Lima, Ricardo Barbosa; D'Acri, Antônio Macedo; Martins, Carlos José

    2016-01-01

    Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

  15. Incidence of cancer in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Banke, Ann; Schou, Morten; Videbaek, Lars;

    2016-01-01

    AIMS: With improvement in survival of chronic heart failure (HF), the clinical importance of co-morbidity is increasing. The aim of this study was to assess the incidence and risk of cancer and all-cause mortality in a large Danish HF cohort. METHODS AND RESULTS: A total of 9307 outpatients......-specific risk of cancer was analysed in an adjusted Poisson and Cox regression analysis. The 975 diagnoses of cancer in the HF cohort and 330 843 in the background population corresponded to incidence rates per 10 000 patient-years of 188.9 [95% confidence interval (CI) 177.2-200.6] and 63.0 (95% CI 63...

  16. 莫西沙星溶液雾化吸入对慢性阻塞性肺疾病合并呼吸衰竭患者炎症介质及血气分析指标的影响%Effects of moxifloxacin solution for inhalation on inflammatory mediators and blood gas analysis in patients with chronic obstructive pulmonary disease with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    李锋; 张翼; 尤慧敏

    2015-01-01

    目的 探讨莫西沙星溶液雾化吸入对慢阻肺合并呼吸衰竭患者炎症介质及血气分析的影响.方法 收集嘉善县第一人民医院呼吸科收治的慢阻肺合并呼衰的患者60例,随机分为对照组和实验组,每组各30例,在常规治疗基础上,对照组患者给予吸入用硫酸沙汀胺醇溶液(2 mg/次,每天3次雾化吸入治疗,实验组给予莫西沙星溶液2 mg/次,每天4次雾化吸入治疗,2组患者均治疗2周,对所有患者的血清CRP、TNF-α、IL-10、IL-18水平及动脉血PO2、PCO2 水平进行检测.结果 与对照组治疗后比较,实验组患者血清CRP、TNF-α、IL-18水平较低(P<0.05),血清IL-10水平较高(P<0.05);实验组患者的动脉血PO2 水平较高,PCO2 水平较低(P<0.05).结论 莫西沙星溶液雾化吸入能够显著降低慢阻肺合并呼衰患者血清CRP、TNF-α以及IL-18水平,提高血清IL-10水平,改善PO2 和PCO2.%Objective To analyse effects of moxifloxacin solution for aerosol inhalation on inflammatory mediators and blood gas analysis index in patients with chronic obstructive pulmonary disease with respiratory failure.Methods 60 patients who were diagnosed with chronic obstructive pulmonary disease with respiratory failure in our hospital were collected.All patients were randomly divided into experimental group and control group,30 cases in each group.On the basis of conventional treatment, control group were given sulfate for inhalation shating amine alcohol solution 2mg per times, 3 times per day atomization inhalation treatment,and experimental group was given 2 mg/times, 4 times per day atomization inhalation treatment,two were treated for 2 weeks.After the treatment, the serum levels of CRP,TNF-α,IL-10,IL-18 and arterial blood PO2 ,PCO2 levels were detected in all patients.Results Compared with control group post-treatment, the serum levels of CRP, IL-18 and TNF-αwere lower in experimental group (P<0.05), and the serum level of IL-10 was higher

  17. [Effect of peripheral vasodilators on pulmonary respiratory function and the indices of bicycle spiroergometry in heart failure patients].

    Science.gov (United States)

    Ordian, M M; Sobol', Iu S; Kassirskiĭ, S G

    1987-01-01

    The effect of corinfar and isosorbide on respiratory function of the lungs and indices of spirobicycle ergometry was studied in 40 patients with heart failure resulting from various heart diseases. The results have shown that despite difference in the mechanism of action, the use of these drugs at the given doses combined with digoxin is accompanied by a distinct and comparable positive influence on external respiratory function and indices of spirobicycle ergometry in patients with heart failure.

  18. Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure

    Institute of Scientific and Technical Information of China (English)

    NING Fang-gang; ZHAO Xiao-zhuo; BIAN Jing; ZHANG Guo-an

    2011-01-01

    Background Infection due to pandrug-resistant Pseudomonas aeruginosa (PDRPA) has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns (60%-80%) with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.Methods We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.Results Four patients recovered from bums and one died after therapy.Conclusions First, compromised immunity caused by delayed healing of burn wounds in patients with large-area bums and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems,ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.

  19. Long-term home non-invasive ventilation therapy in elderly patients with chronic hypercapnic respiratory failure%长期家庭无创机械通气治疗老年人慢性高碳酸血症型呼吸衰竭的疗效分析

    Institute of Scientific and Technical Information of China (English)

    方保民; 孙铁英; 王辰; 杨鹤; 靳毅明; 谭政; 居阳; 于鹏; 孙宁; 严蕊; 柯会星

    2013-01-01

    P<0.01). 结论 长期家庭NIV是治疗老年人慢性高碳酸血症型呼吸衰竭安全有效的方法,且能降低病死率及病期费用.%Objective To evaluate the effects,safety and economic cost of long-term home noninvasive ventilation (NIV) therapy in elderly patients with chronic hypercapnic respiratory failure.Methods A total of 128 elderly patients with chronic hypercapnic respiratory failure were randomly assigned to two groups:the NIV group (n=66) with conventional therapy in addition to long-term home NIV therapy,and the control group (n=62) with conventional therapy alone.Compared were parameters before and after two year follow up,which included dyspnea grade,scale for accessory muscle use,scoring for emotional disorders,mean pulmonary pressure (mPAP) by electrocardiography,arterial blood gas,the times of pulmonary infection and hospitalization rates,the duration of hospitalization invasive ventilation,the duration of in RICU and in hospital stay,tracheal intubation rates and mortality.The medical cost was calculated.Results After two years,the differences in the dyspnea grade,scale for accessory muscle use,anxiety scores,depression scores,mPAP,arterial PaCO2 and PaO2,hospitalization rates,the times of pulmonary infection,the days of hospitalization for exacerbation in the home NIV group [2.2± 0.2,2.4 ± 0.3,4 ± 1,5.3 ± 1.2,(36.6±5.2)mm Hg,(50.2±4.5)mm Hg,(63.5±4.2)mm Hg,(1.3±0.2) times/year,(2.4±0.2) times/year,(15.8 ± 4.4) days/times] were statistically significant compared to the control group [4.1±0.2,4.9±0.5,12±3,11.3±1.6,(45.2±5.2)mm Hg,(67.3±4.5) mm Hg,(48.3±4.3)mm Hg,(5.4±0.4)times/year,(8.9 ±0.3) times/year,(38.5± 6.3) days/times] (all P<0.01).The duration of invasive ventilation,the days in RICU and in hospital stay,tracheal intubation rates on admission to the hospital were significantly decreased in the home NIV group [(8.2 ± 2.2)days,(9.6±3.1) days,(15.8±4.4) days,(2±0.2) times/two years],as compared with the

  20. Chronic renal failure with gout: a marker of chronic lead poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Craswell, P.W.; Price, J.; Boyle, P.D.; Heazlewood, V.J.; Baddeley, H.; Lloyd, H.M.; Thomas, B.J.; Thomas, B.W.

    1984-09-01

    EDTA (calcium disodium edetate) lead mobilization and x-ray fluorescence (XRF) finger bone lead tests were done in 42 patients with chronic renal failure and without persisting lead intoxication. Nineteen of 23 patients with gout and 8 of 19 without gout had positive EDTA lead mobilization tests. Those patients with gout excreted significantly more excess lead chelate than those without gout. In the gout group 17 patients denied any childhood or industrial exposure to lead. They had a greater number of positive tests and excreted significantly more excess lead chelate than 14 patients with neither gout nor lead exposure. These results confirm that gout in the presence of chronic renal failure is a useful marker of chronic lead poisoning. Of 27 patients with positive lead mobilization tests, only 13 had elevated XRF finger bone lead concentrations (sensitivity 48%). Three of 15 patients with negative lead mobilization tests had elevated XRF finger bone lead concentrations (specificity 80%). Although the XRF finger bone lead test is a convenient noninvasive addition to the diagnostic evaluation of patients with chronic renal failure and gout, its application is limited due to the lack of sensitivity of the method.

  1. Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare.

    Science.gov (United States)

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bożena

    2016-01-01

    There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits.

  2. [Chronic heart failure and cachexia: role of endocrine system].

    Science.gov (United States)

    Dei Cas, A; Muoio, A; Zavaroni, I

    2011-12-01

    Chronic heart failure (CHF) is a major health problem that carries a devastating prognosis. The prognosis worsens considerably once cardiac cachexia has been diagnosed. Neurohormonal, metabolic, hemodynamic and immunological alterations are involved in the initiation and progression of cardiac cachexia. Cachexia is characterized by a hypothalamic inappropriate response to the mechanisms controlling energy homeostasis. Levels of the anorexigenic hormone leptin are decreased whereas the orexigenic gherlin hormone levels are normal or elevated. Nevertheless, energy intake is not increased as expected due to a persistent activation of the proopiomelanocortin (POMC) system (anorexigenic) paralleled by a decreased activity of the neuropeptide Y (NPY, orexigenic) neurons. Cachexia is also characterized by an imbalance in anabolic (impairment in the growth hormone/insulin-like growth factor-I axis, insulin resistance) and catabolic (increased levels of catecholamines, increased cortisol/dehydroepiandrosterone ratio and activation of proinflammatory cytokines such as tumor necrosis factor-alpha, interleuchin-6, interleuchin-1') at the basis of the wasting process. This review discusses the complex role of the endocrine system in modulating energy balance, appetite and metabolism in patients with chronic heart failure. A joint multidisciplinary effort of the cardiologists, immunologists and endocrinologists might be useful to identify the precise mechanisms involved in the neuroendocrine alteration and to develop therapeutic strategies able to improve the prognosis of CHF patients.

  3. Skin changes in patients with chronic renal failure

    Directory of Open Access Journals (Sweden)

    Olarenwaju Falodun

    2011-01-01

    Full Text Available Management of patients with renal failure remains a major problem in poor-resource nations. Cutaneous manifestations in this group of patients are varied and remain helpful in differentiating acute from chronic renal failure (CRF. We studied the prevalence and pattern of skin disorders in patients with CRF at The University College Hospital, Ibadan, Nigeria, during the period between May 2006 and February 2007. Relevant information was collected with the aid of a questionnaire. The patients were then examined for skin disorders. One hundred and twenty patients who met the inclusion criteria were recruited into the study. The mean age of the CRF patients was 43.12 ± 15.38 years, while that of the control subjects was 43.13 ± 15.38 years. Seventy-six of the 120 patients (63.3% were on chronic hemodialysis while 44 (36.5% were on conservative management. A total of 107 patients (89.1% had at least one skin problem. The skin disorders seen include xerosis in 72 (60%, pruritus in 32 (26.7%, hyper-pigmentation, icthyosis and pityriasis versicolor in nine patients each (7.5%, either singly or in combination. Pallor of the skin was seen in three of the patients (2.5%, while uremic frost was seen in one (0.8%. Nail changes were seen in 48 patients (40%. We conclude that xerosis, pruritus, pigmentary and nail changes were the most common skin disorders in patients with CRF in our environment.

  4. Neurological Disorders in a Murine Model of Chronic Renal Failure

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    Jean-Marc Chillon

    2014-01-01

    Full Text Available Cardiovascular disease is highly prevalent in patients with chronic renal failure (CRF. However, data on the impact of CRF on the cerebral circulatory system are scarce—despite the fact that stroke is the third most common cause of cardiovascular death in people with CRF. In the present study, we examined the impact of CRF on behavior (anxiety, recognition and ischemic stroke severity in a well-defined murine model of CRF. We did not observe any significant increases between CRF mice and non-CRF mice in terms of anxiety. In contrast, CRF mice showed lower levels of anxiety in some tests. Recognition was not impaired (vs. controls after 6 weeks of CRF but was impaired after 10 weeks of CRF. Chronic renal failure enhances the severity of ischemic stroke, as evaluated by the infarct volume size in CRF mice after 34 weeks of CRF. Furthermore, neurological test results in non-CRF mice tended to improve in the days following ischemic stroke, whereas the results in CRF mice tended to worsen. In conclusion, we showed that a murine model of CRF is suitable for evaluating uremic toxicity and the associated neurological disorders. Our data confirm the role of uremic toxicity in the genesis of neurological abnormalities (other than anxiety.

  5. 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.

  6. Congestive heart failure in patients with chronic kidney disease

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    Poskurica Mileta

    2014-01-01

    Full Text Available Cardiovascular disorders are the most frequent cause of death (46-60% among patients with advanced chronic renal failure (CRF, and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF. Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°. In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable.

  7. [Focal segmental glomerulosclerosis: prognosis of chronic renal failure].

    Science.gov (United States)

    Razukeviciene, Loreta; Kuzminskis, Vytautas; Bumblyte, Inga Arūne

    2003-01-01

    We analyzed 19 patients with focal segmental glomerulosclerosis (FSGS): 11 males and 8 females (mean age 38.3 yrs. (SD 16.4), who were under observation for 39.4 months (SD 17.2). At the moment of renal biopsy 73.7% of patients had arterial hypertension, 52.6%--nephrotic proteinuria, 36.9%--chronic renal failure. Global glomerulosclerosis was present in 14 biopsies (73.7%), and intersticial fibrosis--in 13 biopsies (68.4%). The results of analysis showed multiple risk factors for progression of renal failure: initial renal failure (p=0.005), proteinuria (> or =3 g/l) (p=0.005), expressed glomerulosclerosis (p=0.005) and expressed interstitial fibrosis (p=0.034). Focal segmental glomerulosclerosis were found to have a relatively bad long-term prognosis--the renal survival rate in 5 years was 77.8%. Kaplan-Meier survival analysis showed that expressed glomerulosclerosis was risk factor (logrank p=0.016, Breslov p=0.043) associated with end-stage renal disease in 5 years.

  8. State of the art: strategies for extracorporeal membrane oxygenation in respiratory failure.

    Science.gov (United States)

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

    2012-11-01

    Extracorporeal membrane oxygenation (ECMO) is an important rescue therapy for patients with cardiac and/or respiratory failure, with a growing body of literature supporting its use. Despite widespread use of ECMO, there remains a paucity of data on optimal management strategies for ECMO patients. Management of ECMO patients involves an understanding of the complex interaction between this technology and the critically ill patients being supported. ECMO providers typically rely on a combination of consensus guidelines and institutional experience to make management decisions. Substantial controversy continues to exist regarding many elements of ECMO management, including seemingly straightforward decisions such as the initial implementation of this technology. In addition, there are multiple providers involved in the management of ECMO patients who must be co-ordinated for this supportive therapy to be most effective. This manuscript provides an overview of current techniques for treating respiratory ECMO patients.

  9. Hypokalemic paralysis and respiratory failure due to excessive intake of licorice syrup

    Directory of Open Access Journals (Sweden)

    Mehmet Oguzhan Ay

    2014-04-01

    Full Text Available Licorice is the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypokalemia, hypertension, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this paper, an 34 years old man who admitted to the emergency department with respiratory failure and marked muscle weakness of all extremities that progressed to paralysis after excessive intake of licorice syrup was presented. It was aimed to draw attention to the necessity of questioning whether there is excessive intake of licorice or not in patients who admitted to emergency department with paralysis and dyspnea. Plasma potassium concentration of the patient was 1.4 mmol/L. The patient\\'s respiratory distress and loss of muscle strength recovered completely after potassium replacement. [Cukurova Med J 2014; 39(2.000: 387-391

  10. Successful treatment of two cases of urorectal septum malformation sequence with oligohydramnios and severe respiratory failure

    Directory of Open Access Journals (Sweden)

    Sekiguchi K

    2013-03-01

    Full Text Available Kazuhito Sekiguchi, Daijiro Takahashi, Takehiko Hiroma, Tomohiko Nakamura Division of Neonatology, Nagano Children's Hospital, Nagano, Japan Abstract: Urorectal septum malformation sequence can be diagnosed prenatally. We report herein the successful treatment of severe respiratory failure in two patients with urorectal septum malformation sequence and prenatally diagnosed oligohydramnios. The patients showed significant hypoxic deterioration and persistent pulmonary artery hypertension soon after birth. We used high-frequency ventilation (HFO, nitric oxide (NO, and extracorporeal membrane oxygenation (ECMO. The patients were successfully weaned from ECMO and artificial ventilation and discharged to home. Although termination of the pregnancy has often been selected for fetuses with oligohydramnios-related urorectal septum malformation sequence, our results suggest the opportunity for these fetuses to be treated using respiratory supports including HFO, NO, and ECMO after birth. Keywords: urorectal septum malformation sequence, oligohydramnios, pulmonary hypoplasia

  11. [Watermelon stomach: Chronic renal failure and/or imatinib?].

    Science.gov (United States)

    Montagnac, Richard; Blaison, Dominique; Brahimi, Saïd; Schendel, Adeline; Levasseur, Thomas; Takin, Romulus

    2015-11-01

    Watermelon stomach or gastric antral vascular ectasia (GAVE) syndrome is an uncommon cause of sometimes severe upper gastro-intestinal bleeding. Essentially based on a pathognomonic endoscopic appearance, its diagnosis may be unrecognised because mistaken with portal hypertensive gastropathy, while treatment of these two entities is different. Its etiopathogeny remains still unclear, even if it is frequently associated with different systemic illnesses as hepatic cirrhosis, autoimmune disorders and chronic renal failure. The mechanism inducing these vascular ectasia may be linked with mechanical stress on submucosal vessels due to antropyloric peristaltic motility dysfunction modulated by neurohormonal vasoactive alterations. Because medical therapies are not very satisfactory, among the endoscopic modalities, argon plasma coagulation seems to be actually the first-line treatment because the most effective and safe. However, surgical antrectomy may be sometimes necessary. Recently GAVE syndrome appeared as a new adverse reaction of imatinib mesylate, one of the tyrosine kinase inhibitors used in chronic myeloid leukemia, and we report here the observation of such a pathology in one patient treated at the same time by haemodialysis and by imatinib mesylate for chronic myeloid leukemia.

  12. [Cerebral hemodynamic disorders in patients with chronic decompensated respiratory insufficiency. Physiopathogenetic considerations].

    Science.gov (United States)

    Ionescu, M

    1978-01-01

    The present paper reports on 12 patients (8 males, 4 females) suffering from chronic decompensated respiratory failure, who presented concomitant transient haemodynamic disturbances in the carotid and vertebrobasilary systems, manifested by hemisphere or brain stem symptoms. Owing to the adaptive capacity of these patients there exists a certain tolerance threshold to hypercapnic hypoxemia, but following accentuated or rapid aggravation of acid-base hypercapnic hypoxemia, the biological balance is abruptly perturbed leading to cerebral haemodynamic disturbances. The pathophysiological mechanism of production appears to be the accumulation of acid ions caused by pH acidification of the cerebrospinal fluid. Increase in the cerebral arterial output with decrease in the rate of circulation and vascular resistance take place especially in the vessels with atheromatous or hyaline lesions. Under conditions of severe acidosic hypercapnic hypoxemia this, nevertheless, insures a minimum of 10--20% oxygen required by the metabolism of the nerve cell, sufficient for maintaining the structure of the cell (vita minima). These vasculometabolic mechanisms explain why with improvement of haematosis, following remission of the decompensated disease and fall in acidotic hypercapnic hypoxemia values, the cerebral haemodynamic disturbances also show a more or less evident remission because the nerve cells having maintained their structure are able to take up their function again.

  13. Apolipoprotein and lipid abnormalities in chronic liver failure

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    Spósito A.C.

    1997-01-01

    Full Text Available Total serum lipids, as well as apolipoproteins A-I (apo A-I and B (apo B, were determined in 74 patients with chronic liver failure without cholestasis and in 82 normal subjects. The VLDL, LDL and HDL lipid fractions were reduced in the liver failure group by 36%, 24% and 46%, respectively (P<0.001. Apolipoproteins A-I and B were also reduced by 26% and 25%, respectively (P<0.001. However, the reduction of HDL cholesterol (HDLc was more pronounced than that of apo A-I and the HDLc:apo A-I ratio was significantly lower in the liver failure group. After separating these patients into groups with plasma albumin lower than 3.0, between 3.0 and 3.5, and higher than 3.5 g/dl, the HDLc:apo A-I ratio was proportional to plasma albumin, but the correlation was not statistically significant. When these patients were separated by the Child classification of liver function, there was a correlation between the HDLc:apo A-I ratio and liver function. The differences in the HDLc:apo A-I ratio between the Child groups B and C, and A and C were statistically significant (P<0.05. We conclude that there is a more pronounced reduction in HDL cholesterol than in apo A-I in liver failure patients. Therefore, the HDLc:apo A-I ratio is a marker of liver function, probably because there is a decreased lecithin-cholesterol acyltransferase production by the diseased liver

  14. Anesthetic Challenges in an Adult with Pierre Robin Sequence, Severe Juvenile Scoliosis, and Respiratory Failure.

    Science.gov (United States)

    Rymer, Alyse N; Porteous, Grete H; Neal, Joseph M

    2015-09-15

    Anesthesiologists have the privilege and challenge of providing care for an extremely diverse population of patients, at times in urgent or emergent situations. We present a case of a 31-year-old woman with Pierre Robin sequence, severe juvenile scoliosis, and respiratory failure who underwent successful awake nasal fiberoptic intubation for tracheostomy at an adult tertiary care medical center. Familiarity with patient conditions infrequently encountered within our practice, as well as adherence to practice guidelines, proved essential to providing our patient with the safest care possible.

  15. The Hospital Course of a Successfully Treated Patient with Respiratory Failure: Beginning to End!

    Science.gov (United States)

    Callister, T Brian

    The successful treatment of a patient with acute respiratory failure is a complex undertaking that requires clinical competence, evidence-based interventions, seamless coordination of care transitions, and transparent open communication among all members of the health care team. Many of the processes of care in these critically ill patients are reassuringly consistent across services, across hospitals, across health systems, and even across the country. Although the clinical course of such complicated patients can be extremely unpredictable, we are fortunate that the professional, technical, and psychosocial aspects of care for these patients can be relatively orderly, evidence-based, and transparent.

  16. Major affective disorders in chronic obstructive pulmonary disease compared with other chronic respiratory diseases

    Directory of Open Access Journals (Sweden)

    Pothirat C

    2015-08-01

    Full Text Available Chaicharn Pothirat, Warawut Chaiwong, Nittaya Phetsuk, Sangnual Pisalthanapuna, Nonglak Chetsadaphan, Juthamas InchaiDivision of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailanBackground: Chronic obstructive pulmonary disease (COPD and other chronic respiratory diseases (CRDs have significant impacts on quality of life including psychomotor domain.Purpose: To evaluate three major affective disorders in subjects with COPD compared with other CRDs and nonill population.Materials and methods: The Thai version of Mini International Neuropsychiatric Interview (MINI was used as a diagnostic instrument for three major affective disorders (generalized anxiety disorder, major depressive disorder, and panic disorder by face-to-face interview in assessing patients with CRDs [COPD, asthma, rhinasthma, all asthma (asthma and rhinasthma, and chronic rhinitis], and nonill subjects. Logistic regression analyses were used to determine the relation between major affective disorders and CRDs adjusting for age, sex, and disease severity.Results: Major affective disorders were more prevalent in CRDs than nonill groups (adjusted OR =2.6 [95% CI, 1.8-3.9], P<0.001. COPD patients had significantly more generalized anxiety and panic disorder (adjusted OR =4.0 [95% CI, 1.4-11.9], P=0.011, and 4.4 [95% CI, 1.1-18.1], P=0.038, respectively but not major depressive disorder (adjusted OR =2.7 [95% CI, 0.8-9.0, P=0.105] than nonill group. Comparing with all asthma, COPD patients had lower occurrence of major depressive and panic disorders (adjusted OR =0.1 [95% CI, 0.0-0.4], P=0.002, and 0.1 [95% CI, 0.0-0.9], P=0.043, respectively. There was no difference in major mood disorders in COPD, rhinasthma, and chronic rhinitis patients. Major affective disorders were not increased by disease severity in COPD.Conclusion: Major affective disorders were significantly higher in CRDs than nonill

  17. Effect of renal function on prognosis in chronic heart failure.

    Science.gov (United States)

    Löffler, Adrián Ignacio; Cappola, Thomas P; Fang, James; Hetzel, Scott J; Kadlec, Andrew; Astor, Brad; Sweitzer, Nancy K

    2015-01-01

    Renal dysfunction (RD) is associated with increased mortality in heart failure (HF). The aim of this study was to identify whether worsened or improved renal function during mid-term follow-up is associated with worsened outcomes in patients with chronic HF. A total of 892 participants from a multicenter cohort study of chronic HF were followed over 3.1 ± 1.9 years of enrollment. Worsened and improved renal functions were tested with multivariate models as independent predictors of HF hospitalization and mortality. Although 12% of subjects experienced a ≥25% decrease in estimated glomerular filtration rate (eGFR), 17% experienced a ≥25% increase in eGFR, and there was stability of kidney function observed in the cohort as a whole. The quartile with the worst RD at any point in time had increased risk of HF hospitalization and mortality. Worsened eGFR was associated with HF outcomes in the unadjusted (hazard ratio = 1.71, 95% confidence interval 1.04 to 2.81, p = 0.035), but not the adjusted analysis. Improvement in eGFR was not associated with outcome (p = 0.453). In chronic HF, the severity of RD predicts risk of poor outcome better than changes in renal function during mid-term follow-up. This suggests that in patients with appropriately treated chronic HF, worsening renal function in itself does not yield useful prognostic information and may not reflect poor outcome.

  18. Salt-Induced Changes in Cardiac Phosphoproteome in a Rat Model of Chronic Renal Failure

    OpenAIRE

    Zhengxiu Su; Hongguo Zhu; Menghuan Zhang; Liangliang Wang; Hanchang He; Shaoling Jiang; Fan Fan Hou; Aiqing Li

    2014-01-01

    Heart damage is widely present in patients with chronic kidney disease. Salt diet is the most important environmental factor affecting development of chronic renal failure and cardiovascular diseases. The proteins involved in chronic kidney disease -induced heart damage, especially their posttranslational modifications, remain largely unknown to date. Sprague-Dawley rats underwent 5/6 nephrectomy (chronic renal failure model) or sham operation were treated for 2 weeks with a normal-(0.4% NaCl...

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

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    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.

  20. CHRONIC HEART FAILURE AND IRON-DEFICIENT ANEMIA

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    M. V. Melnik

    2015-12-01

    Full Text Available 62 chronic heart failure (CHF patients with iron-deficient anemia (IDA were studied. Standard CHF therapy (angiotensin converting enzyme inhibitors, β-blockers, diuretics, cardiac glycosides was accompanied with the correction of iron deficiency by intravenous injection of Venofer and subsequent Ferro-Folgamma prescription (average daily dose of iron 137,75±5mg. After treatment serum iron level increased by 95,5% and hemoglobin level – by 9,8%. Left ventricular ejection fraction increased by 32,2% and physical activity tolerance – by 47,6%. Before treatment 32 CHF patients with IDA (51,6% had III functional class (FC of CHF according to NYHA and 16 patients (25,8% – IV FC. After treatment I FC was observed in 18 CHF patients (29%, II FC – in 26 patients and only 18 patients demonstrated III FC of CHF.

  1. PRIMARY CARE PROBLEMS IN PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. A. Shtegman

    2015-09-01

    Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.

  2. PRIMARY CARE PROBLEMS IN PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. A. Shtegman

    2013-01-01

    Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.

  3. Hemostatic biomarkers in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Tarnow, Inge; Falk, Torkel; Tidholm, Anna

    2007-01-01

    Background: Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and abnormalities in hemostatic biomarkers carry a poor prognosis. Alterations in hemostatic pathways can be involved in the pathogenesis of CHF in dogs, and microthrombosis in the myocardium could...... contribute to increased mortality. Hypothesis: That plasma concentration or activity of hemostatic biomarkers is altered in dogs with CHF and that these factors predict mortality. Animals: Thirty-four dogs with CHF caused by either dilated cardiomyopathy (DCM, n = 14) or degenerative valvular disease (CDVD......, n = 20) compared with 23 healthy age-matched control dogs were included in this study. Dogs with CHF were recruited from 2 referral cardiology clinics, and control dogs were owned by friends or colleagues of the investigators. Methods: Clinical examination and echocardiography were performed in all...

  4. Radiological diagnosis of pulmonary edema in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Tret' yakov, A.E. (Tsentral' naya Klinicheskaya Bol' nitsa, Moscow (USSR))

    Pulmonary edema has been revealed in 132 patients (51.6 %) during radiologic examination of 256 patients with chronic renal failure. The performance of anterio-posterior chest radiographs was in most cases necessary and quite sufficient for making diagnostic conclusions. Follow up study of patients with pulmonary edema and analysis of radiologic picture of the alterations permitted physicians to distinguish approximately 3 stages of the process development, which transit from one into another. Stage 1 involves early disorders and prodromes of pulmonary edema; Stage 2 interstitial lung edema; Stage 3 alveolar edema. The circulation enforcement of the upper lobar vessels has been the main feature of stage 1. Radiogramometry provided additional information for the pulmonary edema diagnosis. For instance, cardioradiometric data are useful for pulmonary edema diagnosis and evidence in favour of its close connection with heart disorders.

  5. CHRONIC HEART FAILURE AND IRON-DEFICIENT ANEMIA

    Directory of Open Access Journals (Sweden)

    M. V. Melnik

    2007-01-01

    Full Text Available 62 chronic heart failure (CHF patients with iron-deficient anemia (IDA were studied. Standard CHF therapy (angiotensin converting enzyme inhibitors, β-blockers, diuretics, cardiac glycosides was accompanied with the correction of iron deficiency by intravenous injection of Venofer and subsequent Ferro-Folgamma prescription (average daily dose of iron 137,75±5mg. After treatment serum iron level increased by 95,5% and hemoglobin level – by 9,8%. Left ventricular ejection fraction increased by 32,2% and physical activity tolerance – by 47,6%. Before treatment 32 CHF patients with IDA (51,6% had III functional class (FC of CHF according to NYHA and 16 patients (25,8% – IV FC. After treatment I FC was observed in 18 CHF patients (29%, II FC – in 26 patients and only 18 patients demonstrated III FC of CHF.

  6. Radiological features of progressive tumoral calcinosis in chronic renal failure.

    LENUS (Irish Health Repository)

    Hodnett, P

    2012-02-03

    We present the case of a young adult patient with chronic renal failure who developed painful subcutaneous nodules after failed renal transplant and recommencing dialysis. These nodules were juxta-articular in location and initially located over both shoulders. Radiological evaluation suggested tumoral calcinosis. The patient was placed on a strict dialysis and dietary regimen but was suboptimally compliant with same. The patient developed progressive disease with an increase in size and number of juxta-articular calcified soft-tissue masses. However, 6 months following a second renal transplant clinical and radiological follow up demonstrated marked resolution both in symptomatology and radiographic findings. We present the plain radiographic, CT and MRI findings which demonstrate the typical radiological features of tumoral calcinosis. We correlate these findings with clinical course and histological findings following surgical excision of one of these masses.

  7. Chronic obstructive pulmonary disease in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Iversen, K K; Kjaergaard, J; Akkan, D;

    2008-01-01

    OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study...... a possible relationship between right and left ventricular function and pulmonary function. DESIGN: Prospective substudy. SETTING: Systematic screening at 11 centres. SUBJECTS: Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms...... corresponding to New York Heart Association class III-IV within a month prior to admission. INTERVENTIONS: Forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC) were measured by spirometry and ventricular function by echocardiography. The diagnosis of COPD and HF were made according...

  8. The role of statins in chronic heart failure.

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Szczurek, Wioletta; Król, Bogumiła; Zembala, Marian

    2014-09-01

    The efficacy of statins in reducing morbidity and mortality in patients with documented coronary artery disease is unquestionable. However, in chronic heart failure (CHF), evidence regarding the beneficial effects of statin therapy remains contradictory. Although numerous retrospective studies have demonstrated improved prognosis in CHF patients treated with statins, two randomized trials, GISSI-HF and CORONA, have not confirmed the benefit of rosuvastatin in this group of patients. The benefits of using statins in CHF probably result mostly from their pleiotropic action, including the improvement of endothelial function, the inhibition of neurohormonal activation, and the reduction of proinflammatory activation. On the other hand, it has been recognized that low cholesterol is associated with worse morbidity and mortality in patients with CHF. It appears that it is necessary to conduct further randomized clinical trials using different kinds of statins in different populations of patients with CHF.

  9. Management of chronic heart failure in the older population

    Institute of Scientific and Technical Information of China (English)

    Nahid Azad; Genevieve Lemay

    2014-01-01

    Chronic heart failure (CHF) is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

  10. Cutaneous manifestations in patients with chronic renal failure on hemodialysis

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    Udayakumar P

    2006-01-01

    Full Text Available Background: Chronic renal failure (CRF presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. Aim: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF undergoing hemodialysis. Methods: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. Results: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%, followed by pallor (60%, pruritus (53% and cutaneous pigmentation (43%. Other cutaneous manifestations included Kyrle′s disease (21%; fungal (30%, bacterial (13% and viral (12% infections; uremic frost (3%; purpura (9%; gynecomastia (1%; and dermatitis (2%. The nail changes included half and half nail (21%, koilonychia (18%, onychomycosis (19%, subungual hyperkeratosis (12%, onycholysis (10%, splinter hemorrhages (5%, Mees′ lines (7%, Muehrcke′s lines (5% and Beau′s lines (2%. Hair changes included sparse body hair (30%, sparse scalp hair (11% and brittle and lusterless hair (16%. Oral changes included macroglossia with teeth markings (35%, xerostomia (31%, ulcerative stomatitis (29%, angular cheilitis (12% and uremic breath (8%. Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi′s sarcoma were also observed. Conclusions: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.

  11. Discussion on Respiratory Failure from Chronic Obstructive Pulmonary Diseases(COPD) and Extrapyramidal System Damage%慢性阻塞性肺病呼吸衰竭并发锥体外路系统损害的初步探讨

    Institute of Scientific and Technical Information of China (English)

    孙毅; 刘蓝

    2014-01-01

    44 cases of patients of respiratory failure from COPD withⅡtype arterial blood gas are selected,among whom, 29 cases with severe anoxia and 15 cases with moderate anoxia. All of the 44 cases have compound acid-base unbalance,10 cases with respiratory type triple acid-base unbalance disorders. Clinical symptoms:there are 39 cases with finger static tremor,24 cases with flapping tremor, 18 cases with gear-shaped resistance and 6 cases with head tremor. Madopar experiential treatment for 5-7 days is given to 11 serious patients whose disease has affected their normal life. Conclusion:It is reversible for patients with early COPD hypoxemia,hypercapnia, acid-base unbalance and extrapyramidal system damage. The active treatment of respiratory failure and hypoxemia can prevent extrapy-ramidal system damage.%选取44例COPD动脉血气为Ⅱ型呼吸衰竭患者,其中重度缺氧29例,中度缺氧15例。44例均为复合性酸碱失衡,呼吸型三重酸碱失衡10例。临床表现:手指静止性震颤39例,扑翼样震颤24例,呈“齿轮状”抵抗18例,头部颤动6例。对11例病情严重影响正常生活者给予美多巴试验性治疗5~7天治愈。得出:COPD低氧血症,高碳酸血症及酸碱失衡并发锥体外路系损害早期是可逆性的,积极治疗呼吸衰竭、纠正低氧血症,可防止并发锥体外路系统损害。

  12. High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease.

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    Jose Luiz Proenca-Modena

    Full Text Available Chronic tonsillar diseases are an important health problem, leading to large numbers of surgical procedures worldwide. Little is known about pathogenesis of these diseases. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases, we developed a cross-sectional study to determine the rates of viral detections of common respiratory viruses detected by TaqMan real time PCR (qPCR in nasopharyngeal secretions, tonsillar tissues and peripheral blood from 121 children with chronic tonsillar diseases, without symptoms of acute respiratory infections. At least one respiratory virus was detected in 97.5% of patients. The viral co-infection rate was 69.5%. The most frequently detected viruses were human adenovirus in 47.1%, human enterovirus in 40.5%, human rhinovirus in 38%, human bocavirus in 29.8%, human metapneumovirus in 17.4% and human respiratory syncytial virus in 15.7%. Results of qPCR varied widely between sample sites: human adenovirus, human bocavirus and human enterovirus were predominantly detected in tissues, while human rhinovirus was more frequently detected in secretions. Rates of virus detection were remarkably high in tonsil tissues: over 85% in adenoids and close to 70% in palatine tonsils. In addition, overall virus detection rates were higher in more hypertrophic than in smaller adenoids (p = 0.05, and in the particular case of human enteroviruses, they were detected more frequently (p = 0.05 in larger palatine tonsils than in smaller ones. While persistence/latency of DNA viruses in tonsillar tissues has been documented, such is not the case of RNA viruses. Respiratory viruses are highly prevalent in adenoids and palatine tonsils of patients with chronic tonsillar diseases, and persistence of these viruses in tonsils may stimulate chronic inflammation and play a role in the pathogenesis of these diseases.

  13. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

    Science.gov (United States)

    Grande Villoria, J; Macias Nunez, J F; Miralles, J M; De Castro del Pozo, S; Tabernero Romo, J M

    1988-01-01

    Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

  14. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

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    Gu, Wan-Jie; Chen, Kun; Ni, Hongying

    2017-01-01

    Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation. PMID:28127231

  15. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    2017-01-01

    Full Text Available Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

  16. Quality of life in patients with chronic renal failure

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    Petrović Lada

    2006-01-01

    Full Text Available Introduction. Hemodialysis and transplantation are performed not only to replace renal function, but also to improve patients' quality of life. The aim of our investigation was to compare the quality of life in patients with chronic renal failure (CRF before and after the introduction of active therapy. Material and methods. We tested 76 patients (pts: 20 pts on conservative therapy (CT, 21 pts on chronic hemodialysis and 35 pts with renal transplantation. A questionnaire (combining two questionnaires was used to investigate the physical, emotional and social aspects of health. Results. In regard to physical health of transplantation patients (TP it was established that work capacity and activities were less damaged, whereas physical activity was highest in pts on CT. Social activity was limited in a higher percentage in TP (40% than in hemodialysis patients (HD (19%, while family relationships were most damaged in pts on HD (28.57%. Discomforts were most common in pts on HD. The highest percentage of pts estimated their health status as good or average, but their health status improved after transplantation in 82.86% that is in 57.14% after HD. It was similar with the quality of life: 28.57% of kidney transplant patients rated their quality of life as very good, and 54.28% rated it as good; 38.09% of HD patients rated their quality of life as very good, whereas only 5% of CT patients rated it as very good, and 20% as good. .

  17. Oral disorders in patients with chronic renal failure. Narrative review

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    Carolina Hernández

    2016-02-01

    Full Text Available Chronic renal failure (CRF is one of the best known renal diseases. It is characterized by a deterioration in the overall renal function and is associated with other conditions such as hypertension, diabetes mellitus, uropathy, chronic glomerulonephritis and autoimmune diseases. Patients with CRF show alterations of the masticatory system that are specific to the disease and other type of disorders as a result of treatment. Oral health in dialysis and transplant patients tends to be poor, which makes them more likely to develop pathological conditions in the oral cavity, potentially increasing morbidity, mortality and affecting the quality of life of patients. Among the lesions we can find dysgeusia, periodontitis, candidiasis, gingival bleeding, petechiae, and joint alterations. Gingivitis and xerostomia associated to long-term use medications can cause oral lesions. Children with CRF show two oral conditions of interest: high incidence of dental anomalies and low caries activity. In patients receiving a kidney transplant, previous dental treatment is critical because the immune status of the patient will be affected not only by the toxemia, but by the immunosuppressive drugs used to prevent transplant rejection. Therefore, the dentist plays an important role in training parents and/or guardians, doctors and paramedics on the treatment of oral lesions in these patients

  18. 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

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    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

  19. Evidence-based clinical practice guideline: inhaled nitric oxide for neonates with acute hypoxic respiratory failure.

    Science.gov (United States)

    DiBlasi, Robert M; Myers, Timothy R; Hess, Dean R

    2010-12-01

    Inhaled nitric oxide (INO) is a colorless, odorless gas that is also a potent pulmonary vasodilator. When given via the inhaled route it is a selective pulmonary vasodilator. INO is approved by the United States Food and Drug Administration (FDA) for the treatment of term and near-term neonates with hypoxemic respiratory failure associated with clinical or echocardiographic evidence of pulmonary arterial hypertension. A systematic review of the literature was conducted with the intention of making recommendations related to the clinical use of INO for its FDA-approved indication. Specifically, we wrote these evidence-based clinical practice guidelines to address the following questions: (1) What is the evidence for labeled use? (2) What are the specific indications for INO for neonates with acute hypoxemic respiratory failure? (3) Does the use of INO impact oxygenation, mortality, or utilization of extracorporeal membrane oxygenation (ECMO)? (4) Does INO affect long-term outcomes? (5) Is INO cost-effective therapy? (6) How is the appropriate dosing regimen and dose response to INO established? (7) How is the dose of INO titrated and weaned? (8) Which INO delivery system should be used? (9) How should INO be implemented with different respiratory support devices? (10) What adverse effects of INO should be monitored, and at what frequency? (11) What physiologic parameters should be monitored during INO? (12) Is scavenging of gases necessary to protect the caregivers? Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system, 22 recommendations are developed for the use of INO in newborns.

  20. Impaired cortical processing of inspiratory loads in children with chronic respiratory defects

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    Clément Annick

    2007-09-01

    Full Text Available Abstract Background Inspiratory occlusion evoked cortical potentials (the respiratory related-evoked potentials, RREPs bear witness of the processing of changes in respiratory mechanics by the brain. Their impairment in children having suffered near-fatal asthma supports the hypothesis that relates asthma severity with the ability of the patients to perceive respiratory changes. It is not known whether or not chronic respiratory defects are associated with an alteration in brain processing of inspiratory loads. The aim of the present study was to compare the presence, the latencies and the amplitudes of the P1, N1, P2, and N2 components of the RREPs in children with chronic lung or neuromuscular disease. Methods RREPs were recorded in patients with stable asthma (n = 21, cystic fibrosis (n = 32, and neuromuscular disease (n = 16 and in healthy controls (n = 11. Results The 4 RREP components were significantly less frequently observed in the 3 groups of patients than in the controls. Within the patient groups, the N1 and the P2 components were significantly less frequently observed in the patients with asthma (16/21 for both components and cystic fibrosis (20/32 and 14/32 than in the patients with neuromuscular disease (15/16 and 16/16. When present, the latencies and amplitudes of the 4 components were similar in the patients and controls. Conclusion Chronic ventilatory defects in children are associated with an impaired cortical processing of afferent respiratory signals.

  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. 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

  3. Canadian Practice Assessment in Chronic Obstructive Pulmonary Disease: Respiratory Specialist Physician Perception Versus Patient Reality

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    Paul Hernandez

    2013-01-01

    Full Text Available INTRODUCTION: Chronic obstructive pulmonary disease (COPD is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients’ perceptions of their disease.

  4. Population-wide preventive interventions for reducing the burden of chronic respiratory disease.

    Science.gov (United States)

    Abramson, M J; Koplin, J; Hoy, R; Dharmage, S C

    2015-09-01

    Chronic obstructive pulmonary disease and asthma impose a substantial burden of disease. This narrative review focuses on potential population-wide interventions that are likely to have an impact on these diseases. The developmental origins of adult disease commence in utero, with maternal nutrition being of particular interest. However, to date, trials of maternal allergen avoidance, dietary supplementation or probiotics have not shown consistent protective effects against asthma. Poor indoor air quality, especially from biomass fuels as well as second-hand tobacco smoke, is a well-recognised risk factor for chronic respiratory diseases. This can be modified by cleaner fuels, cooking stoves or heaters, and improved ventilation. Although allergens are a risk factor for childhood asthma, the results of interventions to reduce exposures have been disappointing. Traffic-related air pollution is associated with an increased incidence of asthma in children. Primary prevention of the adverse effects of air pollution has focused on the development of ambient air quality guidelines, but enforcement remains a challenge in many countries. Occupational asthma may be induced by sensitisers or irritants in the workplace. Prevention involves eliminating the agent or reducing exposure as far as possible, which is more effective than respiratory protective equipment. Smoking cessation remains a key proven preventive strategy for chronic respiratory diseases. There is now an international framework for tobacco control, and recent innovations include plain packaging of tobacco. Chronic respiratory diseases can be substantially prevented by the above population-wide interventions.

  5. Vocal Cord Paralysis and Respiratory Muscle Weakness: An Unusual Presentation of Chronic Polyneuropathy

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    LKL Chau

    1998-01-01

    Full Text Available A case of chronic polyneuropathy that manifested with an unusual combination of vocal cord paralysis and respiratory muscle weakness is reported. In addition, results of an exercise test carried out to assess the severity and mechanisms of exertional breathlessness in this unique condition with combined obstructive and restrictive disorders are described.

  6. Persistent activation of an innate immune response translates respiratory viral infection into chronic lung disease.

    Science.gov (United States)

    Kim, Edy Y; Battaile, John T; Patel, Anand C; You, Yingjian; Agapov, Eugene; Grayson, Mitchell H; Benoit, Loralyn A; Byers, Derek E; Alevy, Yael; Tucker, Jennifer; Swanson, Suzanne; Tidwell, Rose; Tyner, Jeffrey W; Morton, Jeffrey D; Castro, Mario; Polineni, Deepika; Patterson, G Alexander; Schwendener, Reto A; Allard, John D; Peltz, Gary; Holtzman, Michael J

    2008-06-01

    To understand the pathogenesis of chronic inflammatory disease, we analyzed an experimental mouse model of chronic lung disease with pathology that resembles asthma and chronic obstructive pulmonary disease (COPD) in humans. In this model, chronic lung disease develops after an infection with a common type of respiratory virus is cleared to only trace levels of noninfectious virus. Chronic inflammatory disease is generally thought to depend on an altered adaptive immune response. However, here we find that this type of disease arises independently of an adaptive immune response and is driven instead by interleukin-13 produced by macrophages that have been stimulated by CD1d-dependent T cell receptor-invariant natural killer T (NKT) cells. This innate immune axis is also activated in the lungs of humans with chronic airway disease due to asthma or COPD. These findings provide new insight into the pathogenesis of chronic inflammatory disease with the discovery that the transition from respiratory viral infection into chronic lung disease requires persistent activation of a previously undescribed NKT cell-macrophage innate immune axis.

  7. 长期家庭无创正压通气治疗对重度慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者稳定期的临床效果%Long-term Home Noninvasive Positive Pressure Ventilation Therapy for Se-vere Chronic Obstructive Pulmonary Disease with Clinical Effect of Plateau Type ⅡRespiratory Failure Patients

    Institute of Scientific and Technical Information of China (English)

    陈黎仙

    2016-01-01

    Objective To treat chronic obstructive pulmonary disease complicated with type II respiratory failure in patients with chronic obstructive pulmonary disease by long-term home non-invasive positive pressure ventilation. Methods Conve-nient selection December 2007 to May 2014 come to our hospital treatment of severe patients with chronic obstructive pul-monary disease combined with type II respiratory failure in 120 cases for research object, according to the different treat-ment methods will be the into two groups,60 cases in each each patient, The control group received conventional drug ther-apy and long-term home oxygen therapy, the study group to implement noninvasive positive pressure ventilation in the treatment of these measures at the same time, the patient was discharged after two years of follow-up, clinical results were compared. Results When they were discharged from the hospital, two groups in the lung function and blood gas analysis do not exist significant differences,(P>0.05),no statistically significant; Two years later, the study group FEV1 score was (1.12± 0.18) points in the control group (0.76±0.22) points; PO2 in the study group for (68.54±5.89 mmHg), control group (47.07± 4.56) mmHg; PaCO2 in study group (42.12±12.13) mmHg, the control group (6.411±10.14) mmHg,large differences between the groups (P0.05);2年后,研究组FEV1评分为(1.12±0.18)分,对照组为(0.76±0.22)分;研究组PO2为(68.54±5.89)mmHg,对照组为(47.07±4.56)mmHg;研究组PaCO2为(42.12±12.13)mmHg,对照组为(64.11±10.14)mmHg,组间差异有统计学意义(P<0.05);研究组使用呼气剂的时候出现人机不协调、面部压迫性损伤、胃肠胀气和口咽干燥等不良反应,经指导后均得到有效改善。结论在重度慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者稳定期治疗期间,给予患者长期家庭无创正压通气治疗,能够有效缓解患者临床症状。

  8. Clinical significance of pain in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    GAN Qian; ZHANG Feng-ru; ZHOU Qing-fen; DAI Li-ying; LIU Ye-hong; CHAI Xi-chen; WU Fang; SHEN Wei-feng

    2012-01-01

    Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure (CHF) patients.This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain.Methods Sociodemographics,serum levels of creatinine,NT-proBNP,high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor (TNF)-α,interleukin (IL)-6 and IL-10,and two-dimensional echocardiographic left ventricular ejection fraction (LVEF) were determined in 305 patients with CHF.A questionnaire packet including the Brief Pain Inventory (BPI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess the degree of pain rated on a 0-10 scale and the quality of life (QOL).A six-minute walking test was performed during routine clinic visits.Major adverse cardiac events (MACE) were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke at follow-up.Results Pain occurred in 25.6% of CHF patients,and was more common when the New York Heart Association (NYHA) functional class was worse.More patients with pain were female in gender,and had more co-morbidities,lower LVEF,and shorter distance during the 6-minute walking test.Despite similar serum levels of creatinine,N-terminal prohormone of brain natriuretic peptide (NT-proBNP),IL-6 and IL-10,the TNF-α levels were higher and MLHFQ scores were greater in CHF patients with pain.At follow-up,CHF patients with moderate to severe pain (≥4 scale) had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke.Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.Conclusions Pain occurs in all stages of the CHF trajectory,and its incidence increases as clinical

  9. [The efficacy of ivabradine in chronic heart failure (review)].

    Science.gov (United States)

    Isakadze, A; Makharadze, T; Gvishiani, M

    2015-04-01

    This review article is devoted to the treatment of chronic heart failure (HF) with a new generation drug - ivabradine. It is well known that HF is one of the most frequent reason of high mortality worldwide. HF is characterised by cardiac remodeling, which is central in the pathophysiology of HF including hemodynamic, neurohumoral and neurohormonal mechanisms during its development and established prognostic factor in patients suffered with this disease. Despite the introduction in medical practice of many drugs for the treatment of chronic HF the lethal outcome associated with HF remains high nowadays, which can be explained by complexity of remodeling mechanisms characteristic for development of HF. Ivabradine that has been introduced in medical practice in last decade is a pure heart rate-slowing agent. A large number of studies in patients with cardiovascular disease have demonstrated that heart rate (HR) is a very important and major independent risk factor for prognosis, because lowering of HR reduces cardiac work and diminished myocardial oxygen requirement. It was shown that ivabradine a selective inhibitor of the hyperpolarisation activated sodium chanel (If) is involved in pacemaker generation and responsiveness of the sino-atrial node resulting in HR reduction without negative inotropic action. Ivabradine in chronic HF improves diastolic function and attenuates cardiac tissue hypoxia. Long-term reduction of HR induced by ivabradine reduced remodeling and preserved nitric oxide (NO) bioavailability, resulting from processes triggered early after reduction of HR. The complex therapy including ivabradine promotes HR fall, leading in reduction of attacks of a stable angina and improved quality of life. Ivabradine may target the endothelial NO production via inhibition of protein tyrosine phosphatase 1B leading to endothelial protection. HR reduction by ivabradine reduces oxidative stress, improves endothelial function and prevents development of

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

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    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.

  11. Respiratory failure in a mouse model of myotonic dystrophy does not correlate with the CTG repeat length.

    OpenAIRE

    Panaite, P.A.; Kuntzer, T; Gourdon, G; Barakat-Walter, I.

    2013-01-01

    Myotonic dystrophy (DM1) is a multisystemic disease caused by an expansion of CTG repeats in the region of DMPK, the gene encoding DM protein kinase. The severity of muscle disability in DM1 correlates with the size of CTG expansion. As respiratory failure is one of the main causes of death in DM1, we investigated the correlation between respiratory impairment and size of the (CTG)n repeat in DM1 animal models. Using pressure plethysmography the respiratory function was assessed in control an...

  12. Sildenafil Improves Erectile Function in Men with Chronic Heart Failure

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    Niloufar Samiei

    2015-06-01

    Full Text Available Background: Patients with Chronic Heart Failure (CHF have been shown to have enhanced risk of Erectile Dysfunction (ED due to low cardiac output, endothelial dysfunction, medications, co-morbid conditions, and psychogenic factors. Objectives: The present study aimed to evaluate the effects of sildenafil on erectile function of patients with stable CHF using the abridged 5-item version of the International Index of Erectile Function (IIEF-5. Patients and Methods: Using convenience sampling, 222 sexually-active adult males with NYHA class I-III stable CHF were included in this cross-sectional study. All the patients filled out the IIEF-5 questionnaire, in which they were required to score the five domains of male sexual function, including erectile function, orgasm function, sexual desire, intercourse satisfaction, and overall satisfaction. All the analyses were performed using the SPSS statistical software (v. 19 and P < 0.05 was considered as statistically significant. Results: In our sample, the patients’ mean age was 47.14 ± 11.86 years, their mean left ventricular ejection fraction was 20% (15% - 25%, and the prevalence of ED was 70.3%. In addition, severe, moderate, mild to moderate, and mild ED were seen in 57%, 17%, 7%, and 19% of the patients with ED, respectively. ED was significantly more prevalent in the patients with ischemic heart failure compared to those with idiopathic dilated cardiomyopathy (84.68% vs. 55.85%, P < 0.001. Moreover, the prevalence of ED was significantly lower in the patients taking sildenafil compared to the other group (42.85% vs. 82.89%, P < 0.001. Conclusions: Sildenafil appears to provide satisfactory results toward improving sexual function in patients with CHF.

  13. Neurodegeneration and chronic renal failure in methylmalonic aciduria--a pathophysiological approach.

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    Morath, M A; Okun, J G; Müller, I B; Sauer, S W; Hörster, F; Hoffmann, G F; Kölker, S

    2008-02-01

    In the last decades the survival of patients with methylmalonic aciduria has been improved. However, the overall outcome of affected patients remains disappointing. The disease course is often complicated by acute life-threatening metabolic crises, which can result in multiple organ failure or even death, resembling primary defects of mitochondrial energy metabolism. Biochemical abnormalities during metabolic derangement, such as metabolic acidosis, ketonaemia/ketonuria, lactic acidosis, hypoglycaemia and hyperammonaemia, suggest mitochondrial dysfunction. In addition, long-term complications such as chronic renal failure and neurological disease are frequently found. Neuropathophysiological studies have focused on various effects caused by accumulation of putatively toxic organic acids, the so-called 'toxic metabolite' hypothesis. In previous studies, methylmalonate (MMA) has been considered as the major neurotoxin in methylmalonic aciduria, whereas more recent studies have highlighted a synergistic inhibition of mitochondrial energy metabolism (pyruvate dehydrogenase complex, tricarboxylic acid cycle, respiratory chain, mitochondrial salvage pathway of deoxyribonucleoside triphosphate (dNTP)) induced by propionyl-CoA, 2-methylcitrate and MMA as the key pathomechanism of inherited disorders of propionate metabolism. Intracerebral accumulation of toxic metabolites ('trapping' hypothesis') is considered a biochemical risk factor for neurodegeneration. Secondary effects of mitochondrial dysfunction, such as oxidative stress and impaired mtDNA homeostasis, contribute to pathogenesis of these disorders. The underlying pathomechanisms of chronic renal insufficiency in methylmalonic acidurias are not yet understood. We hypothesize that renal and cerebral pathomechanisms share some similarities, such as an involvement of dicarboxylic acid transport. This review aims to give a comprehensive overview on recent pathomechanistic concepts for methylmalonic acidurias.

  14. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation

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    Chuchalin AG

    2014-09-01

    Full Text Available Alexander G Chuchalin,1 Nikolai Khaltaev,2 Nikolay S Antonov,1 Dmitry V Galkin,3 Leonid G Manakov,4 Paola Antonini,5 Michael Murphy,5 Alexander G Solodovnikov,6 Jean Bousquet,7 Marcelo HS Pereira,8 Irina V Demko9 1Institute of Pulmonology, Federal Medical and Biological Agency, Moscow, Russia; 2Global Alliance Against Chronic Respiratory Diseases (GARD, Genève, Switzerland; 3GlaxoSmithKline, Moscow, Russia; 4Far Eastern Scientific Center of Physiology and Pathology of Respiration RAS (Russian Academy of Sciences, Blagoveshchensk, Russia; 5Worldwide Clinical Trials, King of Prussia, PA, USA; 6Worldwide Clinical Trials, Ekaterinburg, Russia; 7Institut National de la Santé et de la Recherche Médicale, Montpellier, France; 8Research and Development Chief Medical Office, International Medical, GlaxoSmithKline, London, United Kingdom; 9Krasnoyarsk State Medical University, Krasnoyarsk, Russia Background: Estimation suggests that at least 4 million people die, annually, as a result of chronic respiratory disease (CRD. The Global Alliance against Chronic Respiratory Diseases (GARD was formed following a mandate from the World Health Assembly to address this serious and growing health problem. Objectives: To investigate the prevalence of CRD in Russian symptomatic patients and to evaluate the frequency of major risk factors for CRD in Russia. Methods: A cross-sectional, population-based epidemiological study using the GARD questionnaire on adults from 12 regions of the Russian Federation. Common respiratory symptoms and risk factors were recorded. Spirometry was performed in respondents with suspected CRD. Allergic rhinitis (AR and chronic bronchitis (CB were defined by the presence of related symptoms according to the Allergic Rhinitis and its Impact on Asthma and the Global Initiative for Obstructive Lung Disease guidelines; asthma was defined based on disease symptoms; chronic obstructive pulmonary disease (COPD was defined as a post

  15. Respiratory failure in a mouse model of myotonic dystrophy does not correlate with the CTG repeat length.

    Science.gov (United States)

    Panaite, Petrica-Adrian; Kuntzer, Thierry; Gourdon, Geneviève; Barakat-Walter, Ibtissam

    2013-10-01

    Myotonic dystrophy (DM1) is a multisystemic disease caused by an expansion of CTG repeats in the region of DMPK, the gene encoding DM protein kinase. The severity of muscle disability in DM1 correlates with the size of CTG expansion. As respiratory failure is one of the main causes of death in DM1, we investigated the correlation between respiratory impairment and size of the (CTG)n repeat in DM1 animal models. Using pressure plethysmography the respiratory function was assessed in control and transgenic mice carrying either 600 (DM600) or >1300 CTG repeats (DMSXL). The statistical analysis of respiratory parameters revealed that both DM1 transgenic mice sub-lines show respiratory impairment compared to control mice. In addition, there is no significant difference in breathing functions between the DM600 and DMSXL mice. In conclusion, these results indicate that respiratory impairment is present in both transgenic mice sub-lines, but the severity of respiratory failure is not related to the size of the (CTG)n expansion.

  16. [Chronic systolic heart failure - dosing recommendations at beginning and end of treatment].

    Science.gov (United States)

    Zugck, Christian; Remppis, Andrew; Katus, Hugo A; Frankenstein, Lutz

    2008-10-01

    As a multi-system disease, chronic heart failure requires a complex, multimodal therapy. Achieving maximum guideline adherence in (advanced) chronic heart failure can therefore become a challenge. The important decrease in morbidity and mortality seen lately largely depends on consequent and sometime tedious implementation of guideline targets. The present paper provides a comprehensive overview on medical therapeutic strategies with a particular focus of onset and discontinuation of drugs in patients with chronic systolic dysfunction.

  17. The impact of chronic heamodialysis on the personality of patients with chronic renal failure

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    Evgenia Vlachu D.

    2009-07-01

    Full Text Available People with chronic diseases, deal with permanent changes in their everyday life. At the same time these patients appear to have different pathological behavior and personality disturbances as aresult of the disorders of their biological functions.AIM: The aim of this study is the examination of the psychological behavior of patients with chronic renal failure who submit themselves to recurrent heamodialysis (CRH.MATERIAL METHODS:The research was based on the completion of a questionnaire which has been used on foreigners and Greek patients who complained about chronic diseases. This questionnaire guarantees the highest reliability of all so that it will be possible to specify the negative influence of their disease upon the different sides of their life. Emphasis should be given on the fact that the personality questionnaire of Eysenck has been intensively evaluated on the Greek population as very trustworthy for secure conclusions. It included 84 questions in four different disorders (psychotism, neurotism, ex/introversion and check inversion for inaccuracies. The questionnaire has been proved very useful for the evaluation of the influence of the different interventions upon the quality of life of patients under heamodialysis. It appeared also that it was more reliable in comparison with the Sickness Impact Profile and with a test, whhb ic was aout the exercise under stress conditions. RESULTS: It has been discovered that all the three scales of control of the personality disturbances have systematically been influenced according to the control group of 138 persons from different age and sex groups. Furthermore, it has been found that the men patients underthe CRH were in lower region of the scale of neurotism while women patients appeared to be lower in the scale of psychotism. The T‐test shows that there is no important statistic difference between the two sexes according to the quality of their job. There is also no important difference

  18. [Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): respiratory failure].

    Science.gov (United States)

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

    2011-11-01

    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 mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid- and antioxidant-enriched diets, which could improve outcome.

  19. Microbial communities in the upper respiratory tract of patients with asthma and chronic obstructive pulmonary disease.

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    HeeKuk Park

    Full Text Available Respiratory infections are well-known triggers of chronic respiratory diseases. Recently, culture-independent tools have indicated that lower airway microbiota may contribute to pathophysiologic processes associated with asthma and chronic obstructive pulmonary disease (COPD. However, the relationship between upper airway microbiota and chronic respiratory diseases remains unclear. This study was undertaken to define differences of microbiota in the oropharynx of asthma and COPD patients relative to those in healthy individuals. To account for the qualitative and quantitative diversity of the 16S rRNA gene in the oropharynx, the microbiomes of 18 asthma patients, 17 COPD patients, and 12 normal individuals were assessed using a high-throughput next-generation sequencing analysis. In the 259,572 total sequence reads, α and β diversity measurements and a generalized linear model revealed that the oropharynx microbiota are diverse, but no significant differences were observed between asthma and COPD patients. Pseudomonas spp. of Proteobacteria and Lactobacillus spp. of Firmicutes were highly abundant in asthma and COPD. By contrast, Streptococcus, Veillonella, Prevotella, and Neisseria of Bacteroidetes dominated in the healthy oropharynx. These findings are consistent with previous studies conducted in the lower airways and suggest that oropharyngeal airway microbiota are important for understanding the relationships between the various parts of the respiratory tract with regard to bacterial colonization and comprehensive assessment of asthma and COPD.

  20. Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing.

    Science.gov (United States)

    Carraro, Silvia; Scheltema, Nienke; Bont, Louis; Baraldi, Eugenio

    2014-12-01

    Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease often originate early in life. In addition to a genetic predisposition, prenatal and early-life environmental exposures have a persistent impact on respiratory health. Acting during a critical phase of lung development, these factors may change lung structure and metabolism, and may induce maladaptive responses to harmful agents, which will affect the whole lifespan. Some environmental factors, such as exposure to cigarette smoke, type of childbirth and diet, may be modifiable, but it is more difficult to influence other factors, such as preterm birth and early exposure to viruses or allergens. Here, we bring together recent literature to analyse the critical aspects involved in the early stages of lung development, going back to prenatal and perinatal events, and we discuss the mechanisms by which noxious factors encountered early on may have a lifelong impact on respiratory health. We briefly comment on the need for early disease biomarkers and on the possible role of "-omic" technologies in identifying risk profiles predictive of chronic respiratory conditions. Such profiles could guide the ideation of effective preventive strategies and/or targeted early lifestyle or therapeutic interventions.

  1. An unexpected finding in a man with multiple pulmonary nodules, a pleural effusion and respiratory failure.

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    Pang, Yik Lam; Jones, Quentin

    2017-01-01

    We report the case of a 47-year old Caucasian man with a history of depression and high alcohol intake who presented with a one-month history of weight loss, dry cough and abdominal pain. He had no smoking history of note. The patient was treated for a suspected chest infection, however developed respiratory failure and was intubated. A CT showed multiple pulmonary nodules, left pleural thickening extending to the mediastinum and bilateral pleural effusions-larger on the left, suggestive of disseminated malignancy. A broncho-alveolar lavage surprisingly contained numerous acid-fast bacilli and no malignant cells. Treatment for tuberculosis was initiated and the patient recovered gradually. After several weeks, a pyrazinamide-resistant organism was cultured and subsequently identified to be Mycobacterium Bovis. We discuss this unexpected finding and review the literature on Bovine Tuberculosis in humans.

  2. Intravascular lymphoma presenting as a specific pulmonary embolism and acute respiratory failure: a case report

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    Georgin-Lavialle Sophie

    2009-05-01

    Full Text Available Abstract Introduction The occurrence of an intravascular lymphoma with severe pulmonary involvement mimicking pulmonary embolism is described. Case presentation A 38-year-old man was referred to our intensive care unit with acute respiratory failure and long lasting fever. Appropriate investigations failed to demonstrate any bacterial, viral, parasitic or mycobacterial infection. A chest computed tomography scan ruled out any proximal or sub-segmental pulmonary embolism but the ventilation/perfusion lung scan concluded that there was a high probability of pulmonary embolism. The cutaneous biopsy pathology diagnosed intravascular lymphoma. Conclusion Intravascular lymphoma is a rare disease characterized by exclusive or predominant growth of neoplastic cells within the lumina of small blood vessels. Lung involvement seems to be common, but predominant lung presentation of this disease is rare. In our patient, urgent chemotherapy, along with adequate supportive care allowed complete recovery.

  3. Infected cystic hygroma resulting in septic shock and respiratory failure: A case report

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    Maria E. Linnaus

    2016-06-01

    Full Text Available Macrocystic lymphatic malformations (cystic hygromas are a common cause of cystic neck lesions. These lesions are often diagnosed prenatally in children. In cases without airway compromise, these children are discharged from the hospital for elective treatment. Surgical excision is one treatment modality while sclerotherapy has recently shown adequate results as well. While infection is a relatively common problem for lymphatic malformations, the majority can be treated with antibiotics alone. We present a case in which septic shock and respiratory failure resulted from primary infection of a macrocystic lymphatic malformation in a term infant discharged with a lymphatic malformation of the neck. Urgent surgical drainage failed, and complete excision was ultimately required for source control due to numerous small multiloculated small cysts inaccessible via incision and drainage.

  4. Impaired intestinal fat absorption in chronic renal failure.

    Science.gov (United States)

    Drukker, A; Levy, E; Bronza, N; Stankiewicz, H; Goldstein, R

    1982-01-01

    We performed oral fat loading tests in 10 patients with chronic renal failure (CRF) on hemodialysis (5 children and 5 adults). Fat absorption was measured by hourly determination of serum triglycerides (TG), cholesterol (CHOL), and lipoproteins (LP) after oral administration of a 'milkshake' containing 50 g of fat of dairy origin. 10 age-matched healthy volunteers with normal fasting serum TG levels and 10 subjects with fasting hypertriglyceridemia served as controls. Mean fasting serum TG levels in CRF patients were elevated compared to normal controls (177.6 +/- 14.6 mg/dl, 2.0 +/- 17 mmol/l vs. 91.0 +/- 10.5 mg/dl, 1.03 +/- 12 mmol/l). 6 patients (4 adults, 2 children) had type IV LP patterns and 2 patients (both children) showed type IIb hyperlipidemia. In only 2 patients, 1 child and 1 adult were TG, CHOL and LP electrophoresis all normal. The oral fat loading test in all CRF patients showed delayed appearance of TG and chylomicrons (CHYL) in the bloodstream i.c. impaired or slow absorption of fat from the gut. In contrast to normal and hypertriglyceridemic controls, TG and CHYL levels in CRF did not decrease by 5 h after the oral fat load. This study demonstrates impaired intestinal fat absorption in children and adults with CRF.

  5. The Analysis of Anemia in Chronic Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Yuan Guiyi; Wu Wei; Luo Yilong; Li Yiqing; Zhou Shuxian; Fang Chang

    2006-01-01

    objectives To demonstrate the phenomena and explore the causes of anemia in patients with chronic heart failure (CHF). Methods To observe the phenomena of anemia in patients with CHF, a total of 276 patients with CHF were included in this retrospective study. The clinical characteristics of the patients are: mean age 69.2±11.0 years; male 151,female 125; NYHA Ⅲ and Ⅳ 115 (41.7%). Results ①Among the 276 patients with CHF, 81 (29.4%)had anemia (Mean hemoglobulin concentration 101.5±13.0g/L). ② Patients with Anemia were more likely to be female and to have greater NYHA (Ⅲ or Ⅳ) (P<0.05), higher serum creatinine, as well as lower serum albumin and low-density lipoprotein levels (P<0.01).③ A weak negative correlation was also noted between the level of NYHA and hemoglobulin. ④ There was no significant difference in age, the primary cardiac etiology of the CHF, the history of diabetes, left ventricular end diastolic diameter, and left ventricular ejection fraction between CHF patient with and without anemia. Conclusions The prevalence of anemia is high among patients with CHF. The anemia patients with CHF tend to be female, have greater cardiac and renal functional impairment, but with lower serum albumin and LDL that suggests some degree of malnutrition.

  6. Association of plasma manganese levels with chronic renal failure.

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    Sánchez-González, Cristina; López-Chaves, Carlos; Gómez-Aracena, Jorge; Galindo, Pilar; Aranda, Pilar; Llopis, Juan

    2015-01-01

    Manganese (Mn) is an essential trace element involved in the formation of bone and in amino acid, lipid and carbohydrate metabolism. Mn excess may be neurotoxic to humans, affecting specific areas of the central nervous system. However, relatively little is known about its physiological and/or toxicological effects, and very few data are available concerning the role of Mn in chronic renal failure (CRF). This paper describes a 12-month study of the evolution of plasma Mn levels in predialysis patients with CRF and the relationship with energy and macronutrient intake. The participants in this trial were 64 patients with CRF in predialysis and 62 healthy controls. Plasma levels of creatinine, urea, uric acid, total protein and Mn were measured. The glomerular filtration rate (GFR) was calculated using the Cockcroft-Gault index. The CRF patients had higher plasma levels of creatinine, urea, uric acid and Mn and a lower GFR than the controls. Plasma Mn was positively correlated with creatinine, plasma urea and plasma uric acid and was negatively correlated with the GFR and the intake of energy and macronutrients. In conclusion, CRF in predialysis patients is associated with increases in circulating levels of Mn.

  7. Total and free thyroid hormone levels in chronic renal failure.

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    Mehta H

    1991-04-01

    Full Text Available The levels of serum total thyroxine (TT4, triiodothyronine (TT3, free T3, (FT3 free T4 (FT4 and thyrotropin (TSH were measured in 127 clinically euthyroid patients with varying grades of chronic renal failure (CRF; and 97 healthy individuals. They were grouped as: Group I containing 93 patients on conservative management; Group II containing 34 patients on regular dialysis therapy; and Group III (normals. Group I patients showed significant decrease in TT3, TT4 and FT3 levels (p less than 0.001 as compared to Group III, whereas FT4 and TSH values in group I were not significantly altered. TT3, TT4 and FT3 levels reduced as the severity of renal damage increased. Variations in TT3, TT4, FT3, FT4 and TSH levels in Group II patients were similar to those in Group I, except for a decrease in TSH levels (p less than 0.05 as compared to normals. Several thyroid function tests are abnormal in CRF patients, however, finding of normal FT4 and TSH levels would indicate functional euthyroid status.

  8. Hearing evaluation in patients with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    Evis Bendo; Margarita Resuli; Spiros Metaxas

    2015-01-01

    Objective:To evaluate hearing threshold and the severity of hearing loss at different frequencies in patients with chronic renal failure (CRF), and to analyze the role of duration of disease on hearing threshold in patients of CRF by measuring pure-tone audiometry (PTA) and distortion-product otoacoustic emission (DPOAE). Methods: There were analysed 61 subjects (122 ears) from which 12 were patients starting hemodialise (A), 24 subjects were patients undergoing hemodialise over a year (B), 15 subjects were patients undergoing conservative treatment (C) and 10 controls (D). We did hearing evaluation by testing them using tympanometry, PTA and DPOAEs. Other parameters (blood pressure, body weight, blood chemistries) were also evaluated. Results:It was found a severe high-frequency hearing loss among patients with CRF comparing to the control group. Duration on haemodialysis treatment does not seem to have a significant impact on the incidence of hearing loss, although the method of treatment may influence the impact of the disease on hearing. Hearing loss among patients with CRF seemed to deteriorate further a year after the first evaluation. Conclusions:DPOAE raised the percentages of detection of SNHL indicating that it is a better technique than the conventional PTA for evaluation of hearing acuity.

  9. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure

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    Ilonka Rohm

    2016-01-01

    Full Text Available Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF. Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC. A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  10. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure.

    Science.gov (United States)

    Rohm, Ilonka; Kretzschmar, Daniel; Pistulli, Rudin; Franz, Marcus; Schulze, P Christian; Stumpf, Christian; Yilmaz, Atilla

    2016-01-01

    Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF). Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC). A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α) serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  11. Respiratory failure presenting in H1N1 influenza with Legionnaires disease: two case reports

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    Iannuzzi Michele

    2011-10-01

    Full Text Available Abstract Introduction Media sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis. Case Presentation We report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution. Conclusion Our two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar.

  12. Role of extracorporeal membrane oxygenation in adult respiratory failure: an overview.

    Science.gov (United States)

    Anand, Suneesh; Jayakumar, Divya; Aronow, Wilbert S; Chandy, Dipak

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) provides complete or partial support of the heart and lungs. Ever since its inception in the 1960s, it has been used across all age groups in the management of refractory respiratory failure and cardiogenic shock. While it has gained widespread acceptance in the neonatal and pediatric physician community, ECMO remains a controversial therapy for Acute Respiratory Distress Syndrome (ARDS) in adults. Its popularity was revived during the swine flu (H1N1) pandemic and advancements in technology have contributed to its increasing usage. ARDS continues to be a potentially devastating condition with significant mortality rates. Despite gaining more insights into this entity over the years, mechanical ventilation remains the only life-saving, yet potentially harmful intervention available for ARDS. ECMO shows promise in this regard by offering less dependence on mechanical ventilation, thereby potentially reducing ventilator-induced injury. However, the lack of rigorous clinical data has prevented ECMO from becoming the standard of care in the management of ARDS. Therefore, the results of two large ongoing randomized trials, which will hopefully throw more light on the role of ECMO in the management of this disease entity, are keenly awaited. In this article we will provide a basic overview of the development of ECMO, the types of ECMO, the pathogenesis of ARDS, different ventilation strategies for ARDS, the role of ECMO in ARDS and the role of ECMO as a bridge to lung transplantation.

  13. Advances in the Evaluation of Respiratory Pathophysiology during Exercise in Chronic Lung Diseases

    Science.gov (United States)

    O'Donnell, Denis E.; Elbehairy, Amany F.; Berton, Danilo C.; Domnik, Nicolle J.; Neder, J. Alberto

    2017-01-01

    Dyspnea and exercise limitation are among the most common symptoms experienced by patients with various chronic lung diseases and are linked to poor quality of life. Our understanding of the source and nature of perceived respiratory discomfort and exercise intolerance in chronic lung diseases has increased substantially in recent years. These new mechanistic insights are the primary focus of the current review. Cardiopulmonary exercise testing (CPET) provides a unique opportunity to objectively evaluate the ability of the respiratory system to respond to imposed incremental physiological stress. In addition to measuring aerobic capacity and quantifying an individual's cardiac and ventilatory reserves, we have expanded the role of CPET to include evaluation of symptom intensity, together with a simple “non-invasive” assessment of relevant ventilatory control parameters and dynamic respiratory mechanics during standardized incremental tests to tolerance. This review explores the application of the new advances in the clinical evaluation of the pathophysiology of exercise intolerance in chronic obstructive pulmonary disease (COPD), chronic asthma, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). We hope to demonstrate how this novel approach to CPET interpretation, which includes a quantification of activity-related dyspnea and evaluation of its underlying mechanisms, enhances our ability to meaningfully intervene to improve quality of life in these pathologically-distinct conditions. PMID:28275353

  14. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD

    Directory of Open Access Journals (Sweden)

    Anne E. Holland

    2013-12-01

    Full Text Available Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.

  15. 早期无创正压通气对慢性阻塞性肺疾病急性发作并呼吸衰竭患者血清N末端脑钠肽前体及超敏C反应蛋白的影响%Effect of noninvasive positive pressure ventilation on Brain Natriuretic Peptide and high sensitive C-reactive protein of acute exacerbation of chronic obstructive pulmonary disease patients with respiratory failur

    Institute of Scientific and Technical Information of China (English)

    孙丽; 杨欣荣; 杨勇; 刘琴

    2014-01-01

    目的 观察早期联合应用双水平无创正压通气(BiPAP)治疗对慢性阻塞性肺疾病急性发作(AECOPD)并呼吸衰竭患者血清N末端脑钠肽前体(NT-pro BNP)及血清超敏C反应蛋白(hs-CRP)的影响.方法 将100例AECOPD并呼吸衰竭患者应用计算机随机分成研究组和对照组各50例.两组均给予抗感染、舒张支气管、止咳化痰、氧疗等常规治疗.研究组在常规治疗基础上增加BiPAP呼吸机辅助治疗.在治疗前及治疗3d分别抽取患者的静脉血标本,测定血清NT-pm BNP和hs-CRP浓度进行比较分析,并对两组住院费用及住院时间进行比较.结果 治疗后研究组及对照组血清NT-pro BNP水平分别为(105.79 ±4.56)、(113.33±3.26) ng/L,差异有统计学意义(t=3.03,P<0.05);血清hs-CRP水平分别为(10.83±16.35)、(26.39±26.87) mg/L,差异有统计学意义(t=-3.44,P<0.05).研究组住院时间及住院费用均较对照组减少[(11.15±1.86)、(12.78±2.25)d,(6 659.11±1 609.49)、(8 031.31±1 449.79)元,t值分别为-3.87、-4.38,P均<0.05].结论 AECOPD并呼吸衰竭患者早期联合应用BiPAP治疗,能使血清NT-pro BNP及hs-CRP水平下降更快,病情更快缓解;对患者病情监测及判断临床疗效有一定价值.%Objective To investigate the concentrations of serum N-terminal brain natriuretic peptide (NT-pm BNP) and high-sensitivity C-reactive protein (hs-CRP) of acute exacerbation of chronic obstrnctive pulmonary disease(AECOPD) patients treated by bi-level positive airway pressure(BiPAP) for with respiratory failure.Methods A total of 100 respiratory failure in patients with AECOPD were divided into study group and control group,and 50 cases of each group.Patients in study group were received the conventional treatment(anti infection,diastolic bronchial,cough and phlegm and oxygen therapy) combined with BiPAP therapy,while in control group were received the conventional treatment.Blood samples were drawn at beginning and 3 d later

  16. [Parenteral iron therapy in chronic kidney disease or chronic heart failure].

    Science.gov (United States)

    Eisenga, Michele F; Diepenbroek, Adry; Swinkels, Dorine W; Bakker, Stephan J L; van der Meer, Peter; Gaillard, Carlo A J M

    2015-01-01

    Iron deficiency and anaemia occur frequently in patients with chronic kidney disease (CKD) or chronic heart failure (CHF) and are associated with lower quality of life and higher mortality. Treating anaemia with erythropoietic growth factors produces no improvement. In recent years, the focus has therefore shifted to correction of iron deficiency. Chronic inflammation in CKD increases the production of hepcidin, which blocks iron absorption from the intestine and leads to less efficient re-use of iron from the macrophages. In absolute iron deficiency the body's iron stores are depleted, whereas in functional iron deficiency the supply of iron is not sufficient to meet demand from the bone marrow. Normal or high ferritin levels do not exclude iron deficiency at tissue level. The iron saturation fraction is a more useful indicator. Parenteral iron therapy ameliorates in CHF the symptoms of iron deficiency, irrespective of the effect on haemoglobin levels. The long-term effects of intravenous iron on mortality and morbidity are still unknown.

  17. A 42-year-old farmer from Bangladesh with respiratory failure, septic arthritis, and multiple cavitating consolidations.

    Science.gov (United States)

    AlShati, Mohammed H; Joshi, Rajinder M

    2014-08-01

    A 42-year-old man was directly admitted to the ICU with respiratory failure and hypotension. Two weeks prior and just after returning from Bangladesh, he presented to a polyclinic with fever, right knee pain, and generalized aches, for which he received oral antibiotics. He was a farmer, had diabetes, never smoked, and consumed alcohol occasionally.

  18. Safety and Effectiveness of Bubble Continuous Positive Airway Pressure in Neonates With Respiratory Distress and Its Failure Factors

    Directory of Open Access Journals (Sweden)

    Ajay Sethi

    2015-09-01

    Conclusion: Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm and term neonates with mild to moderate respiratory distress. The major failure factors in our study were sepsis, recurrent apnea, and shock. The survival rate in our study was 60%. [Natl J Med Res 2015; 5(3.000: 202-206

  19. East coast fever caused by Theileria parva is characterized by macrophage activation associated with vasculitis and respiratory failure

    Science.gov (United States)

    Respiratory failure and death in East Coast Fever (ECF), a clinical syndrome of African cattle caused by the apicomplexan parasite Theileria parva, has historically been attributed to pulmonary infiltration by infected lymphocytes. However, immunohistochemical staining of tissue from T. parva infect...

  20. Nasal high-flow therapy for type II respiratory failure in COPD: A report of four cases

    Directory of Open Access Journals (Sweden)

    Ivan Pavlov

    2017-01-01

    Full Text Available Herein we present a report of four cases of severe type II respiratory failure that had contraindications both to conventional non-invasive ventilation and to endotracheal intubation. In all four cases, we successfully used a high-flow nasal oxygen device as a rescue device, with very reassuring outcomes.

  1. The emerging relationship between the airway microbiota and chronic respiratory disease: clinical implications.

    Science.gov (United States)

    Huang, Yvonne J; Lynch, Susan V

    2011-12-01

    Until recently, relationships between evidence of colonization or infection by specific microbial species and the development, persistence or exacerbation of pulmonary disease have informed our opinions of airway microbiology. However, recent applications of culture-independent tools for microbiome profiling have revealed a more diverse microbiota than previously recognized in the airways of patients with chronic pulmonary disease. New evidence indicates that the composition of airway microbiota differs in states of health and disease and with severity of symptoms and that the microbiota, as a collective entity, may contribute to pathophysiologic processes associated with chronic airway disease. Here, we review the evolution of airway microbiology studies of chronic pulmonary disease, focusing on asthma, chronic obstructive pulmonary disease and cystic fibrosis. Building on evidence derived from traditional microbiological approaches and more recent culture-independent microbiome studies, we discuss the implications of recent findings on potential microbial determinants of respiratory health or disease.

  2. CHRONIC HEART FAILURE: CLINICAL GUIDELINES AND REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    E. K. Shavarova

    2016-01-01

    Full Text Available Aim. Expert assessment of real clinical practice compliance with national guidelines on management of patients with chronic heart failure (HF before the opening of the Expert Center of HF treatment.Material and methods. All patients admitted to 2 city clinical hospitals of Moscow with HF were included into the register. Clinical, demographic, laboratory and instrumental characteristics and medical treatment before and during hospitalization were evaluated, as well as recommendations contained in the discharge summary.Results. 300 patients with HF were included into the register. The mean age was 75 years (39, 95; the proportion of men – 44%. 95% of patients had HF IIIV (NYHA, among them 24% HF II, 61% HF III, 15% HF IV (NYHA. HF with reduced ejection fraction (HFrEF was found in 45% of patients. 22% of the patients did not receive medical treatment before admission. 34% of patients with HFrEF received ACE inhibitors/angiotensin receptor blockers (ARBs, of which only 23% in effective dose. β-blockers were prescribed in 41% of HFeEF patients, of which 22% in the target dose. A third of patients needed in mineralocorticoid receptor antagonists (MRA received spironolactone. During hospitalization 81% of HFrEF patients received ACEI therapy, 12% – ARBs, 91% – β-blockers, 90% – MRA, 81% – loop diuretics and 13% – thiazide diuretics. According to the discharge summary 5% of patients did not receive post-discharge blocker of the renin-angiotensin-aldosterone system without explanation in the medical documentation. β-blocker with proven efficacy was prescribed to 70% of HFrEF patients. Spironolactone was recommended after discharge in 89% of HFrEF patients.Conclusion. Implementation of register of hospitalized patients with HF gives an opportunity to identify shortcomings in the provision of medical care both in outpatient and inpatient stages. 

  3. Dry Eye in Children with Chronic Renal Failure

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    Pınar Yüksekkaya

    2014-05-01

    Full Text Available Objectives: To evaluate the dry eye symptoms based on objective test and subjective findings in children with chronic renal failure (CRF and to compare the results with those in healthy subjects. Materials and Methods: Thirty-four children with CRF and 89 age- and sex-matched healthy subjects were included in this prospective study. Tear break-up time (TBUT and Schirmer test, subjective symptoms (burning, foreign-body sensation, hyperemia, itching, tearing, calcification of the conjunctiva, and corneal staining were evaluated. In the study group, relation between TBUT and Schirmer test results and duration of disease, duration of dialysis, serum calcium, phosphorus, urea, creatinine, and total protein levels were recorded. For statistical analysis, t-test, chi-square test, and Pearson’s correlation test were used. Results: In the study group, burning sensation was statistically higher than in the control group. Except this, according to the other subjective tests and corneal staining, there were no significant differences between the two groups (p>0.05. Conjunctival calcification was seen in 3 patients in the study group. The mean Schirmer test result was 21.1±8.0 and 23.7±8.0 mm in the study and control groups, respectively (p=0.101. The mean TBUT was 12.5±5.2 seconds (s in the study and 16.0±5.5 s in the control groups (p=0.002. None of the disease-related variables (the mean duration of disease and dialysis, serum calcium, phosphorus, urea, creatinine, and total protein levels were associated with dry eye syndrome (p>0.05. Conclusion: TBUT was statistically significantly lower, but Schirmet test result was not significantly different between children with CRF and age- and sex-matched healthy subjects. The disease-related variables have no effect in the development of dry eyes. (Turk J Ophthalmol 2014; 44: 196-200

  4. Clinical characteristics and risk factors of pulmonary hypertension associated with chronic respiratory diseases: a retrospective study

    Science.gov (United States)

    Chen, Yonghua; Liu, Chunli; Lu, Wenju; Li, Mengxi; Hadadi, Cyrus; Wang, Elizabeth Wenqian; Yang, Kai; Lai, Ning; Huang, Junyi; Li, Shiyue; Zhong, Nanshan

    2016-01-01

    Background Chronic respiratory disease-associated pulmonary hypertension (PH) is an important subtype of PH, which lacks clinical epidemiological data in China. Methods Six hundred and ninety three patients hospitalized from 2010 to 2013 were classified by echocardiography according to pulmonary arterial systolic pressure (PASP): mild (36≤ PASP 20 mm) were associated with moderate-to-severe PH, while RV [odds ratio (OR) =3.53, 95% CI, 2.17–5.74], NT-proBNP (OR=2.44, 95% CI, 1.51–3.95), HCT (OR=1.03, 95% CI, 1.00–1.07) and PaCO2 (OR=1.01, 95% CI, 1.00–1.03) were independent risk factors. Conclusions PH related to respiratory diseases is mostly mild to moderate, and the severity is associated with the category of respiratory disease. Increased HCT can be an independent risk factor for PH related to chronic respiratory diseases. PMID:27076929

  5. Effects of chronic exposure to crack cocaine on the respiratory tract of mice.

    Science.gov (United States)

    Herculiani, Percyleine P; Pires-Neto, Ruy C; Bueno, Heloisa M S; Zorzetto, Júlio C; Silva, Luiz C; Santos, Angela B G; Garcia, Raphael C T; Yonamine, Mauricio; Detregiachi, Cláudia R P; Saldiva, Paulo H N; Mauad, Thais

    2009-04-01

    Smoked cocaine (crack cocaine) causes several forms of injury to the respiratory tract, including asthma exacerbations, lung edema and hemorrhage, and nasal mucosal alterations. Few studies, however, have assessed respiratory tract pathology in habitual users of crack cocaine. Here, we describe the histological alterations in the respiratory tract of mice caused by chronic inhalation of crack cocaine. Twenty 2-month-old BALB/c mice were exposed to the smoke of 5 g crack cocaine in an inhalation chamber once a day for two months and compared to controls (n = 10). We then morphometrically analyzed nose and bronchiolar epithelial alterations, bronchiolar and alveolar macrophage cell density, alveolar hemosiderin content, and in addition determined the vasoconstriction index and the wall thickness of pulmonary arteries. The serum cocaine level was 212.5 ng/mL after a single inhalation. The mucus content of the nasal epithelium increased in crack-exposed animals, and the nasal and bronchial epithelium thickness decreased significantly. The alveolar hemosiderin content and the alveolar and bronchiolar macrophage cell density increased in animals exposed to crack. The vasoconstriction index increased in the pulmonary arteries of the exposed group. Chronic crack cocaine inhalation causes extensive histological changes along the entire respiratory tract.

  6. Acute electromyostimulation decreases muscle sympathetic nerve activity in patients with advanced chronic heart failure (EMSICA Study.

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    Marc Labrunée

    Full Text Available BACKGROUND: Muscle passive contraction of lower limb by neuromuscular electrostimulation (NMES is frequently used in chronic heart failure (CHF patients but no data are available concerning its action on sympathetic activity. However, Transcutaneous Electrical Nerve Stimulation (TENS is able to improve baroreflex in CHF. The primary aim of the present study was to investigate the acute effect of TENS and NMES compared to Sham stimulation on sympathetic overactivity as assessed by Muscle Sympathetic Nerve Activity (MSNA. METHODS: We performed a serie of two parallel, randomized, double blinded and sham controlled protocols in twenty-two CHF patients in New York Heart Association (NYHA Class III. Half of them performed stimulation by TENS, and the others tested NMES. RESULTS: Compare to Sham stimulation, both TENS and NMES are able to reduce MSNA (63.5 ± 3.5 vs 69.7 ± 3.1 bursts / min, p < 0.01 after TENS and 51.6 ± 3.3 vs 56.7 ± 3.3 bursts / min, p < 0, 01 after NMES. No variation of blood pressure, heart rate or respiratory parameters was observed after stimulation. CONCLUSION: The results suggest that sensory stimulation of lower limbs by electrical device, either TENS or NMES, could inhibit sympathetic outflow directed to legs in CHF patients. These properties could benefits CHF patients and pave the way for a new non-pharmacological approach of CHF.

  7. Coexistence of chronic renal failure, hashimoto thyroiditis and idiopathic hypoparathyroidism: a rare case report.

    Science.gov (United States)

    Yildiz, Saliha; Soyoral, Yasemin; Demirkiran, Davut; Ozturk, Mustafa

    2014-04-01

    Hypoparathyroidism is an uncommon disease and its coexistence with chronic renal failure is quite rare. Hypocalcemia and hyperphosphatemia are seen in both diseases. Diagnosis of hypoparathyroidism may be overlooked when parathormone response is not evaluated in patients with chronic renal failure. A 19-year-old female patient who had been receiving hemodialysis for 3 years because of chronic renal failure was diagnosed as idiopathic hypoparathyroidism and hashimoto thyroiditis. When her medical records on the first admission and medical history were evaluated, hypoparathyroidism and hashimoto thyroiditis were seen to be present also when she was started hemodialysis. Idiopathic hypoparathyroidism should be suspected in case as absence of parathormone response to hypocalcemia in patients with chronic renal failure. It should be taken into consideration that hashimoto thyroiditis may accompany and required analysis should be done.

  8. Solving the conundrum of Job: a probable biblical description of chronic renal failure with neurological symptoms.

    Science.gov (United States)

    Resende, Luiz Antonio de Lima; Kirchner, Daniel Rocco; Ruiz e Resende, Lucilene Silva

    2009-06-01

    The disease described in the Bible's Book of Job is controversial and had been of interest of theologists, psychiatrists, and dermatologists for many years. We describe several signs and symptoms compatible with chronic renal failure with neurological alterations.

  9. Time trend in hospitalised chronic lower respiratory diseases among Danish building and construction workers, 1981-2009

    DEFF Research Database (Denmark)

    Tüchsen, Finn; Hannerz, Harald; Mølgaard, Ellen Fisher;

    2012-01-01

    To show trends in age-standardised hospital admission ratios (SHR) for chronic lower respiratory diseases, estimated for Danish construction workers over three time periods (1981-1990, 1991-2000, 2001-2009).......To show trends in age-standardised hospital admission ratios (SHR) for chronic lower respiratory diseases, estimated for Danish construction workers over three time periods (1981-1990, 1991-2000, 2001-2009)....

  10. Anemia associated with chronic heart failure: current concepts

    OpenAIRE

    Shah R; Agarwal AK

    2013-01-01

    Ravish Shah, Anil K AgarwalDivision of Nephrology, The Ohio State University, Columbus, Ohio, USAAbstract: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not...

  11. Association between Plasma Fibrinogen Levels and Mortality in Acute-on-Chronic Hepatitis B Liver Failure

    OpenAIRE

    Zhexin Shao; Ying Zhao; Limin Feng; Guofang Feng; Juanwen Zhang; Jie Zhang

    2015-01-01

    Acute-on-chronic liver failure (AoCLF) is the most common type of liver failure and is associated with high mortality. Fibrinogen is critical in maintaining primary and secondary hemostasis. Therefore, we prospectively analyzed the association between fibrinogen and outcomes in AoCLF patients. Plasma fibrinogen was measured in 169 AoCLF, 173 chronic hepatitis B (CHB), and 171 healthy patients using a coagulation method. The predictive ability of fibrinogen for 3-month mortality in AoCLF patie...

  12. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

    OpenAIRE

    Perihan Öztürk; Neslihan Dokur; Ergül Kurutaş; Ekrem Doğan; Tuğba Karakaş; Murat Kalender; Hasan Ekerbiçer

    2012-01-01

    Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls. Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined fo...

  13. Variations in the lipid profile of patients with chronic renal failure treated with pyridoxine

    OpenAIRE

    2003-01-01

    Abstract Background Hyperhomocysteinemia and lipid abnormalities are commonly found in patients with chronic renal failure; both are recognized as risk factors for atherosclerosis. The homocysteine-lowering effect of pyridoxine is controversial. This study was performed to determine the effect of a high dose of pyridoxine (300 mg i.v. three times a week) on plasma and red blood cell lipid profile and plasma homocysteine concentration in twelve chronic renal failure patients on regular hemodia...

  14. [Sympathetic nerve activity in chronic renal failure - what are the therapeutic options?].

    Science.gov (United States)

    Hausberg, M; Tokmak, F

    2013-11-01

    Patients with chronic renal failure are characterized by a tonic elevation of sympathetic tone. This factor largely contributes to their increased cardiovascular risk. The increased sympathetic drive is caused by activiation of renal afferent fibers in the diseased kidneys. Therapeutic options for hypertensive patients with chronic renal failure with respect to their sympathetic overactivity are inhibitors of the renin-angiotensin-system and central sympatholytic drugs. The role of catheter-based renal denervation in these patients is currently under investigation.

  15. Clinical utility of biomarkers in chronic kidney disease and chronic heart failure.

    Science.gov (United States)

    Zachariah, Donah; Olechowski, Bartosz; Kalra, Paul R

    2013-09-01

    Biomarkers have an increasingly important clinical role in managing patients with heart failure as well as those with kidney disease, both common conditions with generally poor prognostic outcomes and huge impacts on healthcare economics. For patients with chronic heart failure, biomarkers have become centre place in streamlining diagnostic pathways as well as identifying those with worse prognosis. There is much interest in the role for biomarkers in identifying patients at risk of acute kidney injury, although a number of these currently remain as research tools or are in the early stages of evaluation in clinical practice. Patients with cardiorenal syndrome represent a particular challenge to the clinician, and recent studies have suggested a valuable clinical role for certain biomarkers in this setting, either on their own or in combination. This paper will focus on biomarkers with a current clinical role in patients with cardiorenal disease (natriuretic peptides and neutrophil gelatinase-associated lipocalin), although brief reference will be made to other biomarkers with potential future application.

  16. Chronic renal failure (CRF in children in Jugoslavia

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    Peco-Antić Amira

    2003-01-01

    Full Text Available The aim of this study was to analyse the demographic variables of chronic non-terminal (CRF and terminal (TRF renal failure patients (pts younger than 19 years treated in Serbia in June 2001. The prevalence of CRF pts was registered as 4,7 per million total population (pmtp or 14,1 per million child population (pmcp while corresponding values for TRF pts were 4,5 pmtp or 13,5 pmcp. The incidence of TRF pts during the period Jan.2000-Jan.2002 was 4,35 pmcp. Boys dominated only among CRF pts (34:14; 60,4% beeing between the ages of 6 and 19 yrs while at the time of diagnosis of HBI, 33,3 % of boys were yanger than 2 yrs.The causes of CRF were: reflux nephropathy 58,3%, congenital kidney disease 16,7%, familial/hereditary 14,6% glomerulonephritis 6,2% and Willms tu 4,1%. Reflux nephropathy was also the most common underlying disease of TRF accounted for 36,9% of total cases while glomerulonephritis was responsible for 23,9 %. Reflux nephropathy was associated with neural tube defect in 53,3% and with congenital lower urinary tract obstruction in 66,7%. The most of CRF (81,25% and TRF pts (95,6% were from Serbia, the others were from Monte Negro and Republic Srpska. The most of CRF (65% and TRF (80% pts were treated in University Children’s Hospital in Belgrade. Of CRF pts 46% had serum sreatinine 100-200 μmol/l, in 11% of pts it was 400-600 μmol/l and 2% of pts were in pre-terminal CRF. One third of CRF pts had proteinuria 150-500 mg/l, and second third had proteinuria greater of 1000 mg/l. Anemia was present in 54% of CRf pts, and arterial hypertension in 56%. Hemodialysis was dominant treatment modality for TRF pts and only 23,9% had functioning transplant. Conclusion: This is the first national study of demographic characteristics of pediatric CRF in Serbia. Since its prevalence is considerably lower than that in Western and North European countries the true prevalence is some what higher. The increasing incidence of pediatric TRF from 2

  17. Rhinovirus genome variation during chronic upper and lower respiratory tract infections.

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    Caroline Tapparel

    Full Text Available Routine screening of lung transplant recipients and hospital patients for respiratory virus infections allowed to identify human rhinovirus (HRV in the upper and lower respiratory tracts, including immunocompromised hosts chronically infected with the same strain over weeks or months. Phylogenetic analysis of 144 HRV-positive samples showed no apparent correlation between a given viral genotype or species and their ability to invade the lower respiratory tract or lead to protracted infection. By contrast, protracted infections were found almost exclusively in immunocompromised patients, thus suggesting that host factors rather than the virus genotype modulate disease outcome, in particular the immune response. Complete genome sequencing of five chronic cases to study rhinovirus genome adaptation showed that the calculated mutation frequency was in the range observed during acute human infections. Analysis of mutation hot spot regions between specimens collected at different times or in different body sites revealed that non-synonymous changes were mostly concentrated in the viral capsid genes VP1, VP2 and VP3, independent of the HRV type. In an immunosuppressed lung transplant recipient infected with the same HRV strain for more than two years, both classical and ultra-deep sequencing of samples collected at different time points in the upper and lower respiratory tracts showed that these virus populations were phylogenetically indistinguishable over the course of infection, except for the last month. Specific signatures were found in the last two lower respiratory tract populations, including changes in the 5'UTR polypyrimidine tract and the VP2 immunogenic site 2. These results highlight for the first time the ability of a given rhinovirus to evolve in the course of a natural infection in immunocompromised patients and complement data obtained from previous experimental inoculation studies in immunocompetent volunteers.

  18. August 2014 Phoenix pulmonary journal club: the use of macrolide antibiotics in chronic respiratory disease

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    Robbins RA

    2014-08-01

    Full Text Available No abstract available. Article truncated after 150 words. This month's journal club reviewed the role of macrolide antibiotics in chronic respiratory disease. Macrolide usage was suggested from observational studies in Japan in diffuse panbroncholitis, a disorder associated with chronic respiratory infection, usually Pseudomonas aeruginosa (1. Clinical improvement was noted despite doses of antibiotics well below the minimal inhibitory concentration (MIC of the antibiotic. This suggested the antibiotic was likely working by an anti-inflammatory effect. These observations were extended to cystic fibrosis (CF where prophylactic macrolide therapy in CF patients infected with Pseudomonas has become standard therapy (2. More recently, low dose macrolide therapy has been applied to non-CF lung diseases such as chronic obstructive pulmonary disease (COPD, bronchiectasis and asthma. Time did not permit a review of all studies so a representative sample was discussed. In patients with COPD, the four randomized, placebo-controlled trials reviewed all suggested that chronic therapy with macrolide antibiotics reduced COPD exacerbations (3-5. This ...

  19. Cardiac resynchronization therapy for chronic heart failure in China: guideline and practice

    Institute of Scientific and Technical Information of China (English)

    HUA Wei

    2010-01-01

    @@ The value of cardiac resynchronization therapy (CRT)in chronic heart failure has been well recognized around the world. Multi-center clinical trials have confirmed that CRT not only can improve cardiac function and quality of life, but also reduce mortality and improve the prognosis in patients with advanced heart failure and ventricular dyssynchrony.

  20. Chronic Renal Failure Presenting for the First Time as Pulmonary Mucormycosis with a Fatal Outcome

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    B. Jayakrishnan

    2015-01-01

    Full Text Available Pulmonary mucormycosis is an uncommon, but important, opportunistic fungal pneumonia which is often diagnosed late. Renal failure as the predominant presenting feature is not common in mucormycosis. Moreover, sudden, massive hemoptysis is not a usual complication. In this report we describe fatal pulmonary mucormycosis in a young patient with a previously undiagnosed chronic renal failure.

  1. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale.

    Science.gov (United States)

    Böhm, Michael; Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome.

  2. Anemia associated with chronic heart failure: current concepts.

    Science.gov (United States)

    Shah, Ravish; Agarwal, Anil K

    2013-01-01

    Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.

  3. 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].

  4. 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].

  5. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms

    Directory of Open Access Journals (Sweden)

    Rabahi MF

    2015-07-01

    Full Text Available Marcelo Fouad Rabahi,1,2 Sheila Alves Pereira,1 José Laerte Rodrigues Silva Júnior,1,2 Aline Pacheco de Rezende,1 Adeliane Castro da Costa,2 Krislainy de Sousa Corrêa,2,3 Marcus Barreto Conde4,5 1School of Medicine, Federal University of Goiás, Goiania, Brazil; 2Clínica do Aparelho Respiratório (CLARE, Goiania, Brazil; 3Pontifical Catholic University of Goiás, Goiania, Brazil; 4Faculdade de Medicina de Petrópolis/FASE, Petrópolis, Brazil; 5Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Background: The diagnosis of chronic obstructive pulmonary disease (COPD is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods: This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second <0.70. Results: Of a total of 570 subjects, 316 (55% met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7% patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3% reported no respiratory symptoms; 41 (17.6% patients with arterial hypertension and at least one respiratory symptom, and 10 (12% patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24. The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100% than among those with respiratory symptoms (56.1% (P=0.01. Conclusion: Our findings suggest that

  6. Dexamethasone and indomethacin modify endotoxin-induced respiratory failure in pigs.

    Science.gov (United States)

    Olson, N C; Brown, T T; Anderson, D L

    1985-01-01

    We studied the porcine pulmonary response to endotoxemia before and after administration of nonsteroidal antiinflammatory drugs (NSAID, i.e., indomethacin or flunixin meglumine) or dexamethasone (DEX). Escherichia coli endotoxin was infused intravenously into anesthetized 10- to 12-wk old pigs for 4.5 h. In endotoxemic pigs, the phase 1 (i.e., 0-2 h) increases in pulmonary arterial pressure, pulmonary vascular resistance (PVR), and alveolar-arterial O2 gradient and the decreases in cardiac index (CI) and lung dynamic compliance (Cdyn) were blocked by NSAID. Thus phase 1 changes were cyclooxygenase dependent. Furthermore, these effects were blocked or greatly attenuated by DEX. During phase 2 of endotoxemia (i.e., 2-4.5 h), the increased PVR and decreased CI and Cdyn were not blocked by NSAID but were attenuated by DEX, suggesting the presence of cyclooxygenase-independent metabolites. Both NSAID and DEX blocked the endotoxin-induced increases in lung water, bronchoalveolar lavage (BAL) neutrophil, and BAL albumin content. The fall in plasma proteins persisted in NSAID but not DEX-treated pigs. We conclude that endotoxemia in the pig causes severe acute respiratory failure largely mediated by cyclooxygenase and possibly lipoxygenase products of arachidonic acid metabolism.

  7. Predicting postoperative acute respiratory failure in critical care using nursing notes and physiological signals.

    Science.gov (United States)

    Huddar, Vijay; Rajan, Vaibhav; Bhattacharya, Sakyajit; Roy, Shourya

    2014-01-01

    Postoperative Acute Respiratory Failure (ARF) is a serious complication in critical care affecting patient morbidity and mortality. In this paper we investigate a novel approach to predicting ARF in critically ill patients. We study the use of two disparate sources of information – semi-structured text contained in nursing notes and investigative reports that are regularly recorded and the respiration rate, a physiological signal that is continuously monitored during a patient's ICU stay. Unlike previous works that retrospectively analyze complications, we exclude discharge summaries from our analysis envisaging a real time system that predicts ARF during the ICU stay. Our experiments, on more than 800 patient records from the MIMIC II database, demonstrate that text sources within the ICU contain strong signals for distinguishing between patients who are at risk for ARF from those who are not at risk. These results suggest that large scale systems using both structured and unstructured data recorded in critical care can be effectively used to predict complications, which in turn can lead to preemptive care with potentially improved outcomes, mortality rates and decreased length of stay and cost.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lidegran, Marika; Jorulf, Haakan [Department of Paediatric Radiology, Astrid Lindgren Children' s Hospital, Karolinska Hospital, Karolinska Institute, 17176 Stockholm (Sweden); Palmer, Kenneth; Linden, Viveka [Department of ECMO, Astrid Lindgren Children' s Hospital, Karolinska Hospital, Karolinska Institute, Stockholm (Sweden)

    2002-08-01

    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.)

  9. Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

    NARCIS (Netherlands)

    Teisman, ACH; van Veldhuisen, DJ; Boomsma, F; de Kam, PJ; Pinto, YM; de Zeeuw, D; van Gilst, WH

    2000-01-01

    Background: To date, the use of beta-blockers in treating patients with chronic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these beneficial effects may result from inhibition of deleterious neurohormone activa

  10. Effect of mibefradil on heart rate variability in patients with chronic heart failure

    NARCIS (Netherlands)

    Brouwer, J; de Kam, PJ; Haaksma, J; Crijns, HJGM; van Veldhuisen, DJ

    2000-01-01

    Background: Mibefradil was recently withdrawn from the market because of an unfavorable clinical profile in patients with chronic heart failure. Although drug interactions appear to play a role, other mechanisms such as proarrhythmia and autonomic deterioration could also be relevant. Chronic heart

  11. Serial pulmonary function tests to diagnose COPD in chronic heart failure

    NARCIS (Netherlands)

    Minasian, A.G.; Elshout, F.J.J. van den; Dekhuijzen, P.N.R.; Vos, P.J.E.; Willems, F.F.; Bergh, P.J.P.C. van den; Heijdra, Y.F.

    2014-01-01

    BACKGROUND: It is unknown whether serial pulmonary function tests are necessary for the correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients with stable non-congested chronic heart failure (CHF). The aim of this study was to determine the prevalence of COPD in outpatients wi

  12. Type D personality and cardiac mortality in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Smith, Otto R F; Pedersen, Susanne S.

    2010-01-01

    Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients....

  13. Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

    NARCIS (Netherlands)

    Damman, Kevin; Tang, W. H. Wilson; Felker, G. Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J. V.

    2014-01-01

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients

  14. Temperature effects on outpatient visits of respiratory diseases, asthma, and chronic airway obstruction in Taiwan

    Science.gov (United States)

    Wang, Yu-Chun; Lin, Yu-Kai

    2015-07-01

    This study evaluated the risk of outpatient visits for respiratory diseases, asthma, and chronic airway obstruction not elsewhere classified (CAO) associated with ambient temperatures and extreme temperature events from 2000 to 2008 in Taiwan. Based on geographical and socioeconomics characteristics, this study divided the whole island into seven areas. A distributed lag non-linear model was used to estimate the area-disease-specific cumulative relative risk (RR), and random-effect meta-analysis was used to estimate the pooled RR of outpatient visits, from lag 0 to lag 7 days, associated with daily temperature, and added effects of prolonged extreme heat and cold for population of all ages, the elderly and younger than 65 years. Pooled analyses showed that younger population had higher outpatient visits for exposing to low temperature of 18 °C, with cumulative 8-day RRs of 1.36 (95 % confidence interval (CI) 1.31-1.42) for respiratory diseases, 1.10 (95 % CI 1.03-1.18) for asthma, and 1.12 (95 % CI 1.02-1.22) for CAO. The elderly was more vulnerable to high temperature of 30 °C with the cumulative 8-day RR of 1.08 (95 % CI 1.03-1.13) for CAO. Elevated outpatient visits for all respiratory diseases and asthma were associated with extreme heat lasting for 6 to 8 days. On the contrary, the extreme cold lasting more than 8 days had significant negative association with outpatient visits of all respiratory diseases. In summary, elderly patients of respiratory diseases and CAO are vulnerable to high temperature. Cold temperature is associated with all types of respiratory diseases for younger patients.

  15. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2006-04-01

    Full Text Available 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 only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus, because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives: To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods: An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results: Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed

  16. The application of improved Glasgow coma scale score of 15 as switching point for invasive-noninvasive mechanical ventilation in treatment of severe respiratory failure in chronic obstructive pulmonary disease%以改良格拉斯哥昏迷评分15分为切换点在有创-无创机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭中的应用

    Institute of Scientific and Technical Information of China (English)

    郑大伟; 王承志; 刘仁水; 高峰; 邓顺莲; 周鹏; 何炎

    2011-01-01

    Objective To estimate the feasibility and the efficacy of early extubation and the sequential non-invasive mechanical ventilation (MV) in severe respiratory failure of chronic obstructive pulmonary disease (COPD) with the improved Glasgow coma scale (GCS) score of 15 as the switching point. Methods By a prospective control study, 20 patients with COPD and respiratory failure who had undergone endotracheal intubation and MV from March 2007 to November 2009 were enrolled as treatment group.Invasive MV with synchronous intermittent mandatory ventilation and pressure support ventilation (SIMV+PSV) pattern were given to these patients. When the period of "improved GCS score of 15 standard" window period appeared and being kept for 2 hours, endotracheal tube was extubated, and nasal mask with PSV±positive end-expiratory pressure (PEEP) was used, followed by gradual decrease of the level of pressure support till weaning of MV. Nineteen patients who were treated with MV with ordinary way of weaning from March 2005 to March 2007 served as the control group. Prior to the MV, the ventilation and oxygenation index, the length of invasive MV, total MV time, total hospital stay, re-intubation and ventilator-associated pneumonia (VAP) occurred in the number of cases were observed and compared between two groups. Results There was no significant difference in the ventilation and oxygenation index prior to the MV. Compared with control group, in treatment group, the length of invasive ventilation (days: 3. 2±1.1 vs. 10. 5± 3. 2),the total duration of MV (days: 4. 8±2. 5 vs. 10. 5±3. 2), the length of hospital stay (days:17±3 vs. 22±7) were significantly shorter (all P<0.01), and the incidence of VAP was significantly lower (cases: 0 vs.5, P< 0. 01), while the number of re-intubation was slightly higher but without statistical significance (cases:3 vs. 1, P>0. 05). Conclusion The application of improved GCS score of 15 as the switching point with 2 hours as window

  17. Persistent and Recurrent Bacterial Bronchitis—A Paradigm Shift in Our Understanding of Chronic Respiratory Disease

    Science.gov (United States)

    Ishak, Alya; Everard, Mark L.

    2017-01-01

    The recent recognition that the conducting airways are not “sterile” and that they have their own dynamic microbiome, together with the rapid advances in our understanding of microbial biofilms and their roles in the causation of respiratory diseases (such as chronic bronchitis, sinusitis, and chronic otitis media), permit us to update the “vicious circle” hypothesis of the causation of bronchiectasis. This proposes that chronic inflammation driven by persistent bacterial bronchitis (PBB) causes damage to both the epithelium, resulting in impaired mucociliary clearance, and to the airway wall, which eventually manifests as bronchiectasis. The link between a “chronic bronchitis” and a persistence of bacterial pathogens, such as non-typable Haemophilus influenzae, was first made more than 100 years ago, and its probable role in the causation of bronchiectasis was proposed soon afterward. The recognition that the “usual suspects” are adept at forming biofilms and hence are able to persist and dominate the normal dynamically changing “healthy microbiome” of the conducting airways provides an explanation for the chronic colonization of the bronchi and for the associated chronic neutrophil-dominated inflammation characteristic of a PBB. Understanding the complex interaction between the host and the microbial communities of the conducting airways in health and disease will be a key component in optimizing pulmonary health in the future. PMID:28261574

  18. Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure.

    Science.gov (United States)

    Lee, Yunseok; Kim, Byounggook; Chung, Ju-Hwan; Dan, Jinmyoung

    2011-12-01

    Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

  19. 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.

  20. 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.

  1. Veno-venous extracorporeal membrane oxygenation in a patient with severe acute respiratory failure – case report

    Science.gov (United States)

    Dec, Paweł Łukasz; Lesińska, Anna Justyna; Bocheńska, Anna; Wasilewski, Piotr; Feldyk, Grzegorz; Kubisa, Anna; Pieróg, Jarosław; Bielewicz, Michał; Grodzki, Tomasz

    2015-01-01

    Acute respiratory failure resistant to conventional pulmonary therapy often requires intensive medical care. In rare cases, ventilator therapy proves insufficient, and only the option of employing veno-venous extracorporeal membrane oxygenation (ECMO V-V) remains. The present article describes the case of a 23-year-old patient who experienced severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the pulmonary ward of the Alfred Sokołowski Regional Pulmonary Hospital in Szczecin-Zdunowo with suspected pneumonia of unknown etiology. After the initial 5 days of diagnostics at the pulmonary ward, the patient required a further 97 days of hospital treatment and spent 63 days at the Intensive Care Unit. There, he underwent ECMO V-V therapy lasting 22 days, which resulted in the improvement of his arterial blood gas parameters and clinical condition. PMID:26336483

  2. 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).

  3. 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.

  4. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3

    DEFF Research Database (Denmark)

    Bousquet, J; Farrell, J; Crooks, G;

    2016-01-01

    Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS ...

  5. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3 : Area 5)

    NARCIS (Netherlands)

    Bousquet, J; Farrell, J; Crooks, G; Hellings, P; Bel, E H; Bewick, M; Chavannes, N H; de Sousa, J Correia; Cruz, A A; Haahtela, T; Joos, G; Khaltaev, N; Malva, J; Muraro, A; Nogues, M; Palkonen, S; Pedersen, S; Robalo-Cordeiro, C; Samolinski, B; Strandberg, T; Valiulis, A; Yorgancioglu, A; Zuberbier, T; Bedbrook, A; Aberer, W; Adachi, M; Agusti, A; Akdis, C A; Akdis, M; Ankri, J; Alonso, A; Annesi-Maesano, I; Ansotegui, I J; Anto, J M; Arnavielhe, S; Arshad, H; Bai, C; Baiardini, I; Bachert, C; Baigenzhin, A K; Barbara, C; Bateman, E D; Beghé, B; Kheder, A Ben; Bennoor, K S; Benson, M; Bergmann, K C; Bieber, T; Bindslev-Jensen, C; Bjermer, L; Blain, H; Blasi, F; Boner, A L; Bonini, M; Bonini, S; Bosnic-Anticevitch, S; Boulet, L P; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Burney, P G; Bush, A; Caballero-Fonseca, F; Caimmi, D; Calderon, M A; Calverley, P M; Camargos, P A M; Canonica, G W; Camuzat, T; Carlsen, K H; Carr, W; Carriazo, A; Casale, T; Cepeda Sarabia, A M; Chatzi, L; Chen, Y. Z.; Chiron, R; Chkhartishvili, E; Chuchalin, A G; Chung, K F; Ciprandi, G; Cirule, I; Cox, L; Costa, D J; Custovic, A; Dahl, R; Dahlen, S E; Darsow, U; De Carlo, G; De Blay, F; Dedeu, T; Deleanu, D; De Manuel Keenoy, E; Demoly, P; Denburg, J A; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Dykewicz, M S; El-Gamal, Y; Emuzyte, R; Fabbri, L M; Fletcher, M; Fiocchi, A; Fink Wagner, A; Fonseca, J; Fokkens, W J; Forastiere, F; Frith, P; Gaga, M; Gamkrelidze, A; Garces, J; Garcia-Aymerich, J; Gemicioğlu, B; Gereda, J E; González Diaz, S; Gotua, M; Grisle, I; Grouse, L; Gutter, Z; Guzmán, M A; Heaney, L G; Hellquist-Dahl, B; Henderson, D; Hendry, A; Heinrich, J.; Heve, D; Horak, F; Hourihane, J O' B; Howarth, P; Humbert, M; Hyland, M E; Illario, M; Ivancevich, J C; Jardim, J R; Jares, E J; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Julge, K; Jung, K S; Just, J; Kaidashev, I; Kaitov, M R; Kalayci, O; Kalyoncu, A F; Keil, T; Keith, P K; Klimek, L; Koffi N'Goran, B; Kolek, V; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Lambrecht, B; Lau, S; Larenas-Linnemann, D; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Li, J.; Lodrup Carlsen, K; Louis, R; MacNee, W; Magard, Y; Magnan, A; Mahboub, B; Mair, A; Majer, I; Makela, M J; Manning, P; Mara, S; Marshall, G D; Masjedi, M R; Matignon, P; Maurer, M.; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Menzies-Gow, A; Merk, H.; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Mohammad, G M Y; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; Mösges, R; Mullol, J; Nafti, S; Namazova-Baranova, L; Naclerio, R; Neou, A; Neffen, H; Nekam, K; Niggemann, B; Ninot, G; Nyembue, T D; O'Hehir, R E; Ohta, K; Okamoto, Y; Okubo, K; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Panzner, P; Papadopoulos, N; Papi, A; Park, H S; Passalacqua, G; Pavord, I; Pawankar, R; Pengelly, R; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Poethig, D; Pohl, W; Popov, T A; Portejoie, F; Potter, P; Postma, D; Price, D; Rabe, K F; Raciborski, F; Radier Pontal, F; Repka-Ramirez, S; Reitamo, S; Rennard, S; Rodenas, F; Roberts, J; Roca, J; Rodriguez Mañas, L; Rolland, C; Roman-Rodriguez, M.; Romano, A; Rosado-Pinto, J; Rosario, N; Rosenwasser, L; Rottem, M; Ryan, D.; Sanchez-Borges, M; Scadding, G K; Schunemann, H J; Serrano, E; Schmid-Grendelmeier, P; Schulz, H; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Simons, F E R; Sisul, J C; Skrindo, I; Smit, H. A.; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Sterk, P J; Sunyer, J; Thijs, C.; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valia, E; Valovirta, E; Van Ganse, E; van Hage, M; Vandenplas, O; Vasankari, T; Vellas, B; Vestbo, J; Vezzani, G; Vichyanond, P; Viegi, G; Vogelmeier, C; Vontetsianos, T; Wagenmann, M; Wallaert, B; Walker, S; Wang, D. Y.; Wahn, U; Wickman, M; Williams, D M; Williams, S; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zaidi, A; Zar, H J; Zernotti, M E; Zhang, L.; Zhong, N; Zidarn, M; Mercier, J

    2016-01-01

    Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS int

  6. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3 Area 5)

    NARCIS (Netherlands)

    Bousquet, J; Farrell, J; Crooks, G; Hellings, P; Bel, E H; Bewick, M; Chavannes, N H; de Sousa, J Correia; Cruz, A A; Haahtela, T; Joos, G; Khaltaev, N; Malva, J; Muraro, A; Nogues, M; Palkonen, S; Pedersen, S; Robalo-Cordeiro, C; Samolinski, B; Strandberg, T; Valiulis, A; Yorgancioglu, A; Zuberbier, T; Bedbrook, A; Aberer, W; Adachi, M; Agusti, A; Akdis, C A; Akdis, M; Ankri, J; Alonso, A; Annesi-Maesano, I; Ansotegui, I J; Anto, J M; Arnavielhe, S; Arshad, H; Bai, C; Baiardini, I; Bachert, C; Baigenzhin, A K; Barbara, C; Bateman, E D; Beghé, B; Kheder, A Ben; Bennoor, K S; Benson, M; Bergmann, K C; Bieber, T; Bindslev-Jensen, C; Bjermer, L; Blain, H; Blasi, F; Boner, A L; Bonini, M; Bonini, S; Bosnic-Anticevitch, S; Boulet, L P; Bourret, R; Bousquet, P J; Braido, F; Briggs, A H; Brightling, C E; Brozek, J; Buhl, R; Burney, P G; Bush, A; Caballero-Fonseca, F; Caimmi, D; Calderon, M A; Calverley, P M; Camargos, P A M; Canonica, G W; Camuzat, T; Carlsen, K H; Carr, W; Carriazo, A; Casale, T; Cepeda Sarabia, A M; Chatzi, L; Chen, Y Z; Chiron, R; Chkhartishvili, E; Chuchalin, A G; Chung, K F; Ciprandi, G; Cirule, I; Cox, L; Costa, D J; Custovic, A; Dahl, R; Dahlen, S E; Darsow, U; De Carlo, G; De Blay, F; Dedeu, T; Deleanu, D; De Manuel Keenoy, E; Demoly, P; Denburg, J A; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dray, G; Dubakiene, R; Durham, S R; Dykewicz, M S; El-Gamal, Y; Emuzyte, R; Fabbri, L M; Fletcher, M; Fiocchi, A; Fink Wagner, A; Fonseca, J; Fokkens, W J; Forastiere, F; Frith, P; Gaga, M; Gamkrelidze, A; Garces, J; Garcia-Aymerich, J; Gemicioğlu, B; Gereda, J E; González Diaz, S; Gotua, M; Grisle, I; Grouse, L; Gutter, Z; Guzmán, M A; Heaney, L G; Hellquist-Dahl, B; Henderson, D; Hendry, A; Heinrich, J; Heve, D; Horak, F; Hourihane, J O' B; Howarth, P; Humbert, M; Hyland, M E; Illario, M; Ivancevich, J C; Jardim, J R; Jares, E J; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Julge, K; Jung, K S; Just, J; Kaidashev, I; Kaitov, M R; Kalayci, O; Kalyoncu, A F; Keil, T; Keith, P K; Klimek, L; Koffi N'Goran, B; Kolek, V; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Lambrecht, B; Lau, S; Larenas-Linnemann, D; Laune, D; Le, L T T; Lieberman, P; Lipworth, B; Li, J; Lodrup Carlsen, K; Louis, R; MacNee, W; Magard, Y; Magnan, A; Mahboub, B; Mair, A; Majer, I; Makela, M J; Manning, P; Mara, S; Marshall, G D; Masjedi, M R; Matignon, P; Maurer, M; Mavale-Manuel, S; Melén, E; Melo-Gomes, E; Meltzer, E O; Menzies-Gow, A; Merk, H; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Mohammad, G M Y; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; Mösges, R; Mullol, J; Nafti, S; Namazova-Baranova, L; Naclerio, R; Neou, A; Neffen, H; Nekam, K; Niggemann, B; Ninot, G; Nyembue, T D; O'Hehir, R E; Ohta, K; Okamoto, Y; Okubo, K; Ouedraogo, S; Paggiaro, P; Pali-Schöll, I; Panzner, P; Papadopoulos, N; Papi, A; Park, H S; Passalacqua, G; Pavord, I; Pawankar, R; Pengelly, R; Pfaar, O; Picard, R; Pigearias, B; Pin, I; Plavec, D; Poethig, D; Pohl, W; Popov, T A; Portejoie, F; Potter, P; Postma, D.; Price, D; Rabe, K F; Raciborski, F; Radier Pontal, F; Repka-Ramirez, S; Reitamo, S; Rennard, S; Rodenas, F; Roberts, J; Roca, J; Rodriguez Mañas, L; Rolland, C; Roman Rodriguez, M; Romano, A; Rosado-Pinto, J; Rosario, N; Rosenwasser, L; Rottem, M; Ryan, D; Sanchez-Borges, M; Scadding, G K; Schunemann, H J; Serrano, E; Schmid-Grendelmeier, P; Schulz, H; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Simons, F E R; Sisul, J C; Skrindo, I; Smit, H A; Solé, D; Sooronbaev, T; Spranger, O; Stelmach, R; Sterk, P J; Sunyer, J; Thijs, C; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valia, E; Valovirta, E; Van Ganse, E; van Hage, M; Vandenplas, O; Vasankari, T; Vellas, B; Vestbo, J; Vezzani, G; Vichyanond, P; Viegi, G; Vogelmeier, C; Vontetsianos, T; Wagenmann, M; Wallaert, B; Walker, S; Wang, D Y; Wahn, U; Wickman, M; Williams, D M; Williams, S; Wright, J; Yawn, B P; Yiallouros, P K; Yusuf, O M; Zaidi, A; Zar, H J; Zernotti, M E; Zhang, L; Zhong, N; Zidarn, M; Mercier, J

    2016-01-01

    Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS int

  7. Influence of sex on treatment and outcome in chronic heart failure.

    Science.gov (United States)

    Frankenstein, Lutz; Clark, Andrew L; Ribeiro, Jorge P

    2012-06-01

    The population is aging, the prevalence of heart failure increases with age, and on average women live longer than men. There is evidence for sex-specific effects of individual, guideline-recommended drugs used for treatment of chronic heart failure. Women are underrepresented in most clinical trials and only a minority of drug applications to regulatory authorities have included sex analyses. The present review focuses on the potential female survival benefit in heart failure, the influence of sex on medical treatment in a broader sense, and the potential benefit to be derived from guideline recommended treatment and common adjunctive heart failure medication.

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

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available 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.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.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.The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who

  9. Recurrent Respiratory Papillomatosis Causing Chronic Stridor and Delayed Speech in an 18-Month-Old Boy

    Directory of Open Access Journals (Sweden)

    Adel Alharbi

    2006-01-01

    Full Text Available Recurrent respiratory papillomatosis is a relatively uncommon disease that presents clinically with symptoms ranging from hoarseness to severe dyspnea. Human papilloma virus types 6 and 11 are important in the etiology of papillomas and are most probably transmitted from mother to child during birth. Although spontaneous remission is frequent, pulmonary spread and/or malignant transformation resulting in death has been reported. CO2 laser evaporation of papillomas and adjuvant drug therapy using lymphoblastoid interferon-alpha are the most common treatments. However, several other treatments have been tried, with varying success. In the present report, a case of laryngeal papillomatosis presenting with chronic stridor and delayed speech is described.

  10. 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.

  11. Postmortem changes in lungs in severe closed traumatic brain injury complicated by acute respiratory failure

    Directory of Open Access Journals (Sweden)

    V. A. Tumanskiy

    2013-08-01

    sings of ARDS in the fibroproliferative fase have been detected in the lungs in 50% patients who died on 7-15 th day with SCII complicated with ARI and being carried out ALV. In 50% deceased patients – macrofocal abscess pneumonia with ARDC on the background of the developing alveolar – interstitial fibrosis, that is dominated in deceased patients on the 16-26th day after SCII with respiratory failure in pulmonary, prevailing over the residual effects of the pulmonary edema and inflammation. A complex multicomponents mechanism of ARI with long-term treatment of SCII being indicative of perspective further research in the direction.

  12. Total liquid ventilation provides superior respiratory support to conventional mechanical ventilation in a large animal model of severe respiratory failure.

    Science.gov (United States)

    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 the pulmonary circulation until PaO2:FiO2 ≤ 60 mm Hg, followed by transition to a protective CMV protocol (n = 5) or TLV (n = 5) for 24 hours. Pathophysiology was recorded, and the lungs were harvested for histological analysis. Animals treated with CMV became progressively hypoxic and hypercarbic despite maximum ventilatory support. Sheep treated with TLV maintained normal blood gases with statistically greater PO2 (p < 10(-9)) and lower PCO2 (p < 10(-3)) than the CMV group. Survival at 24 hours in the TLV and CMV groups were 100% and 40%, respectively (p < 0.05). Thus, TLV provided gas exchange superior to CMV in this laboratory model of severe ARDS.

  13. [Atmospheric pollution and chronic respiratory diseases in the blast-furnace areas of iron-works].

    Science.gov (United States)

    Zannini, D; Valente, T; Rotunno, R; Giusto, R

    1977-01-01

    An epidemiologic research together with a study on the environmental pollution were carried out in order to evaluate the risk of chronic respiratory diseases of blast furnace workers. The environment study was performed mainly using personal samplers given to workers with different jobs. Observations on 222 work shifts have shown that the total dust concentration to which cast workmen, maintenance men and blast furnace service men were exposed, marginally exceed the TLV values. Furthermore the level of respirable dusts for blast furnace service men was found slightly excessive. The average SO2 concentration was largely below the TLV values. However this gas could be found in excess for very short periods during the work. The epidemiologic study, conducted on a cohort of blast furnace area workers against a control group cohort, indicated a moderate prevalence of pneumoconiosis and chronic bronchitis amongst blast furnaces workers. The clinic and radiological pictures do not seem to go beyond the initial stages.

  14. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure

    DEFF Research Database (Denmark)

    Brandt, Christopher Filtenborg; Tribler, Siri; Hvistendahl, Mark

    2017-01-01

    BACKGROUND/AIMS: Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and conseque...

  15. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study.

    Science.gov (United States)

    Chung, Wei-Sheng; Lai, Ching-Yuan; Lin, Cheng-Li; Kao, Chia-Hung

    2015-07-01

    Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD).We conducted a population-based case-control study to evaluate the effects of hypnotics on the risk of adverse respiratory events in patients with COPD.The case-control study was investigated using data retrieved from the Taiwan National Health Insurance Research Database. Patients with newly diagnosed adverse respiratory events (pneumonia, COPD with acute exacerbation, acute respiratory failure, and cardiopulmonary arrest) were included in the case group. Patients with COPD and no history of adverse respiratory events were randomly selected for the control group, which was frequency-matched with the case group according to index date, age (per 10 years), and sex. Patients who had used hypnotics within 1 month meant active users. The odds ratios (ORs) and 95% confidence intervals (CIs) of were calculated using univariable and multivariable logistic regression models.Most of the study participants were male (71.6%), and the mean ages of the participants in the case and control groups were 69.2 (±12.4) and 67.5 (±12.3) years, respectively. After potential confounding factors were adjusting for, the adjusted ORs of adverse respiratory events were 12.0 for active users of benzodiazepines (95% CI, 8.11-17.6) and 10.5 for active users of nonbenzodiazepines (95% CI, 7.68-14.2) compared with the adjusted ORs of those who never used hypnotics.The results of this epidemiological study suggested that hypnotics increased the risk of adverse respiratory events in patients with COPD.

  16. Hepatitis C, Chronic Renal Failure, Control Is Possible!

    Directory of Open Access Journals (Sweden)

    Seyed-Moayed Alavian

    2006-06-01

    Full Text Available Hepatitis C virus (HCV infection has come to the top of virus-induced liver diseases in many parts of the world. In Iran, it seems that HCV prevalence in general population is less than one percent, which is much lower than in most of the regional countries(1. However, the infection is emerging in Iran mostly due to problem of intravenous drug abuse and needle-sharing in the country (2, 3. The patients receiving maintenance transfusion such as chronic renal failure (CRF patients and the patients with thalassemia major are the other population who are at the high risk of HCV acquisition although compulsory blood screening has been able to remarkably decrease the HCV incidence in these patients (4. The prevalence of HCV infection among CRF patients on hemodialysis in Tehran, the capital of Iran, was around 13 percent in 2002 (5. There is no valid data regarding HCV incidence rate among CRF patients in country. However, according to the most recent official report of Management of Special Diseases and Transplantation Center (MSDT, the prevalence of HCV infection among patients on hemodialysis in the whole country has decreased from 14.4% in 1999 to 4.5% in 2005. Various reasons might be responsible for this reduction such as blood screening; developing technology of alternative modalities instead of transfusion in Iran like producing domestic Erythropoietin which has been resulted in decreasing transfusion; early transplantation; and training health staffs. On the other hand, the other reason such as mortality ofHCV infected CRF patients should not be neglected. Although there is no data in this regard in Iran, a meta-analysis, demonstrated that HCV infected patients on dialysis have an increased risk of mortality compared to HCV negative cases (6. Therefore, with the lack of data defining incidence rate in Iran, the reduction of HCV prevalence in the country should not overlook the necessity of designing a comprehensive strategy to control HCV

  17. COPD with respiratory failure:common causes and risk factors of death%COPD并发呼吸衰竭的常见诱因及其死亡危险因素分析

    Institute of Scientific and Technical Information of China (English)

    宣瑞萍; 查日田

    2011-01-01

    目的 探讨慢性阻塞性肺疾病(COPD)常见诱因及引起死亡的危险因素.方法 对78例COPD患者的临床资料进行回顾性分析.结果 78例COPD住院患者发生呼吸衰竭45例.呼吸衰竭发生和每年发作次数、全身营养状况、COPD的分级、有无吸人糖皮质激素、酸碱平衡紊乱、高血糖、有无真菌感染等因素有关.呼吸衰竭发生和与年龄、病史时间无关.呼吸衰竭死亡组中,合并心力衰竭、肺性脑病、酸碱平衡紊乱率高达100%.结论 COPD常见诱因复杂,并发呼吸衰竭死亡危险明显增加.%Objective To investigate common causes and risk factors causing death of the chronic obstructive pulmonary disease (COPD). Methods The data of 78 cases of COPD patients from June 2007 to June 2010 were retrospectively analyzed. Results Out of 78 hospitalized COPD patients, 45 cases had respiratory failure. The morbidity of respiratory failure was associated with the annual times of episodes, systemic nutritional status, COPD classification, inhaled corticosteroids application, acid -base balance disorders, high blood sugar,fungal infections and other f~tors. Respiratory failure had no relationship with age and the course of the disease ( P > 0.05 ). In the group who died of respiratory failure, the rate of combined complications including heart failure, pulmonary encephalopathy and acid - base disturbance was as high as 100%. Conclusion The causes of respiratory failure in COPD were complicated and risk of death respiratory failure was significantly increased.

  18. Tumoral calcinosis in a dog with chronic renal failure : clinical communication

    Directory of Open Access Journals (Sweden)

    T.C. Spotswood

    2003-06-01

    Full Text Available A 2-year-old male German shepherd dog in poor bodily condition was evaluated for thoracic limb lameness due to a large, firm mass medial to the left cranial scapula. Radiography revealed several large cauliflower-like mineralized masses in the craniomedial left scapula musculature, pectoral region and bilaterally in the biceps tendon sheaths. Urinalysis, haematology and serum biochemistry showed that the dog was severely anaemic, hyperphosphataemic and in chronic renal failure. The dog was euthanased and a full post mortem performed. A diagnosis of chronic renal failure with secondary hyperparathyroidism was confirmed. The mineralized masses were grossly and histopathologically consistent with a diagnosis of tumoral calcinosis. Tumoral calcinosis associated with chronic renal failure that does not involve the foot pads is rarely seen.

  19. Therapeutic Efficacy Observation on Acupoint Sticking for Edema Due to Chronic Cardiac Failure

    Institute of Scientific and Technical Information of China (English)

    Xu Jia-li

    2014-01-01

    Objective: To evaluate the therapeutic effect of acupoint sticking with Chinese herbs for edema due to chronic cardiac failure. Methods: One hundred and seventy patients in conformity with the diagnostic criteria of edema due to chronic cardiac failure were randomly divided into two groups, 85 cases in each group. The observation group was treated by oral administration of diuretics plus acupoint sticking with Chinese herbs. The control group was treated just by oral administration of diuretics same as the observation group. The therapeutic effects were evaluated after continuous intervention for 14 d. Results: The total effective rate was 90.6% in the observation group, remarkably higher than 67.1% in the control group. The difference of overall therapeutic effect between the two groups was statistically significant (P Conclusion: The therapeutic effect of acupoint sticking with Chinese herbs plus oral administration of diuretics is better than simple oral administration of diuretics in treatment of edema due to chronic cardiac failure.

  20. Sudden cardiac death in patients with diabetes mellitus and chronic heart failure.

    Science.gov (United States)

    Walker, Andrew Mn; Cubbon, Richard M

    2015-07-01

    In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area.

  1. Relationship of chronic pain and opioid use with respiratory disturbance during sleep.

    Science.gov (United States)

    Jungquist, Carla R; Flannery, Marie; Perlis, Michael L; Grace, Jeanne T

    2012-06-01

    This research assessed: 1) whether patients thought to have sleep disordered breathing would have more severe symptoms if they were taking opioids; 2) whether severity of sleep disordered breathing was associated with class or dose of opioid; and 3) whether pain intensity was associated with sleep disordered breathing. A descriptive cross-sectional study of patients referred for assessment of sleep disorders was conducted. Data were collected on a total of 419 subjects (no pain [n = 171], chronic pain without opioid treatment [n = 187], and chronic pain with opioid treatment [n = 61]). The findings suggest that regardless of opioid drug or dose, the management of chronic pain with opioids is not likely to exacerbate obstructive sleep apnea at stable doses. However, central sleep apnea was associated with opioid use. Patients with chronic pain taking opioids had a mean of 5 ± 13 central apneic events per hour compared with 1.6 ± 7 events per hour in patients without pain and not taking opioids. Oxygen saturation mean nadir 83.5% (opioid group) versus 82.9% (no pain, pain without opioid) was not significantly different. The clinical relevance of the effect is unknown, so the potential for marginal respiratory disturbance (an increase of 2.8 central events per hour for every 100 mg morphine-equivalent opioid dose) must be weighed against the therapeutic value of pain management with opioids.

  2. Chronic heart failure: Ca(2+), catabolism, and catastrophic cell death.

    Science.gov (United States)

    Cho, Geoffrey W; Altamirano, Francisco; Hill, Joseph A

    2016-04-01

    Robust successes have been achieved in recent years in conquering the acutely lethal manifestations of heart disease. Many patients who previously would have died now survive to enjoy happy and productive lives. Nevertheless, the devastating impact of heart disease continues unabated, as the spectrum of disease has evolved with new manifestations. In light of this ever-evolving challenge, insights that culminate in novel therapeutic targets are urgently needed. Here, we review fundamental mechanisms of heart failure, both with reduced (HFrEF) and preserved (HFpEF) ejection fraction. We discuss pathways that regulate cardiomyocyte remodeling and turnover, focusing on Ca(2+) signaling, autophagy, and apoptosis. In particular, we highlight recent insights pointing to novel connections among these events. We also explore mechanisms whereby potential therapeutic approaches targeting these processes may improve morbidity and mortality in the devastating syndrome of heart failure.

  3. Extracellular matrix remodeling in patients with ischemic chronic heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2015-04-01

    Full Text Available Aim. To identify features, relationships between parameters of the extracellular matrix and renal function in 110 patients with ischemic chronic heart failure the activity of collagen metabolism markers (MMP-9, TIMP-1, PICP, cystatin C, structural and functional parameters of the heart were studied using ELISA, echocardiography. Results. It was established that imbalance in the system MMP/TIMP in ischemic heart failure with preserved left ventricular ejection fraction leads to disruption of the extracellular matrix structural functional sufficiency, increases functional failure and is associated with impaired renal function. Conclusion. Correlation analysis showed significant relationships between MMP/TIMP and GFR, cystatin C, indicating that the significant role of extracellular matrix imbalance in the development of renal dysfunction in patients with ischemic chronic heart failure.

  4. [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

    Science.gov (United States)

    Genton, Audrey; Hullin, Roger; Tozzi, Piergiorgio; Cook, Stéphane; Liaudet, Lucas

    2012-12-12

    Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

  5. Exercise training in chronic heart failure: mechanisms and therapies

    OpenAIRE

    Piepoli, M. F.

    2012-01-01

    Decreased exercise capacity negatively affects the individuals’ ability to adequately perform activities required for normal daily life and, therefore, the independence and quality of life. Regular exercise training is associated with improved quality of life and survival in healthy individuals and in cardiovascular disease patients. Also in patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and reduce disability, hospitalisation and probably...

  6. Salt-induced changes in cardiac phosphoproteome in a rat model of chronic renal failure.

    Directory of Open Access Journals (Sweden)

    Zhengxiu Su

    Full Text Available Heart damage is widely present in patients with chronic kidney disease. Salt diet is the most important environmental factor affecting development of chronic renal failure and cardiovascular diseases. The proteins involved in chronic kidney disease -induced heart damage, especially their posttranslational modifications, remain largely unknown to date. Sprague-Dawley rats underwent 5/6 nephrectomy (chronic renal failure model or sham operation were treated for 2 weeks with a normal-(0.4% NaCl, or high-salt (4% NaCl diet. We employed TiO2 enrichment, iTRAQ labeling and liquid-chromatography tandem mass spectrometry strategy for phosphoproteomic profiling of left ventricular free walls in these animals. A total of 1724 unique phosphopeptides representing 2551 non-redundant phosphorylation sites corresponding to 763 phosphoproteins were identified. During normal salt feeding, 89 (54% phosphopeptides upregulated and 76 (46% phosphopeptides downregulated in chronic renal failure rats relative to sham rats. In chronic renal failure rats, high salt intake induced upregulation of 84 (49% phosphopeptides and downregulation of 88 (51% phosphopeptides. Database searches revealed that most of the identified phospholproteins were important signaling molecules such as protein kinases, receptors and phosphatases. These phospholproteins were involved in energy metabolism, cell communication, cell differentiation, cell death and other biological processes. The Search Tool for the Retrieval of Interacting Genes analysis revealed functional links among 15 significantly regulated phosphoproteins in chronic renal failure rats compared to sham group, and 23 altered phosphoproteins induced by high salt intake. The altered phosphorylation levels of two proteins involved in heart damage, lamin A and phospholamban were validated. Expression of the downstream genes of these two proteins, desmin and SERCA2a, were also analyzed.

  7. Salt-induced changes in cardiac phosphoproteome in a rat model of chronic renal failure.

    Science.gov (United States)

    Su, Zhengxiu; Zhu, Hongguo; Zhang, Menghuan; Wang, Liangliang; He, Hanchang; Jiang, Shaoling; Hou, Fan Fan; Li, Aiqing

    2014-01-01

    Heart damage is widely present in patients with chronic kidney disease. Salt diet is the most important environmental factor affecting development of chronic renal failure and cardiovascular diseases. The proteins involved in chronic kidney disease -induced heart damage, especially their posttranslational modifications, remain largely unknown to date. Sprague-Dawley rats underwent 5/6 nephrectomy (chronic renal failure model) or sham operation were treated for 2 weeks with a normal-(0.4% NaCl), or high-salt (4% NaCl) diet. We employed TiO2 enrichment, iTRAQ labeling and liquid-chromatography tandem mass spectrometry strategy for phosphoproteomic profiling of left ventricular free walls in these animals. A total of 1724 unique phosphopeptides representing 2551 non-redundant phosphorylation sites corresponding to 763 phosphoproteins were identified. During normal salt feeding, 89 (54%) phosphopeptides upregulated and 76 (46%) phosphopeptides downregulated in chronic renal failure rats relative to sham rats. In chronic renal failure rats, high salt intake induced upregulation of 84 (49%) phosphopeptides and downregulation of 88 (51%) phosphopeptides. Database searches revealed that most of the identified phospholproteins were important signaling molecules such as protein kinases, receptors and phosphatases. These phospholproteins were involved in energy metabolism, cell communication, cell differentiation, cell death and other biological processes. The Search Tool for the Retrieval of Interacting Genes analysis revealed functional links among 15 significantly regulated phosphoproteins in chronic renal failure rats compared to sham group, and 23 altered phosphoproteins induced by high salt intake. The altered phosphorylation levels of two proteins involved in heart damage, lamin A and phospholamban were validated. Expression of the downstream genes of these two proteins, desmin and SERCA2a, were also analyzed.

  8. Effects of home-based respiratory muscle training in children and adolescents with chronic lung disease

    Directory of Open Access Journals (Sweden)

    Iván Rodríguez

    2014-12-01

    Full Text Available OBJECTIVE: Respiratory muscle weakness is a functional repercussion of chronic lung disease (CLD. The objective of this study was to assess the effects of home-based respiratory muscle training (RMT in children and adolescents with CLD or neuromuscular disease (NMD. METHODS: This was a quasi-experimental study involving children and adolescents with CLD or NMD. Before and after 6 months of home-based RMT, we measured respiratory muscle strength (MIP and MEP, PEF, and peak cough flow (PCF. We made statistical comparisons between the pre-RMT and post-RMT values, as well as evaluating the correlation between the duration and effect of RMT. RESULTS: The study included 29 patients, with a mean age of 12 years (range, 5-17 years, of whom 18 (62.1% were male. The CLD group comprised 11 patients (37.9%, and the NMD group comprised 18 (62.1%. The mean duration of the RMT was 60 weeks (range, 46-90 weeks in the CLD group and 39 weeks (range, 24-89 weeks in the NMD group. In comparison with the pre-RMT values, the post-RMT values for MIP and MEP were significantly higher in both groups, whereas those for PEF and PCF were significantly higher only in the NMD group. We found no correlation between the duration and the effect of RMT. CONCLUSIONS: Home-based RMT appears to be an effective strategy for increasing respiratory muscle strength in children and adolescents with CLD or NMD, although it increased the ability to cough effectively only in those with NMD.

  9. Myocardial uptake of Tc-99m MDP in chronic renal failure with cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Eun; Sohn, Hyung Sun; Chung, Yong An; Park, Young Ha; Kim, Sung Hoon; Chung, Soo Kyo [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2000-06-01

    A uremic patient on hemodialysis, who had concurrent cardiomyopathy showed intense myocardial uptake of {sup 99m}Tc-methylene diphosphonate (MDP). The presumed cause of uptake in the myocardium is metastatic calcification due to hypercalcemia secondary to the renal failure. However, supplementary mechanism caused by cardiomyopathy should be considered. We describe a case with bone tracer uptake in the myocardium in the absence of infarction in a patient with chronic renal failure.

  10. Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    SHEN Yu-qin; WANG Le-min; CHE Lin; SONG Hao-ming; ZHANG Qi-ping

    2011-01-01

    Background Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity.Methods A total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) <0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF >0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities.Results The study showed that left ventricular end diastolic / systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P <0.01). The VO2AT, Peak VO2, Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P <0.05), VE/VCO2 slope was increased in patients with chronic heart failure (P <0.01). Multivariate linear regression analysis indicated that the patients' exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P=0.012), while Load AT correlated positively with LVEDD in control patients (P=0.006). VE/VCO2 slope correlated positively with LAD (B=0.477, P <0.0001) in chronic heart failure patients, while the VE/VCO2 slope correlated negatively with LAD in control patients (P=0.009).Conclusion The study indicates that the size of LVEDD and LAD are important

  11. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  12. Erythropoietin treatment does not compromise cardiovascular function in chronic renal failure

    DEFF Research Database (Denmark)

    Haedersdal, C; Mehlsen, J; Stenver, Doris Irene

    1994-01-01

    The anemia in patients with chronic renal failure can be corrected through treatment with recombinant human erythropoietin treatment. This correction is associated with changes in the rheologic variables, which could explain the changes in hemodynamics found by many investigators. The authors have...... followed up 11 patients with chronic renal failure on hemodialysis before and during six months of therapy with erythropoietin. The measurements were made before treatment, after four months of therapy, and after six months of therapy. The measurements included hematocrit, osmotic resistance of the red...

  13. [Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure].

    Science.gov (United States)

    Kazimoğlu, Cemal; Yağdi, Serhan; Karapinar, Hasan; Sener, Muhittin

    2007-01-01

    Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

  14. Physical Exercise and Patients with Chronic Renal Failure: A Meta-Analysis.

    Science.gov (United States)

    Qiu, Zhenzhen; Zheng, Kai; Zhang, Haoxiang; Feng, Ji; Wang, Lizhi; Zhou, Hao

    2017-01-01

    Chronic renal failure is a severe clinical problem which has some significant socioeconomic impact worldwide and hemodialysis is an important way to maintain patients' health state, but it seems difficult to get better in short time. Considering these, the aim in our research is to update and evaluate the effects of exercise on the health of patients with chronic renal failure. The databases were used to search for the relevant studies in English or Chinese. And the association between physical exercise and health state of patients with chronic renal failure has been investigated. Random-effect model was used to compare the physical function and capacity in exercise and control groups. Exercise is helpful in ameliorating the situation of blood pressure in patients with renal failure and significantly reduces VO2 in patients with renal failure. The results of subgroup analyses show that, in the age >50, physical activity can significantly reduce blood pressure in patients with renal failure. The activity program containing warm-up, strength, and aerobic exercises has benefits in blood pressure among sick people and improves their maximal oxygen consumption level. These can help patients in physical function and aerobic capacity and may give them further benefits.

  15. Recommendations for Patients with Chronic Respiratory Disease Considering Air Travel: A Statement from the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Dale Lien

    1998-01-01

    Full Text Available Patients with respiratory disease regularly seek the convenience of commercial airline travel. In addition to the stresses that all patients with chronic disease encounter, these patients are exposed to the affects of acute altitudinal hypoxemia. This in turn has the potential to produce significant symptoms and complications in-flight for patients with chronic respiratory disease. This article reviews the current literature, and seeks to help the practicing physician by providing recommendations on which patients should be assessed preflight, the type of assessment that should be carried out and recommendations for providing advice to these travelling patients.

  16. First case of atypical takotsubo cardiomyopathy in a bilateral lung-transplanted patient due to acute respiratory failure.

    Science.gov (United States)

    Ghadri, Jelena R; Bataisou, Roxana D; Diekmann, Johanna; Lüscher, Thomas F; Templin, Christian

    2015-10-01

    Takotsubo cardiomyopathy which is characterised by a transient left ventricular wall motion abnormality was first described in 1990. The disease is still not well known, and as such it is suggested that an emotional trigger is mandatory in this disease. We present the case of a 51-year old female patient seven years after bilateral lung transplantation, who developed acute respiratory distress syndrome and subsequently suffered from atypical takotsubo cardiomyopathy with transient severe reduction of ejection fraction and haemodynamic instability needing acute intensive care treatment. Acute respiratory failure has emerged as an important physical trigger factor in takotsubo cardiomyopathy. Little is known about the association of hypoxia and takotsubo cardiomyopathy which can elicit a life-threatening condition requiring acute intensive care. Therefore, experimental studies are needed to investigate the role of hypoxia in takotsubo cardiomyopathy.

  17. Diverse and Tissue Specific Mitochondrial Respiratory Response in A Mouse Model of Sepsis-Induced Multiple Organ Failure

    DEFF Research Database (Denmark)

    Karlsson, Michael; Hara, Naomi; Morata, Saori;

    2016-01-01

    Mitochondrial function is thought to play a role in sepsis-induced multiple organ failure. However, the temporal and organ specific alterations in mitochondrial function has yet to be fully elucidated. Many studies show reduced phosphorylating capacity while others have indicated that mitochondrial...... respiration is enhanced. The objective of the study was to evaluate the temporal dynamics of brain and liver mitochondrial function in a mouse model of sepsis.Sepsis was induced by cecal ligation and puncture. Controls were sham operated. Using high-resolution respirometry, brain and liver homogenates from 31......-production was detected.Liver homogenate from the septic mice displayed a significant increase of the respiratory control ratio at 6 hours. In the 24-hour group, the rate of maximal oxidative phosphorylation, as well as LEAK respiration, was significantly increased compared to controls and the resultant respiratory...

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

    NARCIS (Netherlands)

    E.P. 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, exogeno

  19. Pandigital and subcutaneous chronic tophaceous gout with acute renal failure

    Directory of Open Access Journals (Sweden)

    J Shashibhushan

    2015-01-01

    Full Text Available Gout (Podagra is a disorder of purine metabolism characterized by the deposition of monosodium urate crystals in joints and connective tissue and risk of deposition in kidney interstitium. Although acute gouty arthritis is familiar for most physicians, chronic gouty arthritis, which affects small joints of the hands can be difficult to distinguish from other common interphalangeal arthropathies such as rheumatoid arthritis (RA, psoriatic arthritis, and erosive osteoarthritis because of very similar presentations. Here we describe a 60-year-old male diabetic patient with pandigital, extensive subcutaneous tophaceous gout presented with uremic encephalopathy and joint deformities. He had been treated mistakenly as RA for 10 years.

  20. Sensorineural Hearing Affection In Sickle Cell Disease Patients With Chronic Renal Failure Under Dialysis

    Directory of Open Access Journals (Sweden)

    Saeed Abdelwhab Saeed MD*, Magdy M El Sharkawy

    2002-09-01

    Full Text Available Objective: to study the problem of hearing loss in patients of chronic renal failure on regular haemodialysis and The factors which affect it. And to study the effect of sickle cell disease on hearing loss. we studied hearing loss in dialysis patients, sickle cell disease patients and patients of sickle cell disease with chronic renal failure under dialysis compared to normal control subjects. Design: !"",include sickle cell disease patients with chronic renal fa"# $%& ' ", i ,nclude ( # #"# $%&'", , ,( #&'", i 9nclude the normal *+&*+' All groups are subjected to full history, thorough clinical examination including neurological and ENT examination, investigations includes Hb, s. creatinine, s.albumen, s.calcium and calculation of kt/v for dialysis patients. Full audiological assessment, using #,-GSI audiometer was done for all groups with special concentration at frequency of - .Results: hearing loss was found in patients with chronic renal failure more than normal control. Patient with sickle cell disease have hearing disorders significantly higher than $/%- .% 0( # #cell disease have significantly. Marked degree of SNHL than those with SCD only. Hearing loss in patients with 12( # * 3 &4 !4! '#"#"patients with chronic renal failure with or without SCD correlate with duration of dialysis , presence of peripheral neuropathy, s. calcium level, efficiency of dialysis marked by kt/v. Conclusion and recommendation: hearing disorder is common in patients with chronic renal failure under regular haemodialysis and it increase with duration of dialysis it should be suspected if there is Peripheral neuropathy. It can be reduced with efficient dialysis, correction of anemia, adjustment of calcium level. Patients with SCD suffer also some degree of hearing loss especially at higher frequency and this degree of hearing loss

  1. Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Michel Silva Reis

    2010-01-01

    Full Text Available BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12% and FEV1 41±11% predicted and nine age-matched healthy volunteers (64±5 years participated in this study. Heart-rate variability (HRV was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05. Moreover, significant and positive correlations between maximal inspiratory pressure (MIP and the inspiratory-expiratory difference (ΔIE (r = 0.60, p<0.01 were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.

  2. Noninvasive Mechanical Ventilation in COPD Patients with Type Ⅱ Respiratory Failure Failure Analysis%无创机械通气治疗COPD合并Ⅱ型呼吸衰竭失败原因分析

    Institute of Scientific and Technical Information of China (English)

    罗文恒

    2013-01-01

    Objective:To analyze the non-invasive mechanical ventilation in treatment of COPD(chronic obstructive pulmonary disease)to merge the reasons for the failure of Ⅱ -type respiratory failure,is safer,more effective use of non-invasive ventilation. Method:26 cases of hospital COPD(chronic obstructive pulmonary disease)Consolidated Ⅱ type respiratory failure requiring noninvasive mechanical ventilation retrospective analysis. Result:Hypoxemia and hypercapnia can not be corrected or aggravate 15 cases;five cases can not be tolerated;flatulence;to leak large two cases. Conclusion:Indications and contraindications,and establish good communication with patients and their families on the basis of the treatment process closely observed and dynamically adjust the parameter is the key to improve the non-invasive ventilation success rate.%  目的:分析无创机械通气治疗 COPD(慢性阻塞性肺疾病)合并Ⅱ型呼吸衰竭失败的原因,为更安全、更有效地使用无创通气。方法:对本院26例 COPD(慢性阻塞性肺疾病)合并Ⅱ型呼吸衰竭使用无创机械通气的原因进行回顾性分析。结果:低氧血症和高碳酸血症不能得到纠正或加重15例;不能耐受者5例;胃肠胀气4例;漏气量大2例。结论:掌握好适应证及禁忌证,在与患者及家属建立良好沟通的基础上,治疗过程严密观察和动态调节参数是提高无创通气成功率的关键。

  3. Liver disease and the e antigen in HBsAg carriers with chronic renal failure.

    OpenAIRE

    Coughlin, G P; Van Deth, A G; Disney, A P; Hay, J; Wangel, A G

    1980-01-01

    This study was undertaken to assess the frequency of development and the stages of evolution of chronic liver disease in patients with renal failure who are chronic carriers of hepatitis B surface antigen. Cirrhosis or chronic active hepatitis developed in five of 21 patients and could not be predicted by the initial histological appearance or by HLA-A and B typing but was associated with the e antigen in four of the five patients. However, the antigen was not a consistent indicator of a poor...

  4. Observation on the efficacy of noninvasive ventilator of ICU in the treatment of COPD merged with type II respiratory failure

    Institute of Scientific and Technical Information of China (English)

    Xiu-Min Zhang; Hai-Yan Wu; Xiao-Juan Sun

    2016-01-01

    Objective:To explore the efficacy of noninvasive ventilator of ICU in the treatment of COPD merged with type II respiratory failure. Methods:A total of 70 patients with COPD merged with type II respiratory failure were randomized into the observation group and the control group. The patients in the two groups were given anti-infection, cough relieving, phlegm dispersing, asthma relieving, cardiac function improving, electrolyte disturbance and acid-base balance correcting, and appropriate nursing interventions. The patients in the control group were given low-flow oxygen inhalation, while the patients in the observation group were given additional noninvasive ventilator for mask assisted ventilation through the mouth and nose. The changes of PaO2, PaCO2, SaO2, RR, and HR before treatment, and 3d after treatment were detected. The efficacy was evaluated, and the adverse reactions were observed. Results:After treatment, PaO2 and SaO2 in the two groups were elevated, while PaCO2 was reduced when compared with before treatment, and those in the observation group were significantly superior to those in the control group. After treatment, RR and HR were reduced, and those in the observation group were significantly superior to those in the control group. The total effective rate in the observation group was significantly higher than that in the control group (57.1%). And the comparison of the adverse reactions between the two groups was not statistically significant. Conclusions:ICU noninvasive ventilator in the treatment of COPD merged with type II respiratory failure can effectively improve hypoxia and CO2 retention, and rapidly relieve dyspnea, in combined with appropriate nursing intervention can guarantee the successful treatment.

  5. Chronic-Alcohol-Abuse-Induced Oxidative Stress in the Development of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Yan Liang

    2012-01-01

    Full Text Available Chronic alcohol ingestion increases the risk of developing acute respiratory distress syndrome (ARDS, a severe form of acute lung injury, characterized by alveolar epithelial and endothelial barrier disruption and intense inflammation. Alcohol abuse is also associated with a higher incidence of sepsis or pneumonia resulting in a higher rate of admittance to intensive care, longer inpatient stays, higher healthcare costs, and a 2–4 times greater mortality rate. Chronic alcohol ingestion induced severe oxidative stress associated with increased ROS generation, depletion of the critical antioxidant glutathione (GSH, and oxidation of the thiol/disulfide redox potential in the alveolar epithelial lining fluid and exhaled breath condensate. Across intracellular and extracellular GSH pools in alveolar type II cells and alveolar macrophages, chronic alcohol ingestion consistently induced a 40–60 mV oxidation of GSH/GSSG suggesting that the redox potentials of different alveolar GSH pools are in equilibrium. Alcohol-induced GSH depletion or oxidation was associated with impaired functions of alveolar type II cells and alveolar macrophages but could be reversed by restoring GSH pools in the alveolar lining fluid. The aims of this paper are to address the mechanisms for alcohol-induced GSH depletion and oxidation and the subsequent effects in alveolar barrier integrity, modulation of the immune response, and apoptosis.

  6. Erythropoietin treatment does not compromise cardiovascular function in chronic renal failure

    DEFF Research Database (Denmark)

    Haedersdal, C; Mehlsen, J; Stenver, Doris Irene;

    1994-01-01

    The anemia in patients with chronic renal failure can be corrected through treatment with recombinant human erythropoietin treatment. This correction is associated with changes in the rheologic variables, which could explain the changes in hemodynamics found by many investigators. The authors hav...

  7. Vascular endothelial cell function and cardiovascular risk factors in patients with chronic renal failure

    DEFF Research Database (Denmark)

    Haaber, A B; Eidemak, I; Jensen, T

    1995-01-01

    Cardiovascular risk factors and markers of endothelial cell function were studied in nondiabetic patients with mild to moderate chronic renal failure. The transcapillary escape rate of albumin and the plasma concentrations of von Willebrand factor, fibrinogen, and plasma lipids were measured in 29...

  8. Erythropoiesis-stimulating agents for anaemia in chronic heart failure patients

    NARCIS (Netherlands)

    Ngo, Katherine; Kotecha, Dipak; Walters, Julia A. E.; Manzano, Luis; Palazzuoli, Alberto; van Veldhuisen, Dirk J.; Flather, Marcus

    2010-01-01

    Background Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide. Anaemia is a common (12-55%) co-morbid condition and is associated with worsening symptoms and increased mortality. Anaemia is treatable and can be targeted in the treatment of patients with CHF. Erythrop

  9. Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

    LENUS (Irish Health Repository)

    Moran, D

    2014-08-23

    We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.

  10. What Works In Chronic Care Management : The Case Of Heart Failure

    NARCIS (Netherlands)

    Sochalski, Julie; Jaarsma, Tiny; Krumholz, Harlan M.; Laramee, Ann; McMurray, John J. V.; Naylor, Mary D.; Rich, Michael W.; Riegel, Barbara; Stewart, Simon

    2009-01-01

    The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes. We found that pa

  11. Plasma calprotectin levels reflect disease severity in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Jensen, Louise Jn; Kistorp, Caroline Michaela Nervil; Bjerre, Mette

    2011-01-01

    Background: Low-grade inflammation has been associated with cardiovascular disease (CVD) and chronic heart failure (CHF). The aim of the present study was to investigate the potential usefulness of the inflammatory protein calprotectin as a biomarker in CHF. Methods: Plasma calprotectin...

  12. Nebivolol: Its role in the treatment of hypertension and chronic heart failure

    NARCIS (Netherlands)

    Voors, Adriaan; Van Veldhuisen, D.J.

    2006-01-01

    (beta)-blockers are standard therapy in patients with cardiovascular disease, and have become a cornerstone in the treatment of both hypertension and chronic heart failure. However, two meta-analyses have recently raised doubts about the use of (beta)-blockers in patients with essential hypertension

  13. Distinct trajectories of fatigue in chronic heart failure and their association with prognosis

    NARCIS (Netherlands)

    Smith, Otto R. F.; Kupper, Nina; de Jonge, Peter; Denollet, Johan

    2010-01-01

    Aims To identify distinct trajectories of fatigue over a 12-month period and to examine their impact on mortality in chronic heart failure (CHF). Methods and results Consecutive CHF patients (n = 310) were assessed at baseline and at 2- and 12-month follow-up for symptoms of exertion and general fat

  14. Determinants of increased angiotensin II levels in severe chronic heart failure patients despite ACE inhibition

    NARCIS (Netherlands)

    van de Wal, RMA; Plokker, HWM; Lok, DJA; Boomsma, F; van Veldhuisen, DJ; van Gilst, WH; Voors, AA; Van Der Horst, F.A.L.

    2006-01-01

    Introduction: The beneficial effects of ACE inhibitors are generally ascribed to blockade of neurohormonal activation. However, especially in chronic heart failure (CHF) patients plasina angiotensin II and aldosterone levels can be elevated despite ACE inhibition, the so-called ACE escape. In the pr

  15. Exercise-based cardiac rehabilitation in patients with chronic heart failure : a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, A.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.A. (Tinus); Hendriks, E.J.M.

    2015-01-01

    Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate c

  16. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  17. Statins in the treatment of chronic heart failure: A systematic review

    NARCIS (Netherlands)

    van der Harst, P.; Voors, Adriaan; van Gilst, W.H.; Bohm, M.; Van Veldhuisen, D.J.

    2006-01-01

    Background The efficacy of statin therapy in patients with established chronic heart failure (CHF) is a subject of much debate. Methods and Findings We conducted three systematic literature searches to assess the evidence supporting the prescription of statins in CHF. First, we investigated the part

  18. Statins in the treatment of chronic heart failure : A systematic review

    NARCIS (Netherlands)

    van der Harst, Pim; Voors, Adriaan A.; van Gilst, Wiek H.; Boehm, Michael; van Veldhuisen, Dirk J.

    2006-01-01

    Background The efficacy of statin therapy in patients with established chronic heart failure (CHF) is a subject of much debate. Methods and Findings We conducted three systematic literature searches to assess the evidence supporting the prescription of statins in CHF. First, we investigated the part

  19. Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

    NARCIS (Netherlands)

    Conraads, Viviane M.; Spruit, Martijn A.; Braunschweig, Frieder; Cowie, Martin R.; Tavazzi, Luigi; Borggrefe, Martin; Hill, Michael R. S.; Jacobs, Sandra; Gerritse, Bart; van Veldhuisen, Dirk J.

    2014-01-01

    Background- Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF). Methods and Results- Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resyn

  20. Survival in Mediterranean Ambulatory Patients With Chronic Heart Failure. A Population-based Study

    NARCIS (Netherlands)

    Frigola Capell, E.; Comin-Colet, J.; Davins-Miralles, J.; Gich-Saladich, I.J.; Wensing, M.; Verdu-Rotellar, J.M.

    2013-01-01

    INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective

  1. Comparison of FDG-PET/CT images between chronic renal failure patients on hemodialysis and controls.

    Science.gov (United States)

    Toriihara, Akira; Kitazume, Yoshio; Nishida, Hidenori; Kubota, Kazunori; Nakadate, Masashi; Tateishi, Ukihide

    2015-01-01

    The whole-body 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) distribution in chronic renal failure (CRF) patients on hemodialysis would be different from that in subjects with normal renal function, because they lack urinary FDG excretion and remain in a constant volume overload. We evaluated the difference in the physiological uptake pattern of FDG between chronic renal failure patients on hemodialysis and control subjects. The subjects for this retrospective study consisted of 24 chronic renal failure patients on hemodialysis (HD group) and 24 age- and sex-matched control subjects (NC group). Standardized uptake values normalized by the body weight (SUVbw), ideal body weight (SUVibw), lean body mass (SUVlbm), and body surface area (SUVbsa) in the cerebellum, lungs, liver, gluteal muscles and subcutaneous fat, spleen, thoracolumbar spine, thoracic and abdominal aorta, and right atrium were calculated in positron emission tomography/computed tomography (PET/CT) images. SUVbw in the gluteal muscles, subcutaneous fat, spleen and right atrium was significantly higher in the HD group as compared to that in the NC group (p chronic renal failure patients on hemodialysis show significantly higher physiological FDG uptake in the soft tissues, spleen and blood pool.

  2. Effect of atracylodes rhizome polysaccharide in rats with adenine-induced chronic renal failure.

    Science.gov (United States)

    Yang, C; Liu, C; Zhou, Q; Xie, Y C; Qiu, X M; Feng, X

    2015-01-01

    The aim of the study was to elucidate the therapeutic effects of Atracylodes rhizome polysaccharide on adenine-induced chronic renal failure in rats. Fifty male Sprague Dawley rats were selected and randomly divided in to 5 groups (n=10 rats per group): The normal control group, the chronic renal failure pathological control group, the dexamethasone treatment group and two Atracylodes rhizome polysaccharide treatment groups, treated with two different concentrations of the polysaccharide, the Atracylodes rhizome polysaccharide high group and the Atracylodes rhizome polysaccharide low group. All the rats, except those in the normal control group were fed adenine-enriched diets, containing 10 g adenine per kg food for 3 weeks. After being fed with adenine, the dexamethasone treatment group, Atracylodes rhizome polysaccharide high group and Atracylodes rhizome polysaccharide low group rats were administered the drug orally for 2 weeks. On day 35, the kidney coefficient of the rats and the serum levels of creatinine, blood urea nitrogen, total protein and hemalbumin were determined. Subsequent to experimentation on a model of chronic renal failure in rats, the preparation was proven to be able to reduce serum levels of creatinine, blood urea nitrogen and hemalbumin levels (Prenal function. Atracylodes rhizome polysaccharide had reversed the majority of the indices of chronic renal failure in rats.

  3. Clinical, electrophysiological and brain imaging features during recurrent ictal cortical blindness associated with chronic liver failure.

    Science.gov (United States)

    van Pesch, V; Hernalsteen, D; van Rijckevorsel, K; Duprez, Th; Boschi, A; Ivanoiu, A; Sindic, C J M

    2006-12-01

    Transient neuroimaging features indicating primary cortical and secondary subcortical white matter cytotoxic oedema have been described in association with prolonged or intense seizures. We describe the unusual condition of recurrent ictal cortical blindness due to focal occipital status epilepticus, in the context of chronic hepatic failure. There was a close association between the onset and disappearance of clinical, electrophysiological and magnetic resonance imaging abnormalities.

  4. Leontiasis ossea in a patient with hyperparathyroidism secondary to chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Aggunlu, Levent; Akpek, Sergin; Coskun, Bilgen [Department of Radiology, School of Medicine, Gazi University, Besevler, Ankara (Turkey)

    2004-08-01

    Osteitis fibrosa describes the bone changes seen in renal osteodystrophy secondary to longstanding hyperparathyroidism. We report a 19-year-old man with longstanding chronic renal failure with a severe form of osteitis fibrosa affecting the jaws and other maxillofacial bones causing bizarre facial and dental deformity in a patient-uraemic leontiasis ossea. (orig.)

  5. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-01-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  6. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-09-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  7. Anaemia is associated with shorter leucocyte telomere length in patients with chronic heart failure

    NARCIS (Netherlands)

    Wong, Liza S. M.; Huzen, Jardi; van der Harst, Pim; de Boer, Rudolf A.; Codd, Veryan; Westenbrink, B. Daan; Benus, Germaine F. J. D.; Voors, Adriaan A.; van Gilst, Wiek H.; Samani, Nilesh J.; Jaarsma, Tiny; van Veldhuisen, Dirk J.

    2010-01-01

    Aims Anaemia is highly prevalent and associated with poor prognosis in patients with chronic heart failure (CHF). Reduced erythroid proliferation capacity of haematopoietic progenitor cells is associated with reduced telomere length, a marker of cellular ageing. We hypothesize that short telomere le

  8. [Taking into consideration patient concerns for the elaboration of educational programs for chronic renal failure patients].

    Science.gov (United States)

    Ayav, Carole; Empereur, Fabienne; Kessler, Michèle

    2013-02-01

    The objective was to take into consideration patient concerns for an original qualitative approach to the elaboration of three therapeutic education programs (TEP) designed for chronic renal failure patients, transplantation recipients, and dialysis patients. Four discussion groups involved patients with non-terminal chronic renal failure (one group), transplantation recipients (one group), and dialysis patients (two groups). Topics discussed were patients' knowledge of the TEP and their disease and treatment, patients' expectations concerning the educative content and the organisation of the TEP. For all levels of chronic renal failure, patient expectations focused on nutrition, treatments, and the social and occupational supportive network. Patients with non-terminal renal failure also expressed their expectations concerning the comprehension of laboratory tests and the course of their renal disease. Transplantation recipients wanted to strengthen their knowledge about graft evolution and immunosuppression. Dialysis patients expressed their concerns about disease announcement and the decision for dialysis. While certain topics were common, patients were preoccupied by different problems depending on their degree of renal insufficiency. Nephrolor thus integrated these different levels of concern into the elaboration of E'Dire programs designed for non-terminal renal failure patients and EDUGREFFE for transplant recipients. The third program designed for dialysis patients is currently in the development phase.

  9. Insulin resistance and hyperinsulinaemia in mild to moderate progressive chronic renal failure and its association with aerobic work capacity

    DEFF Research Database (Denmark)

    Eidemak, I; Feldt-Rasmussen, B; Kanstrup, I L;

    1995-01-01

    /I ratio in both groups. In conclusion, not only patients with end-stage chronic renal failure but also those with mild to moderate progressive chronic renal failure are insulin resistant and hyperinsulinaemic. The tissue sensitivity to insulin is correlated to the maximal aerobic work capacity suggesting...

  10. Osteotendinous repair of bilateral spontaneous quadriceps tendon ruptures with the Krackow technique in two patients with chronic renal failure.

    Science.gov (United States)

    Kara, Adnan; Sari, Seçkin; Şeker, Ali; Öztürk, Irfan

    2013-01-01

    Although unilateral traumatic quadriceps tendon rupture is a relatively frequent pathology, bilateral non-traumatic spontaneous ruptures are uncommon and are usually associated with chronic renal failure, hyperparathyroidism, gout, and systemic lupus erythematosus. This paper aimed to discuss two patients with chronic renal failure treated with the Krackow suture technique for spontaneous bilateral quadriceps tendon rupture.

  11. Anemic syndrome in patients with ischemic heart disease and chronic heart failure (review

    Directory of Open Access Journals (Sweden)

    Shvarts Y.G.

    2011-12-01

    Full Text Available Anemic syndrome of different severity often accompanies ischemic heart disease (IHD and chronic heart failure (CHF. Anemia has association with unfavorable prognosis in patients with all forms of CVD — acute and chronic. In this article the authors summarize a literature review of English articles dedicated to the problem of anemia and ischemic heart disease (IHD and the results of original research on the relationship between anemic syndrome and prognosis in the hospitalized patients with IHD and chronic heart failure (CHF. Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality in both systolic and diastolic chronic heart failure (CHF, morbidity and rate of hospitalization in CHF patients. Moreover, CHF itself could be involved in the pathogenesis of anemia. Early studies suggested a pathogenic role of inflammation mediators. The normalization of hemoglobin concentration by EPO and iron supply in patients with CHF and chronic renal insufficiency results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease, and lack of information about the effect of anemia treatment on prognosis of acute forms of IHD

  12. Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

    Directory of Open Access Journals (Sweden)

    Beyazit Zencirci

    2010-05-01

    Full Text Available Beyazit ZencirciKahramanmaras, TurkeyBackground: Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth.Case presentation: A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was successfully performed. Invasive blood pressure, central venous pressure, and heart rate were stable during the surgery. The mother returned to regular hemodialysis on the first postoperative day.Conclusion: Pregnancy is uncommon in women with chronic renal failure requiring chronic dialysis. Rates of maternal hypertension, pre-eclampsia, anemia, and infection in the pregnant chronic dialysis patient are high. However, our findings suggest that with careful, close, and effective monitoring preoperatively and intraoperatively, spinal anesthesia can be safely performed for cesarean section in patients undergoing hemodialysis.Keywords: chronic renal failure, pregnancy, spinal anesthesia, hemodialysis, placenta previa

  13. Periodontal Treatment Reduces Risk of Adverse Respiratory Events in Patients With Chronic Obstructive Pulmonary Disease: A Propensity-Matched Cohort Study.

    Science.gov (United States)

    Shen, Te-Chun; Chang, Pei-Ying; Lin, Cheng-Li; Chen, Chia-Hung; Tu, Chih-Yen; Hsia, Te-Chun; Shih, Chuen-Ming; Hsu, Wu-Huei; Sung, Fung-Chang; Kao, Chia-Hung

    2016-05-01

    Treatment of periodontal diseases has been associated with benefit outcomes for patients with chronic obstructive pulmonary disease (COPD). However, no population-based cohort study has been conducted. We evaluated this relationship by retrospective cohort study using a large population data.Using the National Health Insurance claims data of Taiwan, we identified 5562 COPD patients with periodontal diseases who had received periodontal treatment as the treatment group. The comparison group was selected at a 1:1 ratio matched by the propensity score estimated with age, sex, date of COPD diagnosis and periodontal treatment, and comorbidities. Both groups were followed up for 5 years to compare risks of acute exacerbation, pneumonia, and acute respiratory failure.The incidence rates of adverse respiratory events were significantly lower in the treatment group than in the comparison group: 3.79 versus 4.21 per 100 person-years for emergency room visits, 2.75 versus 3.65 per 100 person-years for hospitalizations, and 0.66 versus 0.75 per 100 person-years for intensive care unit admissions. The treatment group also had a 37% reduced risk of deaths (1.81 vs 2.87 per 100 person-years), with an adjusted hazard ratio of 0.57 (95% confidence interval 0.52-0.62).Periodontal treatment for COPD patients could reduce the risk of adverse respiratory events and mortality. The adequate periodontal health care is important for COPD patients with periodontal diseases.

  14. An aggressive merkel cell carcinoma in a patient with chronic renal failure

    Directory of Open Access Journals (Sweden)

    Sevda Gizlenti

    2014-12-01

    Full Text Available Merkel cell carcinoma (MCC is a rare cutaneous tumor arising from neuroendocrine cells and Merkel cells. Early diagnosis and treatment is important because of its aggressive course. We here report a 61 years old man with chronic renal failure, 3x5 cm mass on his right leg and inguinal-paraaortic lymph node metastases and resulting in death. MCC in the literature of the AIDS disease, organ transplantation, immunosuppressive therapy areas, and additional malignancies (multiple myeloma, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and melanoma have been reported in patients with increased incidence. Up to date a patient with renal transplantation and Merkel cell carcinoma have been reported in the literature, Merkel cell carcinoma with chronic renal failure have not been reported.

  15. Antioxidants deficiency: a sensitive indicator of cardiometabolic risk in chronic renal failure?

    Directory of Open Access Journals (Sweden)

    Pooja S.K. Rai

    2013-04-01

    Full Text Available Background: Antioxidant depletion occurring in chronic renal failure patients is an important cause of associated morbidity & mortality, which in turn imposes a great socioeconomic burden of health care. Early diagnosis & targeted management of this preventable deficiency may have a positive impact on the management of co morbidities associated with chronic renal failure. Aims & Objectives: To evaluate the status of antioxidants as an early indicator of cardiometabolic risk in chronic renal failure patients. Settings & Design: This was a randomised case Control study including 10 controls of either sex with normal renal function between age group 20-60 years and 15 patients of chronic renal failure on dialysis between the age group of 16 - 60 years. Methods: 12 hour fasting venous blood samples were collected from all the participants and were assayed for various antioxidants. Statistical analysis: Results were analyzed by unpaired t test, p value was determined & Correlation coefficient was calculated amongst various parameters. Results: In the present study, significantly low levels of vitamin C ( Cases: 0.367 ± 0.13 mg/dl controls: 1.324 ± 0.61 mg/dl; p < 0.01 & vitamin E (cases: 0.235 ± 0.102 mg/dl, controls (0.854 ± 0.28 mg/dl; p < 0.01 were observed in chronic renal failure patients as compared to controls. Conclusion: Diminished levels of Vitamin C & E in our study may be an indicator of increased oxidative stress which can be a responsible factor for increased incidence of cardiovascular complications. Supplementing these patients with recommended dosage of these vitamins may provide an essential tool to reduce the burden of suffering. [Int J Res Med Sci 2013; 1(2.000: 87-92

  16. Delivering Chronic Heart Failure Telemanagement via Multiple Interactive Platforms

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2013-06-01

    Full Text Available Existing telemonitoring systems provide limited support in implementing personalized treatment plans. We developed a Home Automated Telemanagement (HAT system for patients with congestive heart failure (CHF to provide support in following individualized treatment plans as well as to monitor symptoms, weight changes, and quality of life, while educating the patient on their disease. The system was developed for both a laptop computer and a Nintendo Wii. The system is designed to be placed in the patient's home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3-zone CHF action plan. Their medication regimen and suggested actions are determined by their care management team and integrated into the system, keeping a personalized approach to disease management while taking advantage of the technology available. The systems are designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. A feasibility assessment in African American patients with CHF and without prior computer or videogame experience demonstrated high level of acceptance of the CHF HAT laptop and Wii systems. Keywords: telem

  17. Congenital Hepatic Fibrosis: An Uncommon Cause of Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    A Azarfar

    2014-04-01

    Full Text Available Congenital Hepatic Fibrosis (CHF is a rare disease that affects both the liver and kidneys.  Congenital hepatic fibrosis (CHF is an autosomal recessive inherited malformation defined pathologically by a variable degree of periportal fibrosis and irregularly shaped proliferating bile ducts. Affected individuals also have impaired renal function, usually caused, in children and teenagers, by an autosomal recessive polycystic kidney disease (ARPKD. Impaired renal function associated with CHF in adults is caused by an autosomal dominant polycystic kidney disease (ADPKD. Case presentation: We report the case of a 8-year-old Iranian girlwas admitted to our hospital for evaluation ofrenal failure. In patient hepatomegaly was noted incidentally on a routine physical examination and then kidney biopsy showed global sclerosis and   A liver biopsy revealed proliferation of collagen fibres surrounding the portal area, a finding that was compatible with congenital hepatic fibrosisand our patient was scheduled for kidney and  liver transplantation. Conclusion: The relationship of ARPKD to CHF is the subject of substantial controversy. Some clinicians suggest that the two conditions represent one disorder with a range of clinical/pathological presentations Key word: Congenital Hepatic Fibrosis Polycystic Kidney Disease, CRF.

  18. [Quality of life and iron metabolism in patients with anemic syndrome developed on the background of chronic heart failure].

    Science.gov (United States)

    Ryndina, N; Kravchun, P; Tytova, G

    2013-03-01

    The presence of concomitant anemia in many aspects defines an unfavorable course of chronic heart failure, affects patient's quality of life. Among anemic patients with chronic heart failure prevailed persons with a relative deficiency of iron. Aim of the study - to evaluate the quality of life for patients with anemia on the background of chronic heart failure, using a questionnaire FACT-An, and to analyze the existence and nature of the relations between quality of life and indicators of the iron metabolism, based on the study of transferrin saturation and ferritin. Ferritin concentration was determined by ELISA. Transferrin saturation were determined by the formula. Questionnaire FACT-An was used for assess the quality of life in anemic patients with chronic heart failure. The presence of functional iron deficiency in patients with chronic heart failure and anemic syndrome is accompanied by deterioration of parameters of quality of life mainly due to the scale of physical activity and social functioning.

  19. Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis.

    Science.gov (United States)

    Brand, C; Sundararajan, V; Jones, C; Hutchinson, A; Campbell, D

    2005-05-01

    Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).

  20. Complementary and Alternative Medicine Methods in Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Zeynep Erdogan

    2014-08-01

    Full Text Available Despite its long history, use of complementary and alternative medicine (CAM methods has increased dramatically only after 1990s. Up to 57% of patients with chronic renal use CAM methods.These patienys use CAM methods to overcome hypertension, fatigue, constipation, leg edema, pain, cramps, anxiety, depression, sleep disorders, to cope with symptoms such as itching, to stop the progression of kidney disease and to improve their quality of life. Methods used are herbal products and food supplements, acupressure, acupuncture, homeopathy, exercise, aromatherapy, yoga and reflexology. Nephrotoxic effect of several CAM therapies used in patients with renal impairment could disturb hemodynamics by reducing the glomerular filtration rate. For this reason, health care providers should question patients about used of CAM, methods. Communication with patients should be clear and should not act judgmental. Health care personnel should learn more about CAM methods in order to avoid unwanted situations that could develop after the application of CAM methods. Patients should be informed correctly and scientifically about these methods to avoid harmful and unnecessary uses. [Archives Medical Review Journal 2014; 23(4.000: 770-786

  1. Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Kjøller, Erik; Køber, Lars; Iversen, Kasper

    2004-01-01

    AIMS: To evaluate the importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction. METHOD AND RESULTS: Prospective registration of 6669 consecutive patients admitted with infarction and screened...... in patients with acute myocardial infarction without congestive heart failure, but is also a confounding factor for the diagnosis of congestive heart failure....

  2. The management of neonatal acute and chronic renal failure: A review.

    Science.gov (United States)

    Coulthard, Malcolm G

    2016-11-01

    Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure. Conservative management frequently leads to under-nutrition or fluid overload. Acute peritoneal dialysis is often technically fraught in very small patients, and haemotherapies have been limited by vascular access and anticoagulation requirements, the need to blood-prime circuits, and serious limitations in regulating fluid removal. Newer devices, including the Nidus, have been specifically designed to reduce these difficulties.

  3. Micro-RNA-122 levels in acute liver failure and chronic hepatitis C.

    Science.gov (United States)

    Dubin, Perry H; Yuan, Hejun; Devine, Robert K; Hynan, Linda S; Jain, Mamta K; Lee, William M

    2014-09-01

    MicroRNA-122 (miR-122) is the foremost liver-related micro-RNA, but its role in the hepatocyte is not fully understood. To evaluate whether circulating levels of miR-122 are elevated in chronic-HCV for a reason other than hepatic injury, we compared serum level in patients with chronic hepatitis C to other forms of liver injury including patients with acute liver failure and healthy controls. MiR-122 was quantitated using sera from 35 acute liver failure patients (20 acetaminophen-induced, 15 other etiologies), 39 chronic-HCV patients and 12 controls. In parallel, human genomic DNA (hgDNA) levels were measured to reflect quantitatively the extent of hepatic necrosis. Additionally, six HIV-HCV co-infected patients, who achieved viral clearance after undergoing therapy with interferon and ribavirin, had serial sera miR-122 and hgDNA levels measured before and throughout treatment. Serum miR-122 levels were elevated approximately 100-fold in both acute liver failure and chronic-HCV sera as compared to controls (P < 0.001), whereas hgDNA levels were only elevated in acute liver failure patients as compared to both chronic-HCV and controls (P < 0.001). Subgroup analysis showed that chronic-HCV sera with normal aminotransferase levels showed elevated miR-122 despite low levels of hepatocyte necrosis. All successfully treated HCV patients showed a significant Log10 decrease in miR-122 levels ranging from 0.16 to 1.46, after sustained viral response. Chronic-HCV patients have very elevated serum miR-122 levels in the range of most patients with severe hepatic injury leading to acute liver failure. Eradication of HCV was associated with decreased miR-122 but not hgDNA. An additional mechanism besides hepatic injury may be active in chronic-HCV to explain the exaggerated circulating levels of miR-122 observed.

  4. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

    Directory of Open Access Journals (Sweden)

    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  5. DISTRIBUTION OF A 2ND DOSE OF EXOGENOUS SURFACTANT IN RABBITS WITH SEVERE RESPIRATORY-FAILURE

    NARCIS (Netherlands)

    PLOTZ, FB; STEVENS, H; HEIKAMP, A; OETOMO, SB

    1995-01-01

    Newborn infants with respiratory distress who fail to respond to surfactant treatment receive a second dose of surfactant. The effect of this strategy on the distribution of surfactant to the lung is unknown. We therefore investigated the distribution of the first (100 mg/kg body weight) and second

  6. DISTRIBUTION OF EXOGENOUS SURFACTANT IN RABBITS WITH SEVERE RESPIRATORY-FAILURE - THE EFFECT OF VOLUME

    NARCIS (Netherlands)

    VANDERBLEEK, J; PLOTZ, FB; VANOVERBEEK, FM; HEIKAMP, A; BEEKHUIS, H; WILDEVUUR, CRH; OKKEN, A; OETOMO, SB

    1993-01-01

    The transient effect of surfactant therapy that is observed in some patients might, at least in part, be explained by a nonhomogeneous distribution. Therefore, we investigated the distribution of a surfactant preparation (Alvofact, 45 g/L) that is used clinically. Rabbits with severe respiratory fai

  7. Oscillatory behaviour of ventricular action potential duration in heart failure patients at respiratory rate and low frequency

    Directory of Open Access Journals (Sweden)

    Ben eHanson

    2014-10-01

    Full Text Available Oscillations of arterial pressure occur spontaneously at a frequency of approx. 0.1Hz coupled with synchronous oscillations of sympathetic nerve activity (Mayer waves. This study investigated the extent to which corresponding oscillations may occur in ventricular action potential duration (APD.14 ambulatory (outpatient heart failure patients with biventricular pacing devices were studied while seated upright watching movie clips to maintain arousal. Activation recovery intervals (ARI as a measure of ventricular APD were obtained from unipolar electrograms recorded from the LV epicardial pacing lead during steady state RV pacing from the device. Arterial blood pressure was measured non-invasively (Finapress and respiration monitored. Oscillations were quantified using time frequency and coherence analysis.Oscillatory behaviour of ARI at the respiratory frequency was observed in all subjects. The magnitude of the ARI variation ranged from 2.2 ms to 6.9 ms (mean 5.0 ms. Coherence analysis showed a correlation with respiratory oscillation for an average of 43% of the recording time at a significance level of p < 0.05. Oscillations in systolic blood pressure in the Mayer wave frequency range were observed in all subjects for whom blood pressure was recorded (n=13. ARI oscillation in the Mayer wave frequency range was observed in 6/13 subjects (46% over a range of 2.9ms to 9.2ms. Coherence with Mayer waves at the p < 0.05 significance level was present for an average of 29 % of the recording time. In ambulatory patients with heart failure during enhanced mental arousal, left ventricular epicardial APD (ARI oscillated at the respiratory frequency (approx. 0.25Hz. In 6 patients (46% APD oscillated at the slower Mayer wave frequency (approx. 0.1 Hz. These findings may be important in understanding sympathetic activity-related arrhythmogenesis.

  8. Ubiquitination and proteolysis in limb and respiratory muscles of patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Debigaré, Richard; Côté, Claude H; Maltais, François

    2010-02-01

    Peripheral muscle dysfunction associated with chronic diseases is undeniably a growing problem as one of its main causes, chronic obstructive pulmonary disease (COPD), progresses. Among others, muscle atrophy is one component building the concept of muscle dysfunction. Muscle atrophy has a significant impact on patient clinical status, independent of the impairment in lung function. A lot of effort has been devoted lately to increasing our understanding of the relationship between COPD and the initiation and the development of muscle atrophy. A growing body of evidence is showing that the ubiquitin-proteasome system, an ATP-dependent proteolytic pathway, is playing a crucial role in the cascade leading to degradation of contractile proteins, thus promoting the development of muscle atrophy. Interestingly, this system is also involved in essential cellular processes such as response to hypoxemia and muscle tissue regeneration. In this review, existing evidence linking the activity of the ubiquitin-proteasome system and the cellular events taking place in respiratory and peripheral muscles of patients with COPD are reported. Based on this information, the reader should be able to understand the essential role of this pathway in the context of muscle homeostasis and to picture the coming research in this area.

  9. Effects of Abdominal Stimulation during Inspiratory Muscle Training on Respiratory Function of Chronic Stroke Patients.

    Science.gov (United States)

    Jung, Ju-Hyeon; Shim, Je-Myung; Kwon, Hae-Yeon; Kim, Ha-Roo; Kim, Bo-In

    2014-01-01

    [Purpose] The purpose of the present study was to verify a new method for improving respiratory functions by applying both abdominal stimulation and inspiratory muscle training (IMT) to train the inspiratory muscle and the expiratory muscle simultaneously, to improve the efficiency of IMT of chronic stroke patients. [Subjects] Eighteen stroke patients were randomly assigned to an experimental group (n = 9) and a control group (n = 9). [Methods] The experimental group was administered IMT with abdominal stimulation, and the control group was administered only IMT. During the intervention period, the experimental group and control group received training 20 min/day, 3 times/wk, for 4 weeks. To examine the lung functions of the subjects, FVC, FEV1, PEF, and FEF25-75 were measured using an electronic spirometer. The diaphragm thickness ratio was calculated from measurements made with a 7.5-MHz linear probe ultrasonic imaging system. [Result] The experimental group and the control group showed significant increases in diaphragm thickness ratio on the paretic side, but not on the non-paretic side. With regard to lung function, the experimental group showed significant increases in FEV1, PEF, and FEF25-75. The changes between before and after the intervention in the two groups were compared with each other, and the results showed significant differences in FEV1 and PEF. [Conclusion] The present study identified that IMT accompanied by abdominal stimulation improved the pulmonary function of chronic stroke patients.

  10. Chronic respiratory aeroallergen exposure in mice induces epithelial-mesenchymal transition in the large airways.

    Directory of Open Access Journals (Sweden)

    Jill R Johnson

    Full Text Available Chronic allergic asthma is characterized by Th2-polarized inflammation and leads to airway remodeling and fibrosis but the mechanisms involved are not clear. To determine whether epithelial-mesenchymal transition contributes to airway remodeling in asthma, we induced allergic airway inflammation in mice by intranasal administration of house dust mite (HDM extract for up to 15 consecutive weeks. We report that respiratory exposure to HDM led to significant airway inflammation and thickening of the smooth muscle layer in the wall of the large airways. Transforming growth factor beta-1 (TGF-β1 levels increased in mouse airways while epithelial cells lost expression of E-cadherin and occludin and gained expression of the mesenchymal proteins vimentin, alpha-smooth muscle actin (α-SMA and pro-collagen I. We also observed increased expression and nuclear translocation of Snail1, a transcriptional repressor of E-cadherin and a potent inducer of EMT, in the airway epithelial cells of HDM-exposed mice. Furthermore, fate-mapping studies revealed migration of airway epithelial cells into the sub-epithelial regions of the airway wall. These results show the contribution of EMT to airway remodeling in chronic asthma-like inflammation and suggest that Th2-polarized airway inflammation can trigger invasion of epithelial cells into the subepithelial regions of the airway wall where they contribute to fibrosis, demonstrating a previously unknown plasticity of the airway epithelium in allergic airway disease.

  11. Prognostic value of Doppler transmitral filling patterns in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhe-lan郑哲岚; A.Meissner; B.Hausmann; H.Alexander; R.Simon

    2004-01-01

    Background Chronic heart failure is a significant cause of cardiovascular morbidity and mortality.This study tested the hypothesis that restrictive filling pattern may provide useful prognostic data for identifying patients with chronic heart failure at high risk of all-cause cardiac death.Methods Ninety patients with chronic heart failure [70 men and 20 women, mean age (58.1±11.6) years] were investigated and followed for (18. 8±7. 9) months. During this period, 14 patients died of progressive pump failure, 12 patients underwent heart transplantation, 5 patients died suddenly, and 2 patients died of acute myocardial infarction. A new criterion, the restrictive filling index (RFI), was designed to subgroup patients into a restrictive and a nonrestrictive group.Results Patients with restrictive filling pattern had a more severe left ventricular dysfunction and a higher cardiac mortality. Analysis by the Kaplan-Meier method revealed that patients in the RFI≥1 and RFI<1 groups had a cardiac events-free survival rate of 52% versus 94% at 1 year, and 27. 5% versus 92% at 2 years, respectively. The multivariate Cox proportional hazard model selected RFI as the most powerful prognostic factor (χ2 =8. 8017, P =0. 0030) for all-cause cardiac death.

  12. Increased glycation of hemoglobin in chronic renal failure: [corrected] potential role of oxidative stress.

    Science.gov (United States)

    Selvaraj, Nambiar; Bobby, Zachariah; Sridhar, Magadi Gopalakrishna

    2008-04-01

    Among the various mechanisms proposed, the process of non-enzymatic glycation of proteins is believed to play an important role in the pathogenesis of chronic complications associated with renal failure. The two traditional factors found to modulate the early glycation of proteins are the prevailing concentration of glucose and half life of the protein. Among the various proteins that are known to undergo nonenzymatic glycation in vivo, hemoglobin has been the most thoroughly investigated. Determination of glycated hemoglobin in diabetic patients is currently acknowledged as the most reliable indicator for assessment of retrospective glycemic control and the planning of clinical management. The clinical utility of glycated hemoglobin measurements, however, in renal failure is controversial, given the numerous earlier studies showing no correlation between glycated hemoglobin and other indicators of blood glucose control in uremic subjects. With few exceptions, previous studies have suggested that the concentration of glycated hemoglobin was increased in uremic patients. There is documented evidence that increased glycated hemoglobin levels are found in certain non-diabetic states. So it stands to reason that hyperglycemia, although clearly being the culprit in diabetes, does not provide the complete answer to the etiology of increased early glycated products in non-diabetic conditions including chronic renal failure. This article reviews available evidence supporting increased glycation of hemoglobin in patients with chronic renal failure. Potential mechanisms for this increase are examined with special emphasis on the potential role of oxidative stress.

  13. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment

    Directory of Open Access Journals (Sweden)

    Bordoni B

    2015-10-01

    Full Text Available Bruno Bordoni,1–3 F Marelli2,3 1Don Carlo Gnocchi Foundation, Department of Cardiology, IRCCS Santa Maria Nascente, Milan, Italy; 2School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, AN, Italy; 3School CRESO, Osteopathic Centre for Research and Studies, Castellanza, VA, Italy Abstract: Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient. Keywords: manual therapy, fatigue, chronic heart failure, osteopathic

  14. Change of liver echogenicity in chronic renal failure: Correlation with serologic test and pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Eun, Hyo Won; Cho, Kyoung Sik; Kim, Jeong Kon [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of); Kim, Jung Hoon [Soonchunhyang University School of Medicine, Seoul (Korea, Republic of)

    2002-09-15

    To correlate serologic test and pathologic findings with change of hepatic parenchymal echogenicity on ultrasound (US) in patients with chronic renal failure. From January 1995 to April 2000, among eight hundred eighty four patients with kidney transplantation due to chronic renal failure, sixty seven patients who underwent US-guided liver biopsy were selected. Change of liver echogenicity on US was analyzed, and this change was compared with serologic test and pathologic findings. Among sixty seven patients, pathologic findings of thirty four patients with the normal liver echogenicity on US revealed normal in 15 patients (44%), viral hepatitis in 18 (53%), and liver cirrhosis in one patient (3%). Meanwhile, twenty seven patients with chronic liver disease on US were pathologically confirmed as normal in 13 patients (48%), viral hepatitis in 11 (40%), liver cirrhosis in four patients (11%); six patients with cirrhotic change on US, liver cirrhosis in four patients (67%) and viral hepatitis on two patients (33%). Serologic test of thirty four patients with the normal liver echogenicity on US showed positive HBs Ag in 17 patients (50%), positive anti-HCV Ab in 11 (32%), positive in both HBs Ag and anti-HCV Ab in one (3%), and normal result in five patients (15%). In patients with chronic renal failure, it is nor enough to determine the presence of liver disease only based on change of echogenicity on US. A careful correlation with serologic test and, if needed, pathologic confirmation are recommended for the accurate preoperative evaluation of the liver.

  15. Chronic respiratory disease in adults treated for tuberculosis in Khartoum, Sudan

    Science.gov (United States)

    Mortimer, K.; Bjune, G.; El Sony, A. I.

    2016-01-01

    Background: Chronic respiratory disease (CRD) causes substantial morbidity and mortality. Although the global CRD epidemic collides with the tuberculosis (TB) epidemic in many low- and middle-income country settings, the risk of TB-associated CRD is not well described in countries with a high burden of TB. Methods: We recruited 136 patients with a history of sputum smear-positive pulmonary TB (PTB) from the TB clinic at Omdurman Teaching Hospital in Khartoum, Sudan, and 136 age- and sex-matched community controls, between 28 July 2013 and 30 December 2013. Data were collected using standardised questionnaires and spirometry was performed before and after bronchodilator. Results: The mean age of the subjects with previous PTB and controls was respectively 44.0 years (SD 8.5) and 44.5 years (SD 8.6), with 27.2% females in both groups. Chronic respiratory symptoms such as chronic cough (OR 6.67, 95%CI 2.98–14.90, P grupo de los casos fue 44,0 (desviación estándar 8,5 años) y en el grupo de testigos fue 44,5 años (8,6 años); la proporción de mujeres en ambos grupos fue 27,2%. Se observó una fuerte asociación entre la presencia de síntomas respiratorios crónicos como la tos (OR 6,67; IC95% 2,98–14,90; P < 0,001) y la presencia de obstrucción crónica al flujo en las vías respiratorias (OR 12,39; IC95% 1,56–98,40; P = 0,02) en las personas con antecedente de TBP, una vez corregidos los posibles factores de confusión. Conclusión: La presencia de rasgos clínicos de EPC exhibe una fuerte correlación con el antecedente de TBP. Es preciso considerar la posibilidad de aplicar un enfoque integrado con el fin de mejorar la atención de ambas enfermedades tan frecuentes. PMID:27695684

  16. Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5).

    OpenAIRE

    Bousquet, J.; Farrell, J.; Crooks, G.; Hellings, P; Bel, E. H.; Bewick, M; Chavannes, N H; de Sousa, J. Correia; Cruz, A A; Haahtela, T.; Joos, G.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.

    2016-01-01

    Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact ...

  17. 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.

  18. Desferrioxamine treatment of porphyria cutanea tarda in a patient with HIV and chronic renal failure.

    Science.gov (United States)

    Vasconcelos, Pedro; Luz-Rodrigues, H; Santos, Carla; Filipe, Paulo

    2014-01-01

    Porphyria cutanea tarda (PCT) can occur in HIV patients. Current evidence suggests that HIV infection may interfere with the hepatic cytochrome oxidase system, leading to porphyrin metabolism impairment. Moreover, chronic hemodialysis in renal failure may be a risk factor for PCT. In addition to the contributory factors for PCT associated to HIV infection, it is possible that porphyrin accumulation secondary to renal failure may play a role in the expression of this disease. We report a case of PCT in an HIV-1 infected patient under blood dialysis, refractory to antimalarials and controlled with desferrioxamine.

  19. A perspective on sympathetic renal denervation in chronic congestive heart failure.

    Science.gov (United States)

    Madanieh, Raef; El-Hunjul, Mohammed; Alkhawam, Hassan; Kosmas, Constantine E; Madanieh, Abed; Vittorio, Timothy J

    2016-01-01

    Medical therapy has indisputably been the mainstay of management for chronic congestive heart failure. However, a significant percentage of patients continue to experience worsening heart failure (HF) symptoms despite treatment with multiple therapeutic agents. Recently, catheter-based interventional strategies that interrupt the renal sympathetic nervous system have shown promising results in providing better symptom control in patients with HF. In this article, we will review the pathophysiology of HF for better understanding of the interplay between the cardiovascular system and the kidney. Subsequently, we will briefly discuss pivotal renal denervation (RDN) therapy trials in patients with resistant hypertension and then present the available evidence on the role of RDN in HF therapy.

  20. The role of respiratory failure caused by congenital central nervous system abnormalities and the effect of β-casomorphins in sudden infant death syndrome pathogenesis

    Directory of Open Access Journals (Sweden)

    Barbara Sumińska-Ziemann

    2015-08-01

    Full Text Available The aim of the paper is to discuss the role of respiratory failure caused by endogenous (both structural and functional abnormalities in the central nervous system and exogenous food-derived opioid-like peptides in the pathogenesis of sudden infant death syndrome (SIDS. By stimulating μ-opioid receptors, opioid-like peptides may suppress the tonic activity of the respiratory centre in the brain stem.