1
|
Choi SH, Kim DY, Song BY, Yoo YS. [Analysis of ROX Index, ROX-HR Index, and SpO 2/FIO 2 Ratio in Patients Who Received High-Flow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit]. J Korean Acad Nurs 2023; 53:468-479. [PMID: 37673820 DOI: 10.4040/jkan.22152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/27/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. METHODS A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann-Whitney U test, and area under the curve (AUC). RESULTS Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. CONCLUSION The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.
Collapse
Affiliation(s)
- Sun Hee Choi
- Hospice and Palliative Care Team, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Dong Yeon Kim
- Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Byung Yun Song
- Healthcare Quality Policy Team, The Catholic Education Foundation, Seoul, Korea
| | - Yang Sook Yoo
- Department of Clinical Nursing, College of Nursing, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
2
|
Azañero-Haro JA, Chambi-Pérez LV, Alcántara-Díaz AM, Piscoya-Silva TE, Soto-Tarazona AR. [Abdominal pain with neuropsychiatric symptoms and ventilatory failure as a presentation of acute porphyria]. Rev Med Inst Mex Seguro Soc 2023; 61:227-233. [PMID: 37201189 PMCID: PMC10396011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 05/20/2023]
Abstract
Background Acute intermittent porphyria (AIP) is an uncommon metabolic disease, being the most common of the acute porphyrias. The most frequent symptom is acute abdominal pain, although can be accompanied by seizures, neuro-psychiatric alterations or symmetrical motor neuropathies, which in some patients can progress to respiratory musculature paralysis. Objective To describe an atypical presentation of acute porphyria to be considered as differential diagnoses in abdominal pain. Clinical case We present a case of a patient with AIP, presenting acute abdomen, seizures, later developed neuropsychiatric compromise and symmetrical motor neuropathy, and was admitted to mechanical ventilation. Due to the severity of the neurological involvement, he received hemin arginate, presenting with transient hypertransaminemia, an adverse event not previously reported. The evolution was favorable, with mechanical ventilation and hospital discharge withdrawn. Conclusions The diagnosis of AIP should be considered in cases of acute abdominal pain associated with neurological and/or psychiatric symptoms, particularly young women. The administration of hemin is considered the standard of treatment, and even late could have beneficial effects.
Collapse
Affiliation(s)
- Johan Alexander Azañero-Haro
- Universidad Ricardo Palma, Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Facultad de Medicina. Lima, Perú
| | - Liliana Valeri Chambi-Pérez
- Universidad Ricardo Palma, Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Facultad de Medicina. Lima, Perú
| | - Andrés Martín Alcántara-Díaz
- Universidad Ricardo Palma, Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Facultad de Medicina. Lima, Perú
| | - Tatiana Edmee Piscoya-Silva
- Universidad Ricardo Palma, Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Facultad de Medicina. Lima, Perú
| | | |
Collapse
|
3
|
Adnot S, Bernard D, Lipskaia L, Trottein F. [Cell senescence, a new target for respiratory viral infections: From influenza virus to SARS-CoV-2]. Bull Acad Natl Med 2023; 207:193-198. [PMID: 36624738 PMCID: PMC9812359 DOI: 10.1016/j.banm.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023]
Abstract
The accumulation of senescent cells in tissues is a key process of aging and age-related diseases, including lung diseases such as chronic obstructive pulmonary disease, lung fibrosis, or cancer. In recent years, the spectrum of respiratory diseases associated with cellular senescence has been broadened, in particular acute viral pulmonary infections, foremost among which is coronavirus disease 2019 (COVID19), which is particularly severe in the elderly or in subjects with comorbidities. Influenza virus infection, which strikes more severely at the extreme ages of life, is also associated with severe pulmonary senescence. Cellular senescence potentially represents an original target for attacking these diseases, although its specific mechanisms remain largely misunderstood. New anti-senescent therapeutic approaches are thus proposed during severe viral pulmonary infections, with the aim of preventing acute effects and/or, in the longer term, pulmonary sequelae.
Collapse
Affiliation(s)
- S. Adnot
- Inserm U955 et département de physiologie, hôpital Henri-Mondor, AP–HP, FHU- SENEC, université Paris-Est Créteil (UPEC), 94010 Créteil, France,Auteur correspondant. Hôpital Henri Mondor, service de physiologie-explorations fonctionnelles, 94010 Créteil, France
| | - D. Bernard
- Université de Lyon, CNRS, Inserm, U1052 - UMR 5286, centre de recherche en cancérologie de Lyon, centre Léon Bérard, 69373 Lyon, France
| | - L. Lipskaia
- Inserm U955 et département de physiologie, hôpital Henri-Mondor, AP–HP, FHU- SENEC, université Paris-Est Créteil (UPEC), 94010 Créteil, France
| | - F. Trottein
- Université de Lille, CNRS, Inserm, CHU de Lille, institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, 59000 Lille, France
| |
Collapse
|
4
|
Bonny V, Ladoire M, Gabarre P, Missri L, Urbina T, Guidet B. [Acute respiratory failure in the elderly patients]. LA REVUE DU PRATICIEN 2022; 72:775-780. [PMID: 36511970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ACUTE RESPIRATORY FAILURE IN THE ELDERLY PATIENTS Acute respiratory failure (ARF) requiring an admission in intensive care unit in the old patients presents specific characteristics that must be considered for diagnosis, treatment and prognosis. Old patients are at increased risk of ARF after any assault. It is imperative to assess the prognosis of an old patient requiring invasive treatment in the ICU f or an ARF. Age is only one of the factor accounting for high mortality together with comorbidities, previous functional status, severity of the ARF and frailty. Simple and reliable tools are available to determine the degree of frailty. Thus, chronological age should not only be considered to determine the intensity of care; the concept of physiological age may better assist the clinician in his decision making. Management should be comprehensive and multi-professional; rehabilitation should be as early as possible, which emphasizes the absolute necessity of having a physiotherapist attached to the service.
Collapse
Affiliation(s)
- Vincent Bonny
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Mathilde Ladoire
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Paul Gabarre
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Louaï Missri
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Tomas Urbina
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Bertrand Guidet
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France - Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
| |
Collapse
|
5
|
Bongiovanni F, Grieco DL, Anzellotti GM, Menga LS, Michi T, Cesarano M, Raggi V, De Bartolomeo C, Mura B, Mercurio G, D'Arrigo S, Bello G, Maviglia R, Pennisi MA, Antonelli M. Gas conditioning during helmet noninvasive ventilation: effect on comfort, gas exchange, inspiratory effort, transpulmonary pressure and patient-ventilator interaction. Ann Intensive Care 2021; 11:184. [PMID: 34952962 PMCID: PMC8708509 DOI: 10.1186/s13613-021-00972-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023] Open
Abstract
Background There is growing interest towards the use of helmet noninvasive ventilation (NIV) for the management of acute hypoxemic respiratory failure. Gas conditioning through heat and moisture exchangers (HME) or heated humidifiers (HHs) is needed during facemask NIV to provide a minimum level of humidity in the inspired gas (15 mg H2O/L). The optimal gas conditioning strategy during helmet NIV remains to be established. Methods Twenty patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mmHg) underwent consecutive 1-h periods of helmet NIV (PEEP 12 cmH2O, pressure support 12 cmH2O) with four humidification settings, applied in a random order: double-tube circuit with HHs and temperature set at 34 °C (HH34) and 37 °C (HH37); Y-piece circuit with HME; double-tube circuit with no humidification (NoH). Temperature and humidity of inhaled gas were measured through a capacitive hygrometer. Arterial blood gases, discomfort and dyspnea through visual analog scales (VAS), esophageal pressure swings (ΔPES) and simplified pressure–time product (PTPES), dynamic transpulmonary driving pressure (ΔPL) and asynchrony index were measured in each step. Results Median [IqR] absolute humidity, temperature and VAS discomfort were significantly lower during NoH vs. HME, HH34 and HH37: absolute humidity (mgH2O/L) 16 [12–19] vs. 28 [23–31] vs. 28 [24–31] vs. 33 [29–38], p < 0.001; temperature (°C) 29 [28–30] vs. 30 [29–31] vs. 31 [29–32] vs 32. [31–33], p < 0.001; VAS discomfort 4 [2–6] vs. 6 [2–7] vs. 7 [4–8] vs. 8 [4–10], p = 0.03. VAS discomfort increased with higher absolute humidity (p < 0.01) and temperature (p = 0.007). Higher VAS discomfort was associated with increased VAS dyspnea (p = 0.001). Arterial blood gases, respiratory rate, ΔPES, PTPES and ΔPL were similar in all conditions. Overall asynchrony index was similar in all steps, but autotriggering rate was lower during NoH and HME (p = 0.03). Conclusions During 1-h sessions of helmet NIV in patients with hypoxemic respiratory failure, a double-tube circuit with no humidification allowed adequate conditioning of inspired gas, optimized comfort and improved patient–ventilator interaction. Use of HHs or HME in this setting resulted in increased discomfort due to excessive heat and humidity in the interface, which was associated with more intense dyspnea. Trail Registration Registered on clinicaltrials.gov (NCT02875379) on August 23rd, 2016.
Collapse
Affiliation(s)
- Filippo Bongiovanni
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy. .,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy.
| | - Gian Marco Anzellotti
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Luca Salvatore Menga
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Teresa Michi
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Melania Cesarano
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Valeria Raggi
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Cecilia De Bartolomeo
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Benedetta Mura
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Giovanna Mercurio
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Sonia D'Arrigo
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Giuseppe Bello
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Riccardo Maviglia
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Mariano Alberto Pennisi
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.,Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy
| |
Collapse
|
6
|
Jeddah D, Chen O, Lipsky AM, Forgacs A, Celniker G, Lilly CM, Pessach IM. Validation of an Automatic Tagging System for Identifying Respiratory and Hemodynamic Deterioration Events in the Intensive Care Unit. Healthc Inform Res 2021; 27:241-248. [PMID: 34384206 PMCID: PMC8369051 DOI: 10.4258/hir.2021.27.3.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 01/27/2023] Open
Abstract
Objectives Predictive models for critical events in the intensive care unit (ICU) might help providers anticipate patient deterioration. At the heart of predictive model development lies the ability to accurately label significant events, thereby facilitating the use of machine learning and similar strategies. We conducted this study to establish the validity of an automated system for tagging respiratory and hemodynamic deterioration by comparing automatic tags to tagging by expert reviewers. Methods This retrospective cohort study included 72,650 unique patient stays collected from Electronic Medical Records of the University of Massachusetts’ eICU. An enriched subgroup of stays was manually tagged by expert reviewers. The tags generated by the reviewers were compared to those generated by an automated system. Results The automated system was able to rapidly and efficiently tag the complete database utilizing available clinical data. The overall agreement rate between the automated system and the clinicians for respiratory and hemodynamic deterioration tags was 89.4% and 87.1%, respectively. The automatic system did not add substantial variability beyond that seen among the reviewers. Conclusions We demonstrated that a simple rule-based tagging system could provide a rapid and accurate tool for mass tagging of a compound database. These types of tagging systems may replace human reviewers and save considerable resources when trying to create a validated, labeled database used to train artificial intelligence algorithms. The ability to harness the power of artificial intelligence depends on efficient clinical validation of targeted conditions; hence, these systems and the methodology used to validate them are crucial.
Collapse
Affiliation(s)
- Danielle Jeddah
- The Chaim Sheba Medical Center, Tel-Hashomer and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Clew Medical Ltd., Netanya, Israel
| | | | - Ari M Lipsky
- Clew Medical Ltd., Netanya, Israel.,Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Craig M Lilly
- Departments of Medicine, Anesthesiology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,UMass Memorial Health Care, UMass Memorial Medical Center, Worcester, MA, USA
| | - Itai M Pessach
- The Chaim Sheba Medical Center, Tel-Hashomer and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Rahmani F, Mahmoodpoor A, Salmasi S, Ebrahimi Bakhtavar H. Safety of Healthcare Workers During the Airway Management in Adult and Pediatric Patients with COVID-19. Anesth Pain Med 2021; 11:e112508. [PMID: 34336618 PMCID: PMC8314079 DOI: 10.5812/aapm.112508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread worldwide. Although the majority of patients show mild symptoms, the disease can rapidly progress in severe cases and develop acute respiratory distress syndrome (ARDS) that may lead to therapeutic interventions, including oxygenation, tracheal intubation, and mechanical ventilation. It is suggested that the new coronavirus spreads mostly via droplets, surface contact, and natural aerosols. Hence, high-risk aerosol-producing procedures, such as endotracheal intubation, may put the healthcare workers at a high risk of infection. In the course of managing patients with COVID-19, it is essential to prioritize the safety of healthcare workers. Hence, this review study aimed to summarize new guidelines and proper airway management in adult and pediatric COVID-19 patients.
Collapse
Affiliation(s)
- Farzad Rahmani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shiva Salmasi
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | |
Collapse
|
8
|
Faria VS, da Silva SAEHC, Marchini JFM. Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor. Autops Case Rep 2021; 11:e2021266. [PMID: 33968833 PMCID: PMC8087388 DOI: 10.4322/acr.2021.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.
Collapse
Affiliation(s)
- Vanessa Simioni Faria
- Universidade de São Paulo (USP), Hospital das Clínicas, Disciplina de Emergências Clínicas do Departamento de Clínica Médica, São Paulo, SP, Brasil
| | | | - Julio Flávio Meirelles Marchini
- Universidade de São Paulo (USP), Hospital das Clínicas, Disciplina de Emergências Clínicas do Departamento de Clínica Médica, São Paulo, SP, Brasil
| |
Collapse
|
9
|
Apostolakis E, Papakonstantinou NA, Liakopoulou A, Chlapoutakis S. External flail chest stabilization; The simple, low-cost way. J Cardiovasc Thorac Res 2020; 13:174-175. [PMID: 34326973 PMCID: PMC8302900 DOI: 10.34172/jcvtr.2020.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/30/2020] [Indexed: 12/04/2022] Open
Abstract
Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of paramount importance to achieve early extubation in a patient with post-trauma respiratory insufficiency. Hereby, a simple, low cost, harmless and effective approach of external stabilization is presented.
Collapse
Affiliation(s)
- Efstratios Apostolakis
- Cardiothoracic Surgery Department, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
| | | | - Alexandra Liakopoulou
- Cardiothoracic Surgery Department, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
| | - Serafeim Chlapoutakis
- Cardiothoracic Surgery Department, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
| |
Collapse
|
10
|
Vasan A, Weekes R, Connacher W, Sieker J, Stambaugh M, Suresh P, Lee DE, Mazzei W, Schlaepfer E, Vallejos T, Petersen J, Merritt S, Petersen L, Friend J. MADVent: A low-cost ventilator for patients with COVID-19. ACTA ACUST UNITED AC 2020; 3:e10106. [PMID: 32838208 PMCID: PMC7300530 DOI: 10.1002/mds3.10106] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
The COVID‐19 pandemic has produced critical shortages of ventilators worldwide. There is an unmet need for rapidly deployable, emergency‐use ventilators with sufficient functionality to manage COVID‐19 patients with severe acute respiratory distress syndrome. Here, we show the development and validation of a simple, portable and low‐cost ventilator that may be rapidly manufactured with minimal susceptibility to supply chain disruptions. This single‐mode continuous, mandatory, closed‐loop, pressure‐controlled, time‐terminated emergency ventilator offers robust safety and functionality absent in existing solutions to the ventilator shortage. Validated using certified test lungs over a wide range of compliances, pressures, volumes and resistances to meet U.S. Food and Drug Administration standards of safety and efficacy, an Emergency Use Authorization is in review for this system. This emergency ventilator could eliminate controversial ventilator rationing or splitting to serve multiple patients. All design and validation information is provided to facilitate ventilator production even in resource‐limited settings.
Collapse
Affiliation(s)
- Aditya Vasan
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Reiley Weekes
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - William Connacher
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Jeremy Sieker
- School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Mark Stambaugh
- Qualcomm Institute University of California San Diego La Jolla CA 92093 USA
| | - Preetham Suresh
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Daniel E Lee
- Department of Anaesthesiology and Department of Paediatrics School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - William Mazzei
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | | | - Theodore Vallejos
- Department of Respiratory Care School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Johan Petersen
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Sidney Merritt
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Lonnie Petersen
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Radiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - James Friend
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| |
Collapse
|
11
|
Bae S, Han M, Kim C, Lee H, Ahn JJ, Kim JH, Kang BJ. High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study. J Korean Med Sci 2020; 35:e67. [PMID: 32174065 PMCID: PMC7073320 DOI: 10.3346/jkms.2020.35.e67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia. METHODS All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching. RESULTS A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups. CONCLUSION In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.
Collapse
Affiliation(s)
- SooHyun Bae
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Changyoung Kim
- Medical Information Center of Ulsan University Hospital, Ulsan, Korea
| | - Hyeji Lee
- Department of Emergency Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jong Joon Ahn
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin Hyoung Kim
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| |
Collapse
|
12
|
Abstract
Congenital acinar dysplasia is a lethal, developmental lung malformation resulting in neonatal respiratory insufficiency. This entity is characterized by pulmonary hypoplasia and arrest in the pseudoglandular stage of development, resulting in the absence of functional gas exchange. The etiology is unknown, but a relationship with the disruption of the TBX4-FGF10 pathway has been described. There are no definitive antenatal diagnostic tests. It is a diagnosis of exclusion from other diffuse embryologic lung abnormalities with identical clinical presentations that are, however, histopathologically distinct.
Collapse
Affiliation(s)
- Sabrina Oneto
- Mount Sinai Medical Center, A.M. Rywlin, M.D, Department of Pathology and Laboratory Medicine. Miami Beach, FL, USA
| | - Robert J Poppiti
- Mount Sinai Medical Center, A.M. Rywlin, M.D, Department of Pathology and Laboratory Medicine. Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine. Miami, FL, USA
| |
Collapse
|
13
|
Sandoval-Gutiérrez JL. [Acute respiratory distress syndrome. Half a century of its description]. Rev Med Inst Mex Seguro Soc 2019; 56:558-561. [PMID: 30889345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It has been 50 years since the first description of the respiratory distress syndrome or acute respiratory distress syndrome (ARDS), advances from the physiopathological view are immense, unfortunately, the case fatality rate has had little variation, it is important to disseminate the knowledge to achieve the proper diagnosis and treatment.
Collapse
Affiliation(s)
- José Luis Sandoval-Gutiérrez
- Secretaría de Salud, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Jefatura de Áreas Críticas. Ciudad de México, México
| |
Collapse
|
14
|
Patel RA, Mohl L, Paetow G, Maiser S. Acute Neuromuscular Respiratory Weakness Due to Acute Inflammatory Demyelinating Polyneuropathy (AIDP): A Simulation Scenario for Neurology Providers. MedEdPORTAL 2019; 15:10811. [PMID: 30931390 PMCID: PMC6415011 DOI: 10.15766/mep_2374-8265.10811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
Introduction Acute neuromuscular respiratory failure is a source of morbidity and mortality in neurological diseases, including acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome. It is important for health care providers to recognize this condition and provide early ventilatory support. In this simulation, learners must assess and treat a standardized patient with acute respiratory complications related to AIDP. Methods This is a single-session simulation that can be run in a standard simulation center using a live standardized patient. The simulation scenario is followed by a facilitated debriefing session. Details about the simulation scenario, critical action checklist, environment preparation, actors/roles, and debriefing session are outlined. Results A total of 14 neurology residents participated in this simulation. A postsimulation survey revealed that participants thought the simulation achieved its stated objectives, was useful, and would impact their future practice. Discussion We designed this simulation to assess a learner's ability to identify acute neuromuscular respiratory weakness in a patient with AIDP and initiate treatment with ventilatory support. This simulation can easily be incorporated into an existing curriculum for neurology residents or for trainees in other specialties.
Collapse
Affiliation(s)
- Roshni Abee Patel
- Neurology Resident, Department of Neurology, University of Minnesota Medical School
| | - Leighton Mohl
- Neurology Resident, Department of Neurology, University of Minnesota Medical School
| | - Glenn Paetow
- Medical Education & Simulation Fellow, Department of Emergency Medicine, Hennepin Healthcare
| | - Samuel Maiser
- Assistant Professor of Neurology, Department of Neurology, University of Minnesota
- Assistant Professor of Neurology, Department of Neurology, Hennepin Healthcare
| |
Collapse
|
15
|
Kim DK, Lee J, Park JH, Yoo KH. What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure? Tuberc Respir Dis (Seoul) 2018; 81:99-105. [PMID: 29372630 PMCID: PMC5874148 DOI: 10.4046/trd.2017.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 12/13/2022] Open
Abstract
Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.
Collapse
Affiliation(s)
- Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Jungsil Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Ellis TA, Bracho DO, Krishnan S. Responding to a Respiratory Complication in the Recovery Room: A Simulation Case for Anesthesiology Students. MedEdPORTAL 2017; 13:10529. [PMID: 30800731 PMCID: PMC6342152 DOI: 10.15766/mep_2374-8265.10529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/15/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Postoperative respiratory complications have multiple etiologies, are commonly occurring, and are potentially life-threatening complications of anesthesia. Adverse outcomes associated with respiratory complications are a leading cause of injury-related malpractice claims in anesthesiology. Appropriate response to respiratory complications in the postanesthesia care unit (PACU) involves early intervention, development of a differential diagnosis, and an organized approach to respiratory support and patient disposition. METHODS This simulation is designed for medical students, student nurse anesthetists, and junior resident physicians rotating clinically in anesthesiology. It is designed as a 1-hour, small-group, simulation-based learning activity centered upon a single patient encounter. It focuses on a postoperative encounter occurring shortly after a patient arrives in the PACU. The patient is recovering from a prolonged emergent upper abdominal surgery using an anesthetic associated with increased risk of respiratory complications, and has multiple risk factors for postoperative respiratory complications. This scenario is easily reproduced on modern simulation mannequins without specialized programming. The patient's vital signs are displayed and remain within normal limits, with the exception of the oxygen saturation and heart rate, which must be adjusted during the exercise. RESULTS Learners provided evaluations of their experience with this simulation, and these appraisals and comments have been unanimously positive. DISCUSSION We employed this exercise using an anesthesiology resident physician to proctor and debrief, a simulation technician to program and run the model, and a faculty anesthesiologist to mentor each session. We used this simulation case as an educational opportunity for medical students rotating clinically in our department.
Collapse
Affiliation(s)
- Terry Allan Ellis
- Interim Chair, Department of Anesthesiology, Wayne State University School of Medicine
- Director of Simulation, Department of Anesthesiology, John D. Dingell VA Medical Center
- Administrator, Section of Anesthesiology, John D. Dingell VA Medical Center
| | - David Otto Bracho
- Director of Cardiothoracic Anesthesia, Wayne State University School of Medicine
- Associate Program Director for the Anesthesiology Residency, Wayne State University School of Medicine
| | - Sandeep Krishnan
- Resident, Department of Anesthesiology, Wayne State University School of Medicine
| |
Collapse
|
17
|
Jeong H, Matsuura Y, Ohno Y. Measurement of Respiration Rate and Depth Through Difference in Temperature Between Skin Surface and Nostril by Using Thermal Image. Stud Health Technol Inform 2017; 245:417-421. [PMID: 29295128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the present study was to propose a method to measure a respiration rate (RR) and depth at once through difference in temperature between the skin surface and nostril by using a thermal image. Although there have been a lot of devices for contact RR monitoring, it was considered that the subjects could be inconvenienced by having the sensing device in contact with their body. Our algorithm enabled us to make a breathing periodic function (BPF) under the non-contact and non-invasive condition through temperature differences near the nostril during the breath. As a result, it was proved that our proposed method was able to classify differences in breathing pattern between normal, deep, and shallow breath (P < 0.001). These results lead us to conclude that the RR and depth is simultaneously measured by the proposed algorithm of BPF without any contact or invasive procedure.
Collapse
Affiliation(s)
- Hieyong Jeong
- Department of Robotics & Design for Innovative Healthcare, Osaka University, Suita, Osaka, Japan
| | - Yutaka Matsuura
- Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Yuko Ohno
- Department of Robotics & Design for Innovative Healthcare, Osaka University, Suita, Osaka, Japan
| |
Collapse
|
18
|
Filiz KA, Levent D, Emel E, Pelin U, Turkay A, Aybüke K. Characteristics of Active Tuberculosis Patients Requiring Intensive Care Monitoring and Factors Affecting Mortality. Tuberc Respir Dis (Seoul) 2016; 79:158-64. [PMID: 27433176 PMCID: PMC4943900 DOI: 10.4046/trd.2016.79.3.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/20/2016] [Accepted: 04/06/2016] [Indexed: 01/09/2023] Open
Abstract
Background One to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU. Methods The data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated. Results Thirty-five TB patients (27 males) with a median age of 47 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and PaO2/FIO2 levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting survival. Conclusion The survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. Another factor specific to TB patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortality rate.
Collapse
Affiliation(s)
- Koşar A Filiz
- Yedikule Chest Diseases and Chest Surgery Education and Research Center, Istanbul, Turkey
| | - Dalar Levent
- Florance Nightingale Hospital, Chest Diseases and Surgery Center, Bilim University, Istanbul, Turkey
| | - Eryüksel Emel
- Respiratory Intensive Care, Marmara Medical Faculty, Marmara University, Istanbul, Turkey
| | - Uysal Pelin
- Thorax Clinic, Acibadem Halkalı Atakent Hospital, Istanbul, Turkey
| | - Akbaş Turkay
- Department of Internal Medicine, Section of Intensive Care, School of Medicine, Duzce University, Istanbul, Turkey
| | - Kekeçoğlu Aybüke
- Yedikule Chest Diseases and Chest Surgery Education and Research Center, Istanbul, Turkey
| |
Collapse
|
19
|
Amaral FGC, Lima LGCA, Hatanaka VMA, Siqueira SAC, Duarte-Neto AN. Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report. Autops Case Rep 2016; 6:11-20. [PMID: 27284536 PMCID: PMC4880429 DOI: 10.4322/acr.2016.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/15/2016] [Indexed: 12/04/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of death.
Collapse
Affiliation(s)
| | | | | | | | - Amaro Nunes Duarte-Neto
- Anatomic Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil.; Emergency Department - Hospital das Clínicas - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
20
|
Kang SW, Choi WA, Cho HE, Lee JW, Park JH. Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government. J Korean Med Sci 2016; 31:976-82. [PMID: 27247509 PMCID: PMC4853679 DOI: 10.3346/jkms.2016.31.6.976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
Since 2001, financial support has been provided for all patients with neuromuscular disease (NMD) who require ventilatory support due to the paralysis of respiratory muscles in Korea. The purpose of this study was to identify ventilator usage status and appropriateness in these patients. We included 992 subjects with rare and incurable NMD registered for ventilator rental fee support. From 21 February 2011 to 17 January 2013, ventilator usage information, regular follow-up observation, and symptoms of chronic hypoventilation were surveyed by phone. Home visits were conducted for patients judged by an expert medical team to require medical examination. Abnormal ventilatory status was assessed by respiratory evaluation. Chronic respiratory insufficiency symptoms were reported by 169 of 992 subjects (17%), while 565 subjects (57%) did not receive regular respiratory evaluation. Ventilatory status was abnormal in 102 of 343 home-visit subjects (29.7%). Although 556 subjects (56%) reported 24-hour ventilator use, only 458 (46%) had an oxygen saturation monitoring device, and 305 (31%) performed an airstacking exercise. A management system that integrates ventilator usage monitoring, counselling and advice, and home visits for patients who receive ventilator support could improve the efficiency of the ventilator support project.
Collapse
Affiliation(s)
- Seong-Woong Kang
- Department of Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jang Woo Lee
- Department of Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Abstract
BACKGROUND Although type 2 respiratory failure is a plausible late presentation for laryngeal tumours, very little published literature is available to support this theory. METHODS This paper describes the unusual presentation of a subglottic tumour with uncompensated type 2 respiratory failure. RESULTS The patient was initially managed with biphasic positive airway pressure as a bridging measure while awaiting intensive care treatment and to provide sufficient time to arrange a surgical tracheostomy. CONCLUSION This case highlights the importance of clinical suspicion towards subglottic tumours in patients presenting with type 2 respiratory failure. The positive outcome indicates that biphasic positive airway pressure is a potential bridging therapy for upper airway obstruction and a safe and stable treatment option for patients in respiratory distress.
Collapse
|
22
|
Ferreira CR, Sibre V, Schultz R, de Melo AMAGP, Ibidi SM, Torre JD. Congenital generalized lymphangiectasia: a rare developmental disorder for non-immune fetal hydrops. Autops Case Rep 2016; 5:27-33. [PMID: 26894043 PMCID: PMC4757917 DOI: 10.4322/acr.2015.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
Firstly described by Rudolf Virchow in the 19th century, congenital generalized lymphangiectasia is a rare entity characterized by dilation of lymphatic vessels, and was recently classified in primary or secondary lymphangiectasia. Generalized forms may be diagnosed during pre-natal follow-up with ultrasound examination, and, depending on its severity, the newborn outcome is very poor. The authors report the case of a female newborn with a previous diagnosis of fetal hydropsy who was born after a full-term gestation with respiratory failure due to bilateral voluminous pleural effusion and ascites. Physical examination also disclosed syndromic facies. Despite all efforts of the intensive supportive care, the patient died after 24 days of life. The autopsy findings were consistent with the diagnosis of congenital pulmonary lymphangiectasia. The authors call attention to this rare diagnosis in patients with cavitary effusion and respiratory insufficiency at birth.
Collapse
Affiliation(s)
- Cristiane Rúbia Ferreira
- Anatomy Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
| | - Verônica Sibre
- Department of Pathology - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil
| | - Regina Schultz
- Department of Pathology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil.; Anatomy Pathology Service - Instituto do Cancer de São Paulo, São Paulo/SP - Brazil
| | | | - Silvia Maria Ibidi
- Pediatrics Division - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
| | - Jackeline Della Torre
- Pediatrics Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
23
|
Benevides GN, Picciarelli de Lima P, Felipe-Silva A, Lovisolo SM, Pereira de Melo AMAG. Recurrence of alveolar capillary dysplasia with misalignment of pulmonary veins in two consecutive siblings. Autops Case Rep 2015; 5:21-7. [PMID: 26484320 PMCID: PMC4608164 DOI: 10.4322/acr.2014.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/13/2015] [Indexed: 11/28/2022] Open
Abstract
Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, developmental lung disorder, which has been increasingly reported. This entity usually presents as neonatal persistent pulmonary hypertension that is unresponsive to treatment, and is known to be uniformly fatal. Recent discoveries in the genetic field, and intensive treatments, may change the natural course of this disease, permitting easier diagnosis and giving new hope for the dismal prognosis. The authors present two cases of siblings, with two years of difference, from different fathers - one of them was a first-degree and the other a second-degree cousin of the mother. Both patients were full-term babies born apparently without malformations and were sent to the nursery. Both siblings near 35 hours of age presented severe respiratory failure due to pulmonary hypertension. The outcome was fatal in both cases and at autopsy ACD/MPV was diagnosed. The authors call attention to this entity in the differential diagnosis of acute respiratory distress in early life.
Collapse
Affiliation(s)
- Gabriel Nuncio Benevides
- Department of Pediatrics - Childrens Institute - Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Patricia Picciarelli de Lima
- Department of Pathology - Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Aloisio Felipe-Silva
- Anatomy Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP, Brazil
| | - Silvana Maria Lovisolo
- Anatomy Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP, Brazil
| | | |
Collapse
|
24
|
Torre JAGD, Benevides GN, de Melo AMAGP, Ferreira CR. Pertussis: the resurgence of a public health threat. Autops Case Rep 2015; 5:9-16. [PMID: 26484329 PMCID: PMC4584670 DOI: 10.4322/acr.2015.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/28/2015] [Indexed: 11/23/2022] Open
Abstract
Pertussis is an acute and very contagious pulmonary disease, clinically characterized by periods of coughing and paroxysms that may cause death. The disease afflicts mainly the pediatric population and is life threatening to children under the age of 1 year. Since the beginning of the second millennium, the number of cases of pertussis has increased, menacing public health, despite the availability of the pertussis vaccine. The resurgence of the disease among adults and older children creates a reservoir of infection that will afflict the unimmunized or incompletely immunized children. As newborns and infants show the highest mortality rate, immunization during pregnancy is a new strategy to reduce the burden of pertussis. The authors report the case of a newborn that presented respiratory distress accompanied by marked leukocytosis. Bronchiolitis was the initial diagnostic hypothesis, but the clinical picture became typical of pertussis when paroxysmal coughing ensued. Isolation of the Bordetella pertussis and antigenic demonstration by polymerase chain reaction were positive from respiratory secretion. Despite appropriate antibiotic therapy and intensive care management the child died and the autopsy showed characteristic diagnostic findings. The authors call attention to this diagnosis when facing respiratory failure among young children, mainly in the presence of marked leukocytosis. Thorough research on the immunization status of the patient’s social environment is of crucial importance.
Collapse
Affiliation(s)
| | - Gabriel Nuncio Benevides
- Pediatrics Institute - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Cristiane Rúbia Ferreira
- Anatomy Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
25
|
Gjonbrataj J, Kim HJ, Jung HI, Choi WI. Does the Mean Arterial Pressure Influence Mortality Rate in Patients with Acute Hypoxemic Respiratory Failure under Mechanical Ventilation? Tuberc Respir Dis (Seoul) 2015; 78:85-91. [PMID: 25861341 PMCID: PMC4388905 DOI: 10.4046/trd.2015.78.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/07/2014] [Accepted: 12/10/2014] [Indexed: 12/29/2022] Open
Abstract
Background In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality.
Collapse
Affiliation(s)
- Juarda Gjonbrataj
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea. ; Department of Internal Medicine, Mother Thereza University Hospital, Tirana, Albania
| | - Hyun Jung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye In Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Won-Il Choi
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
26
|
Abstract
Background Toxic lung injury may manifest itself in many different ways, ranging from respiratory tract irritation and pulmonary edema in severe cases to constrictive bronchiolitis, being a more distant consequence. It is most often the result of accidental exposure to harmful substances at work, at home, or a consequence of industrial disaster. Case Report This article presents a case of toxic lung injury which occurred after inhalation of legal highs, the so-called “artificial hashish” and at first presented itself radiologically as interstitial pneumonia with pleural effusion and clinically as hypoxemic respiratory insufficiency. After treatment with high doses of steroids, it was histopathologically diagnosed as organizing pneumonia with lipid bodies. Conclusions Due to the lack of pathognomonic radiological images for toxic lung injury, information on possible etiology of irritants is very important. As novel psychoactive substances appeared in Europe, they should be considered as the cause of toxic lung injury.
Collapse
Affiliation(s)
- Dorota Kulhawik
- Department of Radiology, Mazovian Center for Treatment of Lung Diseases and Tuberculosis in Otwock, Otwock, Poland
| | - Jerzy Walecki
- Department of Radiology and Diagnostic Imaging, Independent Public Clinical Hospital, Otwock, Poland
| |
Collapse
|
27
|
Ferreira CR, Aiello VD, de Melo AMAGP, Mota LB, de Carvalho ACN, Souza HSP, Rangel DADS. Classic form of hypoplastic left heart syndrome diagnosed post-natally: an autopsy report. Autops Case Rep 2014; 4:21-30. [PMID: 28573115 PMCID: PMC5444395 DOI: 10.4322/acr.2014.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/07/2014] [Indexed: 11/24/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is a congenital heart disease, which, despite the current improved knowledge about its management and surgical treatment, is still associated with high mortality, especially in the early neonatal period and before the second stage of reconstruction surgery. The low rate of prenatal diagnosis and delayed diagnostic suspicion results in unsuccessful therapeutic intervention, even though the real impact of early diagnosis and intervention on mortality and quality of life of patients is still uncertain. Fortunately, this syndrome of challenging treatment is not that frequent. It involves a spectrum of obstructions to the blood flow within the left heart and is characterized by an inappropriate size of the left ventricle associated with a wide variety of valvular dysfunctions. Treatment ranges from heart transplantation to palliative surgical procedures. The authors describe a case of a newborn with HLHS, whose diagnosis was made after birth because of early respiratory failure. Despite the use of prostaglandin the newborn died. An autopsy was performed and the anatomical findings were described.
Collapse
Affiliation(s)
- Cristiane Rúbia Ferreira
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Lucas Braga Mota
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Ana Carolina Neves de Carvalho
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Heli Samuel Pinto Souza
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Diana Arrais de Souza Rangel
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
28
|
Gutierrez PS, Aiello VD. Aortic stenosis concomitant with microscopic polyangiitis: a challenge in medical reasoning and thinking. Autops Case Rep 2014; 4:7-14. [PMID: 28652987 PMCID: PMC5470560 DOI: 10.4322/acr.2014.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022]
Abstract
Microscopic polyangiitis (MPA) is part of the anti-neutrophil cytoplasmic antibodies (ANCA)-related vasculitis, which usually presents as renal pulmonary syndrome. It is defined as a pauci-immune necrotizing small vessel vasculitis, which usually affects the kidneys, followed by the lungs. It also presents systemic symptoms. The etiology of MPA is still unclear, but evidence reinforces the autoimmune mechanisms as the main etiopathogenic factor. Aortic valve stenosis (AS) is not an uncommon disease whose etiology varies according to geographical differences and the patient's age. The natural history of AS begins with a prolonged asymptomatic period, but when symptomatic, respiratory failure is one of its main clinical presentations. The authors present the case of a 55-year-old woman who was admitted with the diagnosis of renal failure, anemia, and a cardiac murmur. The patient had been recently diagnosed with pneumonia. During hospitalization, diagnostic workup disclosed a normal kidney size as well as parenchymal thickness. A renal biopsy was undertaken but the specimen was exiguous, showing 4 sclerotic glomeruli and 1 glomerulus with crescentic glomerulonephritis. The search for ANCA was positive. The investigation of the cardiac murmur disclosed AS. The patient, on hemodialysis, presented episodes of respiratory failure, which was interpreted as acute pulmonary edema, but a suspicion of ANCA-related pulmonary renal syndrome was raised. However, the aortic valve replacement was prioritized. While awaiting cardiac surgery, the patient died because of respiratory insufficiency. Autopsy findings concluded that MPA with pulmonary hemorrhage due to vasculitis was the immediate cause of death. Although AS was present at autopsy and classified as moderate/severe, this lesion was a bystander in the process of this patient's end of life, demonstrating the value of autopsy for medical learning and reasoning purposes.
Collapse
Affiliation(s)
- Paulo Sampaio Gutierrez
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
29
|
de Campos FPF, Felipe-Silva A, Zerbini MCN, Martines JADS. Primary diffuse large B-cell lymphoma or lymphomatoid granulomatosis grade 3: a still-puzzling diagnosis in autopsy. Autops Case Rep 2013; 3:29-36. [PMID: 28584804 PMCID: PMC5453658 DOI: 10.4322/acr.2013.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/05/2013] [Indexed: 12/02/2022] Open
Abstract
Primary lung lymphoma is a rare entity accounting for approximately 0.3% of all primary neoplasia of the lung and includes diffuse large B-cell lymphoma (DLBL) and lymphomatoid granulomatosis (LYG). Considering that clinical features may be similar, whereas epidemiology, morphology, and radiological features are different, the authors report a case of a middle-aged man who presented multiple pulmonary nodules in the lower lobes and ground-glass opacities scattered bilaterally on computed tomography. Clinically, he presented a consumptive syndrome with respiratory failure and pleurisy, which progressed until death. The autopsy findings were consistent with lymphomatoid granulomatosis (LYG) grade 3/ diffuse large B-cell lymphoma (DLBL). The authors call attention to the difficulty of establishing an accurate diagnosis, mainly when the demonstration of EBV-infected atypical B-cells fails.
Collapse
Affiliation(s)
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | |
Collapse
|
30
|
Jo JY, Kwon YS, Lee JW, Park JS, Rho BH, Choi WI. Acute respiratory distress due to methane inhalation. Tuberc Respir Dis (Seoul) 2013; 74:120-3. [PMID: 23579434 PMCID: PMC3617131 DOI: 10.4046/trd.2013.74.3.120] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 06/19/2012] [Accepted: 08/15/2012] [Indexed: 11/24/2022] Open
Abstract
Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest radiographic findings were consistent with acute pneumonitis. He recovered spontaneously and was discharged after 5 days without other specific treatment. His pulmonary function test, 4 days after methane gas exposure, revealed a restrictive ventilatory defect. In conclusion, acute pulmonary injury can occur with a restrictive ventilator defect after a short exposure to methane gas. The lung injury was spontaneously resolved without any significant sequela.
Collapse
Affiliation(s)
- Jun Yeon Jo
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | | | | | | | | | | |
Collapse
|
31
|
Choi KH, Yu HM, Jeong JS, Kim SR, Lee YC. A Fatal Case of Acute Respiratory Failure Caused by Mycobacterium massiliense. Tuberc Respir Dis (Seoul) 2013; 74:79-81. [PMID: 23483829 PMCID: PMC3591543 DOI: 10.4046/trd.2013.74.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/09/2012] [Accepted: 07/25/2012] [Indexed: 12/03/2022] Open
Abstract
Few recent reports have indicated that Mycobacterium massiliense causes various infections including respiratory infection. However, there is scarce information on the clinical significance, natural history of the infection, and therapeutic strategy. This report describes a case of an immunocompetent old man infected by M. massiliense that causes acute respiratory failure. In light of the general courses of non-tuberculous mycobacterium infections,
rapid progression and fatality are very rare and odd. In addition, we discuss the biological and pathological
properties of M. massiliense with the review of cases reported previously including our fatal one.
Collapse
Affiliation(s)
- Kyoung Hwa Choi
- Division of Pulmonology, Department of Internal Medicine, Presbysterian Medical Center, Jeonju, Korea
| | | | | | | | | |
Collapse
|
32
|
Amini E, Nayeri FS, Hemati A, Esmaeilinia T, Nili F, Dalili H, Aminnejad M. Comparison of High Frequency Positive Pressure Mechanical Ventilation (HFPPV) With Conventional Method in the Treatment of Neonatal Respiratory Failure. Iran Red Crescent Med J 2013; 15:183-6. [PMID: 23983995 PMCID: PMC3745744 DOI: 10.5812/ircmj.2791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 11/22/2022]
Abstract
Background Respiratory failure is a major problem in neonatal medicine in all over the world and has different causes. Using mechanical ventilation is one of its major treatments. Objectives Different strategies have been expressed in this context, including high frequency mechanical ventilation. Patients and Methods This study is a prospective randomized clinical trial conducted on all newborns with respiratory failure hospitalized in the NICU of Tehran vali-asr Hospital during 2009.These patients were divided in to two groups through block Randomization method; conventional mechanical ventilation group and high frequency ventilation group. Results Intraventricular hemorrhage (IVH) and air leak (e.g. pneumothorax) were less in HFPPV group than conventional group (P = 0.012 and P = 0.038). The mean time needed for mechanical ventilation was lower in HFPPV group, but this difference was not statistically significant (P = 0.922). Needing to O2 in 28 days of age was almost equal in both groups (P = 0. 99). Mortality, and refractory hypoxia and PVL were lower in HFPPV group, but the difference was not statistically significant (P = 0.301, P = 0. 508, P = 0. 113). Conclusions Treatment of neonatal respiratory failure with high rate mechanical ventilation may reduce some complications.
Collapse
Affiliation(s)
- Elahe Amini
- Materno-Feral and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
| | - Fatemeh Sadat Nayeri
- Materno-Feral and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
| | - Arezu Hemati
- NICU, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
- Corresponding author: Arezu Hemati, NICU, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran. Tel: +98-2612753026, Fax: +98-2612753026, E-mail:
| | - Tahere Esmaeilinia
- Materno-Feral and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
| | - Firuzeh Nili
- Materno-Feral and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
| | - Hossein Dalili
- Breast Feeding Research Center, Valiasr Hospital, Tehran University of Medical, Tehran, IR Iran
| | - Majid Aminnejad
- NICU, Valiasr Hospital, Tehran University of Medical Science, Tehran, IR Iran
| |
Collapse
|
33
|
Hong SB, Oh BJ, Kim YS, Kang EH, Kim CH, Park YB, Han MS, Shin C. Characteristics of mechanical ventilation employed in intensive care units: a multicenter survey of hospitals. J Korean Med Sci 2008; 23:948-53. [PMID: 19119434 PMCID: PMC2610657 DOI: 10.3346/jkms.2008.23.6.948] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 02/19/2008] [Indexed: 11/20/2022] Open
Abstract
A 1D point-prevalence study was performed to describe the characteristics of conventional mechanical ventilation in intensive care units (ICUs). In addition, a survey was conducted to determine the characteristics of ICUs. A prospective, multicenter study was performed in ICUs at 24 university hospitals. The study population consisted of 223 patients who were receiving mechanical ventilation or had been weaned off mechanical ventilation within the past 24 hr. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic respiratory failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%), and neuromuscular disorders (6%). Mechanical ventilation was delivered via an endotracheal tube in 68% of the patients, tracheostomy in 28% and facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2 centers. In patients who had undergone tracheostomy, the procedure had been performed 16.9+/-8.1 days after intubation. Intensivists treated 29% of the patients. A need for additional educational programs regarding clinical practice in the ICU was expressed by 62% of the staff and 42% of the nurses. Tuberculosis-destroyed lung is a common indication for mechanical ventilation in acute exacerbation of chronic respiratory failure, and noninvasive ventilation was used in a limited number of ICUs.
Collapse
Affiliation(s)
- Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Department of Emergency Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Anane T, Grangaud JP. Diagnosis of tuberculosis in children. Child Trop 2002:20-9. [PMID: 12345139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
35
|
Laparoscopic sterilization - what are the problems? Med Gynaecol Androl Sociol 1974; 8:16-21. [PMID: 12156382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
36
|
Abstract
We conducted a randomized clinical trial to compare the effects of a synthetic (Exosurf) and natural (Survanta) surfactant in infants with neonatal respiratory distress syndrome. Eighty-nine patients were randomly allocated to receive one of the two surfactants. Primary outcome variables were the acute and long-term effects of the surfactant preparations, i.e., ventilatory requirements at 24 h of age as judged by the oxygenation index (OI), and the combined incidence of chronic lung disease or death at 28 days. The OIs in the Exosurf and Survanta groups at 24 h were the same (10.1 and 7, respectively; P > 0.05). The magnitude and rapidity of response, however, were greater for Survanta than for Exosurf. When arterial/alveolar oxygen tension ratios (a/A) were compared, the Exosurf group had a significantly worse a/A ratio at 24 h than the Survanta group (0.21 Exosurf vs. 0.37 Survanta; P < 0.05). The long-term outcome as judged by the combined incidence of death or chronic lung disease was not different in the two groups (18.6% Exosurf vs. 15.2% Survanta; P > 0.05). When the complications of prematurity were compared, there were no statistically significant differences between the two groups. We conclude that both preparations are reasonable choices for the treatment of respiratory distress syndrome of prematurity.
Collapse
Affiliation(s)
- D E da Costa
- Division of Neonatology, Royal Hospital, Sultanate of Oman
| | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Mortality from asthma increased and is now declining in some countries, but little is known about these trends in South America. OBJECTIVE We aimed to assess trends in mortality from asthma in southern Brazil in children and young adults. METHODS Death certificates of 425 people in the state of Rio Grande do Sul aged between 5 and 39 years in whom asthma was reported to be the underlying cause of death during the period 1970 to 1992 were reviewed. Population data were available in 10-year age groups. Testing for trends in mortality rates was conducted using linear and log-linear regression procedures. RESULTS Asthma mortality rates in the age groups 5 to 19 and 20 to 39 years ranged between 0.04 and 0.39/100,000 and 0.28 to 0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in rate in 5- to 19-year olds was +0.01 (95% CI 0.003 to 0.016), an average annual percentage increase of +6.8% (95% CI 3% to 11%), with a total increase of 352% between 1970 and 1992. This increase was not due to a shift in labeling from bronchitis to asthma. In the 20 to 39-year age group, asthma and bronchitis mortality rates showed no trend to increase or decrease. CONCLUSIONS Asthma mortality in southern Brazil is low, but rose significantly between 1970 and 1992 in the 5 to 19-year age group. This trend differs from that found in other states of Brazil and several other Latin American countries. Reasons for this difference remain unclear.
Collapse
Affiliation(s)
- J M Chatkin
- The Medical School, Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | |
Collapse
|
38
|
|
39
|
Rosengren A, Wilhelmsen L. Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men. Int J Epidemiol 1998; 27:962-9. [PMID: 10024189 DOI: 10.1093/ije/27.6.962] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressed respiratory function and respiratory symptoms are associated with impaired survival. The present study was undertaken to assess the relation between respiratory symptoms and mortality from cardiovascular causes, cancer and all causes in a large population of middle-aged men. METHODS Prospective population study of 6442 men aged 51-59 at baseline, free of clinical angina pectoris and prior myocardial infarction. RESULTS During 16 years there were 1804 deaths (786 from cardiovascular disease, 608 from cancer, 103 from pulmonary disease and 307 from any other cause). Men with effort-related breathlessness had increased risk of dying from all of the examined diseases. After adjustment for age, smoking habit and other risk factors, the relative risk (RR) associated with breathlessness of dying from coronary disease was 1.43 (95% CI : 1.16-1.77), from stroke 1.77 (95% CI: 1.07-2.93), from any cardiovascular disease 1.48 (95% CI : 1.24-1.76), cancer 1.36 (95% CI : 1.11-1.67) and from any cause 1.62 (95% CI: 1.44-1.81). An independent effect of breathlessness on cardiovascular death, cancer death and mortality from all causes was found in life-time non-smokers, and also if men with chest pain not considered to be angina were excluded. An independent effect was also found if all deaths during the first half of the follow-up were excluded. Men with cough and phlegm, without breathlessness, also had an elevated risk of dying from cardiovascular disease and cancer, but after adjustment for smoking and other risk factors this was no longer significant. However, a slightly elevated independent risk of dying from any cause was found (RR = 1.18 [95% CI: 1.02-1.36]). CONCLUSION A positive response to a simple question about effort related breathlessness predicted subsequent mortality from several causes during a follow-up period of 16 years, independently of smoking and other risk factors.
Collapse
Affiliation(s)
- A Rosengren
- Section of Preventive Cardiology, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
| | | |
Collapse
|
40
|
Reinert P. [Criteria of gravity of neurological malaria in children]. Dev Sante 1998:16-7. [PMID: 12321846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
41
|
Abstract
The predictive value of the neonatal neurological examination (NNE) adapted from Prechtl, was investigated in 139 term Zimbabwean infants born with an Apgar score of five or less at 5 min. At 4 months, seven infants had died and 13 were lost to follow-up, leaving 119 infants to undergo the Infant Motor Screen (IMS). Eighty-eight infants were diagnosed as normal, six as suspect and 25 as abnormal at screening. The sensitivity, specificity, positive predictive value and negative predictive value of the NNE were 94%, 55%, 42% and 96%, respectively. Seventeen (14%) infants had developed microcephaly at 4 months and 13 (77%) of them scored abnormal on the IMS. Twenty-three of the 48 (48%) infants who had convulsions within 48 h of birth, were diagnosed as abnormal (P < 0.0001). The NNE proved to be very sensitive in detecting neurodevelopmental abnormalities in the neonatal period and the five abnormal syndromes derived from the NNE were able to correctly identify 94% of the abnormal infants.
Collapse
Affiliation(s)
- M J Wolf
- Children's Rehabilitation Unit, Mpilo Central Hospital, Bulawayo, Zimbabwe
| | | | | | | |
Collapse
|
42
|
Mukhopadhyay K, Kumar P, Narang A. Role of early postnatal dexamethasone in respiratory distress syndrome. Indian Pediatr 1998; 35:117-22. [PMID: 9707853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To study the effect of early postnatal dexamethasone therapy on severity of hyaline membrane disease. DESIGN Prospective, randomized, controlled, unblinded study. SETTING Neonatal Intensive Care Unit. METHODS 19 babies who had hyaline membrane disease were included in this study. The inclusion criteria were clinical and radiographic diagnosis of RDS, requiring mechanical ventilation and FiO2 > 0.3. Ten babies received injection dexamethasone 0.5 mg/kg/dose 12 hourly for 3 days starting within 6 hours of birth. The control group did not receive any drug. Babies with active infection, bleeding tendency and congenital malformation were excluded. None of the babies received surfactant. The duration of ventilation and AaDO2 and FiO2 requirements from day one to five were calculated. RESULTS The initial AaDO2 were similar in both the groups but on day 3, 4, 5 AaDO2 were low in study group (201, 85, 70) compared to control group (236, 209, 162). The initial FiO2 were 0.66 and 0.63 in dexamethasone and control groups, respectively and remained high till day 2 and came down in study group on days 3, 4 and 5 (0.41, 0.27, 0.27) compared to control group (0.53, 0.34, 0.42). The mean duration of ventilation was shorter in dexamethasone group (87 hours) vs control group (120 hours). CONCLUSION Early use of postnatal dexamethasone reduces the disease severity and oxygen requirement in RDS and hence would be useful in the Indian context.
Collapse
Affiliation(s)
- K Mukhopadhyay
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh
| | | | | |
Collapse
|
43
|
Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bull World Health Organ 1998; 76:633-40. [PMID: 10191559 PMCID: PMC2312489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Noncommunicable diseases (NCDs) such as hypertension, asthma, diabetes and epilepsy are placing an increasing burden on clinical services in developing countries and innovative strategies are therefore needed to optimize existing services. This article describes the design and implementation of a nurse-led NCD service based on clinical protocols in a resource-poor area of South Africa. Diagnostic and treatment protocols were designed and introduced at all primary care clinics in the district, using only essential drugs and appropriate technology; the convenience of management for the patient was highlighted. The protocols enabled the nurses to control the clinical condition of 68% of patients with hypertension, 82% of those with non-insulin-dependent diabetes, and 84% of those with asthma. The management of NCDs of 79% of patients who came from areas served by village or mobile clinics was transferred from the district hospital to such clinics. Patient-reported adherence to treatment increased from 79% to 87% (P = 0.03) over the 2 years that the service was operating. The use of simple protocols and treatment strategies that were responsive to the local situation enabled the majority of patients to receive convenient and appropriate management of their NCD at their local primary care facility.
Collapse
|
44
|
Vince JD. The management of asthma in children in Papua New Guinea. P N G Med J 1996; 39:329-37. [PMID: 10214092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
In the last decade advances in knowledge of the aetiology and pathogenesis of asthma, and the availability of metered-dose inhalers and nebulisers, has led to a change in emphasis in both the preventive and curative aspects of the management of children with asthma. Metered-dose inhalers are available in Papua New Guinea, and can be used successfully, with spacing devices, even in children less than 2 years of age. Inhaled beta-sympathomimetics, now widely available and relatively inexpensive, may be all that is required for the majority of children with infrequent episodic asthma. For those with frequent episodic and chronic asthma, preventive therapy with inhaled steroids is available and should be given wherever practicable. In the management of acute severe asthma inhaled beta-sympathomimetics should be combined with a short course of oral or parenteral steroids (covered with isoniazid in areas where tuberculosis is prevalent). Whilst asthma classically presents with wheeze, medical personnel should be aware of its other presentations. It is possible, and should be the aim, to achieve a very high level of control for the majority of asthmatic children using currently available therapy.
Collapse
Affiliation(s)
- J D Vince
- Department of Clinical Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| |
Collapse
|
45
|
Gupta P, Faridi MM, Rawat S, Sharma P. Clinical profile and risk factors for oral candidosis in sick newborns. Indian Pediatr 1996; 33:299-303. [PMID: 8772904 DOI: pmid/8772904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To provide the clinical profile and assess the significance of various risk factors contributing to the occurrence of oral candidosis in newborns. DESIGN Case-control study. SETTING Neonatal Intensive Care Unit (NICU). SUBJECTS Twenty newborns with oral candidosis and an equal number of age and weight matched controls. INTERVENTIONS All cases of oral candidosis were treated with local application of 1% Clotrimazole. RESULTS Oral candidosis was documented in 3.2% (20/650) cases in the NICU. Acute pseudomembranous candidosis was the most common presentation. The mean age of onset was 10.5 days. Candida albicans was isolated in 50% cases in addition to C. tropicalis, C. paratropicalis, C. krusei, C. glabrata and C. parapsilosis. On univariate analysis, male sex, birth asphyxia and prolonged antibiotic therapy had a significant correlation with occurence of oral candidosis in neonates. Out of these, birth asphyxia was the only factor significantly associated with oral candidosis (OR 8.09, 95% CI 1.34-48.8, p = 0.0226) on multivariate analysis. CONCLUSIONS C. albicans was the predominant isolate in this series of oral candidosis. Clinical manifestations were evident in the second week of life and birth asphyxia was the most important associated perinatal event.
Collapse
Affiliation(s)
- P Gupta
- Department of Pediatrics, University College of Medical Sciences, Delhi
| | | | | | | |
Collapse
|
46
|
Yang PH. Morbidity of survivors of neonatal respiratory distress syndrome under four years of age. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1996; 37:103-6. [PMID: 8935407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluates the morbidity of neonatal respiratory distress syndrome (RDS) survivors in the Taiwan area. Sixty-three survivors of RDS, without surfactant therapy, were followed from January 1984 to December 1994. Comparisons between RDS survivors and 102 premature controls demonstrated that allergic rhinitis and hyperreactive airway (HRA) were adversely affected in RDS infants and children, especially in patients with chronic lung disease (CLD). It is interesting that a high incidence of otitis media and hypothyroidism was not found in this study, even though these have been reported elsewhere as more frequent among RDS survivors than among control subjects.
Collapse
Affiliation(s)
- P H Yang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C
| |
Collapse
|
47
|
Muhe L. Managing pneumonia. Child Health Dialogue 1996:13. [PMID: 12292168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
48
|
Tamburlini G. Fast action saves lives. Child Health Dialogue 1996:3-4. [PMID: 12292170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
49
|
Kumar A, Bhat BV. Respiratory distress in newborn. Indian J Matern Child Health 1996; 7:8-10. [PMID: 12320381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
50
|
Asindi AA, Antia-Obong OE, Ibia EO, Udo JJ. Neonatal seizures in Nigerian infants. Afr J Med Med Sci 1995; 24:243-8. [PMID: 8798959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nigerian newborns presenting with convulsion in University of Calabar Teaching Hospital, Calabar during the period January 1989 to December 1990 were prospectively studied to determine the aetiology and pattern of their seizures. There were 60 patients representing 4% of admissions into the Newborn Unit during the period. Birth asphyxia, infections and hypoglycaemia were the important identifiable aetiological factors which operated either singly (48% of cases) or in concert (in another 48%) of the infants. Detectable infections included meningitis and septicaemia caused predominantly by coliforms and Staphylococcus aureus. Hypocalcaemia and electrolyte imbalance did not feature. There was an unusually high prevalence (63% of cases) of the generalised type of seizures probably due to the high frequency of mixed aetiology. The mortality rate of 50% encountered appears to be related to the underlying aetiology and prematurity. Detectable caused of neonatal seizures in our environment appear to be potentially preventable by improved obstetric and neonatal care. There is dire need also to provide modern facilities for investigating newborn seizures in order to improve upon the diagnostic yield.
Collapse
Affiliation(s)
- A A Asindi
- Department of Paediatrics, University of Calabar Teaching Hospital, Nigeria
| | | | | | | |
Collapse
|