Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.

BACKGROUND: Mortality rate, the possible factors affecting mortality and intubation in patients with acute exacerbation of chronic obstructive pulmonary diseases (COPD) and hypercapnic respiratory failure (RF) are yet unclear. OBJECTIVE: To identify the possible factors affecting mortality and intubation in COPD patients. DESIGN: A prospective study using data obtained over the first 24h of respiratory intensive care unit (RICU) admission. Consecutive admissions of 656 patients were monitored and 151 of them who had acute exacerbation of COPD and hypercapnic RF were enrolled. SETTING: University hospital, Department of Chest Diseases, RICU. RESULTS: Mean age was 65.1 years. The mean APACHE II score was 23.7. Eighty-seven patients (57.6%) received mechanical ventilation (MV) via an endotracheal tube for more than 24 h. Twenty-two patients received non-invasive ventilation (NIV). Fifty patients died (33.1%) in hospital during the study period. The mortality rate was 52.9% in patients in need of MV. In the multivariate analysis, the need for intubation, inadequate metabolic compensation for respiratory acidosis, and low (=bad) Glasgow Coma Score (GCS) were determined as independent factors associated with mortality. The low GCS (OR: 0.61; CI: 0.48-0.78) and high APACHE II score (OR: 1.24; CI: 1.11-1.38) were determined as factors associated with intubation. CONCLUSION: The most important predictors related to hospital mortality were the need for invasive ventilation and complications to MV. Adequate metabolic compensation for respiratory acidosis at admittance is associated with better survival. A high APACHE II score and loss of consciousness (low GCS) were independent predictors of a need to intubate patients.

Relapsing polychondritis.

Relapsing polychondritis (RP) is a rare, inflammatory disease with multisystem involvement and it should be considered in the aetiology of sudden respiratory distress. A 49-year-old woman was admitted to the emergency service of Osmangazi Hospital in acute respiratory distress. She had a tracheostomy following a diagnosis of laryngeal stenosis 10 years earlier. She was managed thereafter at another hospital with a diagnosis of asthma. At admission she was in respiratory distress, had arthralgias, bilateral subconjunctival hyperaemia, periorbital oedema and skin lesions. A thoracic CT showed tracheal wall thickening. Calcification of the auricular regions were noted bilaterally. Bronchi, conjunctiva and skin lesions were biopsied with a provisional diagnosis of RP. The diagnosis of RP in this patient was based on clinical, pathological and radiological findings. Steroid therapy was begun and she was referred to a surgical centre for stenting. This case report emphasizes the need to consider the possibility of RP as a cause of sudden respiratory distress.

[Serum adenosine deaminase activity in pulmonary tuberculosis]. / Akciger tüberkülozunda serum adenozin deaminaz aktivitesi.

Adenosine deaminase (ADA) activity has been helpful for the diagnosis of tuberculous pleurisy. However, there are few studies about the role of ADA in the diagnosis and follow-up of pulmonary tuberculosis. In our study, serum ADA activity was determined in order to investigate the role of the enzyme in the diagnosis of pulmonary tuberculosis and monitoring the efficiency of therapy. The ADA activity was (mean +/- SD) 21.77 +/- 8.51 U/L in pulmonary tuberculosis patients (n= 44), 6.24 +/- 3.25 U/L in old tuberculosis patients (n= 24), 8.58 +/- 4.38 U/L in healthy control subjects (n= 20), whereas the mean for the patients with bronchial cancer (n= 20) was 18.51 +/- 7.85 U/L. There was no statistical difference between the results of pulmonary tuberculosis patients and the patients with bronchial cancer. On the contrary, the result of these two group were significantly different from both old tuberculosis patients and healthy control subjects (p< 0.001 for both). In 10 pulmonary tuberculosis patients, ADA activities were determined both before and after treatment and a significant decrease was observed in ADA activities after treatment (p< 0.001). In conclusion, serum ADA activity is increased in pulmonary tuberculosis patients, therefore it may be a helpful parameter for monitoring therapy.

[Pleural effusion due to the ovarian hyperstimulation syndrome]. / Over Hiperstimülasyon Sendromuna Bagli Plevra Sivisi.

Ovulation induction is a treatment that aimed to increase the pregnancy probability by increasing the follicular grow up and maturation. The most frequent complication is ovarian hyperstimulation syndrome (OHSS). Pleural effusion and abdominal ascites accumulation is frequently accompany this syndrome. A young patient receiving ovulation induction therapy was admitted to our department with sudden chest pain and dyspnea. Exudative pleural effusion was determined in the right and we suggest that pleural effusion was accumulated due to OHSS because of the presence of abdominal ascites, hemoconcentration, recent application of ovulation induction therapy and elimination of other causative factors for pleural effusion. The disappearance of pleural effusion spontaneously in a week support our idea. We reviewed the literature about the pleural effusion due to ovarian hyperstimulation syndrome. In the differential diagnosis of pleural effusion in young female patients, the accumulation of pleural effusion due to the recent ovulation induction story should be kept in mind which is especially important in the differential diagnosis of pulmonary embolism.