Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series.

Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.

Mendelson's Syndrome: Chemical Pneumonitis After Pesticide Intake.

BACKGROUND Mendelson's syndrome consists of pulmonary aspiration of acidic gastric contents that results in acute lung injury (chemical pneumonitis). CASE REPORT We present the case of a 15-year-old girl who was admitted to the Emergency Department 1 h after ingestion of an organophosphate pesticide. The patient had abundant emesis of aqueous, transparent content, accompanied by drowsiness and moderate sialorrhea. We observed drooling and foaming at the mouth and tachycardia, and her oxygen saturation dropped to 75%, requiring immediate invasive ventilation. Computed tomography (CT) revealed opacities in both lung bases, while bronchoscopy evidenced burn lesions along the airway. A bronchoalveolar lavage (BAL) was performed and microbiological results were negative. Following the BAL, the patient showed a satisfactory evolution and full recovery. CONCLUSIONS This case report describes chemical pneumonitis due to pulmonary aspiration of sterile gastric contents following ingestion of a pesticide. We discuss the importance of timely diagnosis, the characteristic burn lesions found in bronchoscopy, and the role of bronchoalveolar lavage, which most likely allowed for a rapid recovery with favorable results.

Bronchial Visualization of Tetanic Contractions: A Case Report.

BACKGROUND Tetanus is a potentially fatal infectious disease which, during its evolution, creates multiple complications, usually requiring intensive management and care. CASE REPORT We present a clinical case of a 59-year-old male patient with generalized tetanus admitted to the intensive care unit. Flexible bronchoscopy revealed contraction of the bronchial demonstrating that tetany existed at the respiratory level, which rarely becomes evident. The clinical manifestations included trismus, facial paralysis, neck stiffness, and compromised respiratory function. The patient presented a state of respiratory failure that required invasive mechanical ventilation which was evaluated by bronchoscopy and that showed spasms of the bronchial musculature. The patient presented generalized tetanus in which the bronchial affectation was evaluated by bronchoscopy in the intensive care unit. In developed countries, the anti-tetanus toxoid vaccine has ostensibly decreased its incidence, while it is endemic in developing countries, and although there are measures such as vaccination that try to reduce its incidence, in Ecuador there is an increase in incidences. In this patient case, contraction of the bronchial rings was observed, demonstrating that tetany existed at the respiratory level, which rarely becomes evident. CONCLUSIONS Although muscular contractions are widespread, this clinical case evidences bronchial spams reported and visualized by bronchoscopy.

Volume-assured pressure support mode plus pirfenidone as resuscitation therapy in patients with exacerbation of idiopathic pulmonary fibrosis.

INTRODUCTION: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This case report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of apatient'ssymptoms in combination with high-resolution computed tomography (HRCT) evidence. MATERIAL AND METHODS: An 83-year-old female patient with multiple hospital admissions within a six-month period initially presented with cardiac symptoms which were later attributed to apossible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis. CONCLUSION: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis.