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3.
Medicine (Baltimore) ; 99(17): e19810, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332623

RESUMO

INTRODUCTION: Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia. PATIENT CONCERNS: In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI. DIAGNOSES: The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests. INTERVENTIONS: Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given. OUTCOMES: Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter. CONCLUSION: Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.


Assuntos
Gasometria/métodos , Fígado/fisiopatologia , Isquemia Mesentérica/sangue , Veia Porta/fisiopatologia , Insuficiência Respiratória/sangue , Idoso de 80 Anos ou mais , Gasometria/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/fisiopatologia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/fisiopatologia , Tomografia Computadorizada por Raios X/métodos
4.
Neumol. pediátr. (En línea) ; 15(1): 270-277, Mar. 2020. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1088099

RESUMO

Noninvasive ventilatory support (NIVS) combined with mechanical cough assist (MI-E) is an effective tool to treat patients with acute ventilatory failure due to neuromuscular disorders (NMD). Airway respiratory infection could be lethal or with risk of endotraqueal intubation, especially when vital capacity (VC) is less than 15 ml/k. We report 2 obese adolescents, aged 11 and 14 years old, with myasthenic crisis (MC) and Duchenne muscular dystrophy (DMD). The last one with a severe cifoescoliosis treated with nocturnal noninvasive ventilation at home. MC girl has been treated with pyridostigmine, prednisolone and mycophenolate. They were admitted for thymectomy and spinal surgery arthrodesis respectively. After admission they developed airway respiratory infection triggering by Methaneumovirus and were treated with oxygen therapy, non-invasive ventilation with low-pressure support and EV immunoglobulin for the MC girl. After 48 h both patients developed severe respiratory failure, Sa/FiO2 < 200, atelectasis of lower lobes and difficulty to swallow, a peak cough flow (PFT)


El soporte ventilatorio no invasivo (SVNI) y la rehabilitación respiratoria con apilamiento de aire más tos asistida manual o mecánica, son efectivas para tratar la insuficiencia ventilatoria aguda en pacientes con enfermedades neuromusculares (ENM) y deterioro progresivo de la bomba respiratoria. Las agudizaciones gatilladas por infecciones respiratorias causan insuficiencia ventilatoria aguda potencialmente mortal y con alto riesgo de intubación, en especial cuando la capacidad vital (CV) es < de 15ml/k. Se reportan 2 adolescentes obesos con ENM de 11 y 14 años con miastenia gravis y distrofia muscular de Duchenne (DMD) con asistencia ventilatoria no invasiva nocturna con baja presión de soporte (AVNI), ingresados para timectomía y artrodesis de columna respectivamente. Una vez ingresados evolucionan con insuficiencia ventilatoria aguda secundaria a una infección respiratoria por Metaneumovirus. Inicialmente fueron manejados con oxigenoterapia, AVNI y gamaglobulina endovenosa en el caso de la paciente con crisis miasténica (CM). A las 48h presentan dificultad respiratoria severa, Sa/FiO2 < 200, atelectasias bibasales y disfagia, CV de 800ml (11ml/k) en el paciente con CM y de 200 ml (2,5ml/k) en el paciente con DMD y un pico flujo tosido (PFT) < 100 l/m. Se cambia a SVNI con equipo Trilogy® y BipapA40®, en modalidad S/T (espontáneo/tiempo) y AVAPS (volumen promedio asegurado en presión de soporte) con altos parámetros ventilatorios; suspendiendo rápidamente la oxigenoterapia, al combinar tos mecánicamente asistida con in-exsufflator (MI-E) en forma intensiva. Ambos pacientes presentan mejoría clínica sostenida, de la CV, PFT y pico flujo exuflado máximo con MI-E (PFE-MI-E). El SVNI más la aplicación sistemática del MI-E hasta lograr SaO2 de al menos 95% con oxígeno ambiental evita la intubación endotraqueal en ENM, a diferencia del agravamiento producido por AVNI y oxigenoterapia con criterios clásicos.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Insuficiência Respiratória/complicações , Insuficiência Respiratória/terapia , Ventilação não Invasiva/métodos , Evolução Clínica , Doenças Neuromusculares/complicações , Obesidade/complicações
5.
Crit Care Resusc ; 22(1): 63-71, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102644

RESUMO

BACKGROUND: The best sedative medication to reduce delirium, mortality and long term brain dysfunction in mechanically ventilated septic patients is unclear. This multicentre, double-blind, randomised trial investigates the short term and long term effects of dexmedetomidine versus propofol for sedation in mechanically ventilated severely septic patients. OBJECTIVES: To describe the statistical analysis plan for this randomised clinical trial comprehensively and place it in the public domain before unblinding. METHODS: To ensure that analyses are not selectively reported, we developed a comprehensive statistical analysis plan before unblinding. This trial has an enrolment target of 420 severely septic and mechanically ventilated adult patients, randomly assigned to dexmedetomidine or propofol in a 1:1 ratio. Enrolment was completed in January 2019, and the study was estimated to be completed in September 2019. The primary endpoint is days alive without delirium or coma during first 14 study days. Secondary outcomes include 28-day ventilator-free days, 90-day all-cause mortality and cognitive function at 180 days. Time frames all begin on the day of randomisation. All analyses will be conducted on an intention-to-treat basis. CONCLUSION: This study will compare the effects of two sedatives in mechanically ventilated severely septic patients. In keeping with the guidance on statistical principles for clinical trials, we have developed a comprehensive statistical analysis plan by which we will adhere, as this will avoid bias and support transparency and reproducibility. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01739933).


Assuntos
Delírio/induzido quimicamente , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/complicações , Sepse/complicações , Adulto , Estado Terminal , Delírio/diagnóstico , Delírio/prevenção & controle , Método Duplo-Cego , Mortalidade Hospitalar , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Unidades de Terapia Intensiva , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Respiração Artificial/efeitos adversos , Insuficiência Respiratória/terapia , Sepse/mortalidade
6.
BMC Infect Dis ; 20(1): 45, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941459

RESUMO

BACKGROUND: Acinetobacter baumannii is a gram-negative aerobic bacillus that is commonly causes of hospital-acquired infections. Community-acquired pneumonia caused by Acinetobacter baumannii (CAP-Ab) is rare but fatal if diagnosis and treatment are delayed. Conventional culture of clinical specimens is the main method for clinical diagnosis of A. baumannii infections which may suffer from limited positive rate and is time consuming. Timely and precise diagnosis of CAP-Ab remains challenging. CASE PRESENTATION: A 66-year-old man with 24 h history of acute fever and dyspnea was admitted to our hospital. He was diagnosed as severe community acquired pneumonia (CAP), septic shock, respiratory failure and acute kidney injury. Next-generation sequencing (NGS) was performed on the patient's sputum and blood, which identified numerous A. baumannii nucleotide sequences in the sample of sputum and led to the rapid diagnosis and treatment of community acquired pneumonia caused by A. baumannii. This result was confirmed by subsequent sputum culture. CONCLUSIONS: This case described that the successful application of the next generation sequencing assisting the speedy diagnosis of A. baumannii infection provides a new idea for the timely diagnosis of CAP-Ab and highlights that NGS is a promising tool in rapid etiological diagnosis of acute and severe infectious diseases.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/genética , Infecções Comunitárias Adquiridas/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Pneumonia Bacteriana/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Lesão Renal Aguda/complicações , Idoso , Antibacterianos/uso terapêutico , China , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar , Dispneia/complicações , Febre/complicações , Hospitalização , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pneumonia Bacteriana/sangue , Pneumonia Bacteriana/tratamento farmacológico , Insuficiência Respiratória/complicações , Choque Séptico/complicações , Escarro/microbiologia , Resultado do Tratamento
9.
Turkiye Parazitol Derg ; 43(4): 210-212, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31865658

RESUMO

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.


Assuntos
Febre de Causa Desconhecida/diagnóstico , Leishmaniose Visceral/diagnóstico , Adulto , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Doenças Autoimunes/diagnóstico , Biópsia , Medula Óssea/parasitologia , Medula Óssea/patologia , Paralisia Cerebral/complicações , Cromatografia de Afinidade/instrumentação , Diagnóstico Diferencial , Feminino , Febre de Causa Desconhecida/parasitologia , Humanos , Leishmaniose Visceral/tratamento farmacológico , Pancitopenia/diagnóstico , Recidiva , Respiração Artificial , Insuficiência Respiratória/complicações , Insuficiência Respiratória/terapia , Taquipneia , Turquia
10.
Turkiye Parazitol Derg ; 43(4): 213-215, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31865659

RESUMO

The objective of the present study is to present a patient with oral myiasis caused by Calliphoridae larvae. The patient was a 63-year-old male who was transferred from Van Closed Prison to Yüzüncü Yil University, Faculty of Medicine Research and Application Hospital. Five alive larvae localized in different points of gingival region were observed during routine oral cleaning. These larvae belonged to Calliphoridae family. As a result, medical staff should be informed about this infestation and this parasite should be kept in mind especially in risky group of patients and necessary controls should be conducted.


Assuntos
Dípteros , Doenças da Gengiva/parasitologia , Miíase/parasitologia , Animais , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Dípteros/classificação , Evolução Fatal , Gengiva/parasitologia , Doenças da Gengiva/diagnóstico , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Larva , Masculino , Pessoa de Meia-Idade , Miíase/diagnóstico , Respiração Artificial , Insuficiência Respiratória/complicações , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Turquia
11.
Medicine (Baltimore) ; 98(48): e18051, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770219

RESUMO

BACKGROUND: Evaluating the efficacy and safety of low molecular weight heparin (LMWH) for patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF) is a major purpose of this study. METHODS: The following electronic databases will be comprehensively retrieved from the inception to July 1, 2019: Cochrane Library, PUBMED, EMBASE, Google Scholar, Web of Science, Allied and Complementary Medicine Database, WANGFANG, and China National Knowledge Infrastructure without language restrictions. All randomized controlled trials related to LMWH for COPD and RF will be included. Two authors will carry out study selection, data collection, and risk of bias assessment independently. RESULTS: This study will systematically explore the efficacy and safety of LMWH for COPD and RF. The primary outcome is lung function. The secondary outcomes are severity of dyspnea on exertion, quality of life, body mass index, airflow obstruction; and any expected and unexpected adverse events. CONCLUSION: The findings of this study will provide evidence to judge whether LMWH is an effective treatment for patients with COPD and RF. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019 139631.


Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Insuficiência Respiratória/tratamento farmacológico , Índice de Massa Corporal , Dispneia/tratamento farmacológico , Dispneia/etiologia , Humanos , Pulmão/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/complicações , Ventilação Pulmonar/efeitos dos fármacos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Insuficiência Respiratória/complicações , Revisões Sistemáticas como Assunto , Resultado do Tratamento
12.
BMC Infect Dis ; 19(1): 938, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694565

RESUMO

BACKGROUND: Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay. METHODS: Retrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10^5/BAL > 10^4 CFU), low bacterial growth (TA < 10^5/BAL < 10^4 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis. RESULTS: Of 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02). CONCLUSIONS: In this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.


Assuntos
Infecções Bacterianas/epidemiologia , Bronquiolite Viral/terapia , Coinfecção/microbiologia , Respiração Artificial , Insuficiência Respiratória/terapia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Bronquiolite Viral/complicações , Coinfecção/etiologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/efeitos adversos , Tempo de Internação , Masculino , Países Baixos , Prevalência , Insuficiência Respiratória/complicações , Sistema Respiratório/microbiologia , Sistema Respiratório/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
An. pediatr. (2003. Ed. impr.) ; 91(5): 307-316, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186768

RESUMO

Introducción: La ventilación no invasiva (VNI) se ha convertido en un tratamiento habitual de la insuficiencia respiratoria aguda (IRA). Nuestro objetivo ha sido identificar factores predictores de fracaso de VNI para detectar precozmente a los pacientes en los que no tendrá éxito. Pacientes y métodos: Estudio de cohortes prospectivo que incluyó a todos los pacientes con IRA que recibieron VNI como tratamiento inicial entre 2005 y 2009, en una unidad de cuidados intensivos pediátricos de 14 camas de un hospital universitario de tercer nivel. Se recogieron datos clínicos e información sobre la VNI, previamente a su inicio, a las 2, 8, 12 y 24 horas. La razón entre saturación de hemoglobina y fracción de oxígeno inspirada (S/F) se calculó retrospectivamente. Se definió fallo de VNI como necesidad de intubación o necesidad de rescate con presión binivel (BLPAP). Se realizaron análisis estadísticos univariable y multivariable. Resultados: Un total de n = 282 pacientes recibieron soporte no invasivo, presión continua = 71, BLPAP = 211. El porcentaje de éxito de la muestra global fue 71%. Los pacientes tratados con BLPAP vs. presión continua, aquellos con S/F más elevados a las 2horas (odds ratio 0,991, IC 95%: 0,986-0,996, p = 0,001) y los mayores de 6 meses (hazard ratio 0,375, IC 95% 0,171-0,820, p = 0,014), presentaron menor riesgo de fracaso. Los pacientes con frecuencias cardíacas más altas y mayor presión positiva inspiratoria en vía aérea a las 2horas (odds ratio 1,021, IC 95%: 1,008-1,034, p = 0,001; hazard ratio 1,214, IC 95%: 1,046-1,408, p = 0,011) presentaron mayor riesgo de fracaso. Conclusiones: La edad < 6 meses, S/F, frecuencia cardíaca y presión positiva inspiratoria en la vía aérea a las 2 horas son factores predictores independientes de fracaso de VNI inicial en pacientes con IRA admitidos en una unidad de cuidados intensivos pediátricos


Introduction: Despite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment. Patients and methods: Prospective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24hrs. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed. Results: A total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2 hours (odds ratio [OR] 0.991, 95% CI 0.986-0.996, P = .001], and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI 0.171-0.820, P = .014], were also more likely to fail. Patients with higher heart rates (HR) at 2hours (OR 1.021, 95% CI [1.008-1.034], P = .001) and higher inspiratory positive airway pressure (IPAP) at 2hours were more prone to failure (HZ 1.214, 95% CI [1.046-1.408], P = .011). Conclusions: Age below 6 months, S/F ratio, HR, and IPAP at 2 hours are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Ventilação não Invasiva/métodos , Estudos de Coortes , Infecções Respiratórias , Insuficiência Respiratória/diagnóstico , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Estudos Prospectivos , Insuficiência Respiratória/complicações , Fatores de Risco , Intubação Intratraqueal/métodos
15.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586958

RESUMO

Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.


Assuntos
Paralisia Periódica Hipopotassêmica/diagnóstico , Miastenia Gravis/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Análise Química do Sangue , Colinesterases/sangue , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Paralisia Periódica Hipopotassêmica/sangue , Paralisia Periódica Hipopotassêmica/complicações , Infusões Intravenosas , Debilidade Muscular/etiologia , Miastenia Gravis/sangue , Miastenia Gravis/complicações , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Respiração Artificial , Insuficiência Respiratória/complicações
17.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488439

RESUMO

Benign gastrobronchial fistula (GBF) is a rare but potentially life-threatening complication of oesophagectomy for malignancy. We present a case of GBF post Ivor-Lewis surgery manifesting as pulmonary sepsis and type II respiratory failure. Clues to the diagnosis were persistent hypercapnia despite high minute ventilation, aspiration of gastric content through the endotracheal tube and accumulation of air in the nasogastric drainage bag. Flexible bronchoscopy confirmed the diagnosis. Surgical exploration identified necrosis of the proximal stomach as causative factor. Despite reconstruction of the oesophagogastric anastomosis and interposition of an intercostal muscle flap, the patient developed a new episode of type II respiratory failure. Bronchoscopy revealed in situ recurrence of the fistula. Patency of the fistula was proven through application of methylene blue with subsequent gastroscopy. A conservative, symptom-based, management was conducted. The patient died 6 hours later.


Assuntos
Fístula Brônquica/etiologia , Esofagectomia/efeitos adversos , Fístula Gástrica/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Idoso , Fístula Brônquica/cirurgia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Evolução Fatal , Feminino , Fístula Gástrica/cirurgia , Humanos , Insuficiência Respiratória/complicações
18.
Mymensingh Med J ; 28(3): 605-619, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391434

RESUMO

Non invasive ventilation (NIV) plays a vital role in the treatment of an episode of Hypercapnic respiratory failure (HRF) in Chronic obstructive pulmonary disease (COPD) patients. We wanted to investigate the possible effect on NIV outcomes of i) demographic factors, ii) the etiology of an episode of HRF and iii) the overall number and "individual" chronic and acute co-morbidities iv) biochemical parameters in COPD patients ventilated for an episode of HRF. This prospective study of 102(49.29%) COPD patients with HRF were eligible for NIV conducted in Respiratory care unit (RCU) and Intensive care unit (ICU) of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh from July 2016 to December 2017. Among them 70(68.63%) patients were improved and 32(31.37%) were not improved. On the study, some variables were associated with NIV outcome. On gross difference, two sample Z test had been applied in variables - age (p<0.01), mean days hospital stays before introduction of NIV (p<0.0001), APACHE II (Acute Physiological And Chronic Health Evaluation II) (p<0.001), Charlson co-morbidity index (CCI) (p=0.0212), serum albumin (p<0.001), PH (p=0.007), serum potassium (p<0.0001) whereas χ² test had been applied in variables - nutritional status (p<0.01), pneumonia (p=0.0003), dementia (p=0.0004), connective tissue disease (p=0.0094), mild liver disease (p=0.0355), diabetes mellitus with end organ damage (p=0.017), renal disease (p=0.0462), fibrothorax (p=0.0422). Some variables were not associated (p>0.05) with NIV outcome- two sample Z test had been done in variables- smoking status, PaO2 /FiO2 (p=0.7235), HCO3 - (p=0.1552), serum sodium (p=0.0827) whereas χ² test had been done in variables - sex, educational background, congestive heart failure (p=0.06), cardiogenic pulmonary oedema (p=0.6358) and pneumothorax (p=0.06), history of myocardial infarction (p=0.1024), congestive heart failure (p=0.06), peripheral vascular disease (p=0.4636), cerebrovascular disease (p=0.1074), peptic ulcer disease (p=0.06), hemiplegia (p=0.4138) , Diabetes without end organ damage (p=0.1034), tumour without metastasis (p=0.42259), solid tumour with metastasis (p=0.0562), leukaemia (0.1388), lymphoma (p=0.9388), obstructive sleep apnoea (0.9395), bed ridden patients (0.4984), history of pulmonary tuberculosis (p=0.08), kyphoscoliosis (p=0.1388), pneumenectomy (p=0.1388). On logistic regression analysis, eight variables had been shown association with NIV outcome among the seventeen variables which had association with NIV outcome in two sample Z test and χ² tests. Presence of Dementia increased chance of NIV failure 19.32 times, diabetes with end organ damage 10.9375 times and pneumonia 5.3636 times, fibrothorax 3.8077 times, renal disease 2.7273 times. Serum potassium imbalance 1.4615 times and increased serum albumin 1g/dl increased chance of NIV success 1.79 times, PH had also association with NIV outcome. Variables that predict the outcome of NIV are some non modifiable and some modifiable. If special precaution is taken for non modifiable variables and necessary management to correct the abnormalities of modifiable variables, improvements of patient's condition with NIV will be more satisfactory than the present condition.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Bangladesh , Humanos , Hipercapnia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Respiratória/complicações , Resultado do Tratamento
19.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413055

RESUMO

A 79-year-old man, who had significant cardiovascular morbidities, presented with out-of-hospital respiratory arrest. He regained breathing after brief cardiopulmonary resuscitation by his paramedic son. After meticulous investigations, acute cardiovascular events and metabolic causes were ruled out while features of obstructive sleep apnoea were elicited. The findings on in-laboratory polysomnography were compatible with severe obstructive sleep apnoea, with unusually prolonged apnoea duration of up to 2.7 min which most likely accounts for the presentation as 'respiratory arrest'. Thyroid function test for investigation of his weight gain confirmed hypothyroidism. His symptoms improved gradually after positive airway pressure therapy with bi-level support and thyroxine replacement. On further evaluation, his hypothyroidism is believed to be a complication of long-term amiodarone exposure. The case highlights that the combination of obstructive sleep apnoea and hypothyroidism can lead to catastrophic manifestation and the unusually long apnoea could be a feature prompting further workup for possible hypothyroidism.


Assuntos
Hipotireoidismo/diagnóstico , Insuficiência Respiratória/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Idoso , Reanimação Cardiopulmonar , Pressão Positiva Contínua nas Vias Aéreas , Diagnóstico Diferencial , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Masculino , Polissonografia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Tiroxina/administração & dosagem , Tiroxina/uso terapêutico
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