Acute Respiratory Failure In Patients Research Articles

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies.

BackgroundNoninvasive ventilation (NIV) has proved to be a useful technique for breathing support. However, complications, discomfort, and failure of NIV were commonly caused by the mask. Therefore, the helmet was developed to improve performance and reduce complications; however, there has been no conclusive results on its effect until now. Thus, we performed a systematic review and meta-analysis to investigate the effect of NIV with a helmet versus the control strategy in patients with acute respiratory failure (ARF).MethodsWe searched Cochrane Library, PubMed, Ovid, and Embase databases and bibliographies of relevant articles published before June 2016. Randomized and case-control studies that adopted the helmet as an NIV interface and compared it with another interface were included. The primary outcomes were hospital mortality, intubation rate, and complications. The secondary outcomes included the length of intensive care unit (ICU) stay, gas exchange, and respiratory rate. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated by the Mantel-Haenszel method and mean difference by the inverse variance method in a fixed effect model or random effects model according to the heterogeneity.ResultsA total of 11 studies involving 621 patients were included. The overall hospital mortality was 17.53 % in the helmet NIV group versus 30.67 % in the control group. Use of the helmet was associated with lower hospital mortality (OR 0.43, 95 % CI 0.26 to 0.69, p = 0.0005), intubation rate (OR 0.32, 95 % CI 0.21 to 0.47, P < 0.00001), and complications (OR 0.6, 95 % CI 0.4 to 0.92, P = 0.02). In contrast, there was no significant difference in gas exchange and ICU stay (P >0.05). Subgroup analysis found the helmet reduced mortality mainly in hypoxemic ARF patients (P < 0.05) and a lower intubation rate was shown in randomized trials; fewer complications caused by the helmet might be restricted to case-control trials. Additionally, the effect of the helmet on PaCO2 was influenced by type of ARF and ventilation mode (P <0.00001).ConclusionNIV with a helmet was associated with reduced hospital mortality and intubation requirement. The helmet was as effective as the mask in gas exchange with no additional advantage. Large randomized controlled trials are needed to provide more robust evidence.

Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure.

Background:Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients. However, airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance. This study was to evaluate the Paw stress index on lung mechanics and the correlation between Paw stress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients.Methods:Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital, Nanjing, China and Ospedale S. Giovanni Battista-Molinette Hospital, Turin, Italy. All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min. PEEP was set according to the ARDSnet study protocol. The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio. The high elastance group (H group, n = 14) had a ratio ≥30%, and the low elastance group (L group, n = 10) had a ratio <30%. Respiratory elastance, gas-exchange, Paw stress index, and PL stress index were measured. Student's t-test, regression analysis, and Bland–Altman analysis were used for statistical analysis.Results:Pneumonia was the major cause of respiratory failure (71.0%). Compared with the L group, PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs. 9.0 ± 2.3 cmH2O, P < 0.01). Compared with the H group, lung elastance was higher (20.0 ± 7.8 cmH2O/L vs. 11.6 ± 3.6 cmH2O/L, P < 0.01), and stress was higher in the L group (7.0 ± 1.9 vs. 4.9 ± 1.9, P = 0.02). A linear relationship was observed between the Paw stress index and the PL stress index in H group (R2= 0.56, P < 0.01) and L group (R2= 0.85, P < 0.01).Conclusion:In the ARF patients with MV, Paw stress index can substitute for PL to guide ventilator settings.Trial Registration:ClinicalTrials.gov NCT02196870 (https://clinicaltrials.gov/ct2/show/NCT02196870).

Distribution-based estimates of minimal important difference for hospital anxiety and depression scale and impact of event scale-revised in survivors of acute respiratory failure.

This study will estimate distribution-based minimal important difference (MID) for the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) subscales, and the Impact of Event Scale-Revised (IES-R) in survivors of acute respiratory failure (ARF). Secondary analyses of data from two US and three UK studies of ARF survivors (total N=1223). HADS-D and HADS-A were used to assess depression and anxiety symptoms. IES-R assessed post-traumatic stress disorder symptoms. Standard error of measurement, minimal detectable change90, 0.5 standard deviation (S.D.), and 0.2 S.D. were used to estimate MID for the combined sample, by studies, 6- and 12-month follow-ups, country and mental health condition. Overall, MID estimates converged to 2.0-2.5 for the HADS-A, 1.9-2.3 for the HADS-D and 0.17-0.18 for the IES-R. MID estimates were comparable across studies, follow-up, country and mental health condition. Among ARF survivors, 2.0-2.5 is a reasonable range for the MID for both HADS subscales, and 0.2 is reasonable for IES-R. Until anchor-based MIDs for these instruments are available, these distribution-based estimates can help researchers plan future studies and interpret the clinical importance of findings in ARF patient populations.

Management of Acute Respiratory Failure in Patients With Hematological Malignancy.

Acute respiratory failure (ARF) is the leading cause of intensive care unit admission in patients with hematologic malignancies and is associated with a high mortality. The main causes of ARF are bacterial and opportunistic pulmonary infections and noninfectious lung disorders. Management consists of a systematic clinical evaluation aimed at identifying the most likely cause, which in turn determines the best first-line empirical treatments. The need for mechanical ventilation is a major determinant of prognosis. Beneficial outcomes have been demonstrated with early use of noninvasive ventilation (NIV) in selected patients with hematologic malignancies. However, most of these studies did not control the time between onset of ARF to NIV implementation nor accounted for the etiology of ARF or the presence of associated organ dysfunction at the time of NIV initiation. Moreover, the benefits demonstrated with NIV in these patients were derived from studies with high mortality rates of intubated patients. Additional studies are therefore warranted to determine the appropriate patients with hematologic malignancy and ARF who may benefit from prophylactic or curative NIV.

Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives.

Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.

Clinical utility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematological disease.

A high-flow nasal cannula (HFNC) is a newly developed device that enables high-flow oxygen therapy for patients with serious cardiopulmonary problems, but there are few data regarding its use in patients with hematological disease. The efficacy and tolerability of HFNCs for patients who developed ARF during the treatment of various hematological diseases was evaluated. Fifty-six patients underwent HFNC therapy during the last 2 years, and the causes of ARF were mainly pneumonia (n = 37) or acute congestive heart failure (n = 7). Only 11 patients (20 %) showed a good response to HFNC therapy, and remaining 45 patients (80 %) failed to respond to the initial HFNC therapy and, therefore, underwent second-line therapy including endotracheal intubation with mechanical ventilation (n = 15), non-invasive positive pressure ventilation (n = 1), or narcotic palliation alone (n = 29). Thus, HFNC appear not to be a viable treatment option in 4 out of 5 patients in this cohort of patients with hematological disease, but it was well tolerated in most patients (96 %); no major complications except for nasal soreness (n = 2) were observed. Multivariate analysis showed that the cause of ARF (pneumonia, odds ratio 11.2, 95 % CI 1.76–71.5, p = 0.01) was the only risk factor for treatment failure.

Pulse Oximetry Overestimates Oxygen Saturation in COPD.

Measurement of oxygen saturation with a handheld pulse oximeter is widely practiced as a surrogate to invasive arterial blood gas analysis. Oxygen saturation is an important parameter in cases of COPD, but there are insufficient data on the role of pulse oximetry in patients with COPD, moreso in diseases across its spectrum, such as chronic bronchitis and emphysema. We assessed the performance of pulse oximetry in acute respiratory failure of patients with COPD. This was a cross-sectional, observational study. We studied 50 subjects with COPD admitted to the Government General Hospital, a 1,000-bed tertiary referral center in Guntur, India, from June 2013 to July 2013. Simultaneous reading of S(pO2) by a handheld pulse oximeter and S(aO2) by an automated arterial blood gas analyzer were taken. Pulse oximetry was sufficiently sensitive (84.60%) to hypoxemia in respiratory failure to be used in clinical situations. The mean difference (bias) between SaO2 and S(pO2) was -3.98 (95% CI -4.68 to 3.28). There was less sensitivity (82% vs. 85%) and positive predictive value (69% vs. 85%) of the pulse oximeter to respiratory failure in subjects with chronic bronchitis versus emphysema. Pulse oximetry performed poorly in comparison with the invasive arterial blood gas analysis. The variability of the readings was greater in the subjects with chronic bronchitis than in those with emphysema.

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study

BackgroundNoninvasive ventilation (NIV) is used in critically ill patients with acute respiratory failure (ARF) to avoid endotracheal intubation. However, the impact of NIV use on ARF patient’s outcomes is still unclear. Our objectives were to evaluate the rate of NIV failure in hypoxemic patients with an arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg or ≥ 45 mmHg at ICU admission, the predictors of NIV failure, ICU and hospital length of stay and 28-day mortality.MethodsProspective single center cohort study. All consecutive patients admitted to a mixed ICU during a three-month period who received NIV, except for palliative care purposes, were included in this study. Demographic data, APACHE II score, cause of ARF, number of patients that received NIV, incidence of NIV failure, length of ICU, hospital stay and mortality rate were compared between NIV failure and success groups.ResultsEighty-five from 462 patients (18.4 %) received NIV and 26/85 (30.6 %) required invasive mechanical ventilation. NIV failure patients were comparatively younger (67 ± 21 vs. 77 ± 14 years; p = 0.031), had lower arterial bicarbonate (p = 0.005), lower PaCO2 levels (p = 0.032), higher arterial lactate levels (p = 0.046) and APACHE II score (p = 0.034) compared to NIV success patients. NIV failure occurred in 25.0 % of patients with PaCO2 ≥ 45 mmHg and in 33.3 % of patients with PaCO2 < 45 mmHg (p = 0.435). NIV failure was associated with an increased risk of in-hospital death (OR 4.64, 95 % CI 1.52 to 14.18; p = 0.007) and length [median (IQR)] of ICU [12 days (8–31) vs. 2 days (1–4); p < 0.001] and hospital [30 (19–42) vs. 15 (9–33) days; p = 0.010] stay. Predictors of NIV failure included age (OR 0.96, 95 % CI 0.93 to 0.99; p = 0.007) and APACHE II score (OR 1.13, 95 % CI 1.02 to 1.25; p = 0.018).ConclusionNIV failure was associated with an increased risk of in-hospital death, ICU and hospital stay and was not affected by baseline PaCO2 levels. Patients that failed were comparatively younger and had higher APACHE II score, suggesting the need for a careful selection of patients that might benefit from NIV. A well-designed study on the impact of a short monitored NIV trial on outcomes is needed.

Effects of Positive End Expiratory Pressure On Regional Ventilation-Perfusion Matching And Respiratory Mechanics: A Clinical Study

In intubated acute respiratory failure patients, inhomogeneity of ventilation-perfusion matching (i.e., presence of over-ventilated under-perfused lung regions) might determine extreme pH shifts and increase the risk of developing ventilator-induced injury. Positive end-expiratory pressure (PEEP) redistributes tidal ventilation towards more perfused dependent lung regions, potentially improving homogeneity of ventilation-perfusion matching.

High flow nasal cannula improves lung aeration and enhances CO2 removal in hypoxemic critically ill patients

High-flow nasal cannula (HFNC) is a non-invasive respiratory support increasingly applied to hypoxemic acute respiratory failure patients. HFNC decreases dyspnea, improves oxygenation and enhances patient's comfort.

Effects of Sigh on Regional Lung Strain and Ventilation Heterogeneity in Acute Respiratory Failure Patients Undergoing Assisted Mechanical Ventilation.

In acute respiratory failure patients undergoing pressure support ventilation, a short cyclic recruitment maneuver (Sigh) might induce reaeration of collapsed lung regions, possibly decreasing regional lung strain and improving the homogeneity of ventilation distribution. We aimed to describe the regional effects of different Sigh rates on reaeration, strain, and ventilation heterogeneity, as measured by thoracic electrical impedance tomography. Prospective, randomized, cross-over study. General ICU of a single university-affiliated hospital. We enrolled 20 critically ill patients intubated and mechanically ventilated with PaO2/FIO2 up to 300 mm Hg and positive end-expiratory pressure at least 5 cm H2O (15 with acute respiratory distress syndrome), undergoing pressure support ventilation as per clinical decision. Sigh was added to pressure support ventilation as a 35 cm H2O continuous positive airway pressure period lasting 3-4 seconds at different rates (no-Sigh vs 0.5, 1, and 2 Sigh(s)/min). All study phases were randomly performed and lasted 20 minutes. In the last minutes of each phase, we measured arterial blood gases, changes in end-expiratory lung volume of nondependent and dependent regions, tidal volume reaching nondependent and dependent lung (Vtnondep and Vtdep), dynamic intratidal ventilation heterogeneity, defined as the average ratio of Vt reaching nondependent/Vt reaching dependent lung regions along inspiration (VtHit). With Sigh, oxygenation improved (p < 0.001 vs no-Sigh), end-expiratory lung volume of nondependent and dependent regions increased (p < 0.01 vs no-Sigh), Vtnondep showed a trend to reduction, and Vtdep significantly decreased (p = 0.11 and p < 0.01 vs no-Sigh, respectively). VtHit decreased only when Sigh was delivered at 0.5/min (p < 0.05 vs no-Sigh), while it did not vary during the other two phases. Sigh decreases regional lung strain and intratidal ventilation heterogeneity. Our study generates the hypothesis that in ventilated acute respiratory failure patients, Sigh may enhance regional lung protection.

Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

PurposeProne positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). Material and MethodsWe retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). ResultsFifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n = 18), PP improved oxygenation (Pao2/Fio2 124 ± 50 mmHg, 187 ± 72 mmHg, and 140 ± 61 mmHg, during PRE, PRONE, and POST steps, respectively, P < .001), while pH and Paco2 were unchanged. ConclusionsPP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.

Combining nutrition and exercise to optimize survival and recovery from critical illness: Conceptual and methodological issues

Survivors of critical illness commonly experience neuromuscular abnormalities, including muscle weakness known as ICU-acquired weakness (ICU-AW). ICU-AW is associated with delayed weaning from mechanical ventilation, extended ICU and hospital stays, more healthcare-related hospital costs, a higher risk of death, and impaired physical functioning and quality of life in the months after ICU admission. These observations speak to the importance of developing new strategies to aid in the physical recovery of acute respiratory failure patients. We posit that to maintain optimal muscle mass, strength and physical function, the combination of nutrition and exercise may have the greatest impact on physical recovery of survivors of critical illness. Randomized trials testing this and related hypotheses are needed. We discussed key methodological issues and proposed a common evaluation framework to stimulate work in this area and standardize our approach to outcome assessments across future studies.

Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients

The effects of flow triggering (FT) compared with pressure triggering (PT) on breathing effort have been the focus of several studies, and discrepant results have been reported; yet, it remains an area of conflict that warrants further studies. The aim of this work is to compare flow versus PT in ventilating patients with acute respiratory failure. One hundred patients with acute respiratory failure of pulmonary origin were assigned randomly to two groups: 50 patients ventilated with PT and 50 patients ventilated with FT. The primary end points were weaning duration, evaluation of patient/machine synchronization, total duration of ventilation and ICU stay as well time under sedation and occurrence of complications. Mortality was considered the secondary end point. Patients were categorized into those with obstructive, restrictive, and combined pulmonary disease according to their medical history, and clinical and radiological assessment, and also more and less severe disease according to the APACHE II score level (cut-off point). In all the patients studied, including those with restrictive pulmonary disorder and more severe disease (APACHE II score ≥32.5), there was a statistically significantly shorter duration of weaning, duration of ventilation, and duration of ICU stay in the FT group than the PT group. The pre-extubation oxygenation index was highly statistically significantly better in the FT group than the PT group (P < 0.001). In patients with obstructive pulmonary disorders, combined pulmonary disorders, and less severe disease (APACHE II <32.5), there was no significant difference between both PT and FT groups in these parameters. FT may be considered to be better than PT in ventilating acute respiratory failure patients with a restrictive pattern and those with higher severity scoring. In obstructive and mixed ventilatory impairment, use of either of them does not make a difference.

Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study.

BackgroundAcute respiratory failure (ARF) is a life-threatening event, which is frequently associated with the severe exacerbations of chronic obstructive pulmonary disease (COPD). Hypoalbuminemia is associated with increased mortality in patients with COPD. However, to date, little is known regarding whether or not hypoalbuminemia is a risk factor for developing ARF in COPD.MethodsWe conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. A total of 42,732 newly diagnosed COPD patients (age ≥40 years) from 1997 to 2011 were enrolled. Among them, 1,861 (4.36%) patients who had received albumin supplementation were defined as hypoalbuminemia, and 40,871 (95.6%) patients who had not received albumin supplementation were defined as no hypoalbuminemia.ResultsOf 42,732 newly diagnosed COPD patients, 5,248 patients (12.3%) developed ARF during the 6 years follow-up period. Patients with hypoalbuminemia were older, predominantly male, had more comorbidities, and required more steroid treatment and blood transfusions than patients without hypoalbuminemia. In a multivariable Cox regression analysis model, being elderly was the strongest independent risk factor for ARF (adjusted hazard ratio [HR]: 4.63, P<0.001), followed by hypoalbuminemia (adjusted HR: 2.87, P<0.001). However, as the annual average dose of albumin supplementation was higher than 13.8 g per year, the risk for ARF was the highest (adjusted HR: 11.13, 95% CI: 10.35–11.98, P<0.001).ConclusionHypoalbuminemia is a strong risk factor for ARF in patients with COPD. Therefore, further prospective studies are required to verify whether or not albumin supplementation or nutritional support may help to reduce the risk of ARF in patients with COPD.

Does the Body Mass Index Affect the Success of Noninvasive Mechanical Ventilation in Patients with Acute Hypercapnic Respiratory Failure?

Objective: Obesity has many negative effects on lung functions. It is not yet clear whether body mass index (BMI) affects the success of noninvasive mechanical ventilation (NIMV). The aim of this study was to investigate the differences in NIMV strategies, on the basis of BMI, in patients with acute hypercapnic respiratory failure and the effect of BMI on the success of NIMV. Methods: A total of 86 patients who had acute hypercapnic respiratory failure were enrolled consecutively. They were grouped according to BMI as follows: BMI 18.5 - 24.9kg/m 2 (normal); group 1, BMI 25 - 30kg/m2 (overweight); group 2, BMI>30kg/m2 (obese); group 3. Age, gender, duration of ICU stay, pressures of NIMV and Arterial Blood Gas (ABG) before, during and after the NIMV were recorded. Results: In total, 52 patients (60%) were male. The mean age of the patients was 70 ± 12 years. The success rates of NIMV in groups 1, 2 and 3 were 50%, 28% and 21%, respectively. The success rates were not significantly different between groups (p=0.79). In group 3, the respiratory rate was higher and pH was lower during the first hour compared to the other groups (p<0.05, p<0.05). PaCO 2 levels were higher in group 3 on the first day and at the end of NIMV treatment (p=0.04, p<0.05). Conclusion: NIMV strategies should be different in acute hypercapnic respiratory failure patients with a high BMI, and in these patients, clinical improvement requires a long duration.

Feasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies: A retrospective single-center study

PurposeThis study investigated the feasibility of high-flow nasal cannula (HFNC) oxygen therapy for acute respiratory failure in adult patients with hematologic malignancies. Materials and methodsWe identified 45 acute respiratory failure patients with hematologic malignancies who received HFNC therapy between March 2012 and June 2014 at Seoul St Mary's Hospital. Their medical records were reviewed retrospectively to identify useful prognostic factors for successful treatment. ResultsOf the 45 patients, 15 (33.3%) successfully recovered, and 30 were changed to invasive ventilation due to failed HFNC treatment. The etiologies of acute respiratory failure were bacterial pneumonia (57.8%), Pneumocystis jirovecii pneumonia (17.8%), pulmonary edema (8.9%), and bronchiolitis obliterans organizing pneumonia (8.9%). The overall mortality rate was 62.2%. The HFNC treatment success rate was significantly different between the survivors and nonsurvivors. To evaluate risk factors for HFNC treatment failure, differences between the HFNC treatment success and failure groups were compared. There were no significant differences in the severity of underlying medical conditions. The percentage of bacterial pneumonia was significantly higher in the HFNC treatment failure group compared with the success group (73.3% vs 26.7%; P = .004). ConclusionsHigh-flow nasal cannula offers an interesting alternative to invasive ventilation in acute respiratory failure patients with hematologic malignancies. However, attention must be paid to the appropriate choice of HFNC settings such as oxygen flow.

Therapeutic exercise attenuates neutrophilic lung injury and skeletal muscle wasting.

Early mobilization of critically ill patients with the acute respiratory distress syndrome (ARDS) has emerged as a therapeutic strategy that improves patient outcomes, such as the duration of mechanical ventilation and muscle strength. Despite the apparent efficacy of early mobility programs, their use in clinical practice is limited outside of specialized centers and clinical trials. To evaluate the mechanisms underlying mobility therapy, we exercised acute lung injury (ALI) mice for 2 days after the instillation of lipopolysaccharides into their lungs. We found that a short duration of moderate intensity exercise in ALI mice attenuated muscle ring finger 1 (MuRF1)-mediated atrophy of the limb and respiratory muscles and improved limb muscle force generation. Exercise also limited the influx of neutrophils into the alveolar space through modulation of a coordinated systemic neutrophil chemokine response. Granulocyte colony-stimulating factor (G-CSF) concentrations were systemically reduced by exercise in ALI mice, and in vivo blockade of the G-CSF receptor recapitulated the lung exercise phenotype in ALI mice. Additionally, plasma G-CSF concentrations in humans with acute respiratory failure (ARF) undergoing early mobility therapy showed greater decrements over time compared to control ARF patients. Together, these data provide a mechanism whereby early mobility therapy attenuates muscle wasting and limits ongoing alveolar neutrophilia through modulation of systemic neutrophil chemokines in lung-injured mice and humans.

Steroid Treatment Resolves Acute Respiratory Failure in Patient Transferred for ECMO

Space-consuming mediastinal tumors can create respiratory failure. We are reporting on a case of mediastinal lymphoma, which created respiratory failure in our patient. IV steroid therapy was used in our patient, who presented with end-stage respiratory failure. Conservative management of our patient was possible without the application of ECMO. In the right patient population, IV steroid treatment can avoid further deterioration of end-stage respiratory failure.

Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters.

The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory - respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died - one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory - respiratory failure in 18 hours after surgery. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision.