Case Of Acute Respiratory Failure Research Articles

Сlosed chest injury with preservation of the integrity of the ribs in the forensic medical assessment of its severity

The Aim. the forensic determination of the severity of closed chest injuries with intact ribs in victims hospitalized in a specialized surgical hospital to establish diagnostic expert criteria for expert assessment of such dmages.Materials and methods. 52 case histories of patients hospitalized hospitalized at the Kharkiv institute of general and emergency surgery named after V.T. Zaitseva were analyzed. Patients were divided into 4 groups based on the dynamics of morpho-functional pathological changes of the injured organs, the final results of the injury, and the presence of life-threatening phenomena.Results. The analysis of observations showed that the main traumatic factor in the emergence of the studied cases is the impact mechanism of blunt solid objects on the chest. Patients with closed blunt chest trauma were divided into observation groups depending on the morphology of the injuries received. The following main variants of the received injury are distinguished: without a contusion and bruised chest and the presence of intrapleural injuries and complications, a chest contusion without complications. Severe injuries were estimated in 15.4% of cases of acute respiratory failure and cases of trauma of partial or complete lung loss. Injuries of medium severity were established in 26.9% of cases of trauma in the absence of danger to life. Minor injuries were established in 57.7% of cases of trauma in the presence of intrapleural injuries and complications or minor injuries without any complications.Conclusions. When forensically determining the degree of severity of closed injuries of the chest, it is necessary to evaluate the morphology of the injury and clinic functional manifestations of life-threatening phenomena. At the same time, diagnostic signs which must be used when determining the severity of physical injuries are the following: the presence of clinical and functional signs of acute respiratory failure, loss of part or all of the respiratory organ (lungs), dynamics and duration of recovery of post-traumatic morpho-functional changes injured organs.

VACCINE-INDUCED ANTIBODY DEPENDENT ENHANCEMENT IN COVID-19

VACCINE-INDUCED ANTIBODY DEPENDENT ENHANCEMENT IN COVID-19

EVALI-RELATED PULMONARY TOXICITY

TYPE: Case Report TOPIC: Occupational and Environmental Lung Diseases INTRODUCTION: E-cigarette or vaping induced lung injury (EVALI) among those using tetrahydrocannabinol (THC) containing liquid products has been associated with additive Vitamin E Acetate (VEAc), the only common compound bronchoalveolar lavage (BAL) identified. We present a case of acute respiratory failure attributed to EVALI where treatment was based on VEAc role. CASE PRESENTATION: A 44 year old female complaining of dyspnea, cough, and hemoptysis presented with acute hypoxic respiratory failure requiring high flow nasal oxygen therapy in intensive care. She endorsed frequent vaping of THC containing liquid products. Further history revealed recent change in product supplier. CT chest demonstrated diffuse ground glass infiltrates (Figure 1). Labs showed increased white blood cells 12.6 THOU/mcL (3.6-10.5) and C- reactive protein 313 mg/L (<5). BAL deferred for unfavorable respiratory status. Initial treatment included methylprednisolone and bronchodilators. Hypoxia and dyspnea improved on prednisone taper enabling complete weaning of supplemental oxygen. DISCUSSION: As of 2020, 82% of EVALI cases have been attributed to THC containing liquid products. Suspected pathogenesis is linked to VEAc’s pulmonary effects including surfactant layer and viscosity alterations with lipid laden macrophages (LLM), however the driving element remains unclear. Despite routine bronchoscopy, nonspecific LLM findings challenge its diagnostic contribution in cases without suspcious alternative diagnoses. Characterizing radiographic patterns, including organizing pneumonia, ground glass opacities and subpleural sparing, may be advantageous. Continued investigation into EVALI pathogenesis and radiology can improve diagnosis and treatment. CONCLUSIONS: Understanding VEAc's influence on gas exchange can help focus treatment on alveolar recruitment through high flow oxygen therapy and anti-inflammatories. DISCLOSURE: Nothing to declare. KEYWORD: E- cigarette or vaping induced lung injury

ECMO Rescues Patients With Acute Respiratory Failure Related to GPA.

Granulomatosis with polyangiitis (GPA) is a subtype of anti-neutrophil cytoplasmic antibody-associated vasculitis with a wide range of clinical symptoms related to the systemic involvement of small blood vessels. The respiratory system is one of the most frequently involved, and life-threatening acute respiratory failure could occur due to diffusive alveolar hemorrhage and tracheal stenosis. When maximum mechanical ventilation is unable to maintain oxygenation, extracorporeal membrane oxygenation (ECMO) should be considered as the final respiratory supportive method, if available. Here we present a 32-year-old male patient with acute respiratory failure (ARF) related to GPA, who was rescued by winning time for accurate diagnosis and appropriate treatment. Additionally, we reviewed more than 60 GPA-related ARF cases on multiple online databases, summarized the clinical manifestations of these patients, and concluded that ECMO plays an important role in further respiratory support for ARF patients with GPA and assists in accurate and timely diagnosis and appropriate treatment, thus helping them recuperate.

Severe Cardiovascular Complications of COVID-19: a Challenge for the Physician

Introduction Since December 31, 2019, when China reported the appearance of cases of acute respiratory failure caused by a new species of coronavirus, SARS-CoV-2, which causes the disease called COVID-19, almost 20 million cases were confirmed, causing 726 thousand deaths worldwide. In Brazil, on August 8th, 2020, there was approximately 3 million cases and 100 thousand death by the disease. Its rapid spread, its high potential for hospitalization, and its high lethality, especially in the most fragile groups such as [...]

Nasal High Frequency Oscillatory Ventilation for Respiratory Failure due to Respiratory Syncytial Virus Bronchiolitis: Case Report

The authors describe a case of acute respiratory failure due to severe bronchiolitis. During high-flow nasal cannula ventilation, the blood's high levels of hypercapnia had taken them to plan the sedation and the orotracheal intubation. However, before attempting intubation, a nasal high frequency oscillatory ventilation cycle was performed and it led to a marked improvement in the blood gas, avoiding in this way the invasive ventilation.

Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review.

Objectives:With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs.Data Sources:We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.”Study Selection:We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea.Data Synthesis:Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes.Conclusions:Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.

Prehospital reversal of profound respiratory acidosis and hypercapnic coma by non-invasive ventilation: a report of two cases

BackgroundIn chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), non-invasive ventilation (NIV) is generally recommended and has proven its benefits by reducing endotracheal intubation (ETI) rates, intensive care unit (ICU) admissions, complications, and mortality. Choosing between immediate ETI or NIV trial is often difficult when such patients present with an altered mental status. Some guidelines recommend avoiding NIV when consciousness is impaired given the risk of aspiration, and some authors suggest that a pH < 7.25 is highly predictive of NIV failure. Though clinical response to a well-adjusted NIV treatment can be both swift and spectacular, these contraindications probably encourage physicians to proceed to immediate ETI. Some studies indeed report that NIV was not even considered in as many as 60% of patients who might have benefited from this therapy, though ETI related complications might have been avoided had NIV been successfully applied.Case presentationWe report two cases of ARF in COPD patients who were successfully treated by NIV in prehospital setting and avoided ETI despite contraindications (altered mental status with a Glasgow Coma Scale < 8) and failure risk factors (severe respiratory acidosis with pH < 7.25).ConclusionIn COPD patients presenting ARF, NIV trial could be considered even when relative contraindications such as an altered level of consciousness or a severe respiratory acidosis are present.

A RARE AND ATYPICAL PRESENTATION OF ANTISYNTHETASE SYNDROME

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Antisynthetase syndrome (AS) is a rare disease that can be challenging to diagnose, especially with an atypical presentation. The diagnosis of AS requires the presence of several antisynthetase autoantibodies and one of the following: fever, inflammatory polyarthritis, myositis, interstitial lung disease (ILD), Raynaud’s phenomenon or “mechanic’s hands”. We discuss a rare and atypical presentation of AS with acute respiratory distress syndrome (ARDS). CASE PRESENTATION: A 30-year-old Caucasian female without prior medical history presented to an outside hospital with dyspnea, nonproductive cough and chest discomfort for 2 weeks. A CT angiogram of the chest showed dense interstitial and alveolar opacities throughout the left lung and right lower lobe. She was treated for community acquired pneumonia with IV antibiotics for 5 days, without resolution of symptoms. Her respiratory status worsened and was transferred to our institution where she underwent orotracheal intubation for severe hypoxemia refractory to 100% oxygen via a non-rebreather mask. Further workup with an echocardiogram and bronchoscopy was non-revealing for a cause of ARDS, including a negative sequential lavage. Infectious workup including cultures was also negative and she had no fevers. Her review of systems was revisited and disclosed arthralgias, a rash on her forearms and symmetric weakness in handgrip in the preceding 4 weeks. With a high suspicion for an autoimmune cause of ARDS, an autoimmune panel was ordered and high-dose steroids were initiated. She was successfully weaned off mechanical ventilation on day 5 and eventually transferred out of the ICU. A few days later, her autoimmune workup resulted with a positive antinuclear (speckled pattern, 1:320), anti-ribonucleoprotein and anti-Jo-1 (>8.0) antibodies. Steroids were tapered over 14 days and mycophenolate was initiated and gradually titrated outpatient. Mycophenolate was later changed to azathioprine due to side effect of nausea. At 4 year follow up, her disease and symptoms remain well controlled with azathioprine, rituximab and steroids. DISCUSSION: Though ILD is a common manifestation of AS, severe presentations with ARDS are rare with a few previous reports in the literature 1-3. The patient had a good outcome with initiation of high dose steroids in a timely fashion. This case highlights the importance of considering non-infectious causes of pneumonia and ARDS in cases that do not respond appropriately to standard therapies. It also emphasizes the significance of detailed history taking since reaching a diagnosis is challenging in the absence of confirmatory serologic testing. CONCLUSIONS: It is important to have a broad differential for patients with nonresolving pneumonia, including autoimmune etiologies such as in this case. Early recognition and treatment can result in improved outcomes. Reference #1: Katzap E, Barilla-LaBarca ML, Marder G. Antisynthetase syndrome. Curr Rheumatol Rep. 2011;13(3):175-181. Reference #2: Kanchustambham VK, Saladi S, Mahmoudassaf S, Patolia S. Antisynthetase syndrome (ASS) presenting as acute respiratory distress syndrome (ARDS) in a patient without myositis features. BMJ Case Rep. 2016;2016. Reference #3: Malhotra G, Ramreddy N, Chua S, Iliescu M, Kaur T. A Curious Case of Acute Respiratory Failure: Is It Antisynthetase Syndrome? Case Rep Crit Care. 2016;2016:7379829. DISCLOSURES: No relevant relationships by Rodrigo Cavallazzi, source=Web Response No relevant relationships by Bilal Jalil, source=Web Response No relevant relationships by Hassan Zeb, source=Web Response

AMMoL の肺浸潤による急性呼吸不全に対し気管支動注療法が著効を示した 1 症例

AMMoL の肺浸潤による急性呼吸不全に対し気管支動注療法が著効を示した 1 症例

A case of acute respiratory failure in a rheumatoid arthritis patient after the administration of abatacept.

Drug-induced pulmonary disease is an important consideration in the differential diagnosis of patients with rheumatoid arthritis (RA) who present with respiratory symptoms. We report a patient with RA who developed acute respiratory failure two weeks after the administration of abatacept. The clinical findings were consistent with drug-induced acute respiratory failure, most likely acute eosinophilic pneumonia. Pulse steroid was administered at 1000 mg/kg/day in the emergency department. Chest X-ray and arterial blood gas values revealed significant improvement on the second day of hospitalization. However, in the second week, the patient's fever rose up to 40°C, procalcitonin level increased to 15 ng/mL (<0.5 ng/mL is normal), and the patient died because of sepsis in the fourth week. This is the second report of respiratory failure, after the abatacept administration in the literature. We have reported an acute respiratory failure that occurred after use of the biological agent abatacept. With the increasing use of novel immunomodulatory agents, it is important for clinicians and pathologists to add the possibility of a drug reaction to the traditional differentials of acute respiratory failures occurring in these settings.

Influenza A triggered status asthmaticus requiring emergency ECMO

We describe a case of acute respiratory failure due to severe pneumonia triggered by the influenza A virus, rapidly evolving into a refractory status asthmaticus requiring emergent ECMO assistance, in order to facilitate the clinical management of patients suffering from this rare but life-threatening condition. This case report demonstrates that infection with influenza A virus can present with severe pneumonia and status asthmaticus refractory to medical and ventilatory treatment. When medical treatment and mechanical ventilation fail, extracorporeal membrane oxygenation therapy should not be delayed as it will avoid injury resulting from inadequate mechanical ventilation and lung hyperinflation.

A Curious Case of Acute Respiratory Failure: Is It Antisynthetase Syndrome?

Antisynthetase (AS) syndrome is a major subgroup of inflammatory myopathies seen in a minority of patients with dermatomyositis and polymyositis. Although it is usually associated with elevated creatine phosphokinase level, some patients may have amyopathic dermatomyositis (ADM) like presentation with predominant skin involvement. Interstitial lung disease (ILD) is the main pulmonary manifestation and may be severe thereby determining the prognosis. It may rarely present with a very aggressive course resulting in acute respiratory distress syndrome (ARDS). We report a case of a 43-year-old male who presented with nonresolving pneumonia who was eventually diagnosed to have ADM through a skin biopsy without any muscle weakness. ADM may be associated with rapidly progressive course of interstitial lung disease (ADM-ILD) which is associated with high mortality. Differentiation between ADM-ILD and AS syndrome may be difficult in the absence of positive serology and clinical presentation may help in clinching the diagnosis.

What could be hidden behind acute respiratory failure causing emergency intubation?

This paper describes an uncommon case of acute respiratory failure in a patient who presented with low a haemoglobin rate and metabolic acidosis but with normal vital signs. He had a history of persistent atrial fibrillation, long-term therapy with coumarin anticoagulants and amiodarone, diabetes mellitus, and hypothyroidism. The patient was intubated due to severe acidosis, accumulation of lactic acid, and severe tachypnoea. During the investigation, and based on CT findings, it was thought that the patient had an upper gastrointestinal tumour. However, the results of the endoscopy were surprising. This paper outlines our comments, concerns and thoughts for an uncommon case which can present a potentially life-threatening situation for a patient. It also indicates the appropriate clinical and imaging investigation. Moreover, recommendations are given to enable a physician to offer the best possible services to a critically ill patient.

Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of cases of acute respiratory failure in intensive care units (ICUs). A third to half of patients will die in the ICU, in hospital or during follow-up. Mechanical ventilation of people with ALI/ARDS allows time for the lungs to heal, but ventilation is invasive and can result in lung injury. It is uncertain whether ventilator-related injury would be reduced if pressure delivered by the ventilator with each breath is controlled, or whether the volume of air delivered by each breath is limited. To compare pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) in adults with ALI/ARDS to determine whether PCV reduces in-hospital mortality and morbidity in intubated and ventilated adults. In October 2014, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Isssue 9), MEDLINE (1950 to 1 October 2014), EMBASE (1980 to 1 October 2014), the Latin American Caribbean Health Sciences Literature (LILACS) (1994 to 1 October 2014) and Science Citation Index-Expanded (SCI-EXPANDED) at the Institute for Scientific Information (ISI) Web of Science (1990 to 1 October 2014), as well as regional databases, clinical trials registries, conference proceedings and reference lists. Randomized controlled trials (RCTs) and quasi-RCTs (irrespective of language or publication status) of adults with a diagnosis of acute respiratory failure or acute on chronic respiratory failure and fulfilling the criteria for ALI/ARDS as defined by the American-European Consensus Conference who were admitted to an ICU for invasive mechanical ventilation, comparing pressure-controlled or pressure-controlled inverse-ratio ventilation, or an equivalent pressure-controlled mode (PCV), versus volume-controlled ventilation, or an equivalent volume-controlled mode (VCV). Two review authors independently screened and selected trials, assessed risk of bias and extracted data. We sought clarification from trial authors when needed. We pooled risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data with their 95% confidence intervals (CIs) using a random-effects model. We assessed overall evidence quality using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. We included three RCTs that randomly assigned a total of 1089 participants recruited from 43 ICUs in Australia, Canada, Saudi Arabia, Spain and the USA. Risk of bias of the included studies was low. Only data for mortality and barotrauma could be combined in the meta-analysis. We downgraded the quality of evidence for the three mortality outcomes on the basis of serious imprecision around the effect estimates. For mortality in hospital, the RR with PCV compared with VCV was 0.83 (95% CI 0.67 to 1.02; three trials, 1089 participants; moderate-quality evidence), and for mortality in the ICU, the RR with PCV compared with VCV was 0.84 (95% CI 0.71 to 0.99; two trials, 1062 participants; moderate-quality evidence). One study provided no evidence of clear benefit with the ventilatory mode for mortality at 28 days (RR 0.88, 95% CI 0.73 to 1.06; 983 participants; moderate-quality evidence). The difference in effect on barotrauma between PCV and VCV was uncertain as the result of imprecision and different co-interventions used in the studies (RR 1.24, 95% CI 0.87 to 1.77; two trials, 1062 participants; low-quality evidence). Data from one trial with 983 participants for the mean duration of ventilation, and from another trial with 78 participants for the mean number of extrapulmonary organ failures that developed with PCV or VCV, were skewed. None of the trials reported on infection during ventilation or quality of life after discharge. Currently available data from RCTs are insufficient to confirm or refute whether pressure-controlled or volume-controlled ventilation offers any advantage for people with acute respiratory failure due to acute lung injury or acute respiratory distress syndrome. More studies including a larger number of people given PCV and VCV may provide reliable evidence on which more firm conclusions can be based.

Acute respiratory failure and tracheal stenosis following aspiration of activated charcoal

SummaryGastric decontamination with orally administered activated charcoal is a common treatment for many poisonings. However drug ingestion may result in loss of protective airway reflexes and aspiration of activated charcoal in these patients presents an important complication. Although activated charcoal is thought to be an inert substance it may cause damage to the respiratory tract if aspirated. We report a case of acute respiratory failure and pulmonary damage that resulted in tracheal stenosis following accidental aspiration of activated charcoal.

肺動脈血流再開によるシャントで呼吸不全をきたした右肺門部肺癌の一例

肺動脈血流再開によるシャントで呼吸不全をきたした右肺門部肺癌の一例

A case of acute respiratory failure due to bronchial rupture of an intrapulmonary cyst

Introduction Respiratory symptoms resulting from the rupture of peribronchial/tracheal cysts are rarely reported. We report herein a rare case in which the contents of an intrapulmonary cyst caused acute respiratory failure.

Combined noninvasive ventilation and mechanical in‐exsufflator in the treatment of pediatric acute neuromuscular respiratory failure

The present study aims to evaluate the efficacy and complications of combined noninvasive ventilation (NIV) and assisted coughing by mechanical in-exsufflator (MIE) for acute respiratory failure (ARF) in children with neuromuscular disease (NMD). A prospective study was conducted in the pediatric intensive care unit. Children with NMD and ARF treated by combined NIV and MIE were included. Treatment success was defined as freedom from tracheal intubation during the hospital stay. Physiologic indices including PaO2 , PaCO2 , pH, and PaO2 /FiO2 were recorded before and 12, 24 hr after the use of NIV/MIE. Combined NIV/MIE was used in 15 NMD children (mean: 8.1 years, range: 3 months to 18 years) with 16 cases of ARF. There was no mortality in this cohort. Treatment success was achieved in 12 cases (75%), including six cases (38%) demanding "Do Not Intubate." ARF was due to pneumonia, with a mean baseline PaCO2 of 73.2 ± 19.0 mmHg. In the success group, hypercarbia and acidosis improved after use of NIV/MIE for 24 hr (PaCO2 : 71.7 ± 18.6 mmHg vs. 55.8 ± 11.6 mmHg, P < 0.01; pH: 7.29 ± 0.07 vs. 7.38 ± 0.05, P < 0.01). All patients tolerated NIV/MIE well despite transient skin pressure sores in five cases. Combined NIV/MIE is a safe and effective approach to rapidly improve physiologic indices and decrease the need for intubation in NMD children with ARF. NIV/MIE provides a good alternative for those refusing intubation.

Les hospitalisations pour asthme chez l’enfant en France, 2002–2010

Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database. We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age<15years) between 2002 and 2010 in France (excluding French Guyana). In 2010, 35,004asthma admissions and 1381cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010. The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.