Cause Of Acute Respiratory Distress Research Articles

Role of critical care ultrasonography in acute respiratory distress

Introduction: Acute Respiratory Distress and/or Failure (ARF), is a common and serious presentation of patients admitted to intensive care unit (ICU) and traditional diagnosis has a low accuracy except CT chest which may inappropriate to all patient. Bedside ultrasound (US) is now emerging as a valuable tool in dynamic assessment of lungs, heart, vessels and hemodynamic status. Aim of the work: Our aim in this study was to evaluate the diagnostic utility of combined cardiac and thoracic critical care ultrasonography in identifying causes of Acute Respiratory Distress and/or Failure in the early course of critical illness. Patients and method: This prospective observational study was conducted on adult patient admitted to Medical Intensive Care Unit (MICU), Department of Internal medicine, Al Hussein university hospital, Al Azhar University. All included patients underwent bedside CPUS including lung ultrasound (US) and transthoracic echocardiography plus targeted venous US by single investigator, blinded to clinical data. The US diagnosis of ARF etiology was shared with treating intensivist. Initial clinicaldiagnosis (ICD) of each patient were compared with post US clinical diagnosis.

ACUTE RESPIRATORY DISTRESS: A RARE PRESENTATION OF URETERAL RUPTURE

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiorespiratory disorders usually present with acute respiratory distress; likewise, ureteral rupture usually presents as an acute abdomen [1]. We report a case of ureteral rupture presenting with acute respiratory distress leading to a delayed diagnosis. CASE PRESENTATION: An 82 y/o M with a history of congestive heart failure (CHF), chronic obstructive pulmonary disease, chronic renal failure and recently diagnosed COVID -19 pneumonia, was admitted for progressive dyspnea and abdominal discomfort for 2 days. Arterial blood gas showed hypercapnic hypoxic respiratory failure. Chest computed tomographic (CT) scan without contrast showed moderate right-sided pleural effusion but pulmonary embolism (PE) could not be ruled out. He also had a left leg deep venous thrombosis with worsening renal function and B-type natriuretic peptide (BNP) of 139pg/ml.His symptoms were thought to be due to acute decompensated CHF, COVID-19 pneumonia and possible PE. He failed to improve with intravenous furosemide, bilevel positive airway pressure ventilation and empiric anticoagulation. Due to worsening renal function and abdominal pain, an abdominal CT was done which showed right ureteral rupture with retroperitoneal collection and multiple non-obstructing renal calculi. The patient had placement of a double J stent with prompt resolution of respiratory distress. DISCUSSION: There are very few case reports of ureteral rupture occurring spontaneously and causing marked dyspnea. Respiratory distress may occur if the extravasated urine leads to an urinothorax or abdominal compartment syndrome [1]. Suspicion of non-cardiorespiratory causes of acute dyspnea in patients with underlying congestive heart failure includes respiratory distress disproportionate to the size of pleural effusion, unilateral effusions or effusions of markedly disparate size, absence of pulmonary vascular congestion and cardiomegaly, worsening renal function, ascites, urinary retention or anuria, abdominal pain, failure of the effusion to respond to management of heart failure, fever or pleuritic chest pain, and low or near-normal natriuretic peptides [2,3].When there are concerns for non-cardiorespiratory causes of respiratory distress, the diagnosis can be made with thoracentesis and imaging such as abdominal ultrasound, or CT [2]. CONCLUSIONS: This case illustrates a rare presentation of ureteral rupture causing respiratory distress and the key points that should elicit high clinical suspicion for non-cardiorespiratory causes of acute respiratory distress. When these findings are present, appropriate investigations and urgent intervention may be life-saving. REFERENCE #1: Choi SK, Lee S, Kim S, et al. A rare case of upper ureter rupture: ureteral perforation caused by urinary retention. Korean J Urol. 2012;53(2):131-133. doi:10.4111/kju.2012.53.2.131 REFERENCE #2: Leonidas Laskaridis, Spyridon Kampantais, Chrysovalantis Toutziaris, Basileios Chachopoulos, Ioannis Perdikis, Anastasios Tahmatzopoulos, Georgios Dimitriadis, "Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case", Case Reports in Emergency Medicine, vol. 2012, Article ID 395653, 3 pages, 2012. https://doi.org/10.1155/2012/395653 REFERENCE #3: Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med. 2010 Dec;31(6):689-97. DOI: 10.1055/s-0030-1269828. Epub 2011 Jan 6. PMID: 21213200. DISCLOSURES: No relevant relationships by sharmela Brijmohan, source=Web Response No relevant relationships by Angelica Medina-Pena, source=Web Response No relevant relationships by Noura Semreen, source=Web Response

Tuberculous Pneumonia as a Primary Cause of Acute Respiratory Distress Syndrome: A Case Report

Background: Tuberculosis is an uncommon and very rare cause of Acute Respiratory Distress Syndrome.Moreover, it has been associated with poor outcomes with a very high mortality rate (40-80%). The clinicalsymptoms and radiological findings of tuberculous pneumonia that resemble bacterial pneumonia resultin difficulties to decide definitive diagnosis. Case Presentation: A 35-year-old male patient was admittedto hospital with shortness of breath, fever, cough without expectoration. The patient had history of asthmasince childhood. Chest physical examination showed rhonchi and wheezing on both lungs. Initial laboratoryfindings were leucocytosis, granulocytocis, eosinopenia, increased ALT and ALP levels, blood gas analysisrevealed acute respiratory failure. PaO2/FiO2 was 49 mmHg. ECG showed sinus tachycardia and chestX-ray showed consolidation on both lungs. The patient was initially managed for asthma exacerbation andbilateral pneumonia with ARDS. The result of microbiological findings showed acid fast bacilli (AFB)positive. He had been treated with anti-TB first category. Clinical improvement was achieved after 1 week ofanti-TB treatment. Summary: Tuberculous pneumonia with ARDS is a rare case of pulmonary tuberculosis.The diagnosis is established by a prompt and complete examination that lead to optimal treatment withappropriate anti-TB.

Articles of Significant Interest in This Issue

Andes virus (ANDV) selectively infects pulmonary microvascular endothelial cells (PMECs), causing a 35% fatal acute pulmonary edema termed hantavirus pulmonary syndrome (HPS). However, the mechanism of ANDV-induced vascular permeability remains an enigma. Gorbunova and Mackow (e00396-21) found that the ANDV N-protein binds to RhoGDI, the primary repressor of RhoA-directed vascular permeability. N-protein binding to S34-phosphorylated RhoGDI inhibited RhoGDI binding and repression of RhoA, revealing a novel edemagenic mechanism that permits ANDV to cause HPS. These findings rationalize targeting PKCα phosphorylation of RhoGDI to therapeutically inhibit HPS patient edema and may be broadly applicable to other causes of acute respiratory distress.

Point-of-Care Ultrasound Diagnosis of Community-Acquired Pneumonia in a High-Altitude, Resource-Poor Setting

Objective: Point-of-care ultrasound (POCUS) for the evaluation of patients with suspected high-altitude pulmonary edema can be a useful tool in remote, high-altitude areas. The same technique can also yield high differential diagnostic accuracy for other relevant causes of acute respiratory distress at high altitude. With the recent development of high-quality, hand-held ultrasound devices, POCUS can be used with increasing reliability in such environments. We present a case of severe respiratory disease in a young, otherwise healthy patient during a trek at high altitude in the Khumbu valley of Nepal. Methods: By using POCUS, we were able to exclude several important differential diagnoses and diagnose the patient with community-acquired pneumonia. Results: Our findings allowed us to start early on-site treatment and positively influenced shared decision-making with the patient, which led to a helicopter evacuation. Conclusions: This case illustrates that POCUS can be a valuable tool in remote, high-altitude regions and could allow healthcare providers to diagnose and follow-up with patients exhibiting acute respiratory symptoms when other radiological imaging modalities are not available.

Anakinra for severe forms of COVID-19: a cohort study.

SummaryBackgroundCoronaviruses can induce the production of interleukin (IL)-1β, IL-6, tumour necrosis factor, and other cytokines implicated in autoinflammatory disorders. It has been postulated that anakinra, a recombinant IL-1 receptor antagonist, might help to neutralise the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related hyperinflammatory state, which is considered to be one cause of acute respiratory distress among patients with COVID-19. We aimed to assess the off-label use of anakinra in patients who were admitted to hospital for severe forms of COVID-19 with symptoms indicative of worsening respiratory function.MethodsThe Ana-COVID study included a prospective cohort from Groupe Hospitalier Paris Saint-Joseph (Paris, France) and a historical control cohort retrospectively selected from the Groupe Hospitalier Paris Saint-Joseph COVID cohort, which began on March 18, 2020. Patients were included in the prospective cohort if they were aged 18 years or older and admitted to Groupe Hospitalier Paris Saint-Joseph with severe COVID-19-related bilateral pneumonia on chest x-ray or lung CT scan. The other inclusion criteria were either laboratory-confirmed SARS-CoV-2 or typical lung infiltrates on a lung CT scan, and either an oxygen saturation of 93% or less under oxygen 6 L/min or more, or aggravation (saturation ≤93% under oxygen 3 L/min) with a loss of 3% of oxygen saturation in ambient air over the previous 24 h. The historical control group of patients had the same inclusion criteria. Patients in the anakinra group were treated with subcutaneous anakinra (100 mg twice a day for 72 h, then 100 mg daily for 7 days) as well as the standard treatments at the institution at the time. Patients in the historical group received standard treatments and supportive care. The main outcome was a composite of either admission to the intensive care unit (ICU) for invasive mechanical ventilation or death. The main analysis was done on an intention-to-treat basis (including all patients in the anakinra group who received at least one injection of anakinra).FindingsFrom March 24 to April 6, 2020, 52 consecutive patients were included in the anakinra group and 44 historical patients were identified in the Groupe Hospitalier Paris Saint-Joseph COVID cohort study. Admission to the ICU for invasive mechanical ventilation or death occurred in 13 (25%) patients in the anakinra group and 32 (73%) patients in the historical group (hazard ratio [HR] 0·22 [95% CI 0·11–0·41; p<0·0001). The treatment effect of anakinra remained significant in the multivariate analysis (HR 0·22 [95% CI 0·10–0·49]; p=0·0002). An increase in liver aminotransferases occurred in seven (13%) patients in the anakinra group and four (9%) patients in the historical group.InterpretationAnakinra reduced both need for invasive mechanical ventilation in the ICU and mortality among patients with severe forms of COVID-19, without serious side-effects. Confirmation of efficacy will require controlled trials.FundingGroupe Hospitalier Paris Saint-Joseph.

Post esophagectomy diaphragmatic hernia: a case report of a rare cause of acute respiratory distress

BackgroundDiaphragmatic hernia is frequent among the elderly and is usually associated with mild chronic digestive and respiratory symptoms.Case presentationAn elderly post-esophagectomy male patient, in the early postoperative period of cardiac surgery, presented with acute respiratory distress. An emergent surgery was performed to reduce a giant diaphragmatic herniation.ConclusionsAn acute transhiatal herniation can cause serious respiratory impairment; surgical repair should be considered in select patients of cardiac surgery.

Serum soluble receptor for advanced glycation end-products during acute bronchiolitis in infant: Prospective study in 93 cases.

ABSTRACTIntroductionAcute bronchiolitis is a major cause of acute respiratory distress in infants. The soluble receptor for advanced glycation end‐products (sRAGE) is a biomarker of pulmonary damage processes, with a diagnostic and a prognostic value in acute respiratory distress syndrome (ARDS). The RAGE pathway is also implicated in the pathogenesis of other respiratory diseases like asthma, but the value of sRAGE levels in acute bronchiolitis remains under‐investigated.Material and methodsA prospective, observational, and analytical study was conducted at Clermont‐Ferrand University Hospital. The main objective was to evaluate the correlation between serum sRAGE and clinical severity of bronchiolitis in hospitalized infants aged <1 year. We analyzed correlations between serum sRAGE and Wainwright score, short‐term morbidity attributable to bronchiolitis, causal viruses and risk for recurrent wheezing at 1 year.ResultsThe study included 93 infants. sRAGE levels were significantly lower in acute bronchiolitis patients (mean 1101 pg/mL) than in controls (2203 pg/mL, P < 0.001) but did not correlate with clinical severity. No correlation was found between serum sRAGE and severity score, respiratory viruses, and recurrent wheezing at 1 year. Serum sRAGE levels were negatively correlated with age (r = −0.45, P < 0.001).ConclusionSerum sRAGE levels are decreased in acute bronchiolitis but not correlated with disease severity. sRAGE levels should be age‐adjusted in infants. Serum sRAGE levels measured in the setting of acute bronchiolitis were not predictive of recurrent wheezing.

Congenital lobar emphysema – rare cause of acute respiratory distress

Congenital lobar emphysema is defined as the hyper­in­fla­tion of one or more pulmonary lobes in the absence of an extrinsic bronchial obstruction. Clinical presentation ranges from asymptomatic (incidental discovery) to pro­gres­sive respiratory failure installed in the first months of life or acute respiratory failure installed immediately after birth. The sooner the symptom appears, the more the disease causes severe respiratory distress syndrome and the need for surgery is more stringent. The diagnosis will be radiologically established, confirmed by CT scan or nuclear magnetic resonance, and completed by echocardiography for possible associated cardiac abnormalities. The treatment is surgical, namely lobectomy, classically, or video assisted thoracoscopy, and is also indicated for cases discovered by accident, due to the risk of infection or malignancy. The prog­nosis is generally favorable, including in cases where re­section involves several lobes, probably due to the com­pen­sa­tory alveolar growth in the child, although in the case of multiple lobes affected, mortality may exceed 10%.

Role of lung ultrasound in differentiating lung congestion and lung infection in paediatric cardiac patients

INTRODUCTION: Lung sonography in the emergency situations became one of the most appropriate studies. This technique allows us to diagnose major causes of acute respiratory distress at the bedside without major interventions. It is easy, costless approach to diagnose many lung diseases. The success of this technique depends on its simplicity to discover the sonographic artifacts which indicate certain lung pathology. The A-profile associates anterior lung sliding with A lines. A lines are horizontal repetition artifacts of the pleural line. The B-profile associates anterior lung sliding with B lines. B lines appear as shining vertical lines arising from the pleural line and reach the edge of the screen. PATIENTS AND METHODS: A descriptive study included cardiac patients admitted to the pediatric cardiology ward for six months. They had their data completely revised and their treatment recorded and diagnosis traced with a direct question: is it congestion or infection. A lung ultrasound was done to try to assure the diagnosis. Also, chest x ray and echo correlation were assessed. RESULTS: Sixty patients were enrolled over a period of six months (58% male, with the mean age ± SD was (17.33 ± 30.91) months. Twenty-seven of the sixty patients had a B-profile, thirty-five had A-profile, A&B profile was found in six cases, hypoechoic areas were found in nine cases. Lung ultrasound appeared to be normal in three cases. CONCLUSION: By applying use of lung ultrasound in pediatric cardiology ward to diagnose or to confirm the diagnosis of chest infection, air trapping, lung congestion up to pulmonary edema, thus differentiating which line of treatment is better to the patients, antibiotics or bronchodilators or antifailure medication avoiding blind use of antibiotics.

Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea.

Acute dyspnea is a common cause of hospitalization in emergency departments (ED).Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP) in this regard. This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex), vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20. 48 patients with acute respiratory distress were evaluated (50% female). The mean age of participants was 66.94 ± 16.33 (28-94) years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6%) cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive) and BNP in 44 cases (24 false positives). The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3) and 66.3 (95% CI: 49.8-89.2), respectively (p = 0.0021). It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.

Acute Mitral Regurgitation: an important cause of respiratory distress

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

Equine laryngeal dysplasia as a cause of acute respiratory distress in a neonatal foal

SummaryEquine laryngeal dysplasia (ELD) is a congenital disorder caused by hypoplasia or aplasia of the structures derived from the fourth and possibly sixth branchial arches. The severity of the clinical signs varies widely, and depends on which structures are involved and the extent of the defect. In most cases, affected horses present with abnormal respiratory noise during exercise and poor performance. Manifestation of the disease in foals is very rare. This case report describes an unusual presentation of ELD in a neonatal foal. The foal presented with severe respiratory distress and weakness. Equine laryngeal dysplasia was suspected on endoscopy and later confirmed on post mortem examination of the larynx. To the best of our knowledge, this is the first report describing ELD as a cause of respiratory distress in a neonatal foal.

Envenomation: an uncommon cause of respiratory distress in a neonate

Respiratory distress in a neonate is a common problem in our practice. The causes may be respiratory, cardiovascular, metabolic, haematological, surgical and central. However in late neonatal period is often due to pneumonia, metabolic or cardiac. We report an uncommon cause of acute respiratory distress in a 26 day old neonate due to myocarditis secondary to scorpion sting envenomation who recovered with our early diagnosis and prompt treatment.

Acute Respiratory Distress in Children: Croup and Acute Asthma.

Acute respiratory distress is one of the most common reason for emergency visits in children under 5 y of age. An accurate understanding of the epidemiology of these diseases, identification of risk factors and etiology is critical for successful treatment and prevention of related mortality. The cause of acute respiratory distress varies in etiology, and hence is amenable to different treatment modalities. Depending on the predominant symptoms and signs, a child presenting to the clinician can be divided into six groups, viz., stridor; cough, fever and difficulty in breathing or fast breathing; wheezing; mediastinal shift with severe respiratory distress; slow or irregular breathing in absence of any pulmonary sign; and respiratory distress with cardiac findings. A detailed history followed by a thorough clinical examination and laboratory evaluation assisted by imaging modalities if indicated, helps to establish the exact cause of respiratory distress in the child. Early recognition and prompt institution of appropriate management or referral can significantly improve the outcome of this illness. This article offers clinicians a brief update on the general management guidelines of respiratory distress in pediatric patients. Specific treatment depends on the exact cause, however croup and acute severe asthma have been discussed in this article.

Nasopharyngeal choristoma: An unusual and rare cause of acute respiratory distress in the newborn. Case series and review of the literature

Nasopharyngeal choristoma: An unusual and rare cause of acute respiratory distress in the newborn. Case series and review of the literature

Nasopharyngeal choristoma: An unusual and rare cause of acute respiratory distress in the newborn. Case series and review of the literature

To describe three cases of newborn acute respiratory distress caused by a nasopharyngeal choristoma. The cases presented include the radiological, surgical, histological and historical perspective of this entity. Retrospective chart review of three cases and review of the literature. Three cases of nasopharyngeal choristoma are reported each presenting with neonatal respiratory distress during the first day of life. All cases were assessed initially with cross-sectional imaging (CT or MRI) and subsequently confirmed on nasopharyngoscopy/laryngoscopy and surgically removed. Nasopharyngeal choristoma is a rare congenital nasopharyngeal mass which may present with rapid onset of acute upper airway obstruction by virtue of its relative size and anatomic position.

Leptospirosis in horses

Leptospirosis in horses has been considered a relatively uncommon infection. However, recent data suggest that the infection is widespread, with the incidence and infecting serovars varying considerably in different geographical regions. The majority of infections remain asymptomatic. Clinical signs in equine leptospirosis resemble those seen in other animal species. However, leptospirosis as a cause of acute respiratory distress is becoming more frequently recognised. A particular feature of equine leptospirosis is post infection recurrent uveitis (moon blindness or periodic ophthalmia), which appears to be mediated by autoimmune mechanisms involving cross reactivity between ocular tissues and leptospiral membrane proteins. There are no leptospiral vaccines licensed for use in horses, with no prospect for any becoming available in the foreseeable future. Accordingly, prevention of equine leptospirosis must rely on good hygiene practices, minimisation of rodent contact, and vaccination of other species of production and companion animals.

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Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus

Hantaviruses have previously been recognised to cause two separate syndromes: hemorrhagic fever with renal syndrome in Eurasia, and hantavirus pulmonary syndrome (HPS) in the Americas. However, increasing evidence suggests that this dichotomy is no longer fruitful when recognising human hantavirus disease and understanding the pathogenesis. Herein are presented three cases of severe European Puumala hantavirus infection that meet the HPS case definition. The clinical and pathological findings were similar to those found in American hantavirus patients. Consequently, hantavirus infection should be considered as a cause of acute respiratory distress in all endemic areas worldwide.