Frequency Of Respiratory Complications Research Articles

Frequency of Respiratory Complications in Post COVID-19 Patients After Coronary Artery Bypass Grafting

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group 
 Study Design: Analytical Cross- sectional study
 Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022.
 Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. 
 Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=<0.0001) and non-invasive ventilation (NIV) were found to be significant (p=0.007).

Non-invasive ventilation of the lungs in neuromuscular diseases

To describe a clinical case and to analyze our own practice of using NIVL in a myasthenia (MG) gravis patient. Since 2018 in the Republican Research and Clinical Center of Neurology and Neurosurgery NIVL has been performed in 29 patients (21 amyotrophic lateral sclerosis patients and 8 MG patients). The research was carried out using the portable polysomnograph Polymate YH-1000C (BMC, China) and in the Sleep Laboratory of the Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus using SOMNOlab V 2.19 (Weinmann, Germany). Respiratory support was provided by the Ventimotion 2 device (Weinmann, Germany). The article presents our own experience of using NIVL in MG patient and profound description of the diagnostic and therapeutic complex. The development of chronic respiratory failure in NMD is based on a violation of the ventilation-perfusion ratio in the alveoli as a result of the development of hypoventilation due to restrictive disorders (namely, due to weakness of the respiratory muscles). Compensatory mechanisms eventually lead to an increase in the work on the affected respiratory muscles that leads to the formation of a vicious circle. The use of NIVL provides adequate ventilation of the lungs providing rest for the respiratory muscles. Like any other medical intervention NIVL has indications and contraindications, advantages and disadvantages that are described in this article. The use of NIVL helps to reduce the risk and frequency of respiratory complications, the number and duration of hospitalizations that significantly affects the prognosis and course of NMD as well as improves the quality of life and the level of adaptation of patients.

COMPLICATIONS OF ACUTE TRAUMATIC SPINAL INJURIES IN SAINT PETERSBURG

Almost every sailor during performing his job duties aboard receives injuries of varying severity, among which the most common are deck fractures, including compression vertebral fractures, as well as open and closed vertebral fractures with spinal cord injuries. Besides the recovery of disordered functions of the spinal cord, in cases of spinal cord injury, the fight against numerous neurological, infectious and somatic complications affecting the survival and quality of life of patients is still relevant.Objective: to study the incidence of complications of traumatic injuries of the spinal cord under initial hospitalization, their impact on the length of hospital stay, to identify and evaluate the role of risk factors in the development of complications.Materials and methods. A retrospective cohort study was conducted according to the archived case histories of patients hospitalized in neurosurgical hospitals in St. Petersburg. 311 cases of acute spinal cord injury in 2012–2016 were analyzed.Results: complications not directly related to spinal cord injury, such as bronchitis, pneumonia, bedsores, sepsis, thromboembolism, urinary tract infections, postoperative wound pyogenesis and others (damage to other organs and systems), were found in one third of patients (33,8%), in half of the cases there were multiple complications (2 or more), the most frequent — respiratory (23,5%) and pressure sores (10%). Complications significantly increased the length of hospital stay. The dependence of the frequency of complications on age, the level of spinal cord damage and the severity of the injury was revealed. Risk factors such as concomitant head injury and alcohol intoxication have been found. The revealed positive effect of corticosteroids on the regression of neurological deficit was not statistically confirmed. At the same time, there was a significant increase in the frequency of respiratory complications when using corticosteroids.Conclusion: Knowledge of the factors affecting the incidence of complications, optimization of their prevention and therapy will shorten the duration of hospitalization and improve the prognosis and quality of life of patients. The issue of use of corticosteroid therapy in the acute period of traumatic injuries of the spinal cord remains debatable. When choosing therapeutic tactics for managing patients with spinal trauma, it is necessary to take into account the risk of respiratory complications and carefully evaluate the ratio of benefits to harm.

Red cell distribution width as a novel predictor of postoperative respiratory adverse events after adenotonsillectomy.

Respiratory adverse events are commonly observed after adenotonsillectomy in children with sleep-disordered breathing. Preoperative prediction of these events enhances quality of care and resource management in facilities while encouraging precautions against them. Red cell distribution width, a measure of erythrocyte size variability, has recently been linked to adverse outcomes in a variety of disorders. Red cell distribution width has also been found to be associated with severity of obstructive sleep apnea in adults due to hypoxia-mediated inflammation. The objective of this study was to evaluate whether elevated red cell distribution width is associated with postoperative respiratory adverse events in children with symptoms of sleep-disordered breathing. A prospective, observational, assessor-blinded study was conducted with consecutive children undergoing elective adenotonsillectomy for treatment of sleep-disordered breathing. Under general anesthesia, adenoidectomy was performed by curettage, and tonsillectomy was carried out by dissection. The primary outcome was the occurrence of an adverse event during emergence or in the postanesthesia care unit (PACU). Among 287 patients, with mean ± sd age 7.49 ± 3.21, the frequency of respiratory complications during emergence was 62 (22.30%) and in PACU was 56 (20.14%). Mean ± sd red cell distribution width was 14.36 ± 1.06 in patients with complications and higher than that in those without complications 13.53 ± 0.59. Red cell distribution width had an adjusted odds ratio 7.28 (95% CI: 4.30-13.28) and area under the curve value 0.74 (95% CI: 0.67-0.81) to predict postoperative complications. A cutoff value for red cell distribution width was found to be 14.7. Our study showed that preoperative elevated red cell distribution width is associated with an increased risk of respiratory adverse events in children undergoing adenotonsillectomy for sleep-disordered breathing.

GLUCOCORTICOIDS, HYPOTHALAMO-PITUITARY-ADRENAL (HPA) DEVELOPMENT, AND LIFE AFTER BIRTH

Approximately 10% of women in North America are treated with synthetic glucocorticoid (sGC) between 24 and 32 weeks of pregnancy (term∼40 weeks), to promote lung maturation in fetuses at risk of preterm delivery. Such therapy is highly effective in reducing the frequency of respiratory complications, and as a result, repeated course treatment has become widespread. Nothing is known about the impact of repeated sGC treatment on neuroendocrine development in the human, or if specific time windows of increased sensitivity exist. Glucocorticoids are essential for many aspects of normal brain development. However, there is growing evidence from a number of species, that exposure of the fetal brain to excess glucocorticoid can have life-long effects on behaviour and neuroendocrine function. We have shown that exposure of fetuses to sGC in late gestation permanently alters HPA function in pre-pubertal, post-pubertal, and aging offspring, in a sex-dependent manner. These effects are linked to changes in central glucocorticoid feedback. Prenatal glucocorticoid exposure also leads to modification of HPA-associated behaviours and organ morphology, as well as altered regulation of other neuroendocrine systems. Permanent changes in HPA function will have a long-term impact on health, since elevated cumulative exposure to endogenous glucocorticoid has been linked to the premature onset of pathologies associated with aging.

Prophylactic Nasogastric Tube Decompression: Is Its Use Justified?

To evaluate the need for routine prophylactic nasogastric tube decompression following gastrointestinal surgery, we retrospectively reviewed the cases of 177 patients. The patients were classified as those not receiving nasogastric tubes, those whose tubes were removed within 48 hours postoperatively, and those whose tubes remained for more than 48 hours. No significant differences were noted in duration of hospital stay, time for return of adequate bowel function, or time before beginning an oral diet. Further, there were no differences in the frequency of wound complications, anastomotic leakage, or mortality. Patients without tubes had no greater incidence of vomiting, and despite a more frequent occurrence of abdominal distention and nausea, only 8% required insertion of a tube for persistent symptoms. Intubated patients had a greater frequency of respiratory complications. The results indicate that routine prophylactic use of nasogastric decompression is unnecessary and may be safely eliminated in patients having gastrointestinal surgery.

Prevention of nosocomial pneumonia

Prevention of nosocomial pneumonia becomes an achievable goal only to the extent that the mechanisms of infection are known. It is likely that there is variation among microorganisms, patients, type of care and intensive care, and practices that determines the relative efficacy of preventive measures. Certain procedures appear to be universally required and include adequate reprocessing of ventilation equipment and infection control measures in patient care. In contrast, many factors may affect the role of the stomach as a cause of nosocomial pneumonia, including enteral feeding procedures and gastric acidity. Differences in results between studies of preventive measures may reflect uncontrolled practice factors, which make the measures either more or less important. Selective decontamination of the digestive tract is a measure with potentially serious consequences, primarily cost and microbial resistance, and should be undertaken with care probably in selected high-risk patients. Other recommendations such as the use of sucralfate, which is effective in prevention of bleeding without clear side effects, are probably worth instituting based on existing evidence. The primary need may be for better reprocessing of equipment or hand washing and sterile gloves, or it may be several changes at once. Certainly an array of preventive measures is necessary, and there is probably no single procedure likely to solve such a complex problem. Use of the collective findings of many investigators needs to be made and strategies applied to each patient and setting. There has been a marked increase in our knowledge of nosocomial pneumonia, and effective measures for prevention are available. Application of these measures widely should reduce the frequency of respiratory complications. The microbiologic tools to compare bacterial isolates have been developed, and the course of events preceding infection of the patient can be demonstrated. The role of equipment, environment, other patients, personnel, colonization sites, and other factors can now be examined. Future studies should control for the many known factors that may predispose to nosocomial pneumonia to make the results meaningful. This would include definition of infection, patient risk factors, identification of microorganisms, details of enteral nutrition, type of stress ulcer prophylaxis, exposure to antimicrobial agents, and institutional resistance patterns. In some studies, surveillance cultures and molecular epidemiology techniques would be required. Large controlled multicenter studies are necessary to determine the significance of the results of promising smaller studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Correlation of Preoperative Pulmonary Function Testing with Clinical Course in Patients after Pneumonectomy

Postoperative morbidity and mortality were correlated with the preoperative results of three widely used tests of pulmonary function in 90 patients who underwent pneumonectomy for carcinoma of the lung. Factors analyzed following operation included thirty-day mortality, the incidence of arrhythmias, the frequency of respiratory complications, and the number of individuals requiring prolonged mechanical ventilation. Fourteen patients had a forced vital capacity (FVC) of 70% or less of predicted normal value. Eleven had a one-second forced expiratory volume (FEV 1) of 1.5 liters or less, and 32 had an FEV 1 of less than 2 liters. Twenty-six had an FEV 1/FVC ratio of 0.6 or less. There were no differences in morbidity or mortality between these individuals and the patients whose test scores exceeded these criteria. As a general rule, decisions regarding operability and extent of resection cannot be made solely on the basis of the three spirometry tests reviewed.