Improvement In Respiratory Distress Research Articles

Lobar Emphysema Successfully Operated in an Extreme Premature Neonate

Background: Lobar emphysema in a newborn may be due to a rare congenital developmental anomaly of the lung, termed congenital lobar emphysema (CLE) or may develop secondary to lung damage, especially with positive airway pressures in premature newborns, known as acquired lobar emphysema (LE). They may have overlapping clinical and radiological features. However, surgical lobectomy is required whenever there is significant respiratory compromise. Reports of surgery in LE in extreme preterms are sparse. Clinical Description: A female newborn with gestational age of 28 weeks, weight of 1.180 kg, presented with respiratory distress after birth, initially treated as hyaline membrane disease. With worsening respiratory distress on positive airway pressures, repeat chest X-ray and computed tomography (CT) chest on day 15 of life, suggested possible LE on the left side with the tracheo-mediastinal shift to the right. Management and Outcome: Left thoracotomy and left upper lobectomy was done, following which, there was rapid improvement in respiratory distress, the newborn being extubated after 6 hours, and weaned off oxygen over the next 3 days. The baby was discharged after 8 weeks and at the last follow-up of 3 years of age, the child was growing well with no complications. Conclusion: Preterm neonates with initial radiological features of hyaline membrane disease, requiring prolonged respiratory support, may be harboring other underlying lung anomalies, which are identified by CT chest. Lobar emphysema with tracheo-mediastinal shift warrants prompt surgery, which is feasible and successful, even in a low birth-weight premature infant.

The outcome of early use of high-velocity nasal insufflation in acute respiratory failure complicating coronavirus disease 2019

Abstract Background High-flow nasal cannula showed success in some coronavirus disease 2019 (COVID-19) patients. High-velocity nasal insufflation (Hi-VNI) is a refined form of high-flow nasal cannula that delivers heated and humidified gas with high velocity through a simple small-bore nasal cannula. Objective To assess the impact of early use of Hi-VNI in improving hypoxemia and respiratory distress and its effect on the length of ICU stay in COVID-19 patients presented with acute respiratory failure. Patients and methods In total, 30 patients with confirmed COVID-19 presented with respiratory failure admitted to intensive care of COVID-19 zone were recruited to the study from October 2021 to February 2022. They were categorized into two groups: early and late Hi-VNI groups according to whether the shift to Hi-VNI occurred after low-flow nasal cannula or non-rebreathing mask, respectively. Results Successful outcome was achieved in 73.3% in early Hi-VNI group versus 53.3% in late Hi-VNI group. Regarding successful outcome, the duration of Hi-VNI and ICU stay was significantly (P <0.001) lower in early Hi-VNI group. Higher inflammatory markers and lymphopenia are predictors of failure. Conclusion The early use of Hi-VNI in hypoxemic respiratory failure of COVID-19 achieved better improvement of respiratory distress, oxygenation, and shorter ICU stay.

The use of ELMO helmets for the treatment of patients with COVID-19: experience report

Objective: to describe nurses' experience with the use of the ELMO helmet for the treatment of patients with COVID-19. Methods: experience report in an emergency care unit located in a metropolitan city of Ceará, Brazil, in the period from March 15 to June 22, 2021. Content Analysis was used for organization and analysis through references in the area. Results: the potentialities of care during the ELMO helmet use were observed, such as a decrease in indications for orotracheal intubation, improvement in respiratory distress, and decrease in morbidity, but also weaknesses such as diminished patient-healthcare professional communication, need for careful evaluation of the time of use and patient response, risk of psychological instability, and risk of broncho-aspiration; moreover, health teams collaborative aspects such as increased intra-team communication, effective interaction, and greater decision-making were registered. Conclusion: important results in treating COVID-19 can result from the use of this tool; however, there is a need for strict monitoring in order to avoid major respiratory complications as well as physical and psychological sequelae from the wearing of ELMO.

A successful tale of sirolimus treatment in refractory vascular tumors

Sirolimus use in vascular tumors is limited. We present two cases of refractory vascular tumors with impressive response to sirolimus, one with refractory kaposiform hemangioendothelioma with rapid reversal of thrombocytopenia and heart failure and the other with advanced beard distribution hemangioma with improvement of respiratory distress after prolonged respiratory support.

Diagnosis and Treatment Protocol for COVID-19 Patients (Tentative 8th Edition): Interpretation of Updated Key Points.

Diagnosis and Treatment Protocol for COVID-19 Patients (Tentative 8th Edition): Interpretation of Updated Key Points.

English

BACKGROUND Neonatal respiratory distress syndrome (RDS) is among the common complications in infants born before 37 weeks. In India the incidence of RDS ranges from 0.69 - 8.3 %. CPAP is a less invasive method frequently used in premature infants having RDS). We wanted to assess the outcome of preterm neonates treated with CPAP. METHODS Prospective observational study was done in NICU of a tertiary care hospital, Raipur, Chhattisgarh in central India, during April-2014 to April-2015. Eligible Children were included in the study and evaluated using SAS (Silverman Anderson Scoring), blood gas analysis and pulse oximetry. Quantitative variables were presented as mean and standard deviation; categorical variables were presented as frequency and percentages. RESULTS Out of total 50 babies on CPAP, 38 improved with success rate of 76 % whereas 12 babies (24 %) failed requiring higher mode of ventilation. CPAP was more successful among females (n = 22) with a success rate of 88.0 %. CPAP proved more effective in moderate grade RDS with success rate of 83.3 % (statistically significant p < 0.05). Based on SAS score, shows the improvement in respiratory distress following CPAP. CONCLUSIONS Nasal CPAP is safe effective, non-invasive means of respiratory support in RDS. It can considerably decrease the requirement for mechanical ventilation (MV) and surfactant therapy. KEYWORDS Respiratory Distress Syndrome, Positive Airway Pressure, Silverman Anderson Score

High-flow oxygen therapy v. standard care in infants with viral bronchiolitis.

Background High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/ face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. Contributions of the study High-flow humidified oxygen (HFHO) is effective in infants with moderate to severe bronchiolitis, and not only in those with milder forms of the disease. It can be safely used outside the paediatric intensive care unit, where adequate respiratory monitoring is available. This is important in low-resource areas where there may be insufficient critical care resources to manage these patients.

Value of Nasal Continuous Positive Airway Pressure in the Management of Infants with Acute Bronchiolitis

Background: Acute Bronchiolitis is one of the most common reasons of hospital admission in infancy. Treatment depends on humidified oxygen, properly administered fluids and adequate nutrition. The aim of this work is to assess the value of CPAP in the management of infants with severe bronchiolitis in PICU.Methods: 32 infants younger than one year with severe bronchiolitis were recruited. Cases were divided randomly into two groups, Group A used the standard treatment and Group B on nasal CPAP. primary assessment was done for infants by recording baseline vital signs, grade of respiratory distress and capillary blood gases. Re-evaluation was done after 12 hours and 24 hours. Evaluation of the outcome was done for the length of PICU stay, hospital stay, the need for mechanical ventilation and any complication.Results: In the CPAP group a significant improvement of respiratory distress was found after 24 hours. A significant improvement in O2 saturation after 24 hours (P

Outcome of Respiratory distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital

Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 - March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75±84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05±2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71±3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of 38% to 62% whereas 24 (39%) babies required mechanical ventilation and other modalities. This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.

Scimitar Syndrome with Partial Left Pulmonary Artery Sling in a Neonate.

Scimitar syndrome is a rare condition including right lung hypoplasia, anomalous pulmonary venous drainage, dextroposition of the heart, and hypoplastic right pulmonary artery (RPA). The infantile form is sometimes associated with pulmonary hypertension, cardiac failure, and a poorer prognosis. We present a 1-day-old girl with a rare combination of partial left pulmonary artery (LPA) sling and scimitar syndrome, which was suspected in prenatal sonography and confirmed by echocardiography, computed tomography and cardiac catheterization. The patient received re-implantation of the aberrant left lower pulmonary artery and patch augmentation of the main-left upper pulmonary arteries at 4 months of age. Another operation was performed at 7 months of age with patch augmentation for stenosis of the left lower pulmonary artery and left pulmonary vein elevation to relieve its clenching of the left lower bronchus, with improvement of respiratory distress.

Effects of Nebulized Albuterol in Transient Tachypnea of the Newborn A Clinical Trial

Background: To date there is no effective drug treatment for transient tachypnea of the newborn (TTN) and respiratory support is the only means to handle this disease. This study was performed to evaluate the effect of albuterol (Salbutamol) in improvement of respiratory distress in involved neonates. Methods: We conducted a randomized, blinded, placebo-controlled clinical trial Neonates with TTN received either nebulized albuterol (30 neonates) or placebo (30 neonates), and early clinical parameters were measured during and after treatment. Results: Totally 60 neonates including 31 males and 29 females, mean gestational age of 36.9 +/- 1.69 weeks, mean weight of 2703 +/- 589 gr, were analyzed. Respiratory distress score was significantly decreased in treatment compared to placebo group (from 5.6 at the start to 1.7 at the end of study vs 5.6 to 3.9 respectively) and the PO2 was significantly increased in neonates receiving nebulized albuterol compared to the placebo group (from 58.5 at the start to 84.8 at the end of study vs 58.2 to 70.2 respectively). No adverse effects were observed in either group. The duration of continuous positive airway pressure (CPAP) application was significantly decreased in the treatment group compared to the placebo group (1.6 +/- 0.77 vs. 3.3 +/- 0.98 respectively) (P = 0.0001). Conclusions: Application of nebulized albuterol caused a considerable improvement in the respiratory distress of neonates at its primary hour of using via reduction of respiratory scores, duration and concentration of oxygen requirement, and duration of CPAP without any side effects. Therefore, this drug can be applied in the treatment of Transient Tachypnea of the Newborn appropriately.

Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review.

Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.

Surgical management of bilateral abductor vocal cord paralysis using Coblation technology

Objective: Management of bilateral abductor paralysis of vocal folds often poses a surgical challenge. Among various surgical modalities, surgical transaction/excision of posterior aspect of the vocal folds is an established modality. The objective of the present study is to evaluate the effectiveness and safety of the technique using Coblation technology. Study Design: This was a retrospective review. Setting: This study was conducted in a tertiary health care center. Materials and Methods: Fourteen consecutive patients meeting inclusion criterion undergoing posterior cordectomy using Coblator were included in this study. Preoperative subjective voice analysis was done and compared with measurements at 6 months postprocedure. Parameters studied included voice handicap index (VHI), the need for repeat procedures, effect of decannulation, and subjective improvement in respiratory distress. Results: There was a significant improvement in the airway as adjudged by the postoperative subjective improvement in respiratory distress (in 2 nontracheostomized patients) and uneventful decannulation (in 12 tracheostomized patients). However, the postoperative VHI scores showed no statistically significant difference with the preoperative assessment. One of the patients required the procedure to be repeated owing to recurrence of respiratory distress. No untoward incident was reported in any of the surgical procedures. Conclusion: Posterior cordectomy using a Coblator offers a safe and efficacious option for the management of compromised airway secondary to bilateral abductor paralysis of vocal folds. It offers a significant airway improvement without any significant effect on voice.

The role of early inhaled budesonide therapy in meconium aspiration in term newborns: a randomized control study

Objective: To study the clinical spectrum of Meconium aspiration syndrome babies and to find out the efficacy of early nebulized steroids (Budesonide) in the clinical course and outcome (morbidity and mortality) of neonates with meconium aspiration: randomized controlled trial.Method and material: A total of 78 neonates were included in the study. After randomization, intervention group received nebulization with Budesonide (0.5 mg dissolved in 2.5-ml sterile normal saline within 2 h of birth and second dose was given at 12 h of birth) whereas controls were nebulized with normal saline. All neonates were accessed for serial respiratory distress score (Downe's score), requirement (dependence) of oxygen (in days), duration of neonatal intensive-care unit (NICU) stay, any complication and their final outcome.Results: The mean days of oxygen requirement for the cases and controls were 1.79 and 3.46, respectively (p < 0.001). The mean respiratory rate in intervention group up to the age of 5 d was significantly less (p value < 0.01). There was significant difference in mean Downe’s score and mean duration of NICU stay in intervention group.Conclusion: Budesonide nebulization in meconium aspiration results in significant early improvement in general condition (early improvement in respiratory distress and early normalization of Downe’s score) of the newborn with lesser oxygen requirement, thus early discharge from NICU but has no impact on final outcome.

FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis.

Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx.

Vivax malaria in an Amazonian child with dilated cardiomyopathy

A child living in the Brazilian Amazon region who had had vivax malaria at the age of 11 months was admitted three months later with a history of progressive dyspnoea and fever, which culminated in respiratory distress and severe dilated cardiomyopathy at hospital admission in a malaria-free area. She received treatment for cardiac insufficiency and was tested for malaria with two thick blood smears, which were negative. There was general improvement of cardiorespiratory function in the next two weeks, but in the third week of hospital admission, there was re-appearance of fever, severe anaemia, severe plaquetopaenia, and respiratory distress. A third thick blood smear was positive for Plasmodium vivax mono-infection, which was confirmed by molecular methods. A serological panel with the most prevalent infectious agents known to cause myocarditis was performed, and specific anti-cytomegalovirus (CMV) IgM and elevated levels of anti-CMV IgG were also detected in the serum. After treatment for malaria, there was improvement of respiratory distress, although cardiac function did not recover. She was discharged home with drugs for cardiac insufficiency and is currently under follow-up with a paediatric cardiologist as an outpatient. This report presents a young child with several episodes of vivax malaria who suffers from cardiac insufficiency, probably related to CMV-induced myocarditis.

Rigid Bronchoscopy and Mechanical Debulking in the Management of Central Airway Tumors

Treatment options for central airway tumors include surgery, radiotherapy, and in those with inoperable or emergent airway obstruction, therapeutic bronchoscopy. Herein, we report our experience with the exclusive use of rigid bronchoscope in the management of central airway tumors. Retrospective review of charts of patients who underwent rigid bronchoscopy and mechanical coring for the management of central airway (trachea and mainstem bronchi) tumors over a period of 2 years. "Successful" outcome was defined as procedure leading to reduction of luminal obstruction to <50% and improvement of respiratory distress. "Unsuccessful" outcome was defined in cases where the luminal obstruction could not be reduced by ≥50% or there was lack of improvement in the clinical status of the patient. During the study period, 30 patients with symptomatic central airway tumors were encountered. Of these, 23 patients underwent 31 rigid bronchoscopic procedures. Respiratory failure was present in 15 (65.2%) patients. Adenoid cystic carcinoma was the most common primary tracheal tumor, whereas squamous cell carcinoma was the most common secondary tracheobronchial tumor. The procedure was successful in 19 (82.6%) patients. Complications were encountered in 10 of the 31 (32.3%) rigid bronchoscopies. There was no procedural mortality. Rigid bronchoscopy and mechanical debulking as a sole therapy is an effective and safe procedure for airway obstruction resulting from tracheobronchial tumors.

Non-invasive mechanical ventilation in hematology patients: let's agree on several things first

Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.

Juvenile diffuse systemic sclerosis/systemic lupus erythematosus overlap syndrome—a case report

We report a rare case of diffuse systemic sclerosis (SSc) evolving into diffuse SSc/systemic lupus erythematosus (SLE) overlap syndrome. A 15-year-old boy was diagnosed as diffuse SSc with initial presentations of Raynaud's phenomenon and skin tightening. He underwent Chinese herbal treatment and clinical symptoms deteriorated in the following 3years. On admission to our ward, serositis with pleural effusion, severe pulmonary fibrosis with moderate pulmonary hypertension, swallowing difficulty, and polyarthritis were observed. Autoantibody profiles revealed concurrence of anti-double-stranded DNA, anti-Smith, anti-topoisomerase I, and anti-ribonucleoprotein antibodies. The patient fulfills the criteria for both diffuse SSc and SLE. After drainage for pleural effusion accompanied by oral prednisolone and sildenafil, there were improvement of respiratory distress, swallowing difficulty, and pulmonary hypertension. In conclusion, connective tissue diseases may overlap with each other during the disease course. Serial follow-up for clinical symptoms as well as serological changes is recommended.

Prehospital continuous positive airway pressure ventilation in ACPO: part 2

Acute cardiogenic pulmonary oedema (ACPO) is a common medical emergency facing UK paramedics. While swift management can delay progression of ACPO, a significant portion of patients spiral into deteriorating respiratory and cardiac function, leading to respiratory failure requiring endotracheal intubation (ETI). Continuous pulmonary airway pressure (CPAP) is increasingly being adopted into treatment regimens for ACPO in hospital. This is the second part of a paper seeking to critique the literature surrounding CPAP. Part one found how CPAP can provide early improvement in respiratory distress, metabolic abnormalities and need to ETI in hospital, yet these are not transferred into improved survival (Rees, 2011). Adherence and maximisation of medical therapy within JRCALC, and future potential of intravenous nitrates should also be explored by paramedics wishing to introduce CPAP into their practice. Methods: A comprehensive literature search of MEDLINE and CINAHL from 2000 to November 2010 was conducted using ‘CPAP’ as a subject heading combined with the subheadings: ‘pulmonary oedema’, ‘pulmonary edema’ ‘ACPO’, ‘heart failure’ ‘pre hospital’ and ‘paramedic’ as key words. A second search was conducted using ‘non invasive ventilation’ as a subject heading along all subheadings above. Results: A total of 253 papers were retrieved. These were manually scanned for relevance and eligibility, leaving a total of 53 papers for review. Given the relative scarcity in prehospital care literature all articles were reviewed, with nine finally selected for inclusion. No high quality UK prehospital studies were found. Application of CPAP resulted in significant improvements in physiological variables, need to ETI and relief of breathlessness. Despite these benefits, they are not transferred into improved mortality. Conclusion: The use of CPAP patients in ACPO can provide early improvement in respiratory distress, metabolic abnormalities and need to ETI in hospital. However, these are yet to be robustly transferred into improved survival. Despite this, many UK paramedics currently have limited options in supporting ventilation for ACPO. Adoption of CPAP into UK paramedic practice may offer options of a non–invasive means of supporting ventilation prior to ETI, with the potential of improving mortality by intervening early in ACPO. However, the limited number of quality prehospital studies presents many questions over its potential. Quality UK based studies are urgently needed.