Invasive Ventilation Research Articles

The pregnant patient with pulmonary arterial hypertensionand her offspring in the current era. Time to take into account the vasoreactive profile

Abstract Background and aims Pregnancy impose physiological changes that may be difficult to accomplish for women with pulmonary arterial hypertension (PAH). This study evaluates the impact that pregnancy carries in a PAH population managed in a timely manner and whether patients responders to calcium channel blockers (CCB) deserve specific recommendations because of a different prognosis. Methods A retrospective, longitudinal cohort study. All PAH pregnant patients managed at our institution between February 2010 and December 2023 were included. Clinical characteristics at baseline were recorded. Mortality, major complications (maternal death and cardiogenic shock requiring mechanical circulatory support -MCS- or inotropes) and minor complications (hospital admissions for cardiac reason, PAH therapy uptitration and oxygen prescription) were evaluated over the pregnancy course. Long-term follow-up was also assessed. Gestational age, neonatal weight and complications in the new-born (invasive and non-invasive ventilation, inotropic support and neonatal death) were studied. Data were compared between vasoreactive and non-vasoreactive patients. Results 29 patients were studied (median age 31.5, 27-32.7). 8 underwent early termination of pregnancy and 21 decided to proceed. From the latter group, 7 were responders to CCB and none presented complications over the pregnancy course. From the remaining 14 non-respo nders who completed their pregnancy, 13 (92.9%) presented minor complications: 11 (79%) were started on the prostacyclin pathway, 5 (35.7%) required inotropic support, 5 (35.7%) oxygen prescription; and 5 (35.7%) experienced major complications: 2 (14.3%) required MCS, 5 (35.7%) inotropic support, and one patient died (7%). Over a median follow-up period of 5 years (1.2-8.5), 2 patients died from the non-responder cohort (1.4%); while no patient responder to CCB experienced complications; moreover, none lost her vasoreactive response. All the new-borns from non-vasoreactive patients were delivered prematurely; while those from vasoreactive patients reached week 37 in the 85,7% of the cases. One of the new-borns from the non-vasoreactive cohort died, and there was a non-significant trend towards a fewer rate of complications in the vasoreactive offspring (42.9 Vs. 84.6, p = 0.054). Conclusions In spite of the continuous advances in PAH management, pregnancy still associates high maternal and neonatal morbidity. Nevertheless, vasoreactive PAH patients presented a completely different maternal and neonatal prognosis which may prompt specific recommendations for this particular subgroupOutcomes by vasoreactivity profilePregnancy course for the 21 PAH patients

High-flow nasal cannula oxygen therapy versus noninvasive ventilation for elderly chronic obstructive pulmonary disease patients after extubation: a noninferior randomized controlled trial protocol

IntroductionNoninvasive ventilation (NIV) is widely used for sequential extubation in patients with chronic obstructive pulmonary disease (COPD). However, NIV may cause many adverse events such as claustrophobia, facial skin compression, air leakage, bloating, and even reflux aspiration, resulting in poor patient compliance/tolerance and high failure rate, especially for older adults who are at high risk of communication difficulties and consciousness disorder. High-flow nasal cannula (HFNC) oxygen therapy is a new alternative support to NIV, but whether it can effectively reduce the rate of re-intubation after extubation in elderly patients with COPD remains controversial. The purpose of this study is to explore the safety and efficacy of HFNC versus NIV for elderly COPD patients after extubation.Methods and analysisThis study is an investigator-initiated, single-center, prospective, non-inferior, randomized controlled trial. Elderly patients (age > 65 years) who have received invasive ventilation and was diagnosed with COPD will be randomly assigned to HFNC group or NIV group immediately after extubation with a planned enrollment of 168 patients. The primary outcomes will be reintubation rates at 72 h and 7 days after extubation. Secondary outcomes will include treatment failure, post-extubation vital signs and arterial blood gases, the scores of compliance and comfort of patients, duration of respiratory support after extubation, respiratory support related adverse events, sleep quality scores, usage of sedative and analgesic drugs after extubation, and the incidence of delirium. Additionally, clinical outcomes such as ventilator-free days at 28 days post-randomization, tracheotomy rate, duration of intensive care unit (ICU) and hospital stay, ICU and hospital mortality will be evaluated.Ethics and disseminationThis study has been approved by the Ethics Committee of West China Hospital of Sichuan University (2023–2284). Informed consent is required. It is expected that a follow-up randomized controlled trial will be conducted. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registrationThe study was retrospectively registered at ClinicalTrials.gov (ChiCTR2400087312).

Basal natriuresis as a predictor of diuretic resistance and clinical evolution in acute heart failure

Abstract Introduction Current clinical guidelines recommend serial measurement of natriuresis to detect diuretic resistance (DR) and to adjust the dose of furosemide in patients with acute heart failure (AHF) (1-5). However, multiple natriuretic dosages could make more complex the AHF management. Our objective was to correlate a single measurement of basal natriuresis (BN) on admission with the development of DR and cardiovascular (CV) events in patients hospitalized for AHF and during early outpatient follow-up (6-11). Methodology Prospective, multicenter study that included patients admitted to the coronary care unit (CCU) for AHF. Patients in shock or with creatinine >2.5 mg% at admission were excluded. Patients included received 40 mg of intravenous furosemide on admission, BN was measured in the first urination (the result was blinded to the treating physician), and subsequent diuretic treatment was guided by a pre-established protocol. The BN was considered low if it was <70 meq/L. The DR was defined as a combined endpoint composed of the requirement for intravenous furosemide ≥240 mg/day, tubular diuretic blockade (TB), hypertonic saline solution (HSS) or renal replacement therapy (RRT). In-hospital CV mortality was evaluated, as well as CV mortality and AHF readmissions at 60-day post-discharge follow-up. Results 157 patients were included, 56% men, with a median age of 74 years. The median BN was 103 meq/L (IQR 74-122), and BN was low in 22% of the cohort (N=34). DR was presented in 19% (N=30), 12.7% (N=20) required furosemide ≥240 mg/day, 8% (N=13) TB, 1 patient HSS and 4% (N=6) RRT. In-hospital CV mortality was 5.7%, CV mortality at 60-day follow-up 6.8%, and AHF readmissions at 60-day follow-up 12.2%. The group with low BN presented more DR (44% vs 12%; p 0.0001; RR 0.27; 95% CI 0.15-0.5), persistence of congestion at 48 hs (26.5% vs 11.4%; p 0.05; RR 0.48; IC 95% 0.22-1), administration of furosemide ≥240 mg/day (29% vs 8%; RR 0.27; 95% CI 0.12-0.61; p 0.003), more cumulative dose of furosemide at 72 hours (220mg [IQR 180-440] vs 160mg [IQR 100-180]; p 0.0001), use of TB (20.6 vs 4.9%; p 0.008; RR 0.23; 95%CI 0.08-0.65) and RRT (11.8 vs 1.6%; p 0.02; RR 0.14; 95%CI 0.02-0.72). Low BN was associated with in-hospital worsening of AHF (26.5% vs 9%; p 0.016; RR 0.34; 95%CI 0.15-0.74), inotropics use (21% vs 7%; p 0.048; RR 0.36; 95%CI 0.14 -0.88) or mechanical respiratory assistance (12% vs 2%; p 0.02; RR 0.14; 95%CI 0.02-0.72). Low BN presented higher in-hospital CV mortality (12% vs 4%; p 0.1), without association with endpoints in outpatient 60-day follow-up. Conclusions In patients hospitalized for AHF, low BN was associated with DR, persistence of congestion, need for more aggressive decongestion strategies, and a worse in-hospital clinical outcome

Factors of late respiratory support or oxygen weaning in infants with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants. This study aimed at identifying factors associated with early or with late or weaning failure from respiratory support or oxygen (O2) in preterm infants with BPD requiring respiratory support or O2 therapy after discharge from the neonatal intensive care unit (NICU). This retrospective study was conducted in the NICU of a tertiary hospital, in infants born before 32 weeks of gestation between 2012 and 2021, and discharged from the NICU with a respiratory support (tracheostomy [TT], invasive ventilation [IV], Non-IV [NIV], continuous positive airway pressure [CPAP], high flow nasal canula [HFNC]) or O2 therapy for BPD. Univariate and multivariate analyses were performed to identify factors associated with early weaning (before 6 months postmenstrual age [PMA]) or late (after 6 months PMA) and weaning failure. Among the 53 infants included (2% TT, 2% IV, 11% NIV, 25% CPAP or HFNC, 60% O2 at NICU discharge), 23 (43%) were weaned from respiratory support or O2 before 6 months PMA and 39 (73%) before 12 months PMA. IV duration during NICU stay and postnatal steroid treatment were identified as factors associated with a late or weaning failure (OR 1.03, p = .04 and OR 4.11, p = .023, respectively). In this study, nearly half of preterm infants with severe BPD were weaned from respiratory support or O2 before 6 months PMA. IV duration and postnatal steroid treatment during NICU stay were associated with a late or weaning failure.

The association of cytokine levels and postnatal factors with retinopathy of prematurity.

Prematurity has been known to trigger several cellular pathways, leading to the clinical occurrence of retinopathy of prematurity (ROP). This study compared the levels of a panel of serum cytokines in premature infants with and without ROP. This is a prospective observational study. Premature infants at 36-38 weeks' gestational age were recruited, their clinical data recorded, and serum samples collected and assayed for 18 cytokines. Based on follow-up examinations, patients were divided into two groups: No ROP and ROP. The ROP group was further divided into two subgroups: non-vision-threatening ROP (non-VTROP), and vision-threatening ROP (VTROP). On univariate analysis, among the clinical parameters, gestation age, birth weight, duration of invasive ventilation, and duration of stay in neonatal intensive care unit (NICU) were found to be significant. The univariate analysis also showed an association between raised levels of VEGF-D and IL-8 in the VTROP group. Multiple logistic regression indicated that gestation age was a significant risk factor across all subgroups. Additionally, VEGF-D levels were found to be significantly associated with VTROP. Higher VEGF-D levels are associated with an increased risk of severe ROP that requires treatment and could potentially be used as a biomarker.

ECMO support may be associated with improved survival in tuberculosis associated severe ARDS

BackgroundData describing outcome of extracorporeal membrane oxygenation (ECMO) support in Tuberculosis (Tbc)-associated acute respiratory distress syndrome (ARDS) remain sparce and are mostly confined to singular case reports. The aim of this case series was to analyze intensive care unit (ICU) survival in patients with Tbc-associated ARDS receiving veno-venous (vv-) ECMO support and to compare those to patients not receiving ECMO.Case presentationICU survival was analyzed retrospectively in 14 patients treated for Tbc-associated ARDS at three ECMO-referral university hospitals (Hannover Medical School, University Hospital Bonn (both Germany) and University Hospital Zurich (Switzerland)) during the last 14 years, of which eight patients received additional vv-ECMO support and six standard care only.ICU survival was significantly higher in patients receiving additional vv-ECMO support (62.5%, n = 5/8) compared to those that did not (16.7%, n = 1/6) (p = 0.021). ECMO support was associated with reduced ICU mortality (Hazard ratio adjusted for baseline SOFA score [adj. HR] 0.125 (95% confidence interval (CI): 0.023–0.689), p = 0.017). Median (IQR) time on ECMO and invasive ventilation in the vv-ECMO group were 20 (11–26) and 37 (27–53) days, respectively. Major bleeding defined as transfusion requirement of 4 units of blood or more or surgical and/or radiologic intervention occurred only in one patient, in whom pulmonary bleeding was fatal. Thromboembolic events occurred in none of the vv-ECMO patients.Discussion and conclusionsThis retrospective analysis from three large ECMO centers with similar SOPs suggests vv-ECMO support as a feasible approach in patients with severe Tbc-associated ARDS. Although affiliated with extended runtimes, vv-ECMO might be associated with improved survival in those patients. Vv-ECMO support should thus be considered in Tbc-associated ARDS to enable lung protective strategies during prolonged lung recovery.

Optimal fluid resuscitation targets in septic patients with acutely decompensated heart failure

BackgroundTo determine the optimal fluid resuscitation volume in septic patients with acutely decompensated heart failure (ADHF).MethodsSeptic patients with ADHF were identified from a tertiary urban medical center. The generalized additive models were used to explore the association between fluid resuscitation volume and endpoints, and the initial 3 h fluid resuscitation volume was divided into four groups according to this model: < 10 mL/kg group, ≥ 10 to ≤ 15 mL/kg group, > 15 to ≤ 20 mL/kg group, and > 20 mL/kg group. Logistic and Cox regression models were employed to explore the association between resuscitation volume and primary endpoint, in-hospital mortality, as well as secondary endpoints including 30-day mortality, 1-year mortality, invasive ventilation, and ICU admission.ResultsA total of 598 septic patients with a well-documented history of HF were enrolled in the study; 405 patients (68.8%) had sepsis-induced hypoperfusion. Patients with NYHA functional class III and IV were 494 (83.9%) and 22 (3.74%), respectively. Resuscitation volumes above 20 mL/kg (OR 3.19, 95% CI 1.31–8.15) or below 10 mL/kg (OR 2.33, 95% CI 1.14–5.20) significantly increased the risk of in-hospital mortality in septic patients, while resuscitation volumes between 15 and 20 mL/kg were not associated with the risk of in-hospital death in septic patients (OR 1.79, 95% CI 0.68–4.81). In the multivariable Cox models, the effect of resuscitation volume on 30-day and 1-year mortality in septic patients was similar to the effect on in-hospital mortality. Resuscitation volume exceeds 15 mL/kg significantly increased the risk of tracheal intubation, while fluid resuscitation volume was not associated with ICU admission in the septic patients. In septic patients with hypoperfusion, these fluid resuscitation volumes have similar effects on patient outcomes. This association was consistent across the three subgroups with worsened cardiac function, as well as in sensitivity analyses.ConclusionsOur study observed that an initial fluid resuscitation volume of 10–15 mL/kg in the first 3 h was optimal for early resuscitation in septic patients with ADHF, particularly those with worsened cardiac function. These results need to be confirmed in randomized controlled trials with larger sample sizes.

The post ICU trajectory: Post acute and post ICU nutritional care

ICU survivors are growing but a persistent physical and mental disability may occur. The patients discharged from ICU are frequently malnourished and their medical nutritional support is impaired by oral intake limitation due to respiratory support such as non invasive ventilation or high flow nasal cannula oxygen therapy, dysphagia and difficulties to determine energy and protein targets. ICU acquired weakness must be recognized and could be minimized by better energy intake determined by indirect calorimetry, optimal protein intake and physical activity. Early physical activity has become a pivotal element of the improvement of the physical and cognitive condition in the post ICU.

Long-Term Disabilities in ICU Survivors of COVID-19.

COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability. In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied. The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use. Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.

Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients (PRoFLUID)-study protocol for an international multicenter observational cohort study.

The practice of intravenous fluid and vasopressor therapy in intensive care unit (ICU) patients, particularly in those who receive invasive ventilation, has been subject to change. Traditional approaches of 'early and liberal fluid administration' and 'late and restrictive vasopressor use' have been challenged, leading to recommendations for giving less fluids and earlier administration of vasopressors. Recommendations for fluid deresuscitation-active fluid removal-are absent. The global approach to fluid and vasopressor therapy in invasively ventilated patients is currently unclear. Our aim is to explore the practice of intravenous fluid and vasopressor therapy in invasively ventilated ICU patients in a study named 'Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients' (PRoFLUID). PRoFLUID is an international, multicenter, observational cohort study in critically ill adult patients that are invasively ventilated for more than 24 hours. The outcomes include various aspects of fluid and vasopressor therapy, urine output and cumulative fluid balances. We will also collect duration of ventilation, lengths of stay and mortality in ICU and hospital. We expect to collect granular data on fluid and vasopressor therapy in a sample of at least 2,500 patients. PRoFLUID will provide useful insights into the practice of fluid and vasopressor therapy in invasively ventilated critically ill patients. PRoFLUID also allows us to determine whether geo-economic differences in management of intravenous fluid and vasopressor therapy exist, and allows for analyses of associations of aspects of fluid and vasopressor therapy with outcomes. Last but not least, its findings could feed sample size calculations of future randomized clinical trials of fluid and vasopressor therapy. In conclusion, PRoFLUID will collect data on fluid and vasopressor therapy in invasively ventilated ICU patients worldwide, providing insights that will guide future clinical decisions and randomized trial designs. ClinicalTrials.gov NCT05968066. Registered on August 1, 2023. Intensive care; invasive ventilation; fluid therapy; fluid management; vasopressor.

Epidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.

Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes. This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis. Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001). One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

Efficacy of High Flow Nasal Cannula in the Treatment of Patients with COVID-19 with Acute Respiratory Distress Syndrome: Results of Single Centre Study in Vietnam.

Most hospitalized patients required invasive or non-invasive ventilation and High Flow Nasal Cannula (HFNC). Therefore, this study was conducted to describe the characteristics of patients with severe Coronavirus Disease-2019 (COVID-19) treated by HFNC and its effectiveness for reducing the rate of intubated-mechanical ventilation in the Intensive Care Unit (ICU) of Phu Chanh COVID-19 Department-Binh Duong General Hospital. It was a cross-sectional and descriptive study. All severe patients with COVID-19 with acute respiratory failure eligible for the study were included. Patient characteristics, clinical symptoms, laboratory results, and treatment methods were collected for analysis; parameters and data related to HFNC treatment and follow-up were analysed. 80 patients, aged of 49.7 ± 16.6years, were treated with HFNC at admission in ICU. 14 patients had type 2 diabetes (17.5%), 3 patients had chronic respiratory disease (3.8%), 19 patients had high blood pressure (23.8%), and 5 patients with other comorbidities (7.4%). The majority of patients with severe COVID-19 had typical symptoms of COVID-19 such as shortness of breath (97.5%), intensive tired (81.3%), cough (73.7%), anosmia (48.3%), ageusia (41.3%), and fever (26.3%). The results of arterial blood gases demonstrated severe hypoxia under optimal conventional oxygen therapy (PaO2 = 52.5 ± 17.4mmHg). Respiratory rate, SpO2, PaO2 were significantly improved after using HFNC at 1st day, 3rd day and 7th day (P < 0.05; P < 0.05; P < 0.01; respectively). Receiver operating characteristics (ROC) index was significantly increased after treating with HFNC vs before HFNC treatment (4.79 ± 1.86, 5.53 ± 2.39, and 7.41 ± 4.24 vs 2.97 ± 0.39; P < 0.05, P < 0.05 and P < 0.01, respectively). 54 (67.5%) patients were success with HFNC treatment and 26 (32.5%) patients with HFNC failure needed to treat with Continuous Positive Airway Pressure (CPAP) (13 patients; 50%) or intubated ventilation (13 patients; 50%). HFNC therapy could be considered as a useful and effective alternative treatment for patients with acute respiratory failure. HFNC might help to delay the intubated ventilation for patients with respiratory failure and to minimise the risk of invasive ventilation complications and mortality. However, it is crucial to closely monitor the evolution of patient's respiratory status and responsiveness of HFNC treatment to avoid unintended delay of intubation-mechanical ventilation. An independent ethics committee approved the study (The Ethics Committee of Binh Duong General Hospital; No. HDDD-BVDK BINH DUONG 9.2021), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.

Post-COVID-19-pandemic changes and clinical characteristics of invasive group a streptococcal infections from 2015 to 2023.

Since winter 2022, invasive GAS (iGAS) infections have re-emerged in Europe, causing severe diseases in children and adults. We aimed to examine whether this reported post-pandemic increase was associated with an increased disease severity and/or a shift in clinical disease phenotypes. We performed detailed clinical phenotyping of patients hospitalized with iGAS infections at a 1410-bed tertiary German Medical Center from 01/2015 to 09/2023. One hundred seventy-eight patients were included: 50 children (28.1%) and 128 adults (71.9%). IGAS infections of Q1/2023 exceeded the pre-pandemic average by 551% (1200% for children). The mean age of affected patients shifted significantly post-pandemically (49.5 ± 26.5 to 32.4 ± 28.2years of age, p < 0.05), mainly due to the higher percentage of children affected with iGAS infections (15.2% pre-pandemic, 44.2% post-pandemic). CFR was significantly lower for children (2%) compared to adults (11.7%) (p < 0.05) and decreased from 13% to 6.5% post-pandemically (p = 0.148). Duration of antibiotic therapy (13.5 (10 to 21) to 10 (9 to 14) days), length of hospital (10 (4 to 25) to 7 (5 to 15) days), and ICU stay (7.0 (2.5 to 18.0) to 5.0 (3.0 to 8.5) days) were shorter post-pandemically. Despite the higher post-pandemic percentage of affected children, PICU admissions (57% before to 32% after), use of catecholamines (28.6% to 11.8%), invasive ventilation (35.7% to 17.6%) and CFR (7% to 0%) were all lower after the pandemic. Children were at higher risk for iGAS infections post-pandemically. The surge of post-pandemic iGAS infections was not accompanied by increased iGAS-associated morbidity and mortality.

A rare cause of respiratory distress in preterm infants: a case report of acquired subglottic cysts

BackgroundThe Subglottic Cysts (SGCs) are a rare cause of respiratory distress in infants. Typical risk factors include male gender, extreme prematurity, gastro-oesophageal reflux and invasive ventilation, the latter being associated with mucosal damage and blockage of the subglottic cysts’ ducts. We describe a case of acquired subglottic cysts in a premature infants presented with respiratory distress.Case presentationA premature male infant was born at 25 weeks + 2 days with a history of monochorionic diamniotic twin pregnancy with twin-to-twin transfusion syndrome. During hospitalization, invasive mechanical ventilation was necessary for a total of 18 days; the patient was discharged at postmenstrual age of 40 weeks + 1 day in good condition. At 43 weeks post-menstrual age, he presented to our department with mixed stridor and worsening of respiratory dynamics. A laryngotracheoscopy evaluation was performed. The exam showed the presence of multiple SGCs causing an almost complete obstruction of the airway. Because of the significant reduction of the airway’s patency, the child underwent a tracheotomy and thereafter cysts’ removal using cold steel microinstruments. A better airway patency was restored although a slight glottic edema persisted. The histopathology confirmed the benign nature of the lesions. Successive controls showed a completely patent airway and absence of SGCs.ConclusionIn conclusion, SGCs should be considered in preterm infants with respiratory distress previously intubated, which cannot be explained by the most common causes. Early diagnosis and treatment are fundamental to reducing the morbidity and mortality associated with this disease.

Glucagon-like peptide-1 receptor agonists may benefit cardiopulmonary outcomes in patients with COPD

BackgroundClinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary...

Predictive factors and risk scoring system for acute kidney injury (aki) in sick neonates-a prospective cohort study.

Nearly half of sick neonates admitted to NICU have AKI, which is maximum in extremely preterm infants. Sepsis, invasive ventilation, acidosis, and perinatal asphyxia have good diagnostic accuracy in identifying neonates likely to develop AKI. • Asphyxia, prematurity, sepsis, shock, hypotension, drugs, congenital heart diseases contribute to neonatal AKI. • Our simple risk prediction model can be used in sick neonates to identify infants who are at risk for developing AKI.

Fibrotic outcomes from SARS-CoV-2 virus interstitial pneumonia.

Following the onset of the new COVID-19 pandemic, particular attention is paid to the long-term outcomes, especially concerning patients affected by the SARS-CoV-2 virus leading to interstitial pneumonia. The aim of this research is to evaluate the possible evolution over time of interstitial pneumonia into post-inflammatory fibrosing interstitial disease. This research included 42 patients admitted to the COVID ward for SARS-CoV-2 interstitial pneumonia, 10 patients with mild pneumonia and respiratory failure who were treated with O2 only, 32 patients with severe pneumonia in which O2 and non-invasive ventilation were used for respiratory assistance, and 4 patients treated with invasive mechanical ventilation. At 70±30 days, 6, 12, 24, and 36 months after discharge, the cohort of patients carried out the evaluation of inflammation indices, high-resolution computed tomography (CT) chest scans, and functional respiratory tests. The comparative analysis showed that 83.3% of patients had residual parenchymal lung disease at 36-month follow-up, with a significantly higher rate in those with severe pneumonia and more extensive disease on initial CT. Regarding the pulmonary involvement model, patients presented ground-glass opacity or peripheral parenchymal bands, or a combination of them, peri- and intralobular interstitial thickening, which may be representative of fibrotic interstitial lung disease. There is a correlation between the severity of pneumonia, the inflammatory state, the need to increase respiratory support, and the quantity and persistence of CT-related lesions. Reductions in respiratory functions and exercise capacity were observed, the latter more pronounced in patients (24%) who had contracted severe pneumonia and required ventilatory support.Pulmonary outcomes from SARS-CoV-2 respiratory infections show a wide range of radiological findings, from complete recovery to stable outcomes of thickening and distortion of the interstitial architecture. From a functional point of view, there is an impairment of the alveolar-capillary diffusion capacity and, in cases who had contracted severe pneumonia, desaturation and reduced exercise tolerance in 24% of cases at a 36-month follow-up.

Clinical features and risk factors of cholestasis in small for gestational age preterm infants

To investigate the clinical features and risk factors of cholestasis in small for gestational age (SGA) preterm infants. This study selected SGA preterm infants born at less than 37 weeks of gestation and admitted to the Department of Neonatology, Children's Hospital of Soochow Universitywithin 24 hours after birth. The infants were divided into two groups: a cholestasis group and a non-cholestasis group. Clinical data from July 2017 to June 2022 were collected and retrospectively analyzed. Among the 553 SGA preterm infants included, 100 infants (18.1%) developed cholestasis. The incidence rates in different gestational age and birth weight groups were as follows: extremely preterm infants 50.0%, very preterm infants 46.6%, moderate preterm infants 32.7%, and late preterm infants 9.8%; birth weight (BW) <1 000 g 60.9%, 1 000 g≤BW<1 500 g 33.9%, and 1 500 g≤BW<2 500 g 10.7%. Multivariate regression analysis showed that low birth weight, intracranial hemorrhage, duration of invasive ventilation, total amino acid accumulation in the second week, total lipid emulsion accumulation in the first week, and total lipid emulsion accumulation in the second week were independent risk factors for cholestasis in SGA preterm infants (P<0.05). The incidence of cholestasis in SGA preterm infants increases with decreasing gestational age and birth weight. The occurrence of cholestasis in SGA preterm infants is influenced by multiple risk factors, including low birth weight, intracranial hemorrhage, invasive ventilation, and the accumulation of amino acids and lipid emulsions, highlighting the need for comprehensive treatment measures to reduce its occurrence.

Measurement of intrinsic positive end-expiratory pressure and clinical outcomes of infants with severe bronchopulmonary dysplasia

To investigate the levels of intrinsic positive end-expiratory pressure (PEEPi) in infants with severe bronchopulmonary dysplasia (sBPD) and the relationship between different levels of PEEPi and clinical outcomes. A retrospective analysis was conducted on the clinical data of 12 sBPD infants who underwent PEEPi measurement and were hospitalized at Guangzhou Women and Children's Medical Center from January 2022 to June 2023. The clinical manifestations and outcomes at discharge were compared between infants with very high PEEPi (≥10 cmH2O) and those with lower PEEPi (<10 cmH2O). PEEPi measurements were taken in 12 sBPD infants between gestational age 31+3 and 67+2 weeks postmenstrual age, with the lowest PEEPi measured at 0.9 cmH2O and the highest at 19.6 cmH2O; 50% (6/12) of the infants had PEEPi ≥10 cmH2O. All infants with very high PEEPi exhibited ineffective triggering and patient-ventilator asynchrony. Among them, 5 infants could not be weaned off invasive ventilation, resulting in 4 deaths and 1 infant being discharged with a tracheostomy and ventilator support. In contrast, among the infants with PEEPi <10 cmH2O, only 1 infant died, while the others were successfully extubated and discharged. Infants with sBPD may have elevated PEEPi levels, and very high PEEPi may be associated with adverse outcomes in these patients.

A case of oxaliplatin-induced immune thrombocytopenia followed by complete remission of metastatic colon cancer

An 87-year-old male underwent laparoscopic left hemicolectomy for adenocarcinoma of the descending colon in December 2021. Lung metastasis was found in the left upper lobe 6 months postoperatively, and it increased in size after 9 months from the surgery. S-1 plus oxaliplatin (SOX) was started in October 2022. The lung metastasis was shrinking within 23 cycles of SOX therapy. The 24th cycle of SOX (only oxaliplatin) was administrated in April 2024, the catheter of venous infusion line of right forearm was removed after finishing the infusion, however bleeding did not stop. The platelet count was rapidly dropped into 2,000/μl from 131,000/μl (pretreatment) within 7 hours and hemoglobin levels decreased from 10.9 to 8.9 in the same period, furthermore, dropped into 6.2 g/dl in next 24 hours. PA-IgG was significantly high (204.0 ng/107 cells; normal &lt; 30.2). Transfusion of platelet, red blood cell concentrate, steroid pulse therapy, antibiotic treatment with multiple agents and non-invasive positive pressure ventilation (NPPV with oxygen were performed. As a result, the patient’s platelet count was increased and his DIC score was decreased to 3 points (normal range) in April 2024. The patient’s general condition gradually improved, and he was discharged from hospital on the 35th day of hospitalization. CT scan after discharge showed complete remission of the lung metastasis. Possible mechanisms and approach to treatment are discussed.