Need For Non-invasive Mechanical Ventilation Research Articles

Clinical characteristics, complications and in-hospital mortality in patients in the coronary care unit requiring invasive mechanical ventilation

Abstract Funding Acknowledgements None. Introduction Mechanical ventilation (MV) is one of the most widely used life support techniques in critically ill patients and, due to the increasing number of coronary care units (CCU), adequate management of this technique is essential. Purpose The aim of our study was to describe the profile of patients requiring invasive MV (IMV) in our CCU, as well as the mode of ventilation, complications and in-hospital mortality. Methods Single-center retrospective observational study of a cohort of patients admitted to a CCU between January 2018 and March 2023 who required IMV. Baseline characteristics, reason for admission and intubation, as well as evolution and complications during admission were analyzed. Results A total of 157 patients were included, 113 (72%) men. The mean age was 66.9 years (SD 12.2). Table 1 summarizes the history and baseline characteristics of the patients. Image 1 summarizes the reasons for admission. Regarding the causes of oro-tracheal intubation, the most frequent was cardiopulmonary arrest (CPA) (49.7%), followed by respiratory failure (32.5%) and cardiogenic shock (CS) (16.6%). Regarding left ventricular ejection fraction (LVEF) on admission, 69.4% had LVEF<52%, with 32.5% of all patients having LVEF below 30%. The most used ventilation mode as initial mode was volume-controlled mode (VC/AC), used in 71.3% of patients. The mean stay in CCU was 11 (min 1-max 78, SD 12) and of orotracheal intubation was 5 days (min 1-max 64, SD 7). Mean days to weaning from VMI was 2 (min 0-max 8, SD 2). Failure on extubation occurred in 38 patients (19.1%), the most frequent reasons being need for reintubation (12.7%), need for noninvasive MV (8.9%) and self-extubation (2.5%). Only 7 patients (4.5%) required tracheostomy. Regarding complications, 49% developed sepsis, 61.1% had CS, and 7% required renal replacement therapy. In-hospital mortality was 38.2% (60 patients). Conclusions IMV is a technique that is increasingly used in our environment. Patients who require it are usually complex, with multiple comorbidities, with a high percentage of CPA and CS. These patients usually have prolonged stays in the CCU, with an average of more than 10 days, frequent complications and a high in-hospital mortality of almost 40%. It is essential to gather series as large as possible of these patients to improve our knowledge of their management and characteristics.

Lactate level is an independent predictor of mortality in patients with hematologic malignancy receiving urgent chemotherapy in intensive care unit

BackgroundIntensive care unit (ICU) survival of cancer patients has improved. Urgent chemotherapy has become feasible in critically ill patients with specific organ dysfunction due to hematological malignancies. ObjectiveThe aim of the study was to assess ICU mortality rates and the factors associated with mortality in patients with hematologic malignancies receiving urgent chemotherapy in the ICU. MethodsWe retrospectively included all patients admitted to the ICU who received chemotherapy due to hematologic malignancy in 2012–2022. ResultsOf the 129 patients undergoing chemotherapy in the ICU, 50 (38.7 %) died during the ICU follow-up. The following conditions were significantly more common among nonsurvivors: presence of infection at the time of ICU admission (p < 0.001), the requirement for mechanical ventilation during ICU stay (p < 0.001), the need for noninvasive mechanical ventilation during ICU stay (p = 0.014), vasopressor support (p < 0.001), and sepsis (p < 0.001). Logistic regression analysis revealed that among laboratory parameters on ICU admission, lactate (p = 0.008), albumin (p = 0.022), C-reactive protein (p = 0.046), baseline sequential organ failure assessment (SOFA) score (p < 0.001), newly developed heart failure (p = 0.006), and the requirement for vasopressor agents during ICU stay (p < 0.001) significantly influenced the risk of mortality in the univariate analysis. The multivariate analysis revealed lactate levels (p = 0.047) on ICU admission as an independent predictor of mortality. ConclusionThe development of heart failure and lactate levels on admission were the main predictors of mortality. Additionally, higher SOFA scores revealed that illness severity was closely associated with mortality. Future studies should focus on strategies to further reduce these risks and achieve the best outcomes for these patients.

Clinical profile during the first and second pandemic waves in children and adolescents with COVID-19 at pediatric public hospital, Rio de Janeiro, Brazil

Background: COVID-19 is usually milder in children and adolescents, leading to lower hospital admission rates than adults. This study evaluated clinical manifestations in children (&lt; 10 years) and adolescents (10 to &lt; 18 years) with COVID-19 admitted to a tertiary municipal hospital in Rio de Janeiro (Brazil) during the first (February to November 2020) and second pandemic waves (November 2020 to April 2021). Methods: this retrospective observational study considered patients in the pediatric age group (&lt;18 years old) with confirmed diagnosis of COVID-19 using RT-PCR. Descriptive and bivariate analysis were performed assuming a p-value&lt;0.05 level of significance for all analyses. Results: among the 34 included patients (50% boys; 73.5% children), the most prevalent symptom was fever (88.2%), followed by asthenia (85.3%), and cough associated with dyspnea (50%); 29.4% were admitted to the ICU, and 5.9% needed invasive mechanical ventilation. All patients were treated with antibiotics, 88.2% with antivirals, and 52.9% with corticosteroids. Asthenia was more frequent among children than adolescents (96.0% vs. 55.6%; p &lt; 0.01). Tuberculosis was observed in none of the children, but 33.3% of the adolescents (p-value = 0.003). The percentage of hospitalized patients with family members infected with SARS-CoV-2 was smaller among children than adolescents (8.0% vs. 44.0%; p-value = 0.01). Other variables that differed between children and adolescents were C-reactive protein, creatinine, and need for non-invasive mechanical ventilation. There were no deaths among participants. Conclusion: in our hospital, COVID-19 was most often not severe in children and adolescents. Overall, children were hospitalized more frequently by COVID-19 than adolescents, with some differences for clinical characteristics.

Severe Covid-19 in pregnant and postpartum women admitted to an intensive care unit: A retrospective cohort study

Background SARS-CoV-2 infection is associated with worse maternal and fetal outcomes. This study aims to describe the characteristics of pregnant and postpartum women with severe Covid-19 admitted to ICU. Methods and findings It’s a retrospective cohort study evaluating pregnant and postpartum women referenced to a specialized ICU between May 2020 and June 2022. Covid-19 was confirmed with RT-PCR or rapid antigen test on a nasopharyngeal swab. Variables were described by median and IQR when numerical, and by frequency and percentage when categorical. OR with 95% CI were calculated for the evaluation of factors related to death. P-values were calculated using Pearson’s ꭓ2-test, Fisher’s exact test, Wilcoxon rank sum test, and Kruskall-Wallis test, and statistical significance was established as &lt; 0·05. Missing data were excluded. All statistical analysis were performed using R software version 4.2.2. Of the 101 admissions, 85 (84·2%) were of pregnant women. Obesity (23·0%) and systemic arterial hypertension (13·0%) were the most prevalent medical conditions. Sixty-six (65·3%) were admitted using some type of oxygen support. Forty-seven (46·5%) evolved to mechanical ventilation. There were 61 events considered obstetric complications, with 8 stillbirths/fetal losses. The overall lethality was 15·8%. Pregnancy interruption, need for non-invasive mechanical ventilation, level of oxygen support at admission, prone maneuver, hemodialysis, and healthcare-related infections were factors associated with death. Evaluating the WHO 7-category ordinary scale, there was a trend of increase in the risk of death with higher punctuation, with a statistically significant difference of women with 5 (OR = 7·27; 95% IC = 1·17–194; p = 0·031) or 6 points (OR = 12·0; 95% IC = 1·15–391; p = 0·038) when compared to the ones with 3 points, i.e., of women admitted with a high-flow non-rebreathing mask or invasive mechanical ventilation, compared with the ones admitted at room air, respectively. The main limitations of this study are the relatively small number of participants, and the use of data derived of medical records—which are susceptible to misclassification and variable amounts of missing data. Conclusions Pregnant and postpartum women with severe Covid-19 have high lethality and a high incidence of clinical and obstetric complications. These findings support that this population should be prioritized in public health strategies that address Covid-19.

Factors affecting mortality and patient outcome in patients with COPD followed in the intensive care unit

Objective: COPD is characterized by exacerbation and may lead to intensive care unit admission in cases such as pneumonia and sepsis. While non-invasive mechanical ventilation is the first treatment option in intensive care units, it reduces mortality and hospitalization. In our study, we aimed to determine the factors affecting mortality in patients with COPD admitted to intensive care unit. &#x0D; Materials and Methods: In our study, the data of patients admitted to the intensive care unit of Bolu Izzet Baysal State Hospital with COPD were evaluated retrospectively. Duration of intensive care unit stay, APACHE II score, comorbidities, need for noninvasive mechanical ventilation, CRP albumin ratio and leukocyte lymphocyte ratio were recorded. &#x0D; Results: A total of 416 patients, including 177 (42.5%) women, were included in our study. Of the patients, 107 (25.7%) (Group 1) were admitted to ICU for COPD exacerbation, 183 (44%) (Group 2) for pneumonia and 126 (30.3%) (Group 3) for sepsis. Hypertension was the most common comorbidity in 112 patients (26.9%). Mortality was higher in patients with pneumonia and sepsis than in patients with COPD exacerbation. When all patients were compared according to prognosis, age, length of ICU stay, NLR, CAR and APACHE II scores were higher in patients who died. The duration of non-invasive mechanical ventilation was higher in patients with an episode of COPD, while mortality was higher in patients receiving invasive mechanical ventilation support. &#x0D; CONCLUSION&#x0D; While pneumonia and sepsis increase mortality in patients with COPD, NIMV has a favorable prognosis in these patients with encouraging results.

The effects of combination-therapy of tocilizumab and baricitinib on the management of severe COVID-19 cases: a randomized open-label clinical trial.

Background: Tocilizumab and baricitinib are considered standard treatments for hospitalized COVID-19 patients with an inflammatory status. However, the effects of co-administering these medications aiming for more rapid patient recovery are controversial among practitioners. The potential benefits include the rapid improvement of patients and regulation of the immune system, and the potential risks include the increased chance of serious adverse events, including infections. This study aimed to investigate the effects of co-administering these two medications on the 28-day mortality rate, other efficacy parameters, and safety issues. Methods: In this randomized open-label trial, 68 patients were recruited. The study was conducted at Dr. Masih Daneshvari Hospital during 6months (from 21 March 2022 to 23 August 2022). Severely ill patients aged between 18 and 100years old with confirmed COVID-19 were enrolled. The primary outcomes included the need for invasive mechanical ventilation and a 28-day mortality rate. Secondary outcomes included the need for non-invasive mechanical ventilation, the need for admission to the intensive care unit (ICU), the length of hospital stay, and the need for a second dose of tocilizumab. Safety assessments were also performed for 28days. The data were collected from the patients' medical records, which included age, gender, and comorbidities. Results: The 28-day mortality rate or the need for mechanical ventilation was not statistically different among the two groups (p-value = 0.49 for both outcomes). The need for non-invasive mechanical ventilation, the need for admission to the ICU, or the need for a second dose of tocilizumab and the length of hospital stay was not affected either (p-value = 1; 0.1; 0.49 and 0.9, respectively). One patient developed thrombosis in the combination group. No adverse events related to infectious complications were recorded in any groups. Conclusion: This study showed no beneficial effects of combining tocilizumab and baricitinib in managing severe COVID-19 cases. However, the need for ICU admission was meaningfully lower in the combination group. Studies with larger sample sizes are needed to confirm these results. Clinical Trial Registration: Identifier: RCT20151227025726N30M.

Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia

Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia the prognostic role of which is poorely documented.&#x0D; Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIMV) in this setting.&#x0D; Materials and methods: we prospectively studied 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. All the following data were collected at admission to the Emergency Department and processed by univariate and multivariate analysis: clinical and laboratory data, blood gas analysis in room air and lung ultrasound.&#x0D; Results: 33/52 subjects (63,4%) underwent NIMV. At univariate analysis PaCO2 was inversely associated to the need for NIMV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis PaCO2 predicted the need for NIMV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035).&#x0D; Conclusions: our data suggest that hypocapnia could be an early predictor of clinical worsening in these patients independently from other known predictors of unfavourable outcome, reflecting the occurrence of a deep and frequent respiratory pattern possibly related to the generation of excessive transpulmonary pressure swings leading to a self-induced lung injury (P-SILI). Further studies are needed for validating these data on greater populations.

Does Low Mean Corpuscular Hemoglobin Concentration Really Predict Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Background and Aim:&#x0D; Several studies have shown associations of low mean corpuscular hemoglobin concentration (MCHC) with mortality and poor clinical course in conditions associated with chronic inflammation such as cardiac failure and COPD. Thus, in this study we aimed to determine the link between MCHC and readmission mortality in a large patient population with minimum 1 year of follow-up. &#x0D; Methods:&#x0D; Clinical data at admission, laboratory data, number of admissions to emergency room due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) following the discharge of the last patient recruited, number of admissions to pulmonology unit, and number of intensive care unit admissions between 2018 and 2019 were recorded. The follow-up duration ranged between 12 and 36 months. &#x0D; Results:&#x0D; A total of 339 patients were included. Based on a ROC analysis, the cut-off value for MCHC was 32.35 g/dl. Comparison of clinical data according to this cut-off value showed an increase in the incidence of pneumonia during admission, hypercapnic respiratory failure, need for non-invasive mechanical ventilation (NIV), and number of intensive care unit admissions within a 1 year period, as well as reduced survival in non-anemic subjects with MCHC ≤ 32.35 g/dL. In multivariate cox-regression analysis MCHC was not an independent predictor of mortality risk. &#x0D; Conclusion: We recommend careful monitoring and assessment of comorbidities in AECOPD patients with low MCHC but without anemia. MCHC was not found to be an independent predictor of mortality but there was a significant correlation between MCHC and survival in patients without anemia.

Usefulness of lung ultrasound in the early identification of severe COVID-19: results from a prospective study.

There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound(LUS); however, its role in predicting the prognosis has yet to be explored. The aim of the study was to assess the relationshipbetween lung ultrasound findings with the degree of respiratory failure measured by the PaO2/FiO2 ratio (PaFi) andthe prognosis of these patients: need for non-invasive mechanical ventilation (NIMV), admission to the Intensive Care Unit(ICU) and mortality. Prospective, longitudinal and observational study performed in patients with confirmedCOVID-19 underwent a LUS examination and laboratory tests. A total of 107 patients were enrolled: 93.4%with bilateral involvement and 73.83% presented at least one consolidation. A good inverse correlation (Rho Spearman coefficient-0.897) between the ultrasound score and PaFi was obtained. The AUC for identification of patients with more severerespiratory failure, a moderate and severe ARDS, was 0.97 (CI 95%: 0.95-1) and a cut-off score of 34.5 showed a sensitivityof 0.94 and a specificity of 0.91. The Kappa index showed a high concordance (0.83) of the classification by ultrasound lunginvolvement and ARDS. The combination of the ultrasound score and the presence of respiratory failure caneasily identify patients with a higher risk to present complications.

The Factors Related to the 6 Minute Walk Test: The Experience of a Referral Lung Transplantation Center

Objectives: The 6-minute-walk test is a practical and widely used test, which indicates the exercise capacity in patients with a severe pulmonary disease. The study aims to investigate the related factors with the 6-minute-walk test in lung transplantation candidates.&#x0D; Materials and Method: The data were collected retrospectively from 349 patients, between January 2012 and September 2020. The patients were grouped according to their underlying lung disease as obstructive lung diseases, interstitial lung diseases, and infective lung diseases. The data collected included patient demographics, gender, body mass index, artery blood gas, the results of the respiratory function test, six-minute walk test, long-term oxygen therapy, and the need for non-invasive mechanical ventilation [such as group 1 (6MWD&lt;200) and group 2(6MWD≥200)]. All of the collected data were analyzed and compared between the groups.&#x0D; Results: Overall, 349 patients were included in the study, and there were 123 females and 226 males (35.2% and 64.8% respectively) with a mean age of 46.92 ± 14.1 years. Their mean body mass index was 23.58 ± 12.52 kg/m2, the median FEV1(%) was 35.3 (33.4-37.2), the median six-minute walk distance was 222 m (125-335 m), and the mean PaO2/FiO2 (P/F) was 250.32% ± 74.81, the mean PCO2 was 45.71 mmHg ± 11.97. Furthermore, the patients using long-term oxygen therapy were (n=274, 78.5%) and non-invasive mechanical ventilation were (n=125, 35.8%). The mortality status, P/F, long-term oxygen therapy usage, and non-invasive mechanical ventilation usage were different between Group 1 and Group 2 (p=0.001, p=0.001, p&lt;0.001, and p&lt;0.001, respectively). There was no difference between the groups in patients with and without IPF between underlying diseases. The 6-minute walk test was found to have moderate correlation with FEV1 and P/F; and a negative correlation with age and PCO2 (p&lt;0.01, r=0.33.8, p&lt;0.001, r= 38.1 and p=0.17, r=12,7, p&lt;0.001, r=-0.30.6, respectively). There was no correlation between P/F, FEV1, and body mass index; and also, between PCO2, age, and body mass index. Age had a weak correlation with FEV1(p&lt;0.001, r=19.3). There was no correlation between the age and 6MWD, as well as P/F, PCO2, and the body mass index. The factors affecting survival in multivariate analysis were investigated by using the Cox regression model. It was observed that gender (OR, 0.001; 95% CI, 0.246-0.716; p=0.42), FEV1(OR, 1.02; 95% CI, 1.00-1.04; p&lt;0.001), P/F (OR, 1.00; 95% CI, 1.00-1.01; p&lt;0.001), and LTOT (OR, 9.83; 95% CI, 3.70-26.14; p&lt;0.001) were independent factors associated with 6MWD&lt;200 m.&#x0D; Conclusion: The 6-minute walk test is associated with mortality, gender, poor oxygenation, and with the utilization of domiciliary non-invasive mechanical ventilation or long-term oxygen therapy. Furthermore, it is an independent risk factor for mortality in lung transplant candidates and in providing a valuable method for the management of patients.

THE EFFECT OF SMOKING STATUS ON DISEASE SEVERITY IN HOSPITALIZED PATIENTS FOLLOWED-UP FOR COVID-19 PNEUMONIA

Introduction:Severe acute respiratory syndrome (SARS-CoV-2) virus, which has emerged since December 2019, still affects the world with all its violence. The disease presents with different clinical pictures ranging from an asymptomatic case to severe respiratory failure resulting in death. Our aim in this study, is to investigate the relation of smoking with symptoms, clinical course and disease severity in patients hospitalized for COVID-19 pneumonia. Method: 107 patients who were hospitalized with the diagnosis of COVID-19 pneumonia and received treatment, between st th February 1 , 2021 and March 15 , 2021, were analyzed retrospectively. In particular, their smoking history, symptoms at hospital admission, comorbidities, non-invasive mechanical ventilation (NIMV) and intensive care unit (ICU) requirements needed during hospitalization, mortality and the relationship between smoking status and disease severity were examined. Results: 107 patients (68 males and 39 females) with a mean age of 49 years, were included in the study. 42% of the patients were smokers, 22.4% quitters, and 35.5% of them had never smoked. Cough, sputum, and shortness of breath were found to be higher in smokers. Muscle and joint pain was statistically signicantly higher in the smoking group. The symptoms and length of hospital stay were not related with smoking status. Conclusion: As a result of our study; we found that symptoms, comorbidities, need for NIMV and mortality were higher in the smoking group and smoking was higher in the severe disease group. Although these differences were not statistically signicant, they were determined as numerical deections.

Evaluation of skeletal muscle mass as a predictor of prognosis in patients treated in hospital for COVID-19 infection.

Skeletal muscle indexes are known to be one of the important prognostic indicators in many clinical situations. This study aims to evaluate the effects of laboratory values and muscle mass measures such as skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle density (SMD) and skeletal muscle gauge (SMG) obtained from the 12th thoracic vertebra (T12) level of patients hospitalized for COVID-19 infection on prognosis. The patients' age, comorbidity index (CCI) scores, gender, anthropometric criteria such as height, weight, and BMI, laboratory values, development of NIMV and IC need during follow-up, length of hospital stay, and hospital mortality were retrospectively screened. The relationship between clinical and laboratory variables, SMA, SMI, SMD, and SMG values, and patient outcomes such as the need for non-invasive mechanical ventilation (NIMV), need for intensive care, and mortality was investigated using multivariate logistic regression analysis. It was shown in multilinear regression analysis that T12SMD (β=-0.254; p=0.036), albumin (β=-0.465; p=0.005), and procalcitonin values (β=-0.292; p=0.026) were independent risk factors on mortality for intensive care in patients hospitalized due to COVID-19 infection. T12SMD has been shown to be significantly associated with various negative outcomes such as mortality, need for NIMV, and need for intensive care independently of body mass index (BMI) in our study (Tab. 5, Fig. 2, Ref. 25).

Glycemic Control &amp; Morbidity in Diabetics With COPD Exacerbation. A Retrospective Study

Background: Diabetes and chronic obstructive pulmonary disease (COPD) are widely prevalent and comorbidity with these diseases is quite common. However, there is limited data on the interrelation between glycemic control and COPD exacerbations in diabetic patients. Objective: To study the association between pre-admission glycemic control and COPD clinical outcomes including mortality, risk of hospital readmission and the need for mechanical ventilation. Methods: A retrospective population-based cohort study. We screened for patients with both diabetes and COPD exacerbation aged 35 years and above. Pre-admission glycemic control was defined by the last HBA1C level prior to hospitalization. Patients with HBA1C>8% were defined as uncontrolled. We evaluated the difference between controlled and uncontrolled groups in the rates of mortality, readmission and the need for mechanical ventilation. We examined demographic and clinical parameters that might reflect COPD severity including: COPD medication use, blood hemoglobin, platelets, LDH and CRP levels. Results: 513 hospitalizations with diabetes and COPD were screened. 222 hospitalization were excluded either due to unestablished diagnosis of COPD or due to lack of HBA1C test in the preceding year. Of the remaining 291, 208 admissions were with controlled diabetes whereas 83 were uncontrolled. Although not statistically significant, the rate of re-hospitalization was higher in the uncontrolled group (OR 1.99, CI 0.99–4.0, p-value 0.051). There was no statistically significant difference in mortality (OR 1.6, CI 0.73–3.5, p-value 0.243). The use of oxygen and the need for noninvasive mechanical ventilation were significantly higher in the uncontrolled group (67.5% vs. 52.4%, p-value 0.019, 33.7% versus 18.8%, p-value 0.006, respectively). There was no significant difference in possible confounders tested between the groups. Conclusion: Uncontrolled diabetes may adversely affect patients with COPD exacerbation. Larger studies are needed to conclusively determine the impact of glycemic control on COPD morbidity and mortality.

Is there any effect of smoking status on severity and mortality of hospitalized patients with COVID-19 pneumonia?

The Severe Acute Respiratory Syndrome (SARS-CoV-2) virus, which emerged from China and spread all over the world, has affected the world in every aspect and will do so in the foreseeable future. This study was carried out to investigate the possible aggravating effect of smoking on the prognosis of patients with COVID-19 pneumonia presenting with pulmonary involvement. 114 adult patients who received inpatient treatment in our clinic with the diagnosis of COVID-19 pneumonia between 11 March 2020 and 30 April 2020 were retrospectively included in the study; in particular, they were evaluated in terms of smoking history, severity of disease, need for NIMV and ICU admission, and mortality during their hospitalization. The mean age of the 114 patients hospitalized with COVID-19 pneumonia was 51.14 ± 14.97 (range 16-81), and 77 (67.5%) were male. Of the patients, 19 (15.9%) were active smokers, 23 were ex-smokers (20.1%), 72 (63.1%) non-smokers. The effect of smoking on the severity of the disease, length of hospitalization, need for non-invasive mechanical ventilation (NIMV) and intensive care unit (ICU) admission and mortality were not statistically significant. The rate of active smoking in patients hospitalized with COVID- 19 is lower than the population average. In this study, no correlation was observed between smoking status and the severity, prognosis and mortality of the disease. Further studies with larger number of patients and case series are needed to better elucidate the relationship between smoking and COVID-19 and the pathophysiologic mechanisms of the effects of smoking on the natural history of COVID-19 pneumonia.

Evaluation of the diagnostic utility of procalcitonin and some old tools in prediction of the need for noninvasive mechanical ventilation in acute exacerbation chronic obstructive pulmonary disease

Evaluation of the diagnostic utility of procalcitonin and some old tools in prediction of the need for noninvasive mechanical ventilation in acute exacerbation chronic obstructive pulmonary disease

Late-onset thymidine kinase 2 deficiency: a review of 18 cases

BackgroundTK2 gene encodes for mitochondrial thymidine kinase, which phosphorylates the pyrimidine nucleosides thymidine and deoxycytidine. Recessive mutations in the TK2 gene are responsible for the ‘myopathic form’ of the mitochondrial depletion/multiple deletions syndrome, with a wide spectrum of severity.MethodsWe describe 18 patients with mitochondrial myopathy due to mutations in the TK2 gene with absence of clinical symptoms until the age of 12.ResultsThe mean age of onset was 31 years. The first symptom was muscle limb weakness in 10/18, eyelid ptosis in 6/18, and respiratory insufficiency in 2/18. All patients developed variable muscle weakness during the evolution of the disease. Half of patients presented difficulty in swallowing. All patients showed evidence of respiratory muscle weakness, with need for non-invasive Mechanical Ventilation in 12/18. Four patients had deceased, all of them due to respiratory insufficiency. We identified common radiological features in muscle magnetic resonance, where the most severely affected muscles were the gluteus maximus, semitendinosus and sartorius. On muscle biopsies typical signs of mitochondrial dysfunction were associated with dystrophic changes. All mutations identified were previously reported, being the most frequent the in-frame deletion p.Lys202del. All cases showed multiple mtDNA deletions but mtDNA depletion was present only in two patients.ConclusionsThe late-onset is the less frequent form of presentation of the TK2 deficiency and its natural history is not well known. Patients with late onset TK2 deficiency have a consistent and recognizable clinical phenotype and a poor prognosis, due to the high risk of early and progressive respiratory insufficiency.

Çocuk Acil Kliniğimizde Takip Edilen Hastalarda Solunum Yolu Viral Etkenlerin Dağılımı

We aimed to determine the distribution of frequency of respiratory viruses detected in nasopharyngeal swab samples of patients under 5 years of age, who were hospitalized in the inpatient unit of pediatric emergency department during last year, by seasons, age and clinical findings. Hospitalization files of the patients were examined retrospectively. Patients’ age, gender, admission complaint, physical examination findings, season they admitted, need for non-invasive mechanical ventilation, duration of hospital stay and result of nasopharyngeal swab viral polymerase chain reaction (PCR) were recorded. When results of the nasopharyngeal swab viral PCR of the patients were examined, it was determined that no virus was isolated in 43 (26.5%) patients and in 119 (73.5%), however, at least one virus was isolated. Of these 119 patients; only one virus was detected in 82 (68.9%) and two or more viruses in 37 (31.1%). It was observed that 87 (53.7%) did not receive any antibiotics and 75 (46.3%) patients were treated with one or more antibiotics. Early detection of viral pathogens is thought to prevent unnecessary antibiotic use, control of antibiotic resistance, shorten hospital stay and decrease treatment costs.

Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia.

BackgroundThere is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP.MethodsWe conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997–2001, 2002–2006, 2007–2011, 2012–2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation.ResultsFrom a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%–9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38).ConclusionOver time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.

Can NT-pro BNP Levels Predict Prognosis of Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit?

Background:The prognostic value of amino terminal pro-brain natriuretic peptide levels in patients with acute exacerbation of chronic obstructive pulmonary disease has not been fully established.Aims:To investigate the predictive value of amino terminal pro-brain natriuretic peptide levels in terms of mortality, need for noninvasive mechanical ventilation, invasive mechanical ventilation, and weaning success.Study Design:Cohort study.Methods:Patients who were admitted to intensive care unit between December 2015 and December 2016 due to acute exacerbation of chronic obstructive pulmonary disease were included in the study. Demographic data, noninvasive mechanical ventilation application, need for invasive mechanical ventilation, amino terminal pro-brain natriuretic peptide level, duration of mechanical ventilation, intensive care unit and hospital stay, weaning success, and mortality rates were recorded.Results:A total of 110 patients (75 males) were included in the study. The mean age of the participants was 69 (61-76) years, and the mean Acute Physiology and Chronic Health Evaluation II score was 19 (15-23). The mean amino terminal pro-brain natriuretic peptide level was found to be lower in cases with noninvasive mechanical ventilation success than those with noninvasive mechanical ventilation failure (p=0.053). In addition, the mean amino terminal pro-brain natriuretic peptide level was significantly higher (4740 pg/mL vs. 3004 pg/mL, p=0.001) in patients who needed invasive mechanical ventilation support than in patients who did not. The mortality rate was significantly higher in patients who had an increasing trend of amino terminal pro-brain natriuretic peptide levels during hospitalization than in patients who had decreasing levels (59% vs. 23%, p=0.015). Based on the receiver operating characteristic analysis, the increasing trend of amino terminal pro-brain natriuretic peptide levels during intensive care unit stay predicted mortality with area under curve of 0.84 (p<0.0001, 95% CI: 0.75-0.93) and predicted invasive mechanical ventilation need with area under curve of 0.68.Conclusion:In cases of acute exacerbation of chronic obstructive pulmonary disease requiring mechanical ventilation, amino terminal pro-brain natriuretic peptide measurement and monitoring of its trend may be a valuable asset in predicting mortality, noninvasive mechanical ventilation, weaning success, and need for invasive mechanical ventilation.

Predictors of Need for Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Predictors of Need for Non-Invasive Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease