Respiratory Intensive Care Unit Research Articles

PaCO2 is nonlinearly associated with NIV failure in patients with hypoxemic respiratory failure

ObjectiveTo explore the association between PaCO2 and noninvasive ventilation (NIV) failure in patients with hypoxemic respiratory failure.MethodsA retrospective study was performed in a respiratory ICU of a teaching hospital. Patients admitted to ICU between 2011 and 2019 were screened. We enrolled the patients with hypoxemic respiratory failure. However, patients who used NIV due to acute-on-chronic respiratory failure or heart failure were excluded. Data before the use of NIV were collected. Requirement of intubation was defined as NIV failure.ResultsA total of 1029 patients were enrolled in final analysis. The rate of NIV failure was 45% (461/1029). A nonlinear relationship between PaCO2 and NIV failure was found by restricted cubic splines (p = 0.03). The inflection point was 32 mmHg. The rate of NIV failure was 42% (224/535) in patients with PaCO2 >32 mmHg. However, it increased to 48% (237/494) in those with PaCO2 ≤ 32 mmHg. The crude and adjusted hazard ratio (HR) for NIV failure was 1.36 (95%CI:1.13–1.64) and 1.23(1.01–1.49), respectively, if the patients with PaCO2 >32 mmHg were set as reference. In patients with PaCO2 ≤ 32 mmHg, one unit increment of PaCO2 was associated with 5% reduction of NIV failure. However, it did not associate with NIV failure in patients with PaCO2 >32 mmHg.ConclusionsPaCO2 and NIV failure was nonlinear relationship. The inflection point was 32 mmHg. Below the inflection point, lower PaCO2 was associated with higher NIV failure. However, it did not associate with NIV failure above this point.

Sonographic assessment of the diaphragm in COVID 19 and non-COVID ICU patients

BackgroundSonographic evaluation of the diaphragm has gained popularity in the ICU due to the necessity of assessing diaphragmatic function in a variety of clinical situations. The sonographic examination of diaphragmatic dynamics in ICU patients by measuring diaphragmatic thickness and excursion in connection to various modalities of mechanical ventilation (MV) and patient outcomes was the objective of this study.MethodsThis prospective observational study was carried out on 50 patients in respiratory ICU in Kafr Elsheikh and Benha University Hospitals. Patients were classified into 2 equal groups: COVID-19 group and non-COVID group. All patients underwent ultrasound assessment included the diaphragm thickness fraction and excursion in ICU patients on admission and on weaning.ResultsSuccessful weaning (SW) was higher in group I compared to group II. In group I (COVID), diaphragm excursion, thickness at end inspiration and at end expiration in NIV at weaning were significantly higher in patients with SW but thickness at end expiration on admission was significantly lower. In group II (non-COVID) MV patients, excursion at weaning was significantly higher in patients with SW, also were thickness at end inspiration and end expiration on admission, thickness at end inspiration and end expiration at weaning in NIV patients but thickness at end inspiration in MV on admission was significantly lower.ConclusionWeaning success and mortality were significantly predicted by excursion in NIV at weaning, thickness at end inspiration in MV at weaning, thickness at end inspiration in NIV at weaning, and thickness at end expiration in MV at weaning.

Clonal transmission of blaIMP-4-carrying ST196 Klebsiella pneumoniae isolates mediated by IncN plasmid in China

ObjectivesTo investigate the clinical and molecular epidemiological characteristics of blaIMP-4-carrying Klebsiella pneumoniae in a tertiary hospital in China. Methods10 Carbapenem Resistant K. pneumoniae (CRKP) isolates with blaIMP-4 gene were collected. Molecular characteristics were analyzed using whole-genome sequencing. Plasmid conjugation experiment was used to analyze the conjugation of plasmids. We compared and analyzed K. pneumoniae carrying blaIMP-4 on NCBI with the strains in this study. ResultsAll 10 CRKP isolates with blaIMP-4 were collected from 10 adult patients in the respiratory intensive care unit. These strains were only sensitive to polymyxins and tigecycline due to simultaneously carrying multiple resistance genes, such as blaOKP-A-5, fosA, oqxA and oqxB. Notably, R29 harbored two carbapenemase genes (blaNDM-1 and blaIMP-4). These strains had similar drug-resistant phenotypes and drug-resistant genes, all belonging to ST196. Additionally, the patients had spatiotemporal intersection during hospitalization, suggesting that these strains had clonal transmission, but they belonged to different clonal clusters from the blaIMP-4-positive K. pneumoniae currently published on NCBI. Among the 10 strains, blaIMP-4 was located on the IncN plasmid, and 6 strains had successfully transferred the plasmid to the recipient strain EC600 through plasmid conjugation. ConclusionsThe blaIMP-4-positive ST196 CRKP had clonal distribution in the respiratory ICU, which was mediated by IncN plasmid. Consequently, there should be increased monitoring of carbapenem-resistant strains in clinical settings to prevent and control of its transmission.

High-flow nasal oxygen in resource-constrained, non-intensive, high-care wards for COVID-19 acute hypoxaemic respiratory failure: Comparing outcomes of the first v. third waves at a tertiary centre in South Africa

Background. High-flow nasal oxygen (HFNO) is an accepted treatment for severe COVID-19-related acute hypoxaemic respiratory failure (AHRF). Objectives. To determine whether treatment outcomes at Groote Schuur Hospital, Cape Town, South Africa, during the third COVID-19 wave would be affected by increased institutional experience and capacity for HNFO and more restrictive admission criteria for respiratory high-care wards and intensive care units. Methods. We included consecutive patients with COVID-19-related AHRF treated with HFNO during the first and third COVID-19 waves. The primary endpoint was comparison of HFNO failure (composite of the need for intubation or death while on HFNO) between waves. Results. A total of 744 patients were included: 343 in the first COVID-19 wave and 401 in the third. Patients treated with HFNO in the first wave were older (median (interquartile range) age 53 (46 - 61) years v. 47 (40 - 56) years; p<0.001), and had higher prevalences of diabetes (46.9% v. 36.9%; p=0.006), hypertension (51.0% v. 35.2%; p<0.001), obesity (33.5% v. 26.2%; p=0.029) and HIV infection (12.5% v. 5.5%; p<0.001). The partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio at HFNO initiation and the ratio of oxygen saturation/FiO2 to respiratory rate within 6 hours (ROX-6 score) after HFNO commencement were lower in the first wave compared with the third (median 57.9 (47.3 - 74.3) mmHg v. 64.3 (51.2 - 79.0) mmHg; p=0.005 and 3.19 (2.37 - 3.77) v. 3.43 (2.93 - 4.00); p<0.001, respectively). The likelihood of HFNO failure (57.1% v. 59.6%; p=0.498) and mortality (46.9% v. 52.1%; p=0.159) did not differ significantly between the first and third waves. Conclusion. Despite differences in patient characteristics, circulating viral variant and institutional experience with HFNO, treatment outcomes were very similar in the first and third COVID-19 waves. We conclude that once AHRF is established in COVID-19 pneumonia, the comorbidity profile and HFNO provider experience do not appear to affect outcome.

Análisis retrospectivo de las hipoglucemias inducidas por venlafaxina en pacientes con sobredosis

IntroductionRecent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose. Patients and methodsRetrospective study carried out in the Balearic Islands (2020–2023). Inclusion criteria: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX)>800 ng/mL. The characteristics of patients with and without hypoglycemia were compared. ResultsTwenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459–17,976] in patients with hypoglycemia and 1,413 [930–1,719] in patients without hypoglycemia (p<0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p<0.05). ConclusionsThe detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication.

Volume support ventilation versus pressure support ventilation as a weaning mode of mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract Background A dual controlled ventilatory mode called volume support ventilation (VSV) is anew mode, which is intended to speed up weaning and encourage spontaneous breathing. The purpose of the study was to compare the effectiveness of pressure support ventilation (PSV) and VSV in weaning patients with chronic obstructive pulmonary disease (COPD) who are mechanically ventilated. Patients and methods Fifty COPD patients admitted to the respiratory ICU were enrolled. Patients were assigned randomly to either PSV or VSV as a weaning mode. Patients were checked on at intervals of 30, 60 min, and 24 h. Results of weaning and hospital outcomes were recorded. Results Compared with PSV, VSV showed significant shorter weaning duration (12.76 ± 8.02 vs. 18.56 ± 5.97 h, P=0.04). Moreover, there was a higher successful extubation rate of 80% for VSV group compared with 76% for PSV, with the same complications and death rate between the two groups. Conclusion When compared to PSV mode, VSV mode was a safer, more dependable strategy that may be used responsibly for weaning trials in COPD patients. It also has the potential to shorten ICU stays and weaning times.

Evaluating the diagnostic and prognostic ability of ischemia modified albumin in COVID-19

BackgroundPatients with COVID-19 can rapidly deteriorate and develop acute hypoxic respiratory failure. Prominent features of the disease include severe inflammation, endotheliitis, and thrombosis. ObjectivesThe aim of the study was to evaluate the diagnostic and prognostic effectiveness of ischemia modified albumin (ΙΜΑ) in a cohort of COVID-19 patients. MethodsThis prospective observational study included adults with SARS-CoV-2 infection confirmed by reverse transcription polymerase chain reaction test, who were hospitalized specifically for COVID-19. The outcomes of interest were progression to severe acute respiratory failure during the index hospitalization defined as partial pressure of oxygen/fraction of inspired oxygen lower or equal to 150, admission to the intensive care unit (ICU) and in-hospital mortality. Admission IMA levels were determined using the commercially available “IMA Assay Kit” method (Abbexa LTD, Cambridge, UK). Adults without SARS-CoV-2 infection were used as controls. Results135 COVID-19 patients and 64 controls were included. Admission IMA levels were significantly higher in COVID-19 patients compared to controls [[24.38 (11.94) ng/ml vs. 14.69 (3.52) ng/ml, p < 0.01]. Receiver operating characteristic analysis of admission IMA showed an area under the curve (AUC) of 94% (p < 0.0001) for COVID-19 diagnosis (cut-off value: 17.5 ng/ml; sensitivity: 90.37%; specificity: 87.5%). Admission IMA was also associated with mortality (AUC: 68%, p = 0.01). However, it was not associated with severe acute respiratory failure (AUC: 47%, p = 0.53) or ICU admission (AUC: 58%, p = 0.41). ConclusionAdmission IMA was significantly increased in COVID-19 patients and was associated with in-hospital mortality.

Cyclic energy: the transcendental relevance of respiratory rate. A retrospective observational study with Bayesian analysis

Introduction The calculation of energy transfer in patients with acute respiratory distress syndrome (ARDS), has multiple interpretations and proposals. The parameters described as safe to minimize mechanical ventilator-associated lung injury (VALI) include only static values in their conception, and dynamic variables have been relegated to a secondary role. Subjects and Methods Analytical, observational, retrospective study of patients hospitalized in a respiratory intensive care unit, with a diagnosis of severe ARDS due to SARS-CoV-2 in whom mechanical ventilator management was guided by the use of esophageal catheter for the calculation of ventilatory variables. Thirty-four patients were included in this study, 23.5 % were women and the mean body mass index was 34.9 kg/m2. The primary objective was to quantify the amount of energy (Mechanical Power MP) transmitted by using multiple known equations and the secondary objective was to find the variables best associated with such energy transfer and with the severity of ARDS using Bayesian analysis. Results A mean of 22.2 days on invasive mechanical ventilation was recorded. Baseline MPGattinoni averaged 21.4 J/min, which did not change significantly at 30 minutes (7.5%) or 24 hours (- 0.4%) from baseline, despite esophageal catheter-guided management. The Bayesian analyses used to calculate the a posteriori inclusion probability showed that respiratory rate was the only variable consistently related to energy transfer, regardless of the equation used for its calculation and the chronological time at which these equations were measured [baseline MPGattinoni: (mean, 0.89; 95% Cred Interval: 0.75 to 1.02), at 30 minutes: (mean, 1.09; 95% Cred Interval: 0.68 to 1.49), at 24 hours: (mean, 0.65; 95% Cred Interval: 0.01 to 1.03)] or [baseline MPModesto: (mean, 0.1; 95% Cred Interval: 0.09 to 0.1), at 30 minutes: (mean, 0.1; 95% Cred Interval: 0.09 to 0.1), at 24 hours: (mean, 0.1; 95% Cred Interval: 0.09 to 0.1)]. Conclusions In severe ARDS, it is essential to minimize VALI. The calculation of energy transfer, regardless of the equation used, should always be a dynamic objective to be measured. Respiratory rate is probably the most relevant dynamic variable in the genesis of VALI. Keywords: mechanical power, elastic power, respiratory rate, ARDS, COVID-19

Association of vaccination status and severity of SARS-CoV-2 infections in hospitalized patients

Vaccination is considered the most promising approach for addressing the COVID-19 pandemic. However, even vaccinated people remain at risk. In this study, we examined the association between levels of vaccination and clinical outcomes in hospitalized patients. We conducted a retrospective review of adults hospitalized with COVID-19 infection. Of 484 patients, fully vaccinated (OR = 0.49, p = 0.001) and updated patients (OR = 0.46, p = 0.004) had significantly lower probability of critical severity compared to unvaccinated. Vaccination status is significantly related with 30-day mortality (p = 0.005) but not significantly associated with need for respiratory support or ICU stay. Mean length of stay (LOS) of 6.6 days among boosted patients is significantly lower than patients with no vaccination status (10.7 d, p < 0.001). Our study findings provide real-world evidence of the benefit of booster vaccinations against critical infection and death as well as shortcomings in ICU stay, length of stay or need for ventilatory support.

Characteristics, treatments, in-hospital and long-term outcomes among inpatients with acute exacerbation of chronic obstructive pulmonary disease in China: sex differences in a large cohort study

BackgroundData related to the characteristics, treatments and clinical outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in China are limited, and sex differences are still a neglected topic.MethodsThe patients hospitalized for AECOPD were prospectively enrolled from ten medical centers in China between September 2017 and July 2021. Patients from some centers received follow-up for 3 years. Data regarding the characteristics, treatments and in-hospital and long-term clinical outcomes from male and female AECOPD patients included in the cohort were analyzed and compared.ResultsIn total, 14,007 patients with AECOPD were included in the study, and 11,020 (78.7%) were males. Compared with males, female patients were older (74.02 ± 10.79 vs. 71.86 ± 10.23 years, P < 0.001), and had more comorbidities (2.22 ± 1.64 vs. 1.73 ± 1.56, P < 0.001), a higher frequency of altered mental status (5.0% vs. 2.9%, P < 0.001), lower diastolic blood pressure (78.04 ± 12.96 vs. 79.04 ± 12.47 mmHg, P < 0.001). In addition, there were also significant sex differences in a range of laboratory and radiographic findings. Females were more likely to receive antibiotics, high levels of respiratory support and ICU admission than males. The in-hospital and 3-year mortality were not significantly different between males and females (1.4% vs. 1.5%, P = 0.711; 35.3% vs. 31.4%, P = 0.058), while female smokers with AECOPD had higher in-hospital mortality than male smokers (3.3% vs. 1.2%, P = 0.002) and male smokers exhibited a trend toward higher 3-year mortality compared to female smokers (40.7% vs. 33.1%, P = 0.146).ConclusionsIn AECOPD inpatients, females and males had similar in-hospital and long-term survival despite some sex differences in clinical characteristics and treatments, but female smokers had significantly worse in-hospital outcomes than male smokers.Clinical Trial RegistrationRetrospectively registered, registration number is ChiCTR2100044625, date of registration 21/03/2021. URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.

Safety and Diagnostic Yield of Medical Pleuroscopy (MP) Performed under Balanced Analgosedation by a Pneumological Team Compared to Video-Assisted Thoracic Surgery (VATS): A Retrospective Controlled Real-Life Study (TORAPO).

Medical pleuroscopy (MP) is an invasive technique that provides access to the pleural space with a rigid or semi-rigid work instrument, allowing for visualization and the obtaining of bioptic pleural samples. Using pulmonologist-based analgosedation to perform pleuroscopy is still debated for safety reasons. The aim of this real-life study is to demonstrate the safety and diagnostic yield of MP performed under balanced analgosedation by a pulmonologist team with expertise in the management of critically ill patients in the respiratory intensive care unit (RICU) and interventional pulmonology unit as compared to video-assisted thoracic surgery (VATS) performed by a thoracic surgeon team under anesthesiologist-based analgosedation. In this multicentric retrospective controlled study, the inclusion criteria were patients older than 18 years old with pleural effusion of unknown diagnosis consecutively admitted in the years 2017-2022 to the pulmonology unit and RICU of San Donato Hospital in Arezzo (Italy, Tuscany) and to the thoracic surgery unit of Santa Maria Le Scotte in Siena (Italy, Tuscany) to undergo, respectively, MP under balanced propofol-based analgosedation on spontaneous breathing with local anesthesia provided by a pulmonologist team (Group A), and VATS provided by a surgeon team under propofol-based analgosedation managed by an anesthesiologist using invasive mechanical ventilation (IMV) via endotracheal intubation (ETI) (Group B). The primary endpoints were (1) a comparison between the two groups in terms of the diagnostic yield of pleural effusion, and (2) major and minor complications of pleuroscopic procedures. The secondary endpoints were (1) the length of the pleuroscopic procedure; (2) the duration of hospitalization; (3) propofol doses; and (4) the patient's comfort after the procedure assessed using the Visual Analogue Scale (VAS). We enrolled 91 patients in Group A and 116 patients in Group B. A conclusive diagnosis was obtained in 97.8% of Group A vs. 100% of Group B (p = 0.374). Malignant effusion was diagnosed in 59.3% of Group A and in 55.1% of Group B; p = 0.547. No intraoperative or postoperative mortality events or major complications were observed in Group A. The major complications observed in Group B were three major bleeding events (p = 0.079) and one exitus (p = 0.315) not related to the interventional procedure. No significant difference emerged between the two groups in terms of minor complications. The duration of the intervention was significantly lower in Group A (40.0 min ± 12.6 versus 51.5 ± 31.0; p = 0.001). Pain control and, therefore, patient comfort were better in Group A, with an average VAS of 0.34 ± 0.65 versus 2.58 ± 1.26, p < 0.001. The duration of hospitalization was lower in Group B (5.1 ± 2.6 vs. 15.5 ± 8.0, p < 0.001). The average overall dose of propofol administered was significantly lower in Group A (65.6 ± 35.8 mg versus 280 ± 20.0 mg; p < 0.001). This real-life study shows that the MP performed under propofol-based analgosedation by an independent pneumologist team is a safe and well-tolerated procedure with a diagnostic yield and complication rates similar to those obtained with VATS.

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study.

Background: Heart failure with reduced ejection fraction (HFrEF) poses significant health risks. Midodrine for maintaining blood pressure in HFrEF, requires further safety investigation. This study explores midodrine's safety in HFrEF through extensive matched analysis. Methods: Patients with HFrEF (LVEF <50%) without malignancy, non-dialysis dependence, or non-orthostatic hypotension, were enrolled between 28 August 2013, and 27 August 2023. Propensity score matching (PSM) created 1:1 matched groups. Outcomes included mortality, stage 4 and 5 chronic kidney disease (CKD), emergency room (ER) visits, intensive care unit (ICU) admissions, hospitalizations, and respiratory failure. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for each outcome, and Kaplan-Meier survival analysis was performed. Subgroup analyses were conducted based on gender, age (20-<65 vs. ≥65), medication refill frequency, and baseline LVEF. Results: After 1:1 PSM, 5813 cases were included in each group. The midodrine group had higher risks of respiratory failure (HR: 1.16, 95% CI: 1.08-1.25), ICU admissions (HR: 1.14, 95% CI: 1.06-1.23), hospitalizations (HR: 1.21, 95% CI: 1.12-1.31), and mortality (HR: 1.090, 95% CI: 1.01-1.17). Interestingly, midodrine use reduced ER visits (HR: 0.77, 95% CI: 0.71-0.83). Similar patterns of lower ER visit risk and higher risks for ICU admissions, respiratory failure, and overall hospitalizations were observed in most subgroups. Conclusion: In this large-scale study, midodrine use was associated with reduced ER visits but increased risks of respiratory failure, prolonged ICU stays, higher hospitalizations, and elevated mortality in HFrEF patients. Further research is needed to clarify midodrine's role in hemodynamic support and strengthen existing evidence.

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases.

The prompt initiation of empirical anti-infective therapy is crucial in patients presenting with unexplained pulmonary infection. Although imaging acquisition is relatively straightforward in clinical practice, its lack of specificity often necessitates additional time-consuming tests such as sputum culture, bronchoalveolar-lavage fluid culture, or genetic sequencing to identify the underlying etiology of the disease accurately. Moreover, the limited efficacy of empirical anti-infective treatment may contribute to antibiotic misuse. Recent advancements in interpreting microbial background on rapid on-site evaluation (ROSE) slides have enabled clinicians to promptly obtain samples through bronchoscopy (e.g., alveolar lavage, mucosal brushing, tissue clamp), facilitating bedside staining and interpretation that provides essential microbial background information. Consequently, this establishes a foundation for developing targeted anti-infection treatment and individualized drug therapy plans. With a better understanding of which pathogens are causing infections in real-time, physicians can avoid unnecessary broad-spectrum antibiotics contributing to antibiotic resistance. Establishing a rapid and standardized M-ROSE workflow within respiratory medicine departments or intensive care units will greatly assist physicians in formulating accurate treatment strategies for patients, which holds significant clinical implications.

Retrospective Observational Study to Assess Safety and Tolerability of Nebulized Colistin for the Treatment of Patients With Pneumonia in Real-World Settings in Respiratory ICU.

Colistin is used to treat hospital-acquired pneumonia and ventilator-associated pneumonia. However, direct drug deposition at the site of infection may improve its efficacy and reduce systemic exposure. The aim of this study was to assess the safety and tolerability of nebulized colistin among Indian patients diagnosed with pneumonia caused by multidrug-resistant gram-negative bacilli in real-world settings. We retrospectively reviewed the medical records of patients treated with nebulized colistin for pneumonia. We assessed the adverse events and relevant abnormal laboratory findings of nebulized colistin therapy. All enrolled patients (N=30, males: 22, females: 8; average age: 71.06 years) were treated for 13.36 days. Almost 80% of patients had a history of shortness of breath, which was a major symptom when they were admitted to the hospital. The patients were administered nebulized colistin for an average of six days (8 hours per day). The most common dosing schedule was 1 million international units (MIU)/8 hours. No serious adverse event was observed, and only one patient died while on the treatment but the death was not related to colistin treatment. The average sequential organ failure assessment score for all patients was 6.5. Our study demonstrated the efficient clinical utility and well-tolerated safety profile of nebulized colistin in the treatment of patients with pneumonia. Neurotoxicity and nephrotoxicity were not reported. Since a significant percentage of patients were with chronic respiratory diseases, our study further indicates the safety and effectiveness of nebulized colistin in chronic obstructive pulmonary disease (COPD) patients too.

Selection of the appropriate treatment for the combination of interstitial lung disease and lung cancer: A retrospective observational study.

Interstitial lung disease (ILD) independently heightens the risk of lung cancer (LC), often necessitating chemoradiotherapy (CRT) due to advanced disease stages. However, CRT may compromise survival through complications such as ILD exacerbation or radiation pneumonitis. The aim of this study was to determine the optimal surgical or nonsurgical treatment approaches for patients with concurrent ILD and LC. Over a 10-year period, a retrospective evaluation was conducted on 647 patients with confirmed diagnoses of LC and ILD from a total of 4541 patients examined in the polyclinic. This assessment included a comprehensive review of demographic, treatment, and survival records. Study groups included those treated for both ILD and LC with surgical treatment (ST), chemotherapy (CT), radiotherapy (RT), or CRT. A control group comprised ILD-only cases. In the whole sample of 647 patients with complete data, the length of stay in hospital and respiratory intensive care unit was significantly shorter in the ST group and longer in the CT group. Significant differences in discharge status (P < .001) were observed, with higher recovery rates in the ST and RT groups. The CT group showed an increased rate of transfer to other centers, in-hospital mortality was determined to be higher in the CRT group, and the control group exhibited no change in discharge. No statistically significant difference was determined between the groups with respect to the 24- and 48-month survival rates (P = .100). Although no disparity was found in 2- and 4-year survival rates, there were seen to be advantages in survival and quality of life with the addition of radiotherapy to regions aligning with surgical margins for LC patients with ILD, evaluated as radiological N0, undergoing wedge resection. This underscores the need for personalized treatment strategies to balance effective cancer control and to minimize ILD-related complications.

Analysis of 332 fiberoptic bronchoscopies performed in a respiratory intensive care unit: a retrospective study.

Fiberoptic bronchoscopy (FOB) is widely used in the intensive care unit for diagnostic and therapeutic purposes. Our study aimed to evaluate FOB's indications, complications, and clinical outcomes in our intensive care unit's mechanically ventilated patients and identify the microorganisms grown in bronchoalveolar lavage (BAL) specimens. Between January 1, 2022, and June 30, 2023, a total of 332 FOBs were performed on 178 patients in the respiratory intensive care unit. Patients' mean age was 64±19.4 years. Females accounted for 65 (36.6%) and males accounted for 113 (63.4%) of the cases. Leading diagnoses included pneumonia (59.5%), acute respiratory distress syndrome (ARDS) (20.7%), sepsis (17.9%), chronic obstructive pulmonary disease (COPD) attack (21.9%), pulmonary embolism (10.1%), lung malignancy (43.8%), hemoptysis (8.9%), heart failure (15.1%), neurological/neuromuscular conditions (8.4%), and post cardiopulmonaryresuscitation (CPR) (2.8%). FOB purposes were BAL retrieval (43.6%), secretion clearance (30.4%), guided tracheostomy (11.7%), atelectasis (8.7%), and hemoptysis (5.4%). Hypoxemia marked the primary FOB complication (3.6%). Other issues encompassed hypotension (1.5%), bradycardia (1.2%), bleeding (1.2%), tachycardia (0.9%), and hypertension (0.6%). No statistical significance was found in arterial blood gas pH, arterial partial pressure of oxygen (PaO2), and arterial partial pressure of carbon dioxide (PaCO2) values before and after the FOB procedure (p>0.05). Predominant pathogens in aspiration samples were non-albicans Candida (28.9%), Klebsiella pneumoniae (24.8%), Pseudomonas aeruginosa (14.4%), and Acinetobacter baumannii (11.7%). FOB is an important diagnostic and therapeutic method with a low complication rate when performed by an experienced team with appropriate indication in the intensive care unit.

Role of point of care ultrasound in management of deteriorating respiratory intensive care unit patients and its impact on outcome

BackgroundPoint of care ultrasonography (POCUS) is a real time examination that can be used in the emergency room and intensive care unit (ICU). It can provide low-cost modality in short period of time that can help the clinician in better management the ICU patients. The aim of the current work was to evaluate the impact of POCUS (focused heart, lung, IVC and Doppler lower limb) in improving the outcome of deteriorating patients in the respiratory intensive care unit (RICU), via narrowing differential diagnosis and earlier start of target therapy.MethodsThis prospective study included 126 deteriorated patients in the RICU. The POCUS was performed to all included patients, together with the indicated laboratory and radiological investigations (Chest x-ray, computerized tomography, and conventional echocardiography) to detect the agreement between POCUS and the gold standard techniques to assess the POCUS effectiveness. The impact of applying POCUS on the outcome of the studied patients was evaluated regarding ICU and in hospital length of stay and the 30-day mortality.ResultsThe included patients were 51 males (40.5%) and 75 females (59.5%) with a mean ±SD of age 45.4 ± 15.7 years. POCUS showed a good agreement with the gold standard techniques. There was significant improvement in outcome of the studied patients as regard ICU and in hospital stay with early using of POCUS examination but no significant difference in 30 days mortality rate of the studied patients.ConclusionPOCUS is an effective modality in the management of deteriorating patients in the RICU with a good impact on the patient outcome.

Comparative study of percutaneous tracheostomy versus standard surgical tracheostomy

Abstract Background The tracheostomy is an oldest invasive procedure done for critically ill patients. Now, it is usually performed for better weaning and less risk of intubation-related complications either surgically intraoperative or percutaneous procedure which is easily performed at the bedside by an intensivist. The aim of this study is to compare between surgical and percutaneous tracheostomy (PT) in critically ill patients with prolonged ventilation who needed tracheostomy. Methods This randomized controlled study was done at the respiratory ICU - Chest Department, Operating Room of the Otorhinolaryngology Department at Tanta University Hospitals, and respiratory ICU Air Forces Hospital. 30 critically ill patients with prolonged mechanical ventilation were divided into two groups. Group I (15 patients) underwent surgical tracheostomy (ST) and group II (15 patients) underwent fiberoptic bronchoscopic-guided PT, from August 2020 to December 2021. Results 30 patients were enrolled in this study. Neck circumference (cm) was significantly higher in surgical group (P = 0.013). Also, the most important is that the duration of procedure is shorter in percutaneous group (P &lt; 0.001). Regarding delayed complications were insignificantly different between both groups except for stomal infection which was higher in surgical group (P = 0.042). Regarding secondary outcomes of the procedure, successful decannulation, permanent tracheostomy, and death due to primary disease were insignificantly different between the studied groups. Conclusion Percutaneous tracheostomy is safer, faster, time saving and less complicated than surgical tracheostomy.

Microbiological and Clinical Characteristics of Lower Respiratory Tract Infections in Patients from the Pediatric Ward, Adult Respiratory Ward, and Medicine Intensive Care Unit at a University Hospital in Northern India

Abstract Background: Respiratory infections are common infections reported among human beings. Infections involving the respiratory tract can be mild and transient and people tend to neglect them. The chief cause of lower respiratory tract infections (LRTIs) can be attributed to hospitalization. Materials and Methods: We conducted a retrospective, cross-sectional study from January 2021 to April 2021. The clinical, demographic, and microbiological characteristics of the patients admitted to adult respiratory ward (ARW), pediatric ward (PW), and medicine intensive care unit (MICU) were extracted from the electronic records and laboratory registers for this study. Results: We included 788 patients in this study from January 2021 to April 2021. The mean age of patients was 52.67 ± 20.15 years with a male predominance in ARW (248/383, 64.75%) and MICU (252/369, 68.29%) and a female predominance in PW (28/36, 77.78%). Most patients were admitted to the ARW (383/788, 48.60%) followed by the MICU (369/788, 46.83%). Bacterial growth was seen in 358 (358/788, 38.89%) respiratory samples. Blood culture was positive in 188 (188/788, 23.86%) samples. The most common microorganism causing LRTI and bloodstream infection was Klebsiella pneumoniae with an infection rate of 32.68% (117/358, 32.68%) and 25.53% (48/188, 25.53%), respectively. Total leukocyte count (P &lt; 0.0001) and procalcitonin (P = 0.0113) were statistically significant diagnostic parameters associated with MDR isolates. Conclusion: This study establishes the range of bacteria obtained from the respiratory samples of LRTI patients and guides the clinicians in the administration of appropriate antibiotics according to the antibiotic susceptibility pattern to eliminate MDR.

Solunumsal Yoğun Bakım Ünitesinde İzole Edilen Mikroorganizmalar ve Antibiyotik Direnç Durumlarının Yıllara Göre Değişimi ve Mortaliteye Etkisi

BACKGROUND: Intensive care units (ICU) are multidisciplinary departments where patients with life-threatening diseases, major surgical interventions, respiratory failure, coma condition, hemodynamic insufficiency, and ≥1 organ failure are admitted for relevant diagnoses and treatment. AIM: The present study sought to investigate pathogens causing infections in patients admitted to our respiratory ICU and their antibiotic resistance patterns. MATERİALS and METHOD: The antibiogram results and clinical data of all patient samples submitted between January 1, 2008, and December 31, 2010, were retrospectively reviewed. RESULT: In total, 248 patients with 561 culture results were included in the study. Microbial growth was detected in the following samples: blood, 336 (59.9%); deep tracheal aspirate, 104 (18.6%); urine, 89 (15.9%); wound drain, 12 (2.1%); central venous catheter liquid, 7 (1.3%); phlegm, 10 (1.8%); Foley tip liquid, 1 (0.2%); and pleural effusion, and 1 (0.2%). Rapid growth was most frequently noted in the cultures of coagulase-negative staphylococci (25.3%), Acinetobacter spp. (23.1%), and Escherichia coli (12.6%). STATISTICAL ANALYSIS Descriptive statistics for continuous variables were expressed as means and standard deviations. The intermittent variables were converted into cross-tables and analyzed using Fisher’s exact and Pearson’s chi-square tests. The normal distribution of the study data was assessed using Kolmogorov–Smirnov test. The mean values of the variables were analyzed using Student’s t-test. Bidirectional hypotheses were used, and a p-value of &amp;lt;0.05 was considered statistically significant. The IBM Statistical Package for the Social Sciences Ver. 18.0 for Windows (SPSS Inc., Chicago, IL, USA) software was used for statistical analyses. IN CONCLUSION, the present study revealed microorganisms’ resistance profiles similar to those of other relevant studies. The study provides important insights into the selection of empiric antibiotic therapy for patients admitted in intensive care unit. Keywords: respiratory intensive care unit, intensive care infections, antibiotic resistance, antibiotic susceptibility