Respiratory Outcome In Patients Research Articles

Does Baseline Pao2/Fio2 Affect the In-Hospital Outcome in Patients Undergoing Coronary Artery Bypass Grafting?

Background: Oxygen saturation and the PaO2 are the direct risk factors for post -operative respiratory outcome in patients undergoing prolonged surgery under general anaesthesia. However the effect of preoperative PaO2 and PaO2 /FiO2 ratio on the postoperative course of the patient undergoing coronary artery bypass grafting is not known. Hypothesis: Pre-operative PaO2 and PaO2 /FiO2 ratio have a significant effect on the postoperative outcome among the patients undergoing coronary artery bypass grafting. Study design: Prospective clinical study Setting: Tertiary health care centre Materials and Methods: One hundred and fifty eight consecutive patients with a EURO Score of <6 undergoing routine first time coronary artery bypass grafting were selected for this study. Patients with ventricular dysfunction, Chronic Obstructive Pulmonary Disease (COPD), renal or hepatic dysfunction, patients on mechanical ventilation, on preoperative Intra Aortic Ballon Pump (IABP) and those who had to undergo emergency surgery were excluded from the study. All patients were managed by the same anaesthesia and surgical team and the anaesthesia management protocol was similar for all the patients. The pre-operative PaO2 /FiO2 ratio (base line) for all patients was noted before anaesthesia induction in room air. The primary outcome measures were duration of mechanical ventilation, ICU stay and hospital stay. The secondary outcome measures were requirement of inotropes, arrhythmias, requirement of IABP, cardiogenic shock, perioperative myocardial infarction, sepsis, respiratory failure , any other organ dysfunction and death .The total duration of follow up period was one month. Statistical analysis: Seventeen subjects were subsequently dropped because of incomplete data. Consequently, the data for 141 subjects were used for the analysis. The various methods used were Student T test, Spearman’s coefficient correlation, bi-variate and univariate logistic regression analysis. In each case a p value of <0.05 was considered to be significant. Results: There exists a positive correlation between preoperative PaO2 /FiO2 ratio and duration of intubation (r = -0.5607, p = 0.001) as well as Intensive Care Unit (ICU) stay (r = -0.2564, p = 0.002). PaO2 /FiO2 ratio also has a positive correlation with the use of inotropes (p=0.03) and frequency of death (p=0.014) in the patients undergoing CABG . Conclusion: Low pre-operative PaO2 /FiO2 ratio has a direct impact on the in-hospital outcome among the patients undergoing coronary arterybypass grafting. Submit Your Manu Script at: https://symbiosisonlinepublishing.com/submitManuscript.php

Enzyme Replacement Therapy Improves Respiratory Outcomes in Patients with Late-Onset Type II Glycogenosis and High Ventilator Dependency

Type II glycogenosis (GSDII) is a rare and often fatal neuromuscular disorder caused by acid alpha-glucosidase deficiency. Although alglucosidase alfa enzyme replacement therapy (ERT) significantly improves outcomes in subjects with the infantile form, its efficacy in patients with the late-onset one is not entirely clear. The long-term efficacy of ERT in late-onset GSGII complicated by severe pulmonary impairment causing high mechanical ventilation dependency was investigated in this study. The long-term clinical efficacy of ERT was assessed in eight late-onset GSDII patients using home mechanical ventilation (HMV) by comparing their outcomes with those of six historical control patients (GSDII patients) who had received HMV alone. The number of hospitalizations due to pulmonary exacerbations and of hours of daily use of HMV were considered the study's primary efficacy endpoints. The treatment group showed an increased tendency toward shorter follow-up compared to the control group (35.8±29.2 vs. 52.6±8.55months; p=0.04). At the end of the study period, the daily use of HMV (12.5±7.6 vs. 19±14.3h; p=0.004) and the hospitalization rate [incidence rate ratio=0.43 (95% confidence interval 0.18-0.93); p=0.03] were significantly lower in the patients receiving ERT. The differences in the forced vital capacity absolute value and percentage change from baseline were not significantly different in the two groups. ERT reduces ventilator dependency in late-onset GSDII patients and the need for hospitalization due to respiratory exacerbations.

Effect of low volume ventilation during cardiopulmonary bypass on oxygenation and postoperative pulmonary outcome

This study was carried out to evaluate effect of low volume normal frequency ventilation during Cardiopulmonary Bypass (CPB) on immediate postoperative respiratory outcome in patients undergoing elective open heart surgeries. Lung deflation during CPB is considered as major cause of postoperative pulmonary dysfunction. Various methods of ventilation had been tried during CPB to prevent postoperative lung dysfunction. As yet, little information is available comparing low volume normal frequency ventilation with no ventilation during CPB. Thirty six patients aged 18 years to 65 years were included and randomized into two groups; Group V (n = 18) or Group NV (n = 18). Group V patients were ventilated with a tidal volume of 2 mL kg−1with 100 % oxygen during CPB after aortic clamp placement, and respiratory rate was continued as per pre CPB period. Ventilation was discontinued in NV group after aorta was cross clamped. Normal ventilation was restored in both groups after release of aortic clamp. Intraoperative PaO2 and PaCO2 were similar in both groups. The group V patients had improved inspiratory capacity (p = 0.0) in both day 1 (after extubation) and day 2 (24 h after extubation). Extubation was significantly earlier in group V patients (p < 0.05). Low volume normal frequency ventilation during cardiopulmonary bypass improves lung mechanics during early postoperative period in patients undergoing open heart surgery.

Outcome of systemic sclerosis associated interstitial lung disease treated with intravenous cyclophosphamide

Our objective was to audit the respiratory outcome, toxicity and long-term survival of systemic sclerosis associated interstitial lung disease (SSc-ILD) treated with intravenous (i.v.) cyclophosphamide. We ascertained whether i.v. cyclophosphamide associates with a better outcome in SSc-ILD diagnosed due to a decline in screening lung function than in those diagnosed due to respiratory symptoms. A retrospective case-note audit was carried out for SSc-ILD patients treated with i.v. cyclophosphamide between January 1999 and March 2009 at the Royal Derby, Kings Mill and Nottingham University Hospitals. Forced vital capacity (FVC) and transfer factor at 6, 12months after starting i.v. cyclophosphamide were the primary end points. Kaplan-Meier curves were plotted to estimate survival. Thirty-seven i.v. cyclophosphamide treatment cycles were administered to 36 patients (27 women). Fourteen cycles associated with side effects and eight were terminated prematurely. SSc-ILD was diagnosed due to respiratory symptoms in 13 and in response to deteriorating screening pulmonary function test (PFT) in 24 instances. Overall, i.v. cyclophosphamide led to stabilisation in lung function. However, the FVC declined by 7% in SSc-ILD presenting with respiratory symptoms over 12months. These patients had significantly lower FVC at 6 and 12month than those with SSc-ILD diagnosed due to decline in screening lung function. The 5-year survival was 76.1% (overall), 62.9% (diagnosed due to respiratory symptoms) and 91.5% (diagnosed due to decline in screening lung function, p = 0.05). I.V. cyclophosphamide stabilises lung function in individuals with SSc-ILD and may associate with better respiratory outcome in patients diagnosed on screening PFTs.

Cigarette smoking in patients with systemic sclerosis

To determine the effects of cigarette smoking on vascular, gastrointestinal, and respiratory outcomes in patients with systemic sclerosis (SSc). Subjects were patients enrolled in the Canadian Scleroderma Research Group cohort. Smoking history was obtained by patient self-report. The effect of smoking was assessed using multiple regression analysis of each SSc clinical outcome of interest (vascular, gastrointestinal, and respiratory). Smoking was modeled both as categorical variables (current, past, and never) and using the Comprehensive Smoking Index (CSI), which integrates smoking intensity, duration of smoking, and time since cessation into a single covariate of smoking effect. All regression models were adjusted for age, sex, disease duration, and limited or diffuse skin involvement. This study included 606 patients with SSc, of whom 87% were women and 90% were white, and the mean age was 55 years, mean disease duration was 11 years, and 36% had diffuse disease. Of these patients, 16% were current smokers, 42% were past smokers, and 42% were never smokers. The regression analyses showed that smoking had a significant negative effect on almost all vascular, gastrointestinal, and respiratory outcomes. The effects of smoking were in some cases long-lasting (e.g., persistent respiratory abnormalities), and smoking cessation appeared beneficial with respect to some outcomes (e.g., reduced severity of Raynaud's phenomenon). Physicians caring for patients with SSc should prioritize smoking cessation as a recommendation to patients, and resources directed to supporting smoking cessation in patients with SSc should be more readily available.

The role of parity on neonatal respiratory outcome in patients with preterm premature rupture of membranes

Preterm premature rupture of membranes (PPROM), defined as the spontaneous rupture of the membranes before 37 weeks of gestation and prior to the onset of labor, is the leading identifiable cause of preterm delivery, occurring approximately in one third of all preterm births [1]. Although a single factor can seldom be assigned to PPROM, it is most strongly associated with the presence of intrauterine inflammation and/or infection [2]. In nearly half of PPROM cases, or cases of preterm labor with intact membranes, fetal inflammatory response syndrome is present—with increased production of lung surfactant and alterations to lung structure [3].

Évolution respiratoire de patients atteints de mucoviscidose traités par mucofluidifiants puis par dornase alfa

Modifications of bronchial secretions in cystic fibrosis patients account for the long-lasting use of mucolytic agents, despite the lack of adequately controlled clinical studies supporting this approach. Hyperviscosity of bronchial secretions mainly depend on their high DNA content, as a result of degradation of polymorphonuclear neutrophils mobilized by infection and inflammation. This phenomenon has led to the treatment of respiratory complications with human recombinant deoxyribonuclease (dornase alfa). In the present study, we compared the clinical and respiratory outcome in patients receiving mucolytic agents followed by dornase alfa, each for 1 year. Fifty-four patients, aged 5 years or more, have been prospectively followed for 2 years. They received first a 12-month association of mesna (two nebulisations per day) and oral ambroxol (60 mg per day, divided in two doses), followed by a 12-month treatment with one daily aerosol of dornase alfa only (2.5 mg per day). The primary end-points were the results of pulmonary function tests. Secondary end-points were subjective symptoms, bacterial colonization, consumption of antibiotics, and clinical tolerance. At the end of the 12-month mucolytic therapy, a significant decrease of forced expiratory volume/second (FEV1, -10.5% as compared to baseline values) and forced vital capacity (FVC, -12.8%) was observed. At the end of 12-month dornase alfa, FEV1 and FVC had increased by 7.7 and 5.3%, respectively. This change was statistically significant only for FEV1 in most severely disabled patients. However, forced expiratory flow 25-75% (FEF 25-75) decreased during the 2 year period of observation, by 5.6% the first year and 4.9% the second year. The mean number of days with parenteral antibiotics did not statistically differ between both treatments, except for patients more than 15 years of age. In this subgroup, the mean number decreased from 40 days in the first year to 27 in the second year (P < 0.05). Acceptability of treatment by the patients themselves was better with dornase alfa than with mucolytic therapy. However, several episodes of hemoptysis, frequent in only one case, were associated with the treatment by dornase alfa. Dornase alfa was associated with a stabilisation, and even a trend to improvement in pulmonary function tests. This stabilisation is by itself a very encouraging result. Long-term comparative studies are needed to evaluate the benefits of dornase alfa in the treatment of respiratory complications of cystic fibrosis and specify the optimal modalities of its use. Synergistic combinations with mucolytic therapy and/or anti-inflammatory drugs could be viewed as a future prospect.