Signs Of Respiratory Distress Research Articles

Self-Assembled Bubble Continuous Positive Airway Pressure (CPAP) Device as Primary Respiratory Support for Neonatal Respiratory Distress in Low-Resource Settings

Background: Self-assembled, bubble continuous positive airway pressure is a low-cost noninvasive respiratory support modality used to manage newborns with respiratory distress. Very few local studies have been conducted regarding its use in the management of neonatal respiratory distress. This study was conducted to evaluate the effectiveness of this device as a primary treatment modality for neonatal respiratory distress. Methods: This cross-sectional study was conducted in the Department of Pediatrics, Ziauddin Hospital, Karachi from 1st February 2018-31st July 2018 on neonates (n=200) admitted with respiratory distress, in whom self-assembled bubble continuous positive airway pressure was used as a primary respiratory support. The effectiveness of its use was determined, based on the absence of associated complications, signs of respiratory distress, and oxygen saturation at room air of 94% or more. Data were analyzed by SPSS version 20. The Chi-square test was used for categorical variables and a p-value <0.05 was considered statistically significant. Results: The mean gestational age was 34.3+2.73 weeks, the mean age at initiation of bubble continuous positive airway pressure was 7.7 4 hours, and the mean duration of hospital stay was 4.2 days. The observed failure rate in the study population was 8.5%, while the mortality was only 2%. The finding of respiratory distress syndrome on chest- X-ray with (FiO2) > 60% was observed. In addition, bubble CPAP after 6 hours of the onset of respiratory distress showed significant results (p<0.001). Conclusion: Self-assembled bubble continuous positive airway pressure is a significant and effective treatment modality (p=0.001) in neonatal respiratory distress. Keywords: Bubble Continuous Positive Airway Pressure; Neonates; Respiratory Distress.

Trisomy 18 and necrotizing enterocolitis

Both Trisomy 18 (T18) and Necrotizing enterocolitis totalis (NEC-T) are major causes of morbidity and mortality in neonates. However, to our knowledge there has never been a case of a full-term infant born with both T18 and NEC-T published in the literature. We present a case of NEC totalis in male neonate born at 39 weeks gestation with Trisomy 18. He was diagnosed with T18 in-utero, and after genetic counseling, the mother carried the pregnancy to term. After delivery, the newborn developed signs of respiratory distress, requiring use of continuous positive airway pressure support. On day of life (DOL) 8, multiple bloody bowel movements raised suspicion for NEC and after supplemental investigations prompted a series of exploratory laparotomies that revealed extensive necrotizing enterocolitis involving the entire gastrointestinal tract. On DOL 12, the family opted for palliative care and the patient subsequently expired. To our knowledge, after searching through the English literature, no cases were found showing a neonate with a combination of T18 and NEC-T.

SIGNS AND ETIOLOGIES OF RESPIRATORY DISTRESS AMONG MECHANICALLY VENTILATED PATIENTS ATTENDING CHITWAN MEDICAL COLLEGE, BHARATPUR

Background: Respiratory distress (RD) in mechanically ventilated patients may signify life-threatening complications which may be potentially reversible. The aim of the study was to determine the signs and etiologies of respiratory distress in patients under mechanical ventilation. Methods: A hospital-based cross-sectional study was done on adult patients on mechanical ventilation (MV) with Respiratory distress admitted at Chitwan Medical College, Nepal from January 2021 to June 2021.We studied various signs and etiologies of RD in different days on MV. Descriptive analysis was carried out using IBM SPSS version 20. Results: Total 66 patients were included in the study with mean ± SD of age was 55.3 ± 15.8 years with equal proportion of male and female. Out of total 154 occurrences of 11 signs in 66 patients, agitation was the most common one occurring 29.3% of times followed by use of accessory muscle in 15.9%. Most common cause of respiratory distress was interstitial syndrome of increased extra-vascular lung water or density on ultrasound was present more in patients on MV for ≥ 5 days. Most patients (74.2%) had multiple RD signs and 25.8% had only a single sign. Gasping was more common in patients on MV ≥ 5 days and agitation and delirium more in early days of MV. Conclusions: More than half of the conditions associated with RD on MV are relatively reversible and as the patients can develop RD any time or any day after being put on MV, a continued vigilance system is essential for their timely assessment and management.

Accidental swallowing of dentures: case report and literature review

<p class="abstract">Unintentional ingestion of dentures is relatively common. Several factors have been implicated in increasing the risk of accidental denture swallowing including neurological impairments, dementia, cerebral hemorrhage, intoxication, and learning difficulties. This paper will aim to discuss a case and review the literature on accidental ingestion of dentures. The paper involved reviewing a case of accidental denture ingestion by a 34-year-old male patient. The patient ingested his dentures while eating ice cream. He displayed no signs of respiratory distress and reported difficulty ingesting solids, nausea, and a feeling of something lodged in his throat. X-rays revealed an increase in the anteroposterior diameter prevertebral space. The dentures were removed by direct laryngoscopy with the aid of optical foreign body removal forceps.<strong> </strong>The case and the literature review revealed that denture ingestion can occur when engaging in high-risk activities such as falls, eating, anesthesia, drinking, and sleeping. The site of denture impaction determines the signs and symptoms that the patient will present. Complications associated with denture impaction may include necrosis, bleeding, perforation, and obstruction. Assessing the patient involves considering psycho-neurological deficits, the possibility of mental health problems, oral assessment, the nature and dimensions of the ingested denture, and the presence of complications. Treatment typically involves wait-and-watch, endoscopy, or surgery. Accidental ingestion of dentures can constitute a medical or airway emergency that should be managed promptly. The management of such patients should involve considerations of the site of ingestion and the possibility of complications.</p>

Malat1 deficiency prevents hypoxia-induced lung dysfunction by protecting the access to alveoli.

Hypoxia is common in lung diseases and a potent stimulator of the long non-coding RNA Metastasis-Associated Lung Adenocarcinoma Transcript 1 (MALAT1). Herein, we investigated the impact of Malat1 on hypoxia-induced lung dysfunction in mice. Malat1-deficient mice and their wild-type littermates were tested after 8 days of normoxia or hypoxia (10% oxygen). Hypoxia decreased elastance of the lung by increasing lung volume and caused in vivo hyperresponsiveness to methacholine without altering the contraction of airway smooth muscle. Malat1 deficiency also modestly decreased lung elastance but only when tested at low lung volumes and without altering lung volume and airway smooth muscle contraction. The in vivo responsiveness to methacholine was also attenuated by Malat1 deficiency, at least when elastance, a readout sensitive to small airway closure, was used to assess the response. More impressively, in vivo hyperresponsiveness to methacholine caused by hypoxia was virtually absent in Malat1-deficient mice, especially when hysteresivity, a readout sensitive to small airway narrowing heterogeneity, was used to assess the response. Malat1 deficiency also increased the coefficient of oxygen extraction and decreased ventilation in conscious mice, suggesting improvements in gas exchange and in clinical signs of respiratory distress during natural breathing. Combined with a lower elastance at low lung volumes at baseline, as well as a decreased propensity for small airway closure and narrowing heterogeneity during a methacholine challenge, these findings represent compelling evidence suggesting that the lack of Malat1 protects the access to alveoli for air entering the lung.

A Study of NT-ProBNP and ETCO2 in Patients Presenting with Acute Dyspnoea

Objectives: In patients presenting with acute dyspnoea in the emergency department (ED), the early and correct diagnosis may present a significant clinical challenge. The most common diagnoses of acute shortness of breath and manifesting signs of respiratory distress are decompensated heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), pulmonary embolism (PE), asthma, and acute respiratory distress syndrome (ARDS) and other causes like anaemia. The aim of the study was to measure NT-pro brain natriuretic peptide (BNP) and exhaled end-tidal carbon dioxide (ETCO2) in patients presenting with dyspnoea. Material and Methods: This prospective, cross-sectional and observational study was performed at the Government Medical College and Hospital, Nagpur, between October 2019 and October 2021 in patients admitted to the medicine intensive care unit. Three groups of patients were compared: (1) HF-related acute dyspnoea group (n = 52), (2) pulmonary (COPD/PE)-related acute dyspnoea group (n = 31) and (3) sepsis with ARDS-related dyspnoea group (n = 13). All patients underwent initial clinical examination with a recording of initial vital parameters along with on-admission ETCO2 measurement, NT-proBNP testing, arterial blood gas testing, lung ultrasound examination, 2D echocardiography, chest X-rays, and other basic diagnostic laboratory testing. Results: We included 96 patients during the study period. Median NT-proBNP was found to be maximum for the HF group (11,480 pg/ml) followed by the sepsis group (780 pg/ml) and pulmonary group (231 pg/ml). The mean ETCO2 value was found to be maximum in the pulmonary group (48.610 mmHg) followed by HF (31.51 mmHg) and the sepsis group (19.46 mmHg). All results were found to be statistically significant (P < 0.05). Conclusion: NT-proBNP has high diagnostic accuracy in differentiating acute HF-related dyspnoea from pulmonary (COPD and ARDS)-related acute dyspnoea. The higher levels of ETCO2 help in diagnosing patients with COPD.

Automatic Tube Compensation During Spontaneous Breathing Trials.

Automatic tube compensation (ATC) is an option available in any ICU ventilator that compensates for the resistive pressure drop due to the endotracheal tube. The goal of the present study was to compare ATC to other patient triggered modes of support in terms of spontaneous breathing trial (SBT) and extubation success. Two authors (JB and PCF), independently and blinded to each other, searched through PubMed, Web of Science, and Cochrane from inception-May 26, 2021, with the following search terms entered as MeSH terms in all fields: "Automatic Tube Compensation." randomized studies that included subjects > 16 y old undergoing an SBT. crossover studies, pediatric studies, animal studies, or experimental studies on test lungs or on computer simulation; other languages than French, Spanish, or English; studies not published in a full-text format (eg, abstract or letter); and reviews. A frequentist network meta-analysis was conducted with the aim to investigate the effectiveness of ATC on SBT and extubation outcomes. SBT was defined as successful if patients could tolerate the SBT based on predetermined criteria, whether it was followed by extubation. Successful extubation was defined as the absence of re-intubation, noninvasive ventilation, or signs of respiratory distress within the 48 h after extubation. The pooled analyses used random-effect models, and the effect size was expressed as relative risk or mean difference for categorical and continuous variables, respectively. P-scores were used to rank all treatments and to identify the intervention with the highest probability of being the best. Of the 234 retrieved papers, 7 met the inclusion criteria. In terms of SBT success, ATC100+PEEP < 7.5 and PS10+PEEP < 7.5 were superior to T-piece. Likewise, PS10+PEEP < 7.5 was the intervention with the highest probability of being the best (P-score: 0.90). In terms of extubation success, ATC100+PEEP < 7.5 cm H2O was significantly better than PEEP < 7.5 and T-piece. Likewise, it had the highest probability of being the best (P-score= 0.90). ATC is the modality with the highest probability of extubation success but not in terms of SBT success.

Evaluation of a Treadmill-Based Submaximal Fitness Test in Pugs, and Collecting Breed-Specific Information on Brachycephalic Obstructive Airway Syndrome.

Simple SummaryIn the present study, a submaximal fitness test on a treadmill was evaluated to assess its feasibility under standardised conditions. Moreover, its effectiveness in identifying pugs with clinical signs of brachycephalic obstructive airway syndrome was examined. It was apparent that respiratory symptoms can be exposed during the fitness test, and intensified with an increased duration of exercise. This method of testing improves the clinical evaluation of the dogs and helps identify restrictions due to brachycephalic obstructive airway syndrome. Since most of the dogs could be familiarised with the treadmill, it may be a feasible option for performing fitness tests in brachycephalic dogs. Major benefits, therefore, are that each dog can be closely monitored during the entire process, and that the examination can be conducted under standardised conditions.Despite efforts of veterinarians and breeders, brachycephalic obstructive airway syndrome (BOAS) is still a common problem in pugs, underlining the need for objective tests to identify and prevent breeding with affected dogs. In the current study, a submaximal, treadmill-based fitness test was evaluated as a tool to identify signs of airway obstruction not recognisable under rest conditions. In addition to this, different body conformation and measurements were assessed regarding their association with BOAS. A total of 62 pugs and 10 mesocephalic dogs trotted with an individual comfort speed on a treadmill for 15 min. Before and during the examination, dogs were examined for signs of respiratory distress, and a functional BOAS grading was applied. The influence of body conformation on BOAS grading was tested in a univariable and multivariable logistic regression model. During exercise, more respiratory noises were observed, and existing respiratory noises became more apparent in comparison to when at rest. In the multivariable logistic regression model, no factor had a statistically significant influence on BOAS classification. Submaximal fitness testing helped to identify signs of respiratory distress not apparent under resting conditions, and could be a valuable addition for identifying dogs with BOAS. Performing testing on a treadmill facilitates continuous observation of the patients, and enables standardisation of the test regarding the test environment, as well as provides an uninterrupted, steady workload.

Eradication of Livoneca redmanii infestation in cultured Argyrosomus regius

Two Argyrosomus regius nursery ponds suffered from high mortality during the summer season of 2020. Diseased fish showed signs of respiratory distress, mainly during hot days. Physiochemical pond water parameters were normal, except dissolved oxygen was lower than the optimum level. Livoneca redmanii (Cymotidae, Isopoda) was isolated from the gill chamber of infested fish. The infestation percent was 41 and 33%, and the intensity was 1.146 and 1.06 in the first and second ponds, respectively. The diseased fingerlings were infested in the natural habitat (Mediterranean Sea) before collection for culture. L. redmanii infestation was associated with high economic losses due to direct fish mortality, reduced growth rates and lower condition factor. The molecular study confirmed the presence of L. redmanii based on the phylogenetic analysis of 16S rRNA and COI gene sequences. Infested fish gills showed massive destruction in gill filaments, sloughing and curling of secondary gill lamellae with the detachment of the cartilaginous core supporting the primary gill filaments. Deltamethrin and trichlorfon effectively eradicated L. redmanii at concentrations of 12.5 μg.l−1 and 0.5 mg.l−1, respectively. The lowest detectable deltamethrin residue in treated pond water was 2.18 μg.l−1 at 120 h, with a half-life of 47.63 h.

Rupture diaphragmatique et hernie intercostale droites homolatérales sur toux aiguë

We are reporting the case of a 64-year-old patient with chronic cough who has been diagnosed with an intercostal hernia with pleural and hepatic content associated with a diaphragmatic hernia of non-traumatic origin. The patient was treated for an acutely febrile cough with signs of respiratory distress. Thoracic scan showed an intercostal hernia containing an encysted hematoma and a right anterior diaphragmatic hernia with epiploic content. The COVID PCR was negative. This is one of the rare reported cases of intercostal hernia associated with a homolateral diaphragmatic rupture. Visceral and thoracic surgery enabled treatment of the two hernial orifices by raphy as well as omentectomy of the necrotic omentum ascending to the right pulmonary hilum. These two parietal complications of chronic cough should be considered in case of intercostal flap or acute respiratory distress. Surgery must then be carried out as a matter of urgency to reduce the content of the hernias and treat the musculoaponeurotic dehiscent orifices.

Lung Cancer: Solitary Pulmonary Nodule

A 55-year old, middle-aged man, known for hypertension and dyslipidemia, presented to the OPD with complaints of fever along with a mild dry cough. There was no shortness of breath or chest pain associated with the patient’s complaints. Therefore, as a seemingly obvious diagnosis, he was suspected of having a COVID-19 infection. &#x0D; The man has a positive smoking history of approximately 20 cigarettes per day for 25 years. However, his COVID-19 PCR tests provided two negative results. His chest X-ray was also unremarkable. Apart from some abnormalities in his laboratory analyses, which have been discussed in detail in the coming sections, there seemed to be nothing unusual or out of place with the patient.&#x0D; However, when a CT scan without contrast was ordered for the patient, the report showed a mass that was approximately 23 x 21 x 16 mm in size. The mass had a soft, tissue-like consistency. It also appeared to have irregular, lobulated margins. This entire mass was seen to be present in the anterior segment of the upper lobe of the left lung.&#x0D; Apart from this mass, no COVID-19-related consolidations or signs of respiratory distress were seen in this patient.&#x0D; When the mass was confirmed, a needle-core biopsy was done to find out the nature of it. The biopsy report confirmed that the mass was indeed a moderate-to-poorly differentiated non-small cell carcinoma of the lung, which was consistent with adenocarcinoma with sarcomatoid features. All these aspects of the tumor, with radiological evidence, have been discussed below.&#x0D; The patient is being supportively managed as of now and is also being kept on a follow-up schedule.&#x0D; What's worth mentioning, however, is that despite such minor symptoms, the underlying problem could still be serious. If the patient had not gone for an X-ray or CT for their suspected COVID-19 abnormalities, then their case would not have come to a diagnosis and it would have eventually taken a turn for the worse. The whole case, along with the findings and the patient response has been discussed throughout this paper.

Spontaneous Non-Traumatic Emphysema in Toddler: The Neglected Foreign Body

Foreign body aspiration is a major cause of fatality and morbidity in children. The child may present acutely with signs of respiratory distress or chronically with symptoms suggestive of respiratory infection. Variable presentations make it difficult to diagnose a case of foreign body aspiration, especially in the absence of a clear history of aspiration. Subcutaneous emphysema and pneumomediastinum are rare presentations. Here, we report a case of 2-year-old child who presented with non-traumatic extensive neck and upper chest subcutaneous emphysema. Computed tomography revealed there was presence of foreign body in left bronchus. Emergency bronchoscopy found a piece of peanut in the left main bronchus. It was successfully removed and the patient was discharged well after three days.

Pulmonary and laryngeal oedema before induction of anaesthesia in a sheep

AbstractThis case report describes the anaesthesia of a ram undergoing an exploratory laparotomy, which suffered from respiratory distress during the perioperative period. On the morning of surgery, the animal presented with oedematous ears, most likely caused by a tight‐fitting muzzle that had been used for preoperative fasting. After sedation, a mild stridor was heard. During endotracheal intubation, a swollen larynx was observed, and a frothy discharge emerged through the endotracheal tube after placement. Most likely, the tight muzzle caused a partial obstruction of the nostrils, increasing the respiratory effort and causing an increase in the pressure gradient, which provoked laryngeal and pulmonary oedema. Treatment consisted of repeated suctioning of fluid from the endotracheal tube, furosemide, dexamethasone, mechanical ventilation with 100% oxygen during anaesthesia and oxygen supplementation during recovery. Despite moderately low arterial oxygen tension during anaesthesia, the animal recovered uneventfully and did not show further signs of respiratory distress.

Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi

ObjectiveAlthough HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality...

Harlequin Ichthyosis Baby with Coagulase Negative Staphylococcus Infection: A Case Report

Harlequin ichthyosis (HI) is a rare genetic disease caused by the lipid transporter gene ABCA12 mutation. The incidence is 1 in 300,000 live births. Clinically, the skin's keratin layer thickens to form a geometric pattern resembling a Harlequin clown costume. The mortality rate was high, mainly caused by infections and metabolic abnormalities. We report a case of HI in a preterm baby girl with signs of respiratory distress and sepsis that can survive for 4 months.

Multisystem inflammatory syndrome in adults: a\xa0case report\xa0and review of the literature

BackgroundThe current coronavirus disease pandemic has brought recognition of multisystem inflammatory syndrome in adults as a de novo entity, temporally associated with severe acute respiratory syndrome coronavirus 2 viral infection in adults. Hypothesis about its true pathophysiology remains controversial.Case reportThe patient was a 22-year-old African American female presenting to the emergency department with fever, sore throat, and neck swelling for the past 3 days. During her initial emergency department visit, her blood pressure was stable at 110/57 mmHg, temperature of 39.4 °C, and heart rate of 150 beats per minute. While in the emergency department, she received broad-spectrum antibiotics (vancomycin and ceftriaxone) and 30 cc/kg bolus of normal saline. Originally, she was admitted to a telemetry floor. The following night, a rapid response code was called due to hypotension. At that time, her blood pressure was 80/57 mmHg. She appeared comfortable without signs of respiratory distress. She received intravenous fluids and vasopressors, and was transferred to the intensive care unit. The patient had reported a previous coronavirus disease infection a few weeks prior. She was diagnosed and treated for multisystem inflammatory syndrome in adults. Intravenous immunoglobulin infusion was initiated and completed on hospital day 5. She was weaned off vasopressors by day 6, and discharged home on day 11.ConclusionOur case report is an example of the presentation, diagnosis, and management of multisystem inflammatory syndrome. Our research into previous case reports illustrates the wide range of presentations, degree of end organ damage, and treatment modalities. This diagnosis needs to be considered in the presence of recent coronavirus disease infection with new-onset end organ failure, as prompt diagnosis and treatment is crucial for better outcomes.

8: Ultrasonographic assessment of diaphragmatic parameters for predicting weaning outcome in patients on mechanical ventilation in the intensive care unit setting.

Background and Aims:The aim of this study was to ultrasonographically assess diaphragmatic parameters for predicting weaning outcome in patients on mechanical ventilation in the intensive care unit ( ICU ) setting. The primary objective was to assess the diagnostic accuracy of diaphragmatic excursion(DE) and diaphragmatic thickness fraction(DTF) by ultrasonography to predict weaning outcome in patients on mechanical ventilation. The secondary objectives were: To correlate diaphragmatic dysfunction with re-intubation within 48 hours of extubationTo assess which of the two - DE) or DTF is a better predictor of weaning.To compare diaphragmatic rapid shallow breathing index (RSBI) with clinical RSBI. Methods:This cohort study was conducted on 50 adult patients of either sex, admitted in the ICU and scheduled to undergo extubation. The patient’s readiness to wean was assessed by clinical judgment. When the patient was ready to be weaned, he/she was put on pressure support ventilation (PSV). The pressure support was gradually reduced to 6cm H2O. If the patient remained stable and extubation was planned, T-piece trial was given. Baseline parameters (Heart rate, non invasive blood pressure, respiratory rate, tidal volume, RSBI, SpO2, signs of respiratory distress- nasal flaring, sweating, agitation, use of accessory muscles,arterial blood gas analysis, Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure(MEP) were recorded.Results:DE and DTF were assessed ultrasonographically and diaphragmatic RSBI was later calculated. DE andDTF were found to have similar sensitivity (94.12% and 97.06%), specificity (75%), positive predictive values(88.89 and 88.19% respectively) and negative predictive values (85.71% and 92.31% respectively). Overall DTF was comparable to DE in terms of diagnostic accuracy (88% and 90% respectively). (p value=1)Conclusion:DE and DTF are rapid and non invasive ultrasonographic indices with a high diagnostic accuracy for predicting weaning outcome. They provide objective and accurate results and are comparable to each other for predicting weaning outcome. Diaphragmatic RSBI is a good predictor of weaning outcome and is comparable to clinical RSBI.Weaning outcomeDiaphragmatic excursion (mm)Diaphragmatic thickness fraction (%)Sensitivity (95% CI)94.12% (80.32%-99.28%)97.06% (84.67%-99.93%)Specificity (95% CI)75% (47.62%-92.73%)75% (47.62%-92.73%)AUC (95% CI)0.85 (0.72-0.93)0.86 (0.73-0.94)Positive Predictive Value (95% CI)88.89% (73.94%-96.89%)89.19% (74.58%-96.97%)Negative Predictive Value (95% CI)85.71% (57.19%-98.22%)92.31% (63.97%-99.81%)Diagnostic accuracy88.00%90.00%P after Comparison of sensitivity1P after Comparison of specificity1

Interventions for the management of transient tachypnoea of the newborn - an overview of systematic reviews.

Interventions for the management of transient tachypnoea of the newborn - an overview of systematic reviews.

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial.

ABSTRACTObjective:To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. Methods:This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. Results:Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. Conclusions:BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management.

Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.