Type II Respiratory Failure Research Articles

Streptococcus pseudoporcinus bacteremia in a Type II-respiratory failure patient with coronary artery disease: A case report

is a beta-hemolytic Gram-positive, catalase-negative, nonmotile coccus arranged in short chains, usually found in the female genitourinary tract. Only a few human infections associated with this organism have been reported till date. is usually found as colonizer of female genital tract, has been rarely associated with bacteremia. We are reporting a rare case of causing bacteremia in patients with respiratory failure and coronary artery disease, who was treated with clindamycin and piperacillin/tazobactam. This case report illustrates the potential of these bacteria to cause severe invasive and life-threatening disease.

PS-BPC06-4: RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS VERSUS CALCIUM CHANNEL BLOCKERS IN ASSOCIATION WITH MORTALITY RATE IN COVID-19 HYPERTENSIVE PATIENTS: THE EFFECT OF AGE

Objective: To study the association of calcium channel blockers (CCBs), the renin-angiotensin-aldosterone system (RAAS) inhibitors or their combination as antihypertensive medications and the clinical outcome of COVID-19 infection. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of COVID-19 patients in two isolation centers. Medical history, demographic data, symptoms, complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID-19 hospitalized patients between Feb 2020 and July 2021. Hypertension and antihypertensive treatments were confirmed by medical history and clinical records. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to assess the impact of antihypertensive drugs (RAAS inhibitors, CCBs, combination of RAAS inhibitors and CCBs and those not receiving medication) on the prognosis of COVID-19 patients and to explore the risk factors associated with mortality. Result: Out of 406 hospitalized COVID-19 patients, 242 (59.6%) had a history of hypertension. Hypertensive patients under the age of 65 years and receiving RAAS inhibitors or the combination of both RAAS inhibitors and CCBs were at higher risk of mortality than those on CCBs only (odds ratio [OR]: 4.45, 95% confidence interval [CI]: 1.56–12.56, P = 0.005 and OR:3.57, CI: 1.03–12.36, P = 0.045 respectively). Antihypertensive medications did not seem to influence mortality rates among hypertensive patients above 65 years. Routine laboratory investigations were not significantly different between the subgroups receiving different antihypertensive medications regardless of age. Cough was the only symptom associated with mortality among patients under 65 years (OR:2.34, CI:1.24–4.41, P = 0.009). Type II respiratory failure was significantly associated with death among hypertensives under 65 years (OR:5.43, CI:1.08–28.07, P = 0.044) whereas acute kidney injury and septic shocks are the common complications related to death among hypertensives above 65 years (OR:3.59, CI:1.54–8.36, P = 0.003 and OR:7.87, CI: 1.68–36.78, P = 0.009 respectively). Conclusion: Administration of CCBs may improve the outcome of COVID-19 hypertensive patients under 65 years of age. Antihypertensive treatment does not seem to influence the prognosis of COVID-19 patients above 65 years. Such results may affect management strategy of COVID-19 hypertensive patients. Type-II respiratory failure among patients under 65 years of age, acute kidney injury and septic shock among those above 65 years are the most serious complications that can lead to death regardless of blood pressure.

Clinical Profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients Admitted in Tertiary Care Hospital

Background: COPD is one of the most widespread noncommunicable diseases, and its incidence is on the rise in developing countries. Acute COPD exacerbation is linked to a higher financial burden on the health system, as well as a negative impact on patients’ health in terms of lost working days, functional capacity, and mortality. COPD exacerbation is characterized by a worsening of symptoms such as cough and dyspnea, as well as a considerable risk of type-II respiratory failure. An understanding of the symptoms and signs, as well as the causes linked to acute COPD exacerbation in our population, is thought to aid in the prevention of such exacerbations, reducing the burden on patients and the community. Aim: This study is meant to bring forth the clinical profile and variables related with acute exacerbation of COPD among our community, taking into account the specific symptoms preceding an exacerbation of COPD and the variety of factors associated with it in different parts of the world. This study characterizes the clinical signs and symptoms of COPD acute exacerbations, as well as investigates the involvement of a respiratory tract infection in COPD exacerbation establishing a relationship between smoking and COPD exacerbation. Method: This is a hospital-based cross-sectional observational study. The study was conducted at the Dhaka Medical College Hospital’s Department of Medicine (DMCH). A method of purposive sampling was applied. The study took place from November 2012 until June 2013. The sample size computed for this study is 75. Result: Age above 7th decade increases mortality risk by 2.32 times. Meanwhile, comorbidity, low BMI (<18.5 kg/m2), smoking and frequent acute exacerbation increases risk by 1.29 times, 1.16 times, 0.03 times and by 2.07 times respectively in patients having COPD. Conclusion: Chronic obstructive pulmonary disease (COPD) is more frequent in the 6th decade of life and is male predominant. Recovery period has been found longer in the presence of dyspnea or symptoms of a common cold at exacerbations onset, higher PaCO2 and lower pH has been found in the patients admitted in ICU. Low BMI, RTI, Smoking and Comorbidity are more frequent in patients with chronic obstructive pulmonary disease (COPD). Sir Salimullah Med Coll J 2022; 30: 161-167

A study on noninvasive ventilation in Type-II respiratory failure in a tertiary care center

Background: Type II respiratory failure is a common complication with considerable morbidity and mortality. Noninvasive ventilation (NIV) has been used preferentially with better results. The objective of this study was to assess the outcome and complications of NIV in type II respiratory failure patients. Methods: A clinical observational study of 67 consecutive adult patients with Type II respiratory failure who were assigned NIV, fulfilling inclusion and exclusion criteria were recruited in the study. NIV Bi level positive airway Pressure (Bi PAP) (spontaneous mode) was used in all patients with settings of 12/6 initially. Based on arterial blood gas values and clinical status, settings were adjusted and followed up as per British Thoracic Society guidelines (2016). In case of worsening of mental status, deterioration of potential of hydrogen (PH), increased partial pressure of carbon dioxide, and intolerance to NIV, patients were subjected to invasive ventilation within the first 4 h of NIV initiation. Results: Patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease (–92.5%), and cases of obstructive sleep apnea (7.5%), showed significant improvement in NIV trial over 24 h in 91.7% and 100%, respectively, by the way of reduction of PCO2 levels and improvement in partial pressure of oxygen, oxygen saturation, which was statistically significant in 89.5% of patients. Clinical improvement noted by the decrease in heart rate, respiratory rate was also statistically significant with a P < 001. However, PH did not show significant changes in our study. Conclusions: A trial of NIV is a useful alternative to mechanical ventilation in many different situations with Type II respiratory failure. Advantages of cost-effectiveness, minimal utilization of intensive care unit resources, low morbidity and mortality rates with patient-friendly equipment features contribute to its preference over invasive ventilation.

Effect of acupuncture on diaphragmatic function in patients with AECOPD typeⅡ respiratory failure evaluated by ultrasound detection

To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound. A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and diaphragm thickening fraction (TFdi) were observed in each group. Before and after treatment, the inflammatory and immune indexes (levels of white blood cell [WBC], procalcitonin [PCT], hypersensitive C-reactive protein [hs-CRP] and T lymphocyte percentage [ %]), auxiliary respiratory muscle movement score, the score of chronic obstructive pulmonary disease (COPD) assessment test (CAT), the score of the modified British Medical Research Council dyspnea scale (mMRC) and the TCM syndrome score were compared in each group. The duration of mechanical ventilation, relative complications, 14-day clinical controlled discharge rate and the therapeutic effect were observed in each group. On day 3, 7 and 10 of treatment, PaO2 and TFdi were all increased as compared with those before treatment (P<0.01) and PaCO2 was reduced as compared with that before treatment in each group (P<0.01). After treatment, % was increased as compared with that before treatment in each group (P<0.01), WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score, mMRC score and TCM syndrome score were all reduced as compared with those before treatment in each group (P<0.01). After treatment, PaCO2, WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score and mMRC score in the acupuncture group were all lower than the other two groups (P<0.01), PaO2 and TFdi were higher than the other two groups (P<0.01); % was higher and TCM syndrome score was lower in the acupuncture group compared with those in the non-acupoint acupuncture group (P<0.01). The duration of mechanical ventilation and the total incidence of complications in the acupuncture group were all lower than the other two groups (P<0.01), and the 14-day clinical controlled discharge rate and total clinical effective rate were higher than the other two groups (P<0.01). Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.

High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary diseases with acute-moderate hypercapnic respiratory failure: an observational cohort study

Objective To compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate typeⅡ respiratory failure, and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure. Methods Patients diagnosed with COPD with acute moderate typeⅡ respiratory failure (Arterial blood gas pH 7.25-7.35, PaCO2> 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed. All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs, and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group. Those treated with NIV in the same conditions were included in the NIV group. The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality. Results Eighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled. The HFNC group had a treatment failure rate of 28.2%, which was lower than that of the NIV group (39.5%). However, Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228, P=0.268). The 28-day mortality rate in HFNC group was 15.4%, which was no different from 14% in NIV group (Log Rank test 0.049, P=0.824). The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3~8) vs. 11 (7~15)], whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9~22) hours vs. 8 (4~11) hours] (all P<0.05). The incidence of nasal facial lesions in the NIV group was 20.9%, significantly higher than that of HFNC group (5.1%, P <0.05). Conclusion For COPD with acute moderate typeⅡ respiratory failure, HFNC has similar therapeutic effects as NIV. HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure. Key words: Chronic obstructive pulmonary diseases; Respiratory failure; High-flow nasal cannula oxygen therapy; Non-invasive ventilation; Cohort study

The clinical effect observation of the non invasive positive pressure mechanical ventilation for the treatment of chronic obstructive pulmonary disease with II respiratory failure

Objective To explore the noninvasive positive pressure ventilation combined with pulmonary function and blood gas analysis of chronic obstructive pulmonary disease(COPD)with typeⅡrespiratory failure. Methods 120 COPD patients with type II respiratory failure were selected,they were randomly divided into the control group and observation group by using the random number table method,with 60 cases each group.The control group was given conventional low flow oxygen therapy,the observation group was application of noninvasive positive pressure ventilation treatment.The change of blood gas levels,the forced expiratory volume in one second(FEV1),forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC)before treatment and after one week treatment,and the intubation rate,the average hospitalization time were observed .Results After treatment,FEV1,FEV1/ FVC(%),PaO2,p H of the two groups were higher than those before treatment,while PaCO2 was lower than that before treatment,the differences were statistically significant(t= 8.33,12.56,14.71,10.82,7.88,10.14,13.20,15.63, 11.48,8.37,all P<0.05).FEV1 and FEV1/FVC(%)of the observation group after treatment were(2.84±0.42)L and(69.93±0.72),which were higher than those of the control group after the treatment(2.69±0.39)L and(67.11 ±0.78),the difference was statistically significant(t= 8.95,10.76,all P< 0.05).PaO2 and p H of the observation group after treatment were(77.90±1.12)mm Hg and(7.41±0.10),which were higher than those of the control group after treatment(70.88±1.14)mm Hg and(7.29±0.08),the difference was statistically significant(t= 11.58, 7.94,all P<0.05).PaCO2 of the observation group was(50.14±1.23)mm Hg,which was lower than that of before treatment(54.26±1.12)mm Hg,the difference was statistically significant(t= 9.81,P< 0.05).The intubation rate of the observation group was 1.67%(1/60),which was lower than that of the control group 13.33%(8/60),the difference was statistically significant(χ2= 7.90,P< 0.05).The average hospital stay time of the observation group was(11.69±1.32)d,which was lower than that of the control group(15.10±1.28)d,the difference was statistically significant(t= 9.84,P< 0.05). Conclusion Noninvasive positive pressure ventilation could significantly improve lung function of COPD patients with type II respiratory failure,increase PaO2,improve the respiratory status of the patients,reduce intubation rate and shorten the hospitalization time. Key words: Positive pressure ventilation; Pulmonary disease,chronic obstructive; Respiratory failure,type II

The clinical comparative study of different ways of oxygen ventilation on patients with COPD complicated with type II respiratory failure

Objective To observe noninvasive positive pressure ventilation with typeⅡrespiratory failure treatment effect in the combined treatment of acute exacerbations of chronic obstructive pulmonary disease(COPD).To explore the application value of noninvasive positive pressure ventilation in the treatment of COPD with typeⅡrespiratory failure.And to provide clinical indications guidance for the better application of noninvasive positive pressure ventilation. Methods 60 cases of COPD with typeⅡrespiratory failure patients were collected as the research object.30 cases in each group were randomly divided into the control group and treatment group.Two groups of patients were given the treatment of expectorant,anti infection,thearapy according to the basis of disease and complications. The control group were given nasal catheter oxygen.In the treatment group therapy and routine therapy combined with noninvasive positive pressure ventilation.Acute Physiology and Chronic Health EvaluationⅡ(APACHE scoreⅡ) was used as the standard.The two groups were observed before and after treatment in the heart rate,respiratory rate,blood gas analysis and clinical index changes. Results The patients in the two groups after treatment p H,PaO2,PaCO2 of blood gas indexes were better than before treatment,the difference was statistically significant(P< 0.05).The treatment group improved more obviously compared with the control group(P< 0.05).Compared with the control group, the treatment group patients hospitalization days,tracheal intubation and mortality declined or shorten,the differences were statistically significant(P<0.05). Conclusion Chronic obstructive pulmonary disease combined with typeⅡrespiratory failure by using of noninvasive positive pressure ventilation at the same time, can improve the therapeutic effect in the conventional treatment.Noninvasive positive pressure ventilation reduces the incidence of complications and mortality.It is worthy of clinical reference. Key words: Respiratory Insufficiency; Pulmonary Disease,Chronic Obstructive; Ventilators,Mechanical

Assessment of respiratory muscle strength in motor neurone disease: is asking enough?

Motor neurone disease (MND), also known as amyotrophic lateral sclerosis (ALS), is a progressive degenerative neuromuscular disease against which the only licensed drug, Riluzole (Rilutek; Sanofi-Aventis, Paris, France), is only partially effective. When respiratory muscle weakness is sufficiently severe, type-II respiratory failure occurs. Several data suggest that noninvasive ventilation (NIV) improves quality of life and, at least in nonbulbar patients, extends life 1–3. The timing of initiation of NIV requires considerable clinical skill. As the therapy involves hospital attendance, whether or not the patient is admitted 4, it erodes the limited amount of “quality time” the patient has remaining. If administered too early the burdens of the treatment ( i.e. the need to use a mask, its associated complications and increased carer dependence) may outweigh the perceived benefits, in that symptoms of sleep-disordered breathing (SDB) may initially be mild. Evidence from Duchene muscular dystrophy suggests that if used too early, negative initial experience may deter patients from using the therapy when they are more symptomatic and/or in ventilatory failure 5. However, if administered too late the patient may experience unplanned deterioration, which carries the risk of either intubation or poorly managed end-of-life care 6. The most appropriate method of screening for respiratory failure in these patients with a high pre-test probability remains unclear. The ideal test would be noninvasive, simple to perform and simple to interpret allowing …