Ventilation Treatment Research Articles

Chest computed tomography-based artificial intelligence-aided latent class analysis for diagnosis of severe pneumonia.

There is little literature describing the artificial intelligence (AI)-aided diagnosis of severe pneumonia (SP) subphenotypes and the association of the subphenotypes with the ventilatory treatment efficacy. The aim of our study is to illustrate whether clinical and biological heterogeneity, such as ventilation and gas-exchange, exists among patients with SP using chest computed tomography (CT)-based AI-aided latent class analysis (LCA). This retrospective study included 413 patients hospitalized at Xinhua hospital diagnosed with SP from June 1, 2015 to May 30, 2020. AI quantification results of chest CT and their combination with additional clinical variables were used to develop LCA models in an SP population. The optimal subphenotypes were determined though evaluating statistical indicators of all the LCA models, and clinical implications of them such as guiding ventilation strategies were further explored by statistical methods. The two-class LCA model based on AI quantification results of chest CT can describe the biological characteristics of the SP population well and hence yielded the two clinical subphenotypes. Patients with subphenotype-1 had milder infections (P <0.001) than patients with subphenotype-2 and had lower 30-day (P <0.001) and 90-day (P <0.001) mortality, and lower in-hospital (P=0.001) and 2-year (P <0.001) mortality. Patients with subphenotype-1 showed a better match between the percentage of non-infected lung volume (used to quantify ventilation) and oxygen saturation (used to reflect gas exchange), compared with patients with subphenotype-2. There were significant differences in the matching degree of lung ventilation and gas exchange between the two subphenotypes (P<0.001). Compared with patients with subphenotype-2, those with subphenotype-1 showed a relatively better match between CT-based AI metrics of the non-infected region and oxygenation, and their clinical outcomes were effectively improved after receiving invasive ventilation treatment. A two-class LCA model based on AI quantification results of chest CT in the SP population particularly revealed clinical heterogeneity of lung function. Identifying the degree of match between ventilation and gas-exchange may help guide decisions about assisted ventilation.

Noninvasive Positive Pressure Ventilation versus High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease: An Updated Narrative Review.

Chronic obstructive pulmonary disease (COPD) is one of the most common clinical respiratory illnesses, defined by permanent pathological deterioration that leads to respiratory failure. Regarding COPD treatment, oxygen therapy is very important. Non-invasive positive pressure ventilation (NPPV) is a technique for non-invasive mechanical ventilation that enables patients to get positive pressure support without the need of an artificial airway. Instead, it merely employs the mask by covering the mouth and nose, or simply the nose of patients. NPPV has been shown to be beneficial for COPD patients experiencing respiratory failure. High-flow nasal cannula (HFNC) oxygen therapy shows some advantages, including the reduction of anatomical dead space, the prompt correction of low oxygen levels as well as the improvement of patients' tolerance. Owing to its continuous progress, ventilation technology strongly improves COPD treatment. In this study, the authors analyze the application of NPPV and HFNC in COPD so as to provide recommendations for mechanical ventilation treatment.

The Effect of Obesity on Postoperative Analgesia Practices and Complications Following Endoscopic Sinus Surgery: A Propensity Score-Matched Cohort Study.

Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m2) and non-obese (18.5 kg/m2 ≤ BMI < 30 kg/m2) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.

Analysis of Stenotrophomonas maltophilia infections in lower respiratory tract samples at a university hospital: 5 year data

Objectives Patients with reported Stenotrophomonas maltophilia (S. maltophilia) growth in lower respiratory tract samples were investigated. The results of these patients were assessed by clinicians as either infection or colonization. The data of patients considered to have S. maltophilia infection were compared to those considered to have colonization to explore factors associated with infection. Methods Parameters including as age, length of hospital stay, duration of S. maltophilia growth after hospital admission, sex, unit, department, specimen type, mechanical ventilation treatment status, antimicrobial susceptibility results, comorbidities, survival, and antimicrobials used during the period from hospital admission to S. maltophilia growth were investigated. Additionally, some biochemical parameters that were examined include the day of hospital admission, the day of sample collection when the bacterium was isolated (±1 day), and the day of discharge/died. Results The infection group had a significantly higher rate of admissions to internal medical departments and more cases of discharge/died. The infection group showed a lower amount of aminoglycoside antibiotic usage and significantly higher levels of BUN, creatinine, neutrophils, and neutrophil-to-lymphocyte ratio on their day of discharge/died. Conclusion Being admitted to internal medical departments and receiving aminoglycoside treatment were identified to be factors associated with S. maltophilia infection. These patients should be monitored for infection markers such as CRP and neutrophil count, as well as renal function tests. It should be noted that being infected with S. maltophilia is an independent risk factor for mortality. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1095-1103

The role of thrombocyte indices in early determination of sepsis agents in newborns

Purpose: Neonatal sepsis is an important cause of morbidity and mortality. The signs and symptoms of neonatal sepsis are nonspecific, and there is no ideal marker for diagnosis. Our study aimed to investigate the role of platelet indices in determining agents in sepsis. Materials and Methods: A total of 90 records with sepsis data were examined retrospectively, demographic and clinical characteristics of gram-positive, gram-negative and Candida infection patients were evaluated by complete blood counts at the time of diagnosis and on the fifth day of infection and platelet amount (PLT), mean platelet volume (MPV), plateletcrit (PCT) and distribution width (PDW) values were compared by ROC curve analysis. Results: No statistical difference was found between the groups in terms of gender, gestational week, birth weight, surfactant use, need for mechanical ventilator treatment, and necrotizing enterocolitis. When infection was first detected, the Area Under Curve (AUC) of PCT, PLT and MPV (without thrombocytopenia) values in detecting gram-positive bacterial infection were 0.764, 0.765 and 0.792 respectively. Conclusion: The increase in PCT and PLT values at the time of initial diagnosis can be used to detect gram-positive bacterial infections. A decrease in MPV can be used for early diagnosis of fungal infections without thrombocytopenia.

An eight-year follow-up study of Home Invasive Mechanical Ventilation in Finland

BackgroundStudies on long-term invasive mechanical ventilation (IMV) via tracheostomy in chronic respiratory insufficiency are limited. The aim of this study was to clarify the use of HIMV (home invasive mechanical ventilation) within the Finnish population and to analyze the characteristics and survival rate of HIMV patients from 2015 to 2022.MethodsData on HIMV patients was collected annually from all Finnish Hospital District patient registries between January 1, 2015, and December 31, 2022. Data included basic demographic data of the patients, underlying diagnosis, time from diagnosis to HIMV initiation, treatment duration, and mortality.ResultsThis study included 179 patients. In 2015, there were 107 HIMV patients, and as of December 31, 2022, there were 95 patients. During the eight-year follow-up period, 84 patients (46.9%) died and there were 67 new patients between 2015 and2022. The prevalence of HIMV treatment in Finland was 2.4/100,000 on January 1,2015, and 1.8/ 100 000 on December 31, 2022. The average number of years living with HIMV for deceased patients at death was 10.1 ± 10.5 years largely depending on the underlying diagnosis. Of all the HIMV treatments, 32% were elective.ConclusionsHIMV is a rare treatment in Finland, and based on our 8-year follow-up, prevalence of HIMV is diminishing. Given the high demands, and significant costs associated with HIMV, it is essential to prepare for long treatment, when planning HIMV. It is also advisable to prolong non-invasive ventilation (NIV) treatments for as long as possible.

Noninvasive ventilation and laser-assisted unilateral posterior cordotomy as novel multidisciplinary approaches for Charcot–Marie–Tooth disease 4B vocal cord paralysis: a case report

BackgroundCharcot–Marie–Tooth disease (CMT) is one of the most common inherited neuropathies. The disease is generally characterized by sensory loss most prominent in distal extremities, muscle weakness, and muscle wasting. There is still no effective therapy for Charcot–Marie–Tooth disease.Case presentationThe patient is a 6-year-old Iranian girl, of Fars ethnicity, who was admitted with a chief complaint of hoarseness and an impression of Charcot–Marie–Tooth disease type 4B. She was initially treated with noninvasive ventilation and, after a year, electively underwent cordotomy as a novel therapeutic approach.ConclusionsCharcot–Marie–Tooth disease type 4B is a less common but important cause of stridor. Noninvasive ventilation treatment and unilateral posterior cordotomy can be utilized for hereditary neuropathies.

Design and simulation study of positive pressure ventilation system in a simulated human biological lung

Simulation of the human biological lung is a crucial method for medical professionals to learn and practice the use of new pulmonary interventional diagnostic and therapeutic devices. The study on ventilation effects of the simulation under positive pressure ventilation mode provide valuable guidance for clinical ventilation treatment. This study focused on establishing an electrical simulation ventilation model, which aims to address the complexities in parameter configuration and slow display of air pressure and airflow waveforms in simulating the human biological lung under positive pressure ventilation mode. A simulated ventilation experiment was conducted under pressure-regulated volume control (PRVC) positive pressure ventilation mode, and the resulting ventilation waveform was compared with that of normal adults. The experimental findings indicated that the average error of the main reference index moisture value was 9.8% under PRVC positive pressure ventilation mode, effectively simulating the ventilatory effect observed in normal adults. So the established electrical simulation ventilation model is feasible, and provides a foundation for further research on the simulation of human biological lung positive pressure ventilation experimental platform.

Non-Invasive Ventilation for Children Affected by Duchenne Muscular Dystrophy in Ukraine

Background: Duchenne Muscular Dystrophy (DMD) poses significant challenges, especially in Low- and Middle-Income Countries (LMIC) with limited access to Non-Invasive Mechanical Ventilation (NIV), which prolongs life expectancy. Two years after Stage 1 of the successfull “1500 years of survival” NIV programme commenced with 8 DMD boys in Ukraine in 2021, this study further explores the Stage 2 of the programme in 2023. Method: DMD patients underwent a 5-day training program at the National Children’s Clinical Hospital “Okhmatdyt” in Kyiv, Ukraine, utilizing donated second-hand bilevel intermittent positive presure ventilators. Indications for NIV included: sleep-related symptoms, high Apnea-Hypopnea Index (AHI&gt;10 events/hour), decreased Forced Vital Capacity (FVC=50%), low minimum saturation during sleep (SpO2&lt;88%), or age above 17 years. Parallel Masterclass on NIV was conducted for Ukrainian healthcare professionals and patients’ parents. Findings: Thirteen DMD inpatients, aged (mean ± standard deviation) 14.8±2.6 years and FVC of 1.8±0.4L (65.5±22.8% predicted value) were enrolled. Criteria for NIV initiation were: age&gt;17 years (n: 4), FVC% =50% (n :6), AHI&gt;10 (n :2) and SpO2&lt;88% (n :5). Follow-up phone calls were conducted to monitor progress. Three months post-hospitalization, all 13 patients consistently adhered to nocturnal ventilator treatment with a mean use of 7.5 hours per night. Conclusions: Despite the lack of equipment and system of reimbursement, the implementation of the comprehensive Stage 2 training programme supplying NIV for DMD patients in an LMIC such as in Ukraine, was a successful experience. The next steps in the home NIV programme will take place in the coming years.

Naloxone combined with non-invasive ventilation for the treatment of chronic obstructive pulmonary disease based on radioactive X-ray image inspection

The purpose of this study was to investigate the application of radiography in patients with COPD and analyze its value in diagnosis and evaluation. During radiological X-rays, patients wear specific lead protective equipment to reduce radiation exposure and obtain images from different angles and fields of view. The obtained X-ray images were evaluated and analyzed to examine the structural and morphological features of the lung tissue. In this study, the treatment scheme of naloxone combined with salbutamol combined with non-invasive ventilator was adopted, which improved the effectiveness and accuracy of treatment by supporting the computer medical image segmentation recognition system. The analysis results showed that the respiratory function of patients in naloxone combined with non-invasive ventilation treatment group was significantly improved after treatment, and the lung image characteristics also had positive changes. Compared with the conventional treatment group, naloxone combined with noninvasive ventilation has significant advantages in improving ventilation function and reducing pulmonary disease in COPD patients. Naloxone combined with non-invasive ventilation based on medical image recognition has the potential to improve the condition of COPD patients and predict treatment response. The results of this study provide a new idea for the treatment of COPD patients and provide a reference for further optimization of treatment.

Immune and inflammation features of severe and critical Omicron infected patients during Omicron wave in China

ObjectiveThe current study aimed to investigate the baseline immune and inflammatory features and in-hospital outcomes of patients infected with the Omicron variant (PIWO) who presented with different disease severities during the first wave of mass Omicron infections in the Chinese population has occurred.MethodA cross‐sectional study was conducted on 140 hospitalized PIWO between December 11, 2022, and February 16, 2023. The clinical features, antibodies against SARS-CoV-2, immune cells, and inflammatory cytokines among mildly, severely, and critically ill PIWO at baseline and during follow-up period were compared.ResultPatients with severe (n = 49) and critical (n = 35) disease were primarily male, needed invasive mechanical ventilation treatment, and exhibited higher mortality than those with mild disease (n = 56). During acute infection, SARS-CoV-2-specific antibody levels fluctuated with disease severity, serum antibodies increased and the incidence of severe cases decreased in critically ill PIWO over time. Antibody titers in severe or critical PIWO with no antibody responses at baseline did not increase significantly over time. Meanwhile, CD4+T cell, CD8+T cell, and natural killer cell counts were negatively correlated with disease severity, whereas interleukin (IL)-6 and IL-10 levels were positively correlated. In addition, combined diabetes, immunosuppressive therapy before infection, serum amyloid A, IL-10 and neutrophil counts were independently associated with severe and critical illness in PIWO. Among the 11 nonsurvivors, 8, 2, 1 died of respiratory failure, sudden cardiac death, and renal failure, respectively. Compared with survivors, nonsurvivors exhibited lower seropositivity of SARS-CoV-2-specific antibody, reduced CD3+T and CD4+T cell counts, and higher IL-2R, IL-6, IL-8, and IL-10 levels. Of note, lactate dehydrogenase was a significant risk factor of death in severe or critically ill PIWO.ConclusionThis present study assessed the dynamic changes of SARS-CoV-2-specific antibodies, immune cells and inflammatory indexes between severely and critically ill PIWO. Critical and dead PIWO featured compromised humoral immune response and excessive inflammation, which broadened the understanding of the pathophysiology of Omicron infection and provides warning markers for severe disease and poor prognosis.

Posttraumatic hydrocephalus as a complication of decompressive craniectomy-same old story, new perspectives.

Decompressive craniectomy (DC) serves as a vital life-saving intervention, demonstrating efficacy in reducing intracranial pressure (ICP). However, its efficacy hinges on meticulous surgical execution, perioperative management, and vigilance toward potential complications. The incidence of complications associated with DC plays a pivotal role in determining its superiority over medical management for patients experiencing intracranial hypertension following traumatic brain injury (TBI). Severe cases often require more intensive therapy, prolonged mechanical ventilation, and vasopressor treatment. Identifying the optimal moment for early extubation and minimizing vasopressor use is crucial to reducing the risk of complications, including PTH. Our study aims to highlight the potential risks associated with prolonged mechanical ventilation and long-term vasopressor administration. The collected data were demographics, the craniectomy size, the distance from the midline of the craniectomy, the presence or absence of hydrocephalus, duration of mechanical ventilation and vasopressor treatment, and outcome at 30 days. Seventy-two patients with a mean age of 44.2 (range 5-83) were included in the study, with a median craniectomy size of 119.3 cm2. In our series, craniectomy areas ranged between 30 and 207.5 cm2 and had a similar decrease in midline shift in all cases. We did not observe any associations between the surface of craniectomy and the complication rate (p = 0.6302). There was no association between craniectomy size and mortality rate or length of hospital stay. The most common complication of decompressive craniectomy in our study group was posttraumatic hydrocephalus, with an incidence of 13.8%. Our results showed that craniectomy size did not independently affect PTH development (p = 0.5125). Still, there was a strong correlation between prolonged time of vasopressor treatment (p = 0.01843), period of mechanical ventilation (p = 0.04928), and the development of PTH. This study suggests that there is no clear correlation between craniectomy size, midline shift reduction, and survival rate. An extended period of vasopressor treatment or mechanical ventilation is linked with the development of posttraumatic hydrocephalus. Further studies on larger series or randomized controlled studies are needed to better define this correlation.

Economic burden of respiratory syncytial virus in adults in Germany – a health claims analysis between 2015 and 2018

Aims Respiratory syncytial virus (RSV) causes severe lower respiratory tract infections (LRTI) in infants and adults. While the clinical burden was recently estimated in adults in Germany, little is known about the economic burden. To fill this gap, this study aimed to assess hospital and outpatient healthcare resource utilization (HRU) and costs of RSV infections in adults in Germany. Methods In this retrospective, observational study on nationwide, representative, anonymized claims data (2015–2018), we identified patients ≥18 years with ICD-10-GM-codes specific to RSV (“RSV-specific”). To increase sensitivity, patients with unspecified LRTIs (including unspecified bronchitis, bronchiolitis, bronchopneumonia, and pneumonia) during RSV seasons were also included as cases potentially caused by RSV (“RSV-possible”). RSV-related HRU (hospital days, ICU and ventilation treatment, drug dispensation) and direct costs were estimated per episode. Excess costs per episode and for follow-up periods were compared to a matched control cohort. All outcomes were reported per healthcare sector and stratified by age and risk groups as well as disease severity (ICU admission/ventilation). Results Direct inpatient and outpatient mean episode costs were 3,473€ and 82€, respectively, with substantially higher costs for severe cases requiring intensive care and/or ventilation (10,801€). Direct costs for RSV-specific cases were higher than for RSV-possible cases (inpatients: 6,247€ vs. 3,450€; outpatients: 127€ vs. 82€). Moreover, costs were significantly higher for RSV patients than for controls and increased over time (inpatients: 5,140€ per episode vs 10,093€ per year; outpatients: 46€ per quarter vs 114€ per year). Limitations While the number of RSV-specific cases was low, inclusion of seasonal LRTI cases likely increased the sensitivity to detect RSV cases and allowed a better estimation of the total costs of RSV. Conclusions The economic burden of RSV-LRTI in adults in Germany is substantial, persists long-term, and is particularly high in the elderly. This highlights the need for cost-effective prevention measures.

The ReInvigorate Study—phrenic nerve-to-diaphragm stimulation for weaning from mechanical ventilation: a protocol for a randomized pivotal clinical trial

BackgroundIn the United States in 2017, there were an estimated 903,745 hospitalizations involving mechanical ventilation (MV). Complications from ventilation can result in longer hospital stays, increased risk of disability, and increased healthcare costs. It has been hypothesized that electrically pacing the diaphragm by phrenic nerve stimulation during mechanical ventilation may minimize or reverse diaphragm dysfunction, resulting in faster weaning.MethodsThe ReInvigorate Trial is a prospective, multicenter, randomized, controlled clinical trial evaluating the safety and efficacy of Stimdia’s pdSTIM System for facilitating weaning from MV. The pdSTIM system employs percutaneously placed multipolar electrodes to stimulate the cervical phrenic nerves and activate contraction of the diaphragm bilaterally. Patients who were on mechanical ventilation for at least 96 h and who failed at least one weaning attempt were considered for enrollment in the study. The primary efficacy endpoint was the time to successful liberation from mechanical ventilation (treatment vs. control). Secondary endpoints will include the rapid shallow breathing index and other physiological and system characteristics. Safety will be summarized for both primary and additional analyses. All endpoints will be evaluated at 30 days or at the time of removal of mechanical ventilation, whichever is first.DiscussionThis pivotal study is being conducted under an investigational device exception with the U.S. Food and Drug Administration. The technology being studied could provide a first-of-kind therapy for difficult-to-wean patients on mechanical ventilation in an intensive care unit setting.Trial registrationClinicaltrials.gov, NCT05998018, registered August 2023.

COVID-19 vs. non-COVID-19 related nosocomial pneumonias: any differences in etiology, prevalence, and mortality?

This review explores the similarities and differences between coronavirus disease 2019 (COVID-19)-related and non-COVID-related nosocomial pneumonia, particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It critically assesses the etiology, prevalence, and mortality among hospitalized patients, emphasizing the burden of these infections during the period before and after the severe acute respiratory syndrome coronavirus 2 pandemic. Recent studies highlight an increase in nosocomial infections during the COVID-19 pandemic, with a significant rise in cases involving severe bacterial and fungal superinfections among mechanically ventilated patients. These infections include a higher incidence of multidrug-resistant organisms (MDROs), complicating treatment and recovery. Notably, COVID-19 patients have shown a higher prevalence of VAP than those with influenza or other respiratory viruses, influenced by extended mechanical ventilation and immunosuppressive treatments like corticosteroids. The findings suggest that COVID-19 has exacerbated the frequency and severity of nosocomial infections, particularly VAP. These complications not only extend hospital stays and increase healthcare costs but also lead to higher morbidity and mortality rates. Understanding these patterns is crucial for developing targeted preventive and therapeutic strategies to manage and mitigate nosocomial infections during regular or pandemic care.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective: To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Methods: 70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects, and randomly divided into the control group and the experimental group, each with 35 cases. The control group received only conventional treatment, and the experimental group received non-invasive positive pressure ventilation, and the treatment effects and changes in the levels of IL-18, hs-CRP, and CES2 inflammatory factors were observed and evaluated in the two groups. Results: There was no significant difference between the general data of the two groups (P &gt; 0.05); after treatment, the total effective rate of clinical efficacy of the observation group (91.43%) was significantly higher than that of the control group (71.43%), and the difference showed a significant correlation (P &lt; 0.05); after treatment, the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group, and the difference showed a highly significant correlation (P &lt; 0.001). Conclusion: The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect, effectively controls the level of inflammatory factors, and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure, showing a good clinical application prospect.

The Relationship Between Ionized Calcium Levels and Prognosis in Patients with Spontaneous Subarachnoid Hemorrhage

The serum calcium plays a role as a cofactor in critical steps such as cardiac contractility, vascular tone, and the coagulation cascade. This study aimed to determine if the level of ionized calcium can predict outcomes in patients with spontaneous subarachnoid hemorrhage (SAH) in the emergency department. The study was a retrospective cross-sectional case series. Patients aged 18 and over diagnosed with spontaneous SAH in the emergency department were included in the study. Patients' demographic characteristics, comorbidities, vital signs, laboratory parameters, World Federation of Neurosurgical Societies score, SAH grading according to the Fisher scale, needs of mechanical ventilation and inotropic treatment, administered treatments, complications, Rankin scores at discharge, and outcome were recorded in a standard data form. A total of 267 patients were studied, with a mean age of 55.5 ± 13.4years, and 53.9% (n= 144) were female. Hydrocephalus was present in 16.5% of patients. The average hospital stay was 20.4 ± 19.8days. Mortality rate was 34.8% (n= 93). Mortality was significantly higher in patients with low calcium levels upon admission (P= 0.024). Ionized calcium levels during complication development independently predicted mortality (OR: 0.945, 95% CI: 0.898-0.996, P= 0.034). Patients with poor neurologic outcomes (Rankin: 3-6) had significantly lower initial ionized calcium levels (P= 0.002). The ionized calcium level is a readily accessible blood gas parameter that assists clinicians in predicting functional independence and mortality at discharge in patients presenting to the emergency department with spontaneous SAH.

Lesión pulmonar unilateral aguda secundaria a reexpansión pulmonar. Reporte de caso

Introduction: Lung reexpansion is a rare complication, generally less than 1%, that can occur after rapid drainage of a pneumothorax or pleural effusion. Its mortality can reach 20%.Clinical case: A 22-year-old female patient reported experiencing dizziness, weakness, vomiting containing food, presence of blood clots and bloody-looking stools, which is why she was taken to the hospital to the emergency department, and underwent surgery for upper digestive bleeding. In its evolution, it presents a picture of acute unilateral lung injury secondary to lung reexpansion when draining a pleural effusion. Medical and ventilatory treatment is imposed and the patient evolves favorably.Conclusions: Lung injury due to lung re-expansion is a rare entity; clinical suspicion is essential to act diligently and thus avoid complications. Good ventilatory management of Respiratory Distress Syndrome is essential, emphasizing protective mechanical ventilation and the appropriate use of PEEP

Risk Factors of Fungal Growth in Sputum Culture from Severe and Critical COVID-19 Patients

Patients infected with Coronavirus Disease (COVID-19), especially those with comorbidities, immunosuppressive treatment, intubated, and on ventilators, are more likely to contract fungal infection. This study aimed to describe the profile of fungal growth in sputum culture from severe and critical COVID-19 patients, and to determine the association between the fungal growth with the patient's outcome and the association between several risk factors with the fungal growth. A retrospective case-control study was carried out at Husada Utama Hospital, Surabaya. This study samples were 119 patients; fungal growth on sputum culture was seen in 64 (53.8%) patients; the three types of fungi with the highest frequency were Cryptococcus neoformans found in 23 (19.3%) patients, Candida tropicalis found in 11 (9.2%) patients and Candida dubliniensis found in 10 (8.4%) patients. There was no significant association between fungal growth and patient mortality with a p-value of 0.940 (p&gt;0.05), also between the patient's history of diabetes mellitus and fungal growth (p=0.496) and between corticosteroid treatment and fungal growth (p=0.168). Still, there was a significant association between the use of ventilators in patients and fungal growth with a p-value of 0.001 (p&lt;0.05). A significant association was also found between IL-6 inhibitor (Tocilizumab) treatment and fungal growth with a p-value of 0.003 (p&lt;0.05). The most common fungi found in this study with the highest frequency was Cryptococcus neoformans. There was an association between two risk factors (the use of a ventilator and tocilizumab treatment) and fungal growth.

Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county

BackgroundPrevious work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. MethodsThe trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. ResultsMost firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. ConclusionsIn Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.