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Context Patients in the intensive care unit (ICU) are at risk not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients. Indeed, diagnosis of ventilator-associated pneumonia (VAP) requires a high clinical suspicion combined with bedside examination, radiographic examination, microbiological analysis of respiratory secretions, and blood test. Aims This study aimed to evaluate the effectiveness and accuracy of lung ultrasound for VAP diagnosis and follow-up. Settings and design A prospective cohort study was conducted on 74 patients, with a total number of 54 with a high likelihood of VAP and 20 with a low likelihood of VAP. Methods and material Mechanically ventilated patients for 48 h or more were included. We calculated the clinical pulmonary infection score and the lung ultrasound was performed within 24 h. Statistical analysis Data were collected and analyzed using SPSS (Statistical Package for the Social Sciences, version 20, IBM, and Armonk, New York). Quantitative data were expressed as mean ±standard deviation (SD) and compared with Student’s t-test. Nominal data were given as number (n) and percentage (%). Chi2 test was implemented on such data. Results Based on the clinical pulmonary infection score (CPIS) with a cutoff point of ≥6, the sensitivity of transthoracic ultrasound was 81.5%, the specificity was 82%, and the accuracy was 81.6%. Regarding sonographic signs, the highest sensitivity was for subpleural dots of consolidation (82%), then B-lines (56%), followed by pleural effusion, and air bronchogram (both 19%). The highest specificity was for air bronchogram (100%), then B-lines, and pleural effusion (both 90%), followed by subpleural dots of consolidation (80%). The positive predictive value for transthoracic ultrasound was 92%; the area under the receiver-operating characteristic (ROC) curve (AUC) for the total ultrasound score was 0.82. Conclusions Transthoracic ultrasound is an easy bedside tool for the diagnosis and follow-up of ventilator-associated pneumonia.

Background Weaning and extubation follow each other in clinical practice, and are two isolated processes that pose distinct problems. Extubation failure is the need for reinstitution of ventilatory support within 24 to 72 hours of planned removal of endotracheal tube. Nearly 20% of patients require reintubation. Reintubation is more serious and may be associated with more adverse effect than the initial intubation procedure. Patients needing reintubation had significantly increase the duration of mechanical ventilation as well as ICU, hospital stay and mortality. Objective of the study To predict risk factors of reintubation in respiratory patients. Patients and methods The present study was a prospective observational study. It involved 100 mechanically ventilated patients who were admitted to RICU with different respiratory diseases. All patients met the criteria for readiness to wean: 50 patients need to be reintubated (group 1), and the other 50 patients were successfully extubated without needing for reintubation within 48–72 hours of extubation process (group 2). Different clinical, laboratory analysis, hemodynamic and respiratory variables, ventilator parameter and SAPS II score were collected in both groups. Results The mean age of reintubated patients was (66.06±10.3 years) and most of them were males (58%). We found that heamoglobin level (11.4±1.93) and Albumin level (2.47±0.61 g/dl) were significantly lower in reintubated group. Also, PH (7.11±0.032) and PaO2 (38.3±4.85 mmHg) at time of first intubation were significantly lower in reintubated cases. Half (50%) of reintubated cases expressed difficult weaning. On the other hand, 64% in non reintubated patients expressed simple weaning. Age (≥64 years old), PH (≤7.13), PaO2 (≤45) at first intubation, SAPS II Score, hemoglobin level (≤10.1), albumin level (≤3.1) were independent predictors of reintubation in respiratory ICU patients. Conclusion Age, arterial PH, PaO2 at first intubation, SAPS II Score, hemoglobin, albumin, higher length of ICU stay and hospital stay were an independent predictors of reintubation in respiratory ICU patients.

Background Despite improvements in asthma medication, intubation is deemed necessary in severe asthma with its complications. Noninvasive ventilation (NIV) is an evolving method to manage acute respiratory failure in those patients. However, the effect of NIV is unclear, and there are debates regarding its safety. Aims To evaluate the role of NIV in patients with acute severe asthma and to assess predictors for its use in those patients. Patients and methods In a prospective interventional study, 90 patients with acute asthma were divided into two groups: medical one and NIV group. The outcomes were the improvement in forced expiratory volume in the first second, as well as clinical and respiratory parameters. Results The respiratory rate showed a significant improvement after 6 h (16.6±3.7 breath/min), and also the heart rate (95.8±11.3 beat/min) and arterial partial pressure of oxygen (88.09±20.2). The time needed to alleviate accessory muscle use was shorter in the NIV group (1.93±0.3 vs. 3.07±0.4 h in the other group). The need for endotracheal intubation and invasive mechanical ventilation was more with group 1. There was no mortality in any group of our study. Conclusion NIV group demonstrated clinical improvement regarding the grade of dyspnea and accelerating the time needed for the absence of accessory muscle usage in acute severe asthma. NIV also has a significant benefit in improving oxygenation, lowering the intubation rate, and shortening the length of hospital and ICU stay in comparison with conventional medical therapy.

Background: Diagnosis of pulmonary embolism (PE) in early stages by conventional laboratory methods is difficult because the currently available tests lack sufficient sensitivity and specificity. Hepatocyte growth factor (HGF) was originally regarded as specific to hepatocytes, but has been found to be identical to the scatter factor affecting a wide range of tissues including the lungs. The aim of this work is to study the relationship between HGF and PE. Patients and methods: This study included 40 patients with PE, 40 stable angina (SA) patients, and 10 healthy controls. HGF and d-dimer were measured in all patients of this study. Results: Mean HGF was significantly higher in the PE group (788.8 ± 361.5 pg/ml) compared to the SA group (262.4 ± 158.1 pg/ml) and control group (215.5 ± 18.5 pg/ml) (P = 0.0001). The predictive values of d-dimer in the diagnosis of PE were as follows: 100% sensitivity and negative predictive value, 80% specificity, 83.3% positive predictive value and 90% accuracy, while those of HGF were: 97.5% sensitivity, 97.4% negative predictive value, 92.5% specificity, 92.9% positive predictive value and 95% accuracy. When used both d-dimer and HGF together the values improved to: 100% sensitivity and negative predictive value, 97.5% specificity, 97.6% positive predictive value and 98.8% accuracy. Conclusions: Our observations suggest that the plasma HGF level may be a useful biological marker of pulmonary ischemia, and a valuable tool for early diagnosis of PE. Clarification of the mechanisms, characteristics, and biological significance of HGF elevation is important for clinical use in diagnosing and treating pulmonary ischemia. The use of both d-dimer and HGF increases the predictive power of both tests when used together. The clinical significance of the role of HGF in PE opens a new therapeutic area in treating acute ischemic pulmonary disease that would be able to prolong the time frame for the application of reperfusion–thrombolytic therapy.

Background: OSA is associated with an increased prevalence of coronary artery disease, heart failure and rhythm disturbance. Also, P-wave dispersion (Pd) reflects inhomogeneous atrial depolarization secondary to insults such as chronically elevated atrial pressure, ischemia, or metabolic stress that promote atrial structure remodeling and provide a substrate for atrial fibrillation. We aimed to investigate Pd in patients with OSA and to determine if there is any relationship with severity of the disease. Patients and methods: This study was conducted in Chest & Cardiology Departments, Assuit University Hospital, Egypt on 40 OSA patients (29 males and 11 females), and 20 healthy controls. We excluded patients with COPD and any diagnosed cardiac disease. For every patient, we did a polysomnography and ECG. Results: Pd was significantly more in OSA (98.50 ± 4.77 m/s) than controls (72.00 ± 3.37 m/s) (p value

The management of patients with malignant pleural effusion (MPE) remains problematic. Various modalities are available in the management of MPE. However, optimal treatment is still controversial and there is no universal standard approach. Management options include observation, thoracentesis, indwelling pleural catheter (IPC) or chest tube placement and pleurodesis. The aim of the study: To evaluate the efficacy, safety and tolerability of pigtail catheters in comparison to intercostal tubes in pleurodesis of malignant pleural effusions. Patients and methods: This study was carried out at Chest Department, Zagazig University Hospitals during the period from January 2012 to September 2013. The study included 100 patients (39 males and 61 females with a mean age of 61.8 ± 11.3 years) with pleural effusion of malignant etiology. Patients were classified into two groups Group I: included 50 patients 18 males and 32 females with a mean age of 63.8 years who were subjected to pigtail catheter drainage then pleurodesis. Group II: included 50 patients 21 males and 29 females with a mean age of 61.8 years who were subjected to tube thoracotomy drainage then pleurodesis. Results: As regards pleurodesis outcome, there was a high frequency of success in group I (33 patients, 66%) when compared with group II (27 patients, 54%). However, the difference is not statistically significant. As regards pleurodesis complications the higher frequency of complications was in group II (22 patients, 44%) when compared with group I (43 patients, 86%). These differences were statistically significant (P

Background: NIV could be beneficial in selected patients with severe asthma exacerbation (SAE). However, its role is still not well defined. Objective: To evaluate the efficacy of NIV using proportional assist ventilation (PAV) in severe asthma exacerbation after failure of conventional medical therapt (CMT). Patients and Methods: Thirty patients with severe asthma exacerbation were failed to respond on conventional medical therapy. NIV was applied via face mask as a last option before intubation and mechanical ventilation. Results: The mean age was 39.2 ± 9.7 with female predominance (19 females vs. 11 males). The successful outcome was achieved in 23/30 patients (76.6%). Follow up of the mean of respiratory distress and gasometric parameters before recruitment vs. 1 h after NIV in successful group showed statistically significant improvement after NIV application as follows: HR (125.4 vs. 107.4), RR (38.2 vs. 25.4), PH (7.28 vs. 7.36), PaCO2 (55.3 vs. 42.5), PaO2 (58 vs. 87) and PEFR% Predicted (39 vs. 64) respectively (P

Background: Assessment of severity of the disease in community-acquired pneumonia (CAP) is very important to decide the site of care. The conventional CURB-65 score is composed of five separate elements namely, Confusion, Uremia, Respiratory rate, BP, and age ⩾65 years. These elements could be calculated electronically. The electronic CURB (eCURB) utilizes the 5 CURB-65 data elements as continuous, weighted variables. The aim of this study was to evaluate the performance of eCURB elements in predicting in-hospital mortality and ICU admission in comparison to the conventional CURB-65. Material and methods: This study was conducted upon 134 adult patients diagnosed as CAP and confirmed by radiographic findings, admitted to chest department, Assiut University Hospital, Egypt. The CURB-65 elements were retrospectively extracted from the medical records. The eCURB variables were introduced to electronically calculate the risk using the Excel appendix model (provided by Prof. Nanthan Dean, University of Utah, Salt Lake city, USA) and its predictive values and area under the receiver-operating characteristic (ROC) curve were compared with the conventional CURB-65 in predicting in-hospital mortality and the need for ICU admission. Results: The study revealed that the conventional CURB-65 score could predict in-hospital mortality with an area under the curve (AUC) of 0.81 and the need for ICU admission with an AUC of 0.87. Using the eCURB-65 elements proved to be superior to the conventional CURB-65 in predicting in-hospital mortality with cut off point >7.5 and an AUC of 0.83 (P 3.8 and an AUC of 0.89 (P