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Background Early diagnosis of acute kidney injury (AKI) in neonates is difficult with a high mortality rate. However, there is currently a lack of research on severe neonatal asphyxia complicated with AKI. Objective To investigate the risk factors and short-term prognosis of neonatal asphyxia complicated with AKI, and analyze the predictive value of related factors, so as to take measures to reduce the occurrence of AKI and improve the success rate of resuscitation of the neonates. Methods A total of 172 neonates with severe asphyxia who were hospitalized in the Neonatal Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2023 were included as the study subjects and divided into AKI group (n=43) and non-AKI group (n=129) according to whether the neonates were complicated with AKI. Clinical data and laboratory results were collected, and the short-term prognosis (survival or death during hospitalization) of the children with AKI was recorded. Multivariate Logistic regression analysis was used to explore the influencing factors of severe neonatal asphyxia complicated with AKI, and receiver operating characteristics (ROC) curve was used to explore the predictive value of related indicators for severe neonatal asphyxia complicated with AKI. Results Gestational age, birth weight, 5-min Apgar score and platelet count in AKI group were lower than those in non-AKI group, and the proportions of coma, invasive mechanical ventilation and combined respiratory failure, cystatin C (Cys C) were higher than those in non-AKI group, with statistically significant difference (P

Introduction. During the SARS-CoV-2 pandemic, many countries experienced decreased respiratory virus circulation, followed by an out-of-season outbreak. In a pediatric hospital in Colombia, we observed a surge in severe adenovirus infections, leading to concerns about the impact of eased public health restrictions and immune debt in children under five years old. Objective. To describe the clinical characteristics of patients with severe adenovirus infection in a pediatric hospital in Colombia. Materials and methods. We reviewed the data of 227 patients with severe adenovirus infection at the Fundación Hospital Pediátrico La Misericordia. Results. A total of 196 patients were included in this study. The median age was two years, and 62% were male. Adenoviruses were isolated from all patients’ samples. Ninetyseven percent were admitted to the pediatric intensive care unit, 94% required respiratory support, and the in-hospital lethality rate was 11%. Conclusion. In 2022, there was an outbreak of severe adenovirus infections, affecting mainly children under five years of age, with higher-than-usual mortality.

Introduction. Congenital tongue base cysts are uncommon in everyday clinical practice and they could be asymptomatic or cause stridor, respiratory distress and asphyxia. We are presenting a case of two-month-old infant with the symptoms of stridor and the acute respiratory insufficiency caused by congenital tongue base cyst. Case outline. A two-month-old apyretic male infant was admitted to hospital with the symptoms of severe dyspnea, nonproductive cough and stridor. Due to severe respiratory insufficiency the infant was on mechanical ventilation. Computed tomography scans of thorax and neck was performed along with the application of the intravenous contrast where a cystic formation was shown. The depicted formation narrowed the lumen of oropharynx which is the same as the size of valleculas (3 mm). The formations pressed both valleculas, more significantly the left one. The same day the marsupialization of the cyst was done and the material was sent to the pathohistological analysis (the report of the pathologist indicates the cyst of the thyroid channel). Conclusion. Clinical manifestations of cyst depend on the level of obstruction and can be presented as inspiratory stridor, apnea, cyanosis, chronic coughing and feeding difficulty. The flexible nasopharyngeal laryngoscopy or bronchoscopy, CT and MR imaging help consider the differential diagnosis. The symptoms of stridor were removed completely after applied marsupialization of the cyst.

Background Extracorporeal membrane oxygenation (ECMO) has been widely used in the treatment of various acute and critical heart and respiratory failure diseases. However, platelet (PLT) counts decrease significantly during the treatment, which increases the risk of bleeding and thus affecting the prognosis of patients. Therefore, the explore of changes in PLT counts during ECMO support can help prevent bleeding related risks caused by thrombocytopenia, thus improving the prognosis of patients. Objective To retrospectively analyse the changes of PLT counts during ECMO support under different support modes. Methods 40 adult patients received veno-venous ECMO (V-V ECMO) or veno-arterial ECMO (V-A ECMO) support from January 2019 to October 2021 at the heart center of the People's Hospital of Gaozhou were included as study subjects and divided into the death group (n=22) and survival group (n=18) according to the occurrence of death after ECMO. PLT and platelet infusion were collected at baseline, before ECMO, and during the intervention. Results The average age of patients was (49.0±17.8) years, and the average duration of ECMO support was (6.0±3.2) days. There was statistically significant difference in the proportion of ECMO intervention reasons between the operation group and the non-operation group (P

Abstract Background Limb-girdle muscular dystrophies (LGMDs) are a group of heterogeneous inherited diseases predominantly characterized by limb-girdle muscle weakness and dystrophic changes on histological analysis. The frequency of LGMD subtypes varies among regions in China and ethnic populations worldwide. Here, we analyzed the prevalence of LGMD subtypes, their corresponding clinical manifestations, and molecular data in a cohort of LGMD patients in Southeast China. Methods A total of 81 consecutive patients with clinically suspected LGMDs from 62 unrelated families across Southeast China were recruited for targeted next-generation sequencing and whole-exome sequencing from July 2017 to February 2020. Results Among 50 patients (41 families) with LGMDs, the most common subtypes were LGMD-R2/LGMD2B (36.6%) and LGMD-R1/LGMD2A (29.3%). Dystroglycanopathies (including LGMD-R9/LGMD2I, LGMD-R11/LGMD2K, LGMD-R14/LGMD2N and LGMD-R20/LGMD2U) were the most common childhood-onset subtypes and were found in 12.2% of the families. A total of 14.6% of the families had the LGMD-R7/LGMD2G subtype, and the mutation c.26_33dupAGGTGTCG in TCAP was the most frequent (83.3%). The only patient with the rare subtype LGMD-R18/LGMD2S had TRAPPC11 mutations; had a later onset than those previously reported, and presented with proximal‒distal muscle weakness, walking aid dependency, fatty liver disease and diabetes at 33 years of age. A total of 22.0% of the patients had cardiac abnormalities, and one patient with LMNA-related muscular dystrophy/LGMD1B experienced sudden cardiac death at 37 years of age. A total of 15.4% of the patients had restrictive respiratory insufficiency. Muscle imaging in patients with LGMD-R1/LGMD2A and LGMD-R2/LGMD2B showed subtle differences, including more severe fatty infiltration of the posterior thigh muscles in those with LGMD-R1/LGMD2A and edema in the lower leg muscles in those with LGMD-R2/LGMD2B. Conclusion We determined the prevalence of different LGMD subtypes in Southeast China, described the detailed clinical manifestations and distinct muscle MRI patterns of these LGMD subtypes and reported the frequent mutations and the cardiorespiratory involvement frequency in our cohort, all of which might facilitate the differential diagnosis of LGMDs, allowing more timely treatment and guiding future clinical trials.

Key Clinical Message We used independent lung ventilation (ILV) during veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) after lung abscess surgery in a patient with severe hypoxia and air leak. ILV can be effective in V‐V ECMO as unilateral lung air leak.

Metofluthrin is a volatile pyrethroid insecticide. Despite being widely used as a safe household insecticide, it could cause severe systemic symptoms. A 19-month-old girl was taken to the emergency department after ingesting 1 mL of a mosquito repellent containing metofluthrin. After the arrival, the girl developed respiratory distress, which worsened progressively despite the administration of oxygen with nebulized salbutamol and budesonide. Additionally, she underwent application of high-flow nasal cannula, and administration of activated charcoal and systemic steroids. Her dyspnea gradually improved, and she was thus discharged on day 4 with oral prednisolone. All medications were discontinued 10 days after the discharge without any complication. Respiratory distress can develop after the ingestion of even a small amount of metofluthrin. Symptomatic and adjunctive steroid therapies can be effective therapeutic options.

Introduction: Coronavirus disease 2019 (COVID-19) induces organic damage mainly through the patient's immune overreaction. Hemoperfusion (HPF) can remove inflammatory cytokines and can reduce the negative effects of cytokine storm in COVID-19. We compared the mortality rate, inflammatory response, and acute kidney injury (AKI) prevalence among patients suffering from respiratory insufficiency secondary to COVID-19 treated with and without HPF with HA330 cartridge. Methods: Mortality rate, serum creatinine, and ferritin values were compared between patients suffering from respiratory insufficiency secondary to COVID-19 who received conventional treatment and another group of patients who additionally received four sessions of HPF with HA330. Results: Of 116 patients suffering from acute respiratory insufficiency secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), one group (n: 84) received support treatment and the other group (n: 32) additionally received HPF with HA330 cartridge. Both groups had no renal disease and similar age and comorbidities at admission, except for obesity and mechanical ventilation requirement, which were significantly higher in the HPF group. Mortality rate (61% vs. 31%, P: 0.008), serum creatinine (1.4 vs. 0.5 mg/dl, P < 0.001), and post-HPF serum ferritin (2868 vs. 1675, P < 0.001) were significantly lower in the HPF group. Conclusion: Mortality rate, serum ferritin, and AKI were significantly reduced in critical COVID-19 patients who received HPF with HA330 cartridge than in those who did not receive it. These results were obtained despite the HPF group risk factors, such as obesity and mechanical ventilation, worsening its prognosis. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation support for respiratory failure in the intensive care unit continues to have an expanded role in select patients. While acute respiratory distress syndrome remains the most common indication, extracorporeal membrane oxygenation may be used in other causes of refractory hypoxemia and/or hypercapnia. The most common configuration is veno-venous extracorporeal membrane oxygenation; however, in specific cases of refractory hypoxemia or right ventricular failure, some patients may benefit from veno-pulmonary extracorporeal membrane oxygenation or veno-venoarterial extracorporeal membrane oxygenation. Patient selection and extracorporeal circuit management are essential to successful outcomes. This narrative review explores the physiology of extracorporeal membrane oxygenation, indications and contraindications, ventilator management, extracorporeal circuit management, troubleshooting hypoxemia, complications, and extracorporeal membrane oxygenation weaning in patients with respiratory failure. As the footprint of extracorporeal membrane oxygenation continues to expand, it is essential that clinicians understand the underlying physiology and management of these complex patients.

Advances in perinatal and pediatric intensive care and recent advances in mechanical ventilation during the last two decades have resulted in an exponential increase in the number of children undergoing home mechanical ventilation (HMV) treatment. Although its efficacy in chronic respiratory failure is well established, HMV in children is more complex than that in adults, and there are more considerations. This review outlines clinical considerations for HMV in children. The goal of HMV in children is not only to correct alveolar hypoventilation but also to maximize development as much as possible. The modes of ventilation and ventilator settings, including ventilation masks, tubing, circuits, humidification, and ventilator parameters, should be tailored to the patient’s individual characteristics. To ensure effective HMV, education for the parent and caregiver is important. HMV continues to change the scope of treatment for chronic respiratory failure in children in that it decreases respiratory morbidity and prolongs life spans. Further studies on this topic with larger scale and systemic approach are required to ensure the better outcomes in this population.

Abstract Background and Aims The timing of transition from non‐invasive ventilation (NIV) to invasive ventilation in the intensive care unit (ICU) is uncertain due to a lack of clinical evidence. This study aimed to identify the optimal timing of intubation in patients with respiratory failure managed with NIVs. Methods A single‐center observational study was conducted in Tokyo, Japan. Patients in the ICU managed with NIV between 2013 and 2022 were screened. The primary outcome was 28‐day invasive ventilator‐free days. Statistical analyses used locally estimated scatter plot smoothing (LOESS) and generalized linear mixed models to estimate the association between the timing of transition and prolonged intubation duration. Results During the study period, 139 of 589 adult ICU patients receiving NIV transitioned to invasive ventilation. The LOESS curve indicated the longest 28‐day ventilator‐free days around 24 h after NIV initiation, after which the primary outcome decreased linearly. Late intubation after 24 h of NIV initiation was associated with fewer 28‐day ventilator‐free days (adjusted mean difference: −0.22 days [95% confidence interval: −0.31, −0.13]). Conclusion We identified a non‐linear association between the timing of intubation and 28‐day invasive ventilator‐free days. The critical 24‐h time window for patients on NIV was associated with longer 28‐day invasive ventilator‐free days.

At our Pneumology Department, we dealt with three waves of COVID-19 pandemics. The purpose of this study is to compare patients' epidemiological and clinical characteristics across waves and to assess the effect of vaccination on clinical presentation, course, and prognosis. From March 2020 to March 2022, a retrospective cohort study was conducted to compare patient characteristics. Based on the time of hospital admission, data from 456 patients were collected and divided into three groups (IW, IIW, and IIIW). In addition, we looked at the link between vaccination and clinical presentation and hospitalization outcome. The average age and comorbidities of patients increased, as did the worsening of respiratory conditions at admission (PaO2/FiO2 median 207 in IW, 95.5 in IIW, and 99 in IIIW). Continuous positive airway pressure (CPAP) was the primary respiratory support during the first wave, but an increase in the use of high flow nasal cannula and noninvasive ventilation was later observed, resulting in a higher hospital discharge rate and a lower intubation rate. Vaccinated patients had less severe COVID-19-related respiratory failure, a better clinical course, and a higher hospital discharge rate (71.4% in V-group vs 44.7% in NV-group, p

Background Obstructive sleep apnea-hypopnea syndrome (OSAHS) can cause secondary polycythemia and elevated hemoglobin, but the prevalence and predictive value of elevated hemoglobin in OSAHS patients remain unclear. Objective To explore the prevalence and associated factors of elevated hemoglobin (HGB) and its potential role in predicating pulmonary hypertension and type Ⅱ respiratory failure in OSAHS patients. Methods We conducted a retrospective analysis of 1 035 patients with OSAHS diagnosed by polysomnography who were hospitalized at Sleep Medical Center, First People's Hospital of Yunnan Province from 2018 to 2020. Data of polysomnography, clinical parameters, and comorbidity were compared between 145 cases with polycythemia and 145 cases with normal HGB. The propensity score matching (PSM) was used to balance the baseline variables of the age, sex and BMI. Spearman correlation and multiple regression analysis were used to explore the associated factors of HGB level. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of elevated HGB for pulmonary hypertension and type Ⅱ respiratory failure in OSAHS. Results The overall prevalence of polycythemia was 16.8% (174/1 035) in OSAHS patients. Males (25.7%, 157/610) had higher prevalence of polycythemia than females (4.0%, 17/425) (P

ABSTRACT BACKGROUND: Respiratory failure is the most common cause of death in patients with amyotrophic lateral sclerosis (ALS), and morbidity is related to poor quality of life (QOL). Non-invasive ventilation (NIV) may be associated with prolonged survival and QOL in patients with ALS. OBJECTIVES: To assess whether NIV is effective and safe for patients with ALS in terms of survival and QOL, alerting the health system. DESIGN AND SETTING: Systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards using population, intervention, comparison, and outcome strategies. METHODS: The Cochrane Library, CENTRAL, MEDLINE, LILACS, EMBASE, and CRD databases were searched based on the eligibility criteria for all types of studies on NIV use in patients with ALS published up to January 2022. Data were extracted from the included studies, and the findings were presented using a narrative synthesis. RESULTS: Of the 120 papers identified, only 14 were related to systematic reviews. After thorough reading, only one meta-analysis was considered eligible. In the second stage, 248 studies were included; however, only one systematic review was included. The results demonstrated that NIV provided relief from the symptoms of chronic hypoventilation, increased survival, and improved QOL compared to standard care. These results varied according to clinical phenotype. CONCLUSIONS: NIV in patients with ALS improves the outcome and can delay the indication for tracheostomy, reducing expenditure on hospitalization and occupancy of intensive care unit beds. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database: CRD42021279910 — https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279910.

Background Measurement of lung function during tidal breathing is an important method in the diagnosis, management and severity assessment for infants with respiratory diseases. Nasal obstruction is a common comorbidity of respiratory tract infections, and severe nasal obstructionmay affect the results of pulmonary function test. Objective To assess the association of nasal obstruction with pulmonary function and airway resistance during tidal breathing, and to evaluate the effect of normal saline nasal drops on relieving nasal congestion and improving pulmonary function in infants with wheezing. Methods A total of 55 children with wheezing were included, including wheezing with nasal congestion in 25 cases and wheezing without nasal congestion in 30 cases. Fifty-five infants with wheezing as the chief symptom who were treated in the First Affiliated Hospital of Guangzhou Medical University were retrospectively selected from June 2015 to May 2016. They received the measurement of pulmonary function during tidal breathing, respiratory resistance using the respiratory resistance tester with single-breath method and body plethysmography. Nasal obstruction was assessed, and those with three points were excluded, the remaining infants with 0 and 1-2 points were assigned to wheezing without nasal obstruction group (n=30), wheezing with nasal obstruction group (n=25), respectively. Baseline lung functions were compared between wheezing with nasal obstruction group before nasal obstruction treatment and without nasal obstruction group. And pulmonary functions of wheezing with nasal obstruction group were compared before and after nasal obstruction treatment. Results Wheezing infants with nasal obstruction had higher specific effective airway resistance (sReff) and effective airway resistance (Reff) than those without (P

Key Clinical Message Although extracorporeal membrane oxygenation is relatively contraindicated in patients with severe disseminated intravascular coagulation (DIC), it can be safely introduced by providing adequate anti‐DIC therapy.

Background: Health-related quality of life (HRQOL) refers to perceived physical, mental, emotional, and social well-being. The purpose of this study is to evaluate HRQOL in patients with chronic respiratory failure (CRF). Methods: The present mixed methods study is conducted since 2020 by simultaneous implementation of quantitative and qualitative phases. The quantitative phase is cross-sectional research to determine HRQOL in patients with CRF. In this phase, 171 patients will be selected based on the inclusion criteria from the internal medicine, respiratory, and neurology wards of hospitals affiliated with the Golestan University of Medical Sciences (Gorgan, Iran). The stratified sampling method is applied by calculating the bed occupancy rate. To collect data in this phase, the Persian version of the HRQOL questionnaire will be used for patients with CRF. In addition, the questionnaire will be translated and evaluated in terms of psychometric properties. Data obtained from the quantitative phase are analyzed by descriptive statistics using SPSS 16 software. Simultaneously with the quantitative phase, the researcher will achieve an understanding of HRQOL in the patients by using the contractual content analysis method in the qualitative phase. In this phase, the subjects will be selected via Purposeful sampling. Data are collected through semi-structured interviews and sampling will continue until reaching data saturation. Data analysis is done by the Graneheim and Lundman method. In this regard, after extracting and categorizing the codes, subclasses and classes will be formed. Finally, the findings of the quantitative and qualitative phases will be compared and integrated for discussion and interpretation of the data. Conclusion: Evaluation of HRQOL by implementing combined qualitative and quantitative approaches can provide a complete picture of this concept in patients with CRF. Moreover, the results of such studies can help predict outcomes and the efficacy of therapeutic interventions.

BackgroundPatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have a significantly increased risk of developing type Ⅱ respiratory failure. In clinical treatment, BiPAP is widely used in this kind of patients to correct respiratory acidosis and delay the deterioration of lung function, but the therapeutic effect of BiPAP in this kind of patients is still controversial.ObjectiveTo systematically review the effect of BiPAP intervention on the treatment of patients with AECOPD complicated with type Ⅱrespiratory failure.MethodsCNKI, Wanfang Database, CQVIP, CBM, PubMed, The Cochrane Library, Springer, Medline, and Web of Science were retrived by computer for the RCTs published from inception to October 2020 regarding the application of BiPAP in patients with AECOPD complicated with type Ⅱ respiratory failure. Two researchers independently screened the retrieved documents, extracted data and evaluated the quality. The first author, country, population characteristics, age, sample size, intervention methods of the experimental group and control group, frequency and duration of intervention of the experimental group, outcome indicators〔pH, partial pressure of carbon dioxide (PaCO2) , partial pressure of oxygen (PaO2) , respiratory frequency (RR) , tracheal intubation rate, incidence of adverse reactions〕 and other information were extracted. The Review Manager 5.4 software was used to conduct a meta-analysis of the included literature, and the TSA v0.9 developed by the Copenhagen Clinical Trial Center was used to complete the trial sequential analysis.ResultsA total of 10 RCTs were included, of which 4 were of high quality and 6 were of medium quality. The experimental group could improve the pH value of patients with acute COPD and type Ⅱ respiratory failure 〔MD=0.04, 95%CI (0.03, 0.04) , P

Background Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitoring the oxygen reserve index (ORi) can detect hypoxia earlier. Case We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention. Conclusions Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.

Background: Diffuse parenchymal lung disease (DPLD) is the inflammation and fibrosis of lung interstitium, resulting in respiratory failure. The rate of hypoxic respiratory failure is high as the disease progresses. In idiopathic pulmonary fibrosis (IPF) patients, acute deterioration leads to type 2 respiratory failure, etiology and management of which remains to be completely understood. Aims and Objectives: To identify the causes of type 2 respiratory failure and assess the outcome of invasive and non-invasive ventilation in patients with IPF. Materials and Methods: This prospective single center study included >18-year-old 44 patients with IPF. History of patients, complete blood count, chest radiograph, urine routine, spirometry with bronchodilator reversibility, DLCO (diffusing capacity for carbon monoxide) testing, arterial blood gas measurements, and antinuclear antibody (ANA) test were evaluated. Results: Fourteen (31.8%) patients developed type 2 respiratory failure (within 1.5–6 years from the time of onset of illness). Causes of respiratory failure included acute exacerbation of IPF (35.71%), infections (14.29%), heart failure (14.29%), ischemic heart disease (14.29%), pulmonary embolism (21.43%), pneumothorax (7.14%), and surgical lung biopsy (7.14%). Patients were initiated on non-invasive mechanical ventilation (NIV) (64.29%) and invasive mechanical ventilation (IMV) (35.71%). Eight (88.89%) out of 9 patients on NIV survived, whereas all 5 patients (100%) on IMV expired. Conclusion: Considering the higher mortality rate associated with IMV, NIV is a better technique than IMV for improving patient outcome and management. NIV may be effectively implemented for improving the treatment outcome in patients with IPF and avoiding any aggressive therapeutic approaches.

Children, although mostly affected mildly or asymptomatically, have also developed severe coronavirus disease 2019 (COVID-19). This study aims to assess potential predictors of intensive care unit (ICU) admission in a large population (n = 21,121) of children aged 0–9 years with laboratory-confirmed disease. We performed a cross-sectional analysis of a publicly available dataset derived from the normative epidemiological surveillance of COVID-19 in Mexico. The primary binary outcome of interest was admission to the ICU due to respiratory failure. Results showed that immunosuppressed children and those with a personal history of cardiovascular disease had a higher likelihood of being admitted to the ICU, while increasing age and the pandemic duration were associated with a lower likelihood of admission. The study’s results have the potential to inform clinical decision-making and enhance management and outcomes for children affected by COVID-19 in Mexico.

Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.

Hypomagnesemia is an electrolyte disorder associated with decreased nutritional intake, gastrointestinal losses, and renal clearance of magnesium, a divalent cation that, having a higher concentration at the intracellular level, makes it difficult to analyze its absolute deficit and establish an adequate correction that supplies daily losses and requirements; For this reason, knowledge of the etiologies of hypomagnesemia, as well as the calculation of the excreted fraction of magnesium and measurement of magnesiuria in 24 hours, are useful tools to establish adequate guidelines for continuous magnesium correction, in order to avoid complications associated with its toxicity or poor correction that perpetuates this electrolyte disorder, and generates the appearance of symptoms as severe as tetany and ventilatory failure. These severe manifestations were resent in the patient described, who, in the absence of shock or base acid disorder, required admission to the intensive care unit for invasive mechanical ventilation and correction of their electrolyte disorders associated with ulcerative colitis (hypocalcemia, hypokalemia, and hypomagnesemia).

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory process characterized by hyperostosis at tendon insertions and around joint capsules and ossification of the anterior longitudinal ligament of the spine. The flexibility of the spinal column is reduced in DISH and affects the movement of the thorax, leading to restrictive ventilatory function. In this report, we describe the first two cases of severe type 2 (hypercapnic) respiratory failure associated with DISH. Two older men presented with histories of shortness of breath. Radiography of the spine revealed DISH with coexisting ankylosis of the costovertebral joints. The patients’ thoracic motion was severely restricted, reducing the mechanism of lung expansion to diaphragm contraction only. Both patients required non-invasive positive-pressure ventilation therapy to cope with their conditions. Our report sheds light on the risk of potentially life-threatening respiratory manifestations of DISH among older adults.

Resumen: El síndrome respiratorio agudo severo causado por el coronavirus SARS-CoV-2 lleva a padecer insuficiencia respiratoria e hipoxemia grave y requiere la implementación de ventilación mecánica invasiva, además de estrategias como la posición en decúbito prono para mejorar la oxigenación arterial. Las complicaciones extrapulmonares como neumotórax espontáneo, neumomediastino o derrame pleural complican su manejo, en especial en posición de decúbito prono. La toracostomía con colocación de sonda pleural es el tratamiento de primera línea; este procedimiento conlleva un riesgo elevado de contagio por la generación de aerosoles, además del riesgo de lesión pulmonar durante la inserción del drenaje pleural debido a la posición en decúbito prono. Informamos un caso de infección por SARS-CoV-2 con asistencia ventilatoria mecánica complicada con neumotórax espontáneo que requirió colocar drenaje pleural cuando el paciente se encontraba en posición de decúbito prono. Describimos la técnica, que no se encuentra descrita en la literatura. Abstract: The severe acute respiratory syndrome caused by the SARS-CoV-2 coronavirus, leads to respiratory failure and severe hypoxemia, and requires the implementation of invasive mechanical ventilation in addition to strategies such as prone position to improve arterial oxygenation. Extrapulmonary complications such as spontaneous pneumothorax, pneumomediastinum, pleural effusion complicate its management, especially in the prone position. Chest tube thoracostomy is the first treatment line. This procedure leads to a high risk of contagion by the generation of aerosols, in addition to the risk of lung injury during insertion of the pleural drain due to the prone position. We report a case of SARS-CoV-2 infection with mechanical ventilatory assistance complicated by spontaneous pneumothorax that required placement of pleural drainage when the patient was in the prone position. We describe the technique that is not described in the literature.

Background/Aims Current evidence supports lung ultrasound as a point-of-care alternative diagnostic tool for various respiratory diseases. We sought to determine the utility of lung ultrasound for early detection of pneumonia and for assessment of respiratory failure among patients with coronavirus disease 2019 (COVID-19). Methods Six patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction were enrolled. All had undergone chest X-ray and chest computed tomography (CT) on the day of admission and underwent multiple point-of-care lung ultrasound scans over the course of their hospitalization. Results Lung ultrasound detected early abnormal findings of representative B-lines in a patient with a normal chest X-ray, corresponding to ground-glass opacities on the chest CT scan. The ultrasound findings improved as her clinical condition improved and her viral load decreased. In another minimally symptomatic patient without significant chest X-ray findings, the ultrasound showed B-lines, an early sign of pneumonia before abnormalities were detected on the chest CT scan. In two critically ill patients, ultrasound was performed to assess for evaluation of disease severity. In both patients, the clinicians conducted emergency rapid sequence intubation based on the ultrasound findings without awaiting the laboratory results and radiological reports. In two children, ultrasound was used to assess the improvement in their pneumonia, thus avoiding further imaging tests such as chest CT. Conclusions Lung ultrasound is feasible and useful as a rapid, sensitive, and affordable point-of-care screening tool to detect pneumonia and assess the severity of respiratory failure in patients hospitalized with COVID-19.

Freeman-Sheldon syndrome (FSS) is a rare distal arthrogryposis syndrome. There are few reports on the respiratory insufficiency of FSS. Additionally, there is no detailed information on pulmonary functional evaluation. A 17-year-old male patient with FSS developed respiratory failure, leading him to be admitted to hospital several times for evaluation and treatment. Of those times he was admitted, two were due to pneumonia. His pulmonary functions were indicative of a restrictive lung disease potentially caused by severe scoliosis. After a non-invasive ventilatorwas applied correctly to the patient, pulmonary hypertension was normalized. His pulmonary function has been maintained for 13 years. Since receiving proper respiratory care, which includes assisted coughing methods, the patient has not developed pneumonia. It is important to properly evaluate the pulmonary function of patients who have FSS and scoliosis to eliminate the risk of long-term respiratory complications.

Abstract Background Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and is associated with high mortality. Noninvasive oxygenation strategies such as high-flow nasal cannula, standard oxygen therapy, and noninvasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network meta-analysis is to summarize the evidence and compare the effect of noninvasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure. Methods We will search key databases for randomized controlled trials assessing the effect of noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology. Discussion This study will help to guide clinical decision-making when caring for adult patients with acute hypoxemic respiratory failure and improve our understanding of the limitations of the available literature assessing noninvasive oxygenation strategies in acute hypoxemic respiratory failure. Systematic review registration PROSPERO CRD42019121755

Some studies have found that patients with asthma have bilateral foot dorsal flexion limitations, contributing to impaired quality of life. The authors hypothesised that foot misalignments could also occur in patients with chronic obstructive pulmonary disease (COPD), and that foot orthoses could increase the motor benefits of their pulmonary rehabilitation (PR). Presented herein are the results from a nonrandomised controlled study in 40 patients with COPD. Twenty patients had foot misalignment (Group 1) and wore foot orthoses for a 1-month PR period. Their data were compared to those obtained in 20 other patients with COPD who had no foot misalignment and did not wear foot orthoses (Group 2). Bodily fatigue, 6-minute walk test (6MWT) distance, peak plantar flexion force (PFF), and oscillations of the centre of pressure (CoP) were measured. Measurements were performed prior to and following completion of PR (Groups 1 and 2), immediately after wearing the foot orthosis (Group 1), and after completion of PR plus foot orthoses (Group 1). In Group 2, PR increased the 6MWT distance, but did not increase PFF nor reduce CoP oscillations and fatigue scale. Wearing the foot orthosis for the first time significantly increased the 6MWT distance (+98+12 m). Following PR with foot orthoses (Group 1), a further increase in 6MWT distance occurred (+120+13 m), bodily fatigue was reduced, PFF increased, and CoP oscillations decreased. In patients with COPD and foot misalignment, foot orthoses enhanced the functional capacity and improved the postural control.

Hospitalized patients with COVID-19 are at increased risk of thrombosis, acute respiratory distress syndrome and death. The optimal dosage of thromboprophylaxis is unknown. The aim was to evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate, and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia. PROTHROMCOVID is a randomized, unblinded, controlled, multicenter trial enrolling non-critical, hospitalized adult patients with COVID-19 pneumonia. Patients were randomized to prophylactic (4500 IU), intermediate (100 IU/kg), or therapeutic (175 IU/kg) groups. All tinzaparin doses were administered once daily during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non-invasive mechanical ventilation, or death within 30 days. The main safety outcome was major bleeding at 30 days. Of the 311 subjects randomized, 300 were included in the prespecified interim analysis (mean [SD] age, 56.7 [14.6] years; males, 182 [60.7%]). The composite endpoint at 30 days from randomization occurred in 58 patients (19.3%) of the total population; 19 (17.1 %) in the prophylactic group, 20 (22.1%) in the intermediate group, and 19 (18.5%) in the therapeutic dose group (p = 0.72). No major bleeding event was reported; non-major bleeding was observed in 3.7% of patients, with no intergroup differences. Due to these results and the futility analysis, the trial was stopped. In non-critically ill COVID-19 patients, intermediate or full-dose tinzaparin compared to standard prophylactic doses did not appear to affect the risk of thrombotic event, non-invasive ventilation, or mechanical ventilation or death. Trial RegistrationClinicalTrials.gov Identifier (NCT04730856). Edura-CT registration number: 2020-004279-42.

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.

Fundamento: la tomografía de pulmón es el estudio de elección para evaluar el parénquima pulmonar en la enfermedad intersticial pulmonar difusa, este tipo de lesión puede ser causado por la COVID-19.Objetivo: describir hallazgos clínicos, radiológicos y tomográficos, en pacientes diagnosticados con la COVID-19 en el Hospital Cubano de Catar, entre marzo y junio de 2020.Métodos: se realizó un estudio descriptivo a una serie de 15 casos positivos a la COVID-19, con estudio de tomografía axial computarizada (TAC) de tórax, atendidos en el hospital y periodo de tiempo declarados. Se dividió la muestra en dos grupos: evolución satisfactoria y no satisfactoria. Se evaluaron: edad, sexo, nacionalidad, presencia de comorbilidades, exámenes de laboratorio (leucograma, lactato deshidrogenasa (LDH), proteína C reactiva, glucemia), Rx inicial de tórax, hallazgos tomográficos (cantidad de segmentos afectados, morfología de la lesión y justificación del estudio).Resultados: los grupos de edades más numerosos fueron los de 41-50 y 51-60 años. Siete pacientes tuvieron evolución no satisfactoria y ocho satisfactoria. La nacionalidad filipina fue la más frecuente, los egipcios tuvieron peor evolución. El sexo femenino fue más numeroso y de peor evolución. La diabetes fue la comorbilidad que más incidió. Los pacientes con mala evolución mostraron: leucograma evolutivo, LDH, proteína C reactiva y glucemia alterados; Rx inicial de tórax con afectación de más de dos cuadrantes; lesiones de 10-18 segmentos en TAC de pulmón y presencia de lesiones en vidrio deslustrados.Conclusiones: se describieron los hallazgos clínicos, radiológicos y tomográficos encontrados, logrando tipificar características para los pacientes con mala evolución.

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ± 1.9 g.w. were included in the study. The average birth weight was 3182.5 ± 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our difficult to treat asthma and frequently unresponsive exacerbation. Brittle Asthma. Brittle asthma is a rare form of 1 severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF), 1in spite of high doses of inhaled steroids and bronchodilator therapy. Brittle asthmatic patients have very serious and often, life threatening, attacks. There are two forms of brittle asthma. CASE PRESENTATION We present the cases of a 45yr old Nurse anesthetics who was diagnosed>5yrs ago and a 56yr old unemployed who was diagnosed>15yrs ago. Both have been stable for years on add on maintenance therapy with high doses of inhaled corticosteroid and β2 agonist as oral salbutamol and an inhaler therapy 2 during exacerbation. Recently, both patients noticed worsening of symptoms despite high dose therapy, They have been in and out of hospital recently for uncontrolled asthma. They later had to be admitted in ICU because of respiratory insufficiency. These two lapsed into brittle asthma with recurrent bronchospasm, due to repeated exposure to anesthetic agents and environmental exposure at home respectively.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis.

There is limited evidence of the potential benefits of the use of high-flow nasal cannula (HFNC) for the management of bronchiolitis in the ward. Our aim is to describe the ventilation trends for bronchiolitis in our hospital along with the introduction of an HFNC ward protocol and to determine the need for respiratory support escalation and transfer to an intensive care unit (ICU). A retrospective analytical observational study of children < 12 months old requiring admission for a first RSV bronchiolitis episode in a single centre from January 2009 to December 2018. The sample was divided into four groups according to the type of respiratory support that would ensure the clinical stability of the infants on admission. A total of 502 infants were recruited. The total number and percentage of patients admitted in the ward grew progressively over time. Simultaneously, there was an increase in HFNC and, paradoxically, an increase in ICU transfers. The risk of failure was higher for those who required HFNC or CPAP for clinical stabilisation in the first 12 h after admission. Moreover, the risk of failure was also higher in children with standard oxygen therapy promptly escalated to HFNC, especially if they had atelectasis/viral pneumonia, coinfections or a history of prematurity. Despite the limitations of a retrospective analysis, our study reflects usual clinical practice and no correlation was found between the usage of HFNC and a shorter length of hospital stay or less time spent on oxygen therapy.

Acute respiratory failure is the primary cause of mortality in patients with acute pesticide poisoning. The aim of the present study was to develop a new and efficient score system for predicting acute respiratory failure in patients with acute pesticide poisoning. This study was a retrospective observational cohort study comprised of 679 patients with acute pesticide poisoning by intentional poisoning. We divided this population into a ratio of 3:1; training set (n = 509) and test set (n = 170) for model development and validation. Multivariable logistic regression models were used in developing a score-based prediction model. The Prediction of Respiratory failure in Pesticide intoxication (PREP) scoring system included a summation of the integer scores of the following five variables; age, pesticide category, amount of ingestion, Glasgow Coma Scale, and arterial pH. The PREP scoring system developed accurately predicted respiratory failure (AUC 0.911 [0.849−0.974], positive predictive value 0.773, accuracy 0.873 in test set). We came up with four risk categories (A, B, C and D) using PREP scores 20, 40 and 60 as the cut-off for mechanical ventilation requirement risk. The PREP scoring system developed in the present study could predict respiratory failure in patients with pesticide poisoning, which can be easily implemented in clinical situations. Further prospective studies are needed to validate the PREP scoring system.

Background: non-invasive mechanical ventilation (NIMV) has been on the increase during the last decades. The specialized literature reveals its undeniable success in medical care of seriously ill patients. However, publications on the use of this method in daily medical practice in Cuba are scarce.Objective: to characterize the patients with criterion of acute respiratory failure who required mechanical ventilation at the intensive care unit of the “Amalia Simoni Argilagos” General Teaching Hospital of Camagüey, from January 2018 to January 2019.Methods: a prospective longitudinal descriptive study was carried out with the patients, institution and period of time stated in the objective. The sample consisted of 52 patients. Two groups were formed: one for those who received non-invasive mechanical ventilation (cases) and another group with patients who were treated invasively according to traditional ventilation criteria (controls). The data were processed according to descriptive statistics.Results: non-invasive ventilation was applied mostly to young patients; pneumonia was the main cause of application of both ventilatory methods, followed by chronic obstructive pulmonary disease; most of those who received treatment with NIMV had a hospital stay of less than 7 days (78,84 %), this group also had a lower mortality.Conclusions: the patients who required mechanical ventilation were characterized. Better results were evidenced when using non-invasive mechanical ventilation.

Congenital acinar dysplasia is a lethal, developmental lung malformation resulting in neonatal respiratory insufficiency. This entity is characterized by pulmonary hypoplasia and arrest in the pseudoglandular stage of development, resulting in the absence of functional gas exchange. The etiology is unknown, but a relationship with the disruption of the TBX4-FGF10 pathway has been described. There are no definitive antenatal diagnostic tests. It is a diagnosis of exclusion from other diffuse embryologic lung abnormalities with identical clinical presentations that are, however, histopathologically distinct.

Pneumonia caused by Pneumocystis jirovecii is an uncommon infection in kidney transplant patients that can have an acute and rapid progression to respiratory failure and death. The period of greatest risk occurs in the first six months after the transplant, and it relates to the high doses of immunosuppression drugs required by patients. However, it may occur late, associated with the suspension of prophylaxis with trimethoprim-sulfamethoxazole. We present two cases of renal transplant patients who had severe hypoxemic respiratory failure due to P. jirovecii six years after transplantation. In addition to steroids, they received treatment with trimethoprim-sulfamethoxazole. One patient died, while the other had clinical recovery, with preservation of the renal graft function.

INTRODUCTION: To investigate the effect of tracheostomy on weaning and prognosis in patients undergoing long-term invasive mechanical ventilation (IMV) due to acute respiratory insufficiency. METHODS: The study was prospectively conducted on 24 tracheostomized T(+) and 26 non-tracheostomized T(-) patients who undergo long-term IMV due to acute respiratory insufficiency, between 2007-2009. RESULTS: The mean age of patients was 50+-18 in T(+) group and was 61+-18 years in T(-) group (p=0.04). The mean values of the APACHE II score on the first day were 22.25+-6 in the T(+) group and 27+-7 in the T(-) group, respectively (p=0.01). In T(+) group, the duration of intensive care and mechanical ventilation was longer than T(-) group, and the mean age and APACHE II score was lower (p0.05). In T(+) group, one patient developed transient tracheal stenosis and another one developed pneumothorax. The presence of acute renal failure (ARF) was associated with mortality, regardless of tracheostomy (P

Purpose: Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh.Method: All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD).Results: Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months.Conclusion: Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible. [ABSTRACT FROM AUTHOR]

(1) Background: According to the literature, most outcomes of neonates born to mothers infected with SARS-CoV-2 are favorable. This study aimed to assess the clinical characteristics of newborns born to infected women in a tertiary center in Poznan, Poland. (2) Methods: The study comprised 101 newborns delivered by women infected with SARS-CoV-2. The control group consisted of 101 newborns born before the pandemic. Data were collected retrospectively from the medical records. (3) Results: Most newborns of SARS-CoV-2-positive mothers were delivered by cesarean section—83.17% vs. 40.59% in the control group (p < 0.05). The groups did not differ in Apgar scores and the need for resuscitation. Newborns of SARS-CoV-2-positive mothers were more likely to present with respiratory distress and require respiratory support. The most common diagnosis was transient tachypnea of the newborn, not correlated with the mode of delivery. Newborns of the study group were never exclusively breastfed, 0% vs. 64.36% (p < 0.05). None of the patients in the study group was tested positive for the virus. (4) Conclusions: Infants born to SARS-CoV-2-positive mothers seem to be more at risk of moderate respiratory failure than other newborns. Separation of mother–baby dyads results in a dramatic fall in breastfeeding in the short-term post-partum period.