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Background: Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study. Methods: We conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (⩾18 years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded. Results: Out of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 60-84), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment. Conclusions: Our results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment. [ABSTRACT FROM AUTHOR]

Aim To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection. Methods The retrospective observational study included all mechanically ventilated adult patients of three university- affiliated hospitals between November T 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerasechain- reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Results The study included 50 patients, 31 male (62%), aged 43±13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%. Conclusion Influenza 2009 H1N1 infection in three southeast European ICUs affected predominantly healthy young patients and was associated with rapid deterioration after hospital admission and severe respiratory and multiorgan failure. These emerging ICUs provided contemporary ICU services, resulting in case-fatality rate comparable to reports from well-established ICU settings. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge of tuberculosis among patients with the disease is crucial for early disease recognition, patients' full cooperation during the treatment, and prevention of future relapses. Our major aim was to evaluate knowledge about tuberculosis among patients and its correlation to their socioeconomic status (education level, employment status, monthly income, living conditions). Patients and methods: In this prospective study we interviewed 200 adult patients with newly diagnosed, active pulmonary tuberculosis treated at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia (July, 2006-June, 2008). The information for analysis was obtained from two questionnaires and patients' medical records. Results: The majority of the patients, 158 (79%), were male, with a mean age of 49 years (±15.4). Most of the patients knew that tuberculosis is an infectious disease (n=188, 92%), but they were unaware of the cause (n=84, 42%). The patients with a higher education level (61.2% vs. 90%, p=0.03), satisfactory living conditions (88.7% vs. 63.2%, p=0.02), and higher economic status (78.4% vs. 100%, p=0.04) demonstrated more knowledge about the disease. Half of the patients (n=98, 49%) believed that concomitant diseases (HIV, tumors) might contribute to the genesis of tuberculosis. Conclusions: Patients with tuberculosis demonstrated good knowledge of their disease. Patients with higher socioeconomic status and education level were more knowledgeable about their disease. [ABSTRACT FROM AUTHOR]

Patients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p<0.0001; 1.7±0.3, p<0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists. [ABSTRACT FROM AUTHOR]

Transfusion-associated circulatory overload (TACO) is a frequent complication of blood transfusion. Investigations identifying risk factors for TACO in critically ill patients are lacking. We performed a 2-year prospective cohort study of consecutive patients receiving blood product transfusion in the medical intensive care unit (ICU) of the tertiary care institution. Patients were followed for development of transfusion-related complications. TACO was defined as acute hydrostatic pulmonary edema occurring within 6 hours of transfusion. In a nested case-control design, transfusion characteristics were compared between cases (TACO) and controls after matching by age, sex, and ICU admission diagnostic category. In a secondary analysis, patient characteristics before transfusion were compared between cases (TACO) and randomly selected controls. Fifty-one of 901 (6%) transfused patients developed TACO. Compared with matched controls, TACO cases had a more positive fluid balance (1.4 L vs. 0.8 L, p = 0.003), larger amount of plasma transfused (0.4 L vs. 0.07 L, p = 0.007), and faster rate of blood component transfusion (225 mL/hr vs. 168 mL/hr, p = 0.031). In a secondary analysis comparing TACO cases and random controls, left ventricular dysfunction before transfusion (odds ratio [OR], 8.23; 95% confidence interval [CI], 3.36-21.97) and plasma ordered for the reversal of anticoagulant (OR, 4.31; 95% CI, 1.45-14.30) were significantly related to the development of TACO. Volume of transfused plasma and the rate of transfusion were identified as transfusion-specific risk factors for TACO. Left ventricular dysfunction and fresh-frozen plasma ordered for the reversal of anticoagulant were strong predictors of TACO before the onset of transfusion. [ABSTRACT FROM AUTHOR]

The article presents a study on the quality of life (QOL) and long-term survivability of patients who developed post-transfusion edema either through transfusion-related acute lung injury (TRALI), or transfusion-associated circulatory overload (TACO). It states that QOL and survival was compared between patients who experienced TACO or TRALI and those who did not. It reveals that TRALI rather than TACO is associated with less long-term survivability of patients.

BACKGROUND: The diagnostic workup of transfusion-related acute lung injury (TRALI) requires an exclusion of transfusion-associated circulatory overload (TACO). Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic (NT-pro-BNP) accurately diagnosed TACO in preliminary studies that did not include patients with TRALI. STUDY DESIGN AND METHODS: In this prospective cohort study, two critical care experts blinded to serum levels of BNP and NT-pro-BNP determined the diagnosis of TRALI, TACO, and possible TRALI based on the consensus conference definitions. The accuracy of BNP and NT-pro-BNP was assessed based on the area under the receiver operating curve (AUC). RESULTS: Of 115 patients who developed acute pulmonary edema after transfusion, 34 were identified with TRALI, 31 with possible TRALI, and 50 with TACO. Median BNP was 375 pg per mL (interquartile range [IQR], 123 to 781 pg/mL) in TRALI, 446 pg per mL (IQR, 128 to 743 pg/mL) in possible TRALI, and 559 pg per mL (IQR, 288 to 1348 pg/mL) in TACO patients (p = 0.038). The NT-pro-BNP levels among patients with TRALI, possible TRALI, and TACO differed significantly with a median value of 1559 pg per mL (IQR, 629 to 5114 pg/mL), 2349 pg/mL (IQR, 919 to 4610 pg/mL), and 5197 pg/mL (IQR, 1695 to 15,714 pg/mL; p = 0.004), respectively. The accuracy of BNP and NT-pro-BNP to diagnose TACO was moderate with an AUC of 0.63 (95% confidence interval [CI], 0.51-0.74) and 0.70 (95% CI, 0.59 to 0.80). CONCLUSIONS: Natriuretic peptides are of limited diagnostic value in a differential diagnosis of pulmonary edema after transfusion in the critically ill patients. [ABSTRACT FROM AUTHOR]