Case Report: Case report: Pulmonary hemorrhage as a rare cause of lung ultrasound A/B-profile

When using lung ultrasound to determine the cause of acute respiratory failure, the BLUE protocol is often used. In a 65-year old patient, an A/B-profile was found, suggesting pneumonia, following the flowchart of this protocol. In this case, however, pulmonary hemorrhage confirmed by bronchoscopy was the final diagnosis. This case report outlines the importance of understanding the limitations of the BLUE protocol and that lung ultrasound findings should always be used in the context of the patient’s history and physical exam. In addition, pulmonary hemorrhage should be considered in patients with no clinical signs of pneumonia and/or presence of risk factors for lung bleeding as a rare cause of lung ultrasound A/B-profile.

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Chest Ultrasonography in Diagnosing Etiology of Acute Respiratory Failure

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v19i1.26670 ◽

2020 ◽

Vol 19 (1) ◽

pp. 20-25

Author(s):

Chiranjibi Pant ◽

Anusmriti Pal ◽

Manoj Yadav ◽

Bishow Kumar Shrestha ◽

Suraj Rana

Keyword(s):

Critical Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Diagnostic Accuracy ◽

Lung Ultrasound ◽

Tertiary Care ◽

Cost Effective ◽

Final Diagnosis ◽

Chronic Obstructive ◽

Chest Ultrasonography

Introduction: Lung ultrasonography (LUS) is a useful diagnostic tool in critical care setting. Lung ultrasound at bed side is relatively easy to perform, cost effective and reproducible. Analysis of various sign and profile, alone or in combination is as accurate as gold standard test like Computed Tomography scan of the chest in detection of etiology of acute respiratory failure. The aim of our study was to perform bed side lung ultrasound in patent with ARF and to find out the diagnostic accuracy of lung ultrasound when compared with diagnosis made by the clinician. Methods: This descriptive observational study was conducted at tertiary care teaching centre in Nepal between February 2019 and July 2019. Consecutive samples of acute respiratory failure patient were included. Lung ultrasound was performed at bed side by fellows of pulmonary critical care medicine. Specific 10 signs of blue protocol were assessed in six different sites of both the chest. Findings of LUS was recorded and analysed to formulate a diagnosis, and finally compared with the final diagnosis. Results: Forty eight patients of acute respiratory failure with median age of 66 years (17 to 89 years) were included with 66.7% being females. 97.9 % of the patient presented with acute shortness of breath of less than one week duration. A total of 13 different diagnosis was made at the end of the treatment for all the patient. LUS accurately diagnosed them in 43 cases, with an overall accuracy of 89.6 %. Chronic obstructive pulmonary disease, pulmonary edema, pneumonia, pleural effusion, pneumothorax were accurately diagnosed with LUS however in acute respiratory distress syndrome and interstitial lung disease, lung ultrasound had poor diagnostic accuracy. Conclusions: Lung ultrasound is useful tool in diagnosing etiology of acute respiratory failure. Diagnosis made by lung ultrasound was 89.6% correct when compared with final diagnosis made by clinician.

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Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients,

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132015000100008 ◽

2015 ◽

Vol 41 (1) ◽

pp. 58-64 ◽

Cited By ~ 11

Author(s):

Felippe Leopoldo Dexheimer Neto ◽

Juliana Mara Stormovski de Andrade ◽

Ana Carolina Tabajara Raupp ◽

Raquel da Silva Townsend ◽

Fabiana Gabe Beltrami ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Diagnostic Accuracy ◽

Lung Ultrasound ◽

Medical Training ◽

Imaging Modality ◽

Final Diagnosis ◽

Lung Edema ◽

One Year ◽

Spontaneously Breathing

Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.

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Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU With Acute Respiratory Failure—A Reevaluation of the Risk Factors and Outcomes

Journal of Intensive Care Medicine ◽

10.1177/0885066621989244 ◽

2021 ◽

pp. 088506662198924

Author(s):

Matthew Schrader ◽

Matheni Sathananthan ◽

Niranjan Jeganathan

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Mortality Rate ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Acute Respiratory Failure ◽

Small Sample ◽

Apache Score ◽

Non Invasive ◽

Organ Failures

Introduction: Idiopathic pulmonary fibrosis (IPF) patients admitted to the ICU with acute respiratory failure (ARF) are known to have a poor prognosis. However, the majority of the studies published to date are older and had small sample sizes. Given the advances in ICU care since the publication of these studies, we sought to reevaluate the outcomes and risk factors associated with mortality in these patients. Methods: Retrospective study using a large multi-center ICU database. We identified 411 unique patients with IPF admitted with ARF between 2014-2015. Results: Of all IPF patients admitted to the ICU with ARF, 81.3% required mechanical ventilation (MV): 48.9% invasive and 32.4% non-invasive alone. The hospital mortality rate was 34.5% for all patients; 48.8% in patients requiring invasive MV, 21.8% in those requiring non-invasive MV and 19.5% with no MV. In multiple regression analyses, age, APACHE score, invasive MV, and hyponatremia at admission were associated with increased mortality whereas post-op status was associated with lower mortality. In patients requiring invasive MV, baseline PaO2/FiO2 ratio was also predictive of mortality. Non-pulmonary organ failures were present in less than 20% of the patients. Conclusions: Although the overall mortality rate for IPF patients admitted to the ICU with ARF has improved, the mortality rates for patients requiring invasive MV remains high at approximately 50%. Older age, high APACHE score, and low baseline PaO2/FiO2 ratio are factors predictive of increased mortality in this population.

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Acute respiratory failure as presentation of late-onset Pompe disease complicating the diagnostic process as a labyrinth: a case report

Multidisciplinary Respiratory Medicine ◽

10.1186/s40248-018-0145-4 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Francesco Menzella ◽

Luca Codeluppi ◽

Mirco Lusuardi ◽

Carla Galeone ◽

Franco Valzania ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Pompe Disease ◽

Late Onset ◽

Diagnostic Process

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Urgent Lung Transplantation in Severe Acute Respiratory Failure Based on Rapidly Progressive Interstitial Lung Disease: A Case Report

Transplantation Proceedings ◽

10.1016/j.transproceed.2017.06.020 ◽

2017 ◽

Vol 49 (7) ◽

pp. 1544-1548 ◽

Cited By ~ 3

Author(s):

I. Madurka ◽

J. Elek ◽

N. Schönauer ◽

T. Bartók ◽

K. Kormosói-Tóth ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease

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Acute respiratory failure as presentation of late-onset Pompe disease complicating the diagnostic process as a labyrinth: a case report

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2018.176 ◽

2018 ◽

Vol 13 ◽

Author(s):

Francesco Menzella ◽

Luca Codeluppi ◽

Mirco Lusuardi ◽

Carla Galeone ◽

Franco Valzania ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Pompe Disease ◽

Late Onset ◽

Correct Diagnosis ◽

Ventilatory Support ◽

Diagnostic Process ◽

Caucasian Woman ◽

Enzyme Replacement

Background: Acute respiratory failure can be triggered by several causes, either of pulmonary or extra-pulmonary origin. Pompe disease, or type II glycogen storage disease, is a serious and often fatal disorder, due to a pathological accumulation of glycogen caused by a defective activiy of acid α-glucosidase (acid maltase), a lysosomal enzyme involved in glycogen degradation. The prevalence of the disease is estimated between 1 in 40,000 to 1 in 300,000 subjects. Case presentation: This case report describes a difficult diagnosis of late-onset Pompe disease (LOPD) in a 52 year old Caucasian woman with acute respiratory failure requiring orotracheal intubation and subsequent tracheostomy for long-term mechanical ventilation 24 h/day. Despite a complex diagnostic process including several blood tests, bronchoscopy with BAL, chest CT, brain NMR, electromyographies, only a muscle biopsy allowed to reach the correct diagnosis. Discussion: The most frequent presentation of myopathies, including LOPD, is proximal limb muscle weakness. Respiratory related symptoms (dyspnea on effort, reduced physical capacity, recurrent infections, etc.) and respiratory failure are often evident in the later stages of the diseases, but they have been rarely described as the onset symptoms in LOPD. In our case, a third stage LOPD, the cooperation between pulmonologists and neurologists was crucial in reaching a correct diagnosis despite a very complex clinical scenario due to different confounding co-morbidities as potential causes of respiratory failure and an atypical presentation. In this patient, enzyme replacement therapy with infusion of alglucosidase alfa was associated with progressive reduction of ventilatory support to night hours, and recovery of autonomous walking.

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