Just the Facts: What are the roles of oxygen escalation and noninvasive ventilation in COVID-19?

A 37-year-old female presents with cough, fever, dyspnea, and myalgias for five days after recent contact with a family member with confirmed 2019 coronavirus disease (COVID-19). Her vital signs include T 38.3° C, HR 108, BP 118/70 mm Hg, RR 26 breaths per minute, and oxygen saturation 67% on room air. She is not in respiratory distress currently and is protecting her airway. Her chest X-ray reveals bilateral airspace opacities. You plan to immediately intervene and address her hypoxia.

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Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

Journal of Neonatology ◽

10.1177/09732179211023763 ◽

2021 ◽

Vol 35 (2) ◽

pp. 93-94

Author(s):

Jyotsna Bhushan ◽

Shagufta Iqbal ◽

Abhishek Chopra

Keyword(s):

Respiratory Distress ◽

Conservative Management ◽

Preterm Neonate ◽

Late Preterm ◽

Intravenous Fluids ◽

X Rays ◽

Blood Gas ◽

X Ray ◽

Spontaneous Pneumomediastinum ◽

Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

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Acute Mitral Regurgitation: an important cause of respiratory distress

Acute Medicine Journal ◽

10.52964/amja.0598 ◽

2016 ◽

Vol 15 (1) ◽

pp. 30-32

Author(s):

Legate Philip ◽

◽

Neil Andrews ◽

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Respiratory Distress ◽

Severe Mitral Regurgitation ◽

Shortness Of Breath ◽

Valve Repair ◽

X Ray ◽

Clinical Presentations ◽

Acute Mitral Regurgitation ◽

Chest X Ray

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

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Correlation between chest x-ray findings and outcomes of patients with mechanical ventilation

Paediatrica Indonesiana ◽

10.14238/pi53.1.2013.6-11 ◽

2013 ◽

Vol 53 (1) ◽

pp. 6

Author(s):

Indah Nurhayati ◽

Muhammad Supriatna ◽

Kamilah Budhi Raharjani ◽

Eddy Sudijanto

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Pleural Effusion ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Patient Outcomes ◽

Morbidity And Mortality ◽

Chi Square ◽

X Ray ◽

Chest X Ray

Background Most infants and children admitted to the pediatricintensive care unit (PICU) have respiratory distress and pulmonarydisease as underlying conditions. Mechanical ventilation may beused to limit morbidity and mortality in children with respiratoryfailure.Objective To assess a correlation between chest x-ray findingsand outcomes of patients with mechanical ventilation.Methods This retrospective study was held in Dr. KariadiHospital, Semarang, Indonesia. Data was collected from themedical records of children admitted to the PICU from Januaryto December 2010, who suffered from respiratory distress andused mechanical ventilation. We compared chest x-ray findings tothe outcomes of patients. Radiological expertise was provided byradiologists on duty at the time. Chi-square and logistic regressiontests were used for statistical analysis.Results There were 63 subjects in our study, consisting of 28 malesand 35 females. Patient outcomes were defined as survived or died,43 subjects ( 68%) and 20 subjects (3 2%), respectively. Chest x-rayfindings revealed the following conditions: bronchopneumonia48% (P=0.298; 95%CI 0.22 to 1.88), pleural effusion 43%(P=0.280; 95%CI 0.539 to 4.837) , pulmonary edema 6%(P=0.622; 95%CI 0.14 to 14.62) and atelectasis 3% (P=0.538;95%CI 0.03 to 7 .62). None of the chest x-ray findings significantlycorrelated to patient outcomes.Conclusion Chest x-ray findings do not correlate to patientoutcomes in pediatric subjects with mechanical ventilation inthe PICU of Dr. Kariadi Hospital, Semarang, Indonesia.

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Recurrent Empyema Thoracic Secondary to Pulmonary Nocardiosis in Immunocompetent Patients

Case Reports in Pulmonology ◽

10.1155/2020/8840920 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Samshol Sukahri ◽

Lily Diana Zainudin ◽

Mohd Firdaus Hadi ◽

Mohd Al-Baqlish Mohd Firdaus ◽

Muhammad Imran Abdul Hafidz

Keyword(s):

Vital Signs ◽

C Reactive Protein ◽

Nocardia Species ◽

X Ray ◽

Reactive Protein ◽

Pulmonary Nocardiosis ◽

Erythrocyte Sedimentation ◽

Chest X Ray ◽

The Right ◽

Tomography Scan

Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.

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DOZ047.79: Bronchoscopic treatment of plastic bronchitis in children

Diseases of the Esophagus ◽

10.1093/dote/doz047.79 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

M Y Erdas ◽

N Valiyev ◽

K K Cerit ◽

Y Gokdemir ◽

G Kiyan

Keyword(s):

Respiratory Distress ◽

Rare Condition ◽

Airway Disease ◽

Underlying Disease ◽

Bronchial Tree ◽

X Rays ◽

Plastic Bronchitis ◽

Left Hemithorax ◽

X Ray ◽

Chest X Ray

Abstract Purpose Plastic bronchitis or cast bronchitis is a rare condition characterized by the formation of large gelatinous or rigid airway casts. Classification of plastic bronchitis is done by disease association and cast histology. This rare condition can cause airway obstruction and there is no standardized treatment. Here are presented two cases with plastic bronchitis treated by bronchoscopic removal of casts in our clinic. Patients Case 1: A 9-year-old boy presented with wheezing, cough, and respiratory distress. He expectorated the cast spontaneously and the cast was misdiagnosed as germinative membrane of a hydatid cyst at the previous center. Total collapse of the left hemithorax was seen on chest X-ray. Any underlying disease was not detected. The plastic-like solid structure was detected and easily extracted from the bronchial tree. Pathology results of the casts were eosinophilic mucoid casts. The patient experienced three bronchoscopic removals and had no recurrence thereafter for two years. Case 2: A 7-year-old girl presented with persistent cough and respiratory distress. The patient was referred to our center with the diagnosis of foreign body aspiration. Total collapse of the right middle and lower segment and partial collapse of the upper segment were seen on chest X-ray. Previously, she was diagnosed with reactive airway disease. The plastic-like semisolid structure was detected during bronchoscopy its extraction from the bronchial tree was not easy but was possible. Pathology results were eosinophilic mucoid and fibrinotic casts. This patient still needs bronchoscopy for cast removal after 12 bronchoscopic removals but her symptoms and bronchoscopy findings have regressed with time. Conclusion Bronchoscopic extraction of casts provides fast improvement of patients’ symptoms and postoperative chest X-rays, but recurrence of cast formation is common. Nevertheless, it is the mostly chosen therapy in the literature. Further researches in this area are required.

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Longitudinal Analysis of Continuous Pulse Oximetry as Prognostic Factor in Neonatal Respiratory Distress

American Journal of Perinatology ◽

10.1055/s-0040-1718877 ◽

2020 ◽

Author(s):

Gonzalo Solís-García ◽

Elena Maderuelo-Rodríguez ◽

Teresa Perez-Pérez ◽

Laura Torres-Soblechero ◽

Ana Gutiérrez-Vélez ◽

...

Keyword(s):

Heart Rate ◽

Intensive Care ◽

Respiratory Distress ◽

Oxygen Saturation ◽

Continuous Monitoring ◽

Vital Signs ◽

Epidemiological Data ◽

Monitoring Data ◽

Joint Models ◽

Neonatal Icu

Objective Analysis of longitudinal data can provide neonatologists with tools that can help predict clinical deterioration and improve outcomes. The aim of this study is to analyze continuous monitoring data in newborns, using vital signs to develop predictive models for intensive care admission and time to discharge. Study Design We conducted a retrospective cohort study, including term and preterm newborns with respiratory distress patients admitted to the neonatal ward. Clinical and epidemiological data, as well as mean heart rate and saturation, at every minute for the first 12 hours of admission were collected. Multivariate mixed, survival and joint models were developed. Results A total of 56,377 heart rate and 56,412 oxygen saturation data were analyzed from 80 admitted patients. Of them, 73 were discharged home and 7 required transfer to the intensive care unit (ICU). Longitudinal evolution of heart rate (p < 0.01) and oxygen saturation (p = 0.01) were associated with time to discharge, as well as birth weight (p < 0.01) and type of delivery (p < 0.01). Longitudinal heart rate evolution (p < 0.01) and fraction of inspired oxygen at admission at the ward (p < 0.01) predicted neonatal ICU (NICU) admission. Conclusion Longitudinal evolution of heart rate can help predict time to transfer to intensive care, and both heart rate and oxygen saturation can help predict time to discharge. Analysis of continuous monitoring data in patients admitted to neonatal wards provides useful tools to stratify risks and helps in taking medical decisions. Key Points

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Laryngo-Tracheal Displacement and Respiratory Distress in an Infant with Congenital Thymic Hyperplasia

ISRN Pulmonology ◽

10.5402/2011/659103 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Michael Wolff ◽

Süha Demirakca ◽

Anna Kristina Kilian ◽

Horst Schroten ◽

Tobias Tenenbaum

Keyword(s):

Young Children ◽

Respiratory Distress ◽

Corticosteroid Therapy ◽

Clinical Symptoms ◽

Thymic Hyperplasia ◽

Feeding Disorder ◽

X Ray ◽

Chest X Ray

Thymic hyperplasia is usually an asymptomatic condition observed in infancy. A five-week-old boy presented with respiratory distress and feeding disorder, in which chest X-ray and bronchoscopy revealed a strong laryngotracheal displacement. Sonography and MRI confirmed the diagnosis of a thymic hyperplasia. Corticosteroid therapy led to improvement of clinical symptoms. Thymic hyperplasia may lead to laryngo-tracheal displacement and respiratory distress in neonates and young children.

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Sotrovimab: is it effective in early treatment of mild and moderate COVID-19 infections? A retrospective study

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00104-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ahmed Elesdoudy

Keyword(s):

Kidney Function ◽

United Arab Emirates ◽

Early Treatment ◽

Vital Signs ◽

Laboratory Studies ◽

Kidney Function Tests ◽

X Ray ◽

Function Tests ◽

Significant Difference ◽

Chest X Ray

Abstract Background The monoclonal antibody sotrovimab is manufactured to antagonize many types of coronaviruses including the SARS-CoV-2. It is used mainly to treat mild and moderate COVID-19 infection and to prevent the progression of the disease from critical disease to severe. Objectives To assess the effectiveness of sotrovimab in the early treatment of mild and moderate COVID-19 infections and prevention of disease progression to severe and critical disease. Methods This study was performed on 220 outpatients who have already received sotrovimab in Obaidullah Hospital, United Arab Emirates. All patients underwent the following before receiving sotrovimab: routine laboratory studies (CBC, liver function tests, and kidney function tests) and other laboratory tests (C reactive protein (CRP), D dimer, and chest x-ray). All patients received sotrovimab in a dose of 500 mg once intravenous infusion over 30 min. All laboratory studies and CXR are repeated after 1 week of receiving the dose of sotrovimab. Results The outcome was 43 patients deteriorated (19.5%) and 177 patients improved (80.5%). The progress of patients’ symptoms after receiving sotrovimab where the shortness of breath (SOB) deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The cough symptom deteriorated in 43 patients (19.5%), improved in 177 patients (80.5%). The progress of patients' radiology (chest x-ray) where it is deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The rate of hospitalization after receiving sotrovimab where 41 patients were hospitalized (18.6%) and 179 patients were not hospitalized (81.4%). There was a statistically significant difference before and after using sotrovimab in vital signs, inflammatory markers, kidney function tests, electrolytes, endocrine functions, and hepatic profile. Conclusion Among adults with mild and moderate COVID-19, the use of sotrovimab significantly improved resolution of symptoms, outcome, radiology, or laboratory marker and decreased hospitalization. The findings support using sotrovimab in the early treatment of mild and moderate COVID-19. Wide-scale studies may be required for clarifying the effects of sotrovimab in the treatment of mild and moderate COVID-19 infections.

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Duplication cyst of the esophagus: A rare congenital cause for vomiting and respiratory distress

Asian Journal of Health Sciences ◽

10.15419/ajhs.v6i1.464 ◽

2020 ◽

Vol 6 (1) ◽

pp. 13

Author(s):

Saeed Al Hindi ◽

Khaled Nazzal ◽

Husain Al Aradi ◽

Mohamed Mubarak

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Neuromuscular Disorders ◽

Failure To Thrive ◽

Duplication Cyst ◽

X Ray ◽

Chest X Ray ◽

Female Baby ◽

Cystic Masses ◽

Foreign Body Inhalation

A duplication cyst of the esophagus is the 2ndmost common congenital anomaly of the gastrointestinal tract. Although these benign cystic masses can be picked up routinely on a chest X-ray, patients may experience symptoms such as stridor or dysphagia corresponding to lesions within the neck or mediastinum. We present a rare case of a duplication cyst of esophagus in a 2-week-old female baby, which was surgically excised. Our aim in this case report is to raise awareness of this congenital disorder; especially when differential diagnoses such as acute respiratory distress syndrome (ARDS), failure to thrive, asthma, pneumonia, neuromuscular disorders and suspected foreign body inhalation have been ruled out in the pediatric patient.

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Comparison of the Effect of Foot and Palm Reflexology Massage on Respiratory Distress Syndrome in Premature Infants under Noninvasive Ventilation

Complementary Medicine Research ◽

10.1159/000517982 ◽

2021 ◽

pp. 1-9

Author(s):

Aysan Miralizadeh ◽

Akram Peyman ◽

Neda Jamali Soltani ◽

Tahereh Ashktorab

Keyword(s):

Respiratory Distress ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Preterm Infants ◽

Noninvasive Ventilation ◽

Statistical Tests ◽

Sensory Deprivation ◽

Control Group ◽

Distress Score ◽

Significant Difference

Introduction: Respiratory distress is one of the life-threatening conditions in preterm infants. Sensory deprivation in preterm infants hospitalized in the intensive care units affects their physiological and psychological development. Therefore, this study is an attempt to compare the effects of foot and palm reflexology on respiratory distress in infants subjected to noninvasive ventilation. Methods: In this clinical study, 150 infants hospitalized at Fatemieh Hospital in Hamadan were randomly assigned to 3 groups. In the intervention groups, the reflexology massage to foot and palm was performed for 10 min within 3 days in 6 rounds. In the control group, leg warming was performed. In each group, the personal information checklist, the respiratory distress score, oxygen saturation percentage, and respiratory rate before and after the daily intervention were examined. Data analysis was performed using the standard statistical tests in SPSS. Results: The results mirrored the statistically significant difference between the intervention and control groups 3 days into the intervention with regard to the average oxygen saturation percentage, respiratory rate, and the respiratory distress score (p < 0.05). When eliminating the effect of confounding variables, therapeutic intervention applied to palm compared to foot had a greater effect on reducing respiratory distress score in the studied infants. Conclusion: The reflexology massage method, especially palm reflexology massage, contributes to the mitigation of respiratory distress in preterm infants subjected to noninvasive ventilation. Hence, this low-cost and efficient intervention program can be recommended as a complementary method for preterm infants with respiratory distress.

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