scholarly journals Persistent type 2 respiratory failure on background of advanced thymoma with lung metastases

2019 ◽  
Vol 12 (11) ◽  
pp. e231690
Author(s):  
Abrar Munir ◽  
Mohsin Ijaz Khan ◽  
Jason Kah Chun Cheong
Keyword(s):  
Respiratory Failure ◽  
Lung Metastases ◽  
Pulmonary Arteries ◽  
High Titre ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
History Of ◽  
Bilateral Lung ◽  
End Stage

We report a patient in her 60s with history of end-stage thymoma with bilateral lung metastases on palliative chemotherapy presented to the hospital with sudden shortness of breath initially treated for probable pulmonary embolism (PE) pending CT of the pulmonary arteries which was subsequently negative for PE. During this admission, she developed transient right-sided facial droop and slurred speech which resolved spontaneously; however, the patient became unresponsive and desaturated with severe decompensated type 2 respiratory failure. Patient was supported with non-invasive ventilation (biphasic positive airway pressure) for few days. Myasthenia gravis was suspected due to clinical features and confirmed by the high titre of acetylcholine receptor antibody titre.

scholarly journals Non-invasive ventilation in acute exacerbation of COPD with mild to moderate type 2 respiratory failure

2021 ◽  
Vol 6 (3) ◽  
pp. 143-151
Author(s):  
Suprova Chakraborty ◽  
Jaykumari Choudhary ◽  
Ganesh Patel
Keyword(s):  
Respiratory Failure ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Study Group ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Exacerbation Of Copd

Chronic obstructive pulmonary disease is a syndrome of progressive airflow limitation caused by abnormal inflammatory reaction of airway and lung parenchyma. Risk factor for development of COPD is a complex interaction of genetic factors and many environmental exposures, with the cigarette smoking being the most common etiological agent.It is a prospective observational comparative study conducted among patient with mild to moderate type 2 respiratory failure, secondary to acute exacerbation of Chronic Obstructive Pulmonary Disease admitted in chest ward department of Respiratory medicine, Late Shri Lakhi Ram Agrawal Memorial Medical College, Raigarh, Chhattisgarh, India for a period of one year from April 2020- April 2021.A total 60 patients were studied. Out of which, 30 patients in study group for whom non-invasive ventilation support along with conventional treatment was given and remaining 30 patients in comparison group, same treatment was given without non-invasive ventilation support. Both groups had similar demographic, clinical, biochemical profile at the time of admission. Distribution of comorbidities, smoking history were similar as shown below in tables. After application of Non-invasive ventilation along with conventional treatment in study group, the result showed that mean hours of NIV use in study group was 27 hours and mean hours of Oxygen use in comparison group was 98 hours.Use of non-invasive ventilation in acute exacerbation of COPD, with mild to moderate type 2 respiratory failure, reduced tachypnoea, tachycardia, after 4 hours. There were improvement in oxygen saturation after 4 hours, improvement in PH also occurred after 4 hours by 0.04. Non-invasive ventilation gives rest to fatigued inspiratory muscle so work of breathing is reduced. It also restores functional and biochemical changes associated with fatigued muscle so all complication were reduced with use of non- invasive ventilation.

scholarly journals Effectiveness of non-invasive ventilation in patients with type 2 respiratory failure

2021 ◽  
Vol 9 (3) ◽  
pp. 794
Author(s):  
Shahid M. Patel ◽  
Girija P. Nair ◽  
Balaji G. Tuppekar ◽  
Abhay G. Uppe
Keyword(s):  
Respiratory Failure ◽  
Type Ii ◽  
Invasive Ventilation ◽  
Emergency Visits ◽  
Non Invasive ◽  
First Line Therapy ◽  
Non Invasive Ventilation ◽  
Hospitalised Patients ◽  
Complete History

Background: Assess the use of non-invasive ventilation as an alternative way for ventilation in acute respiratory failure, determine factors that can predict the successful use of NIV, evaluate factors hindering success of NIV.Methods: Thirty hospitalised patients fulfilling inclusion criteria, diagnosed with Type II Respiratory Failure on ABG were recruited after obtaining an informed written consent. Complete history and detailed physical examination were followed by routine investigations.Results: Comparison of the pH on admission with the pH after 1st hour of NIV, the latter showed statistically significant improvement. Drop in PaCo2 and rise in PaO2 on ABG from admission and after stopping NIV was statistically significant. Patients with lower MMRC grade and severe cough showed significant improvement in pH, however patient with higher emergency visits and past hospitalisation showed less improvement in pH, after 1 hour of NIV therapy. A total 4 patients were intubated, with mean pH of 7.22, 3 out of them had higher emergency visits, 2 out of them had ICU admission.Conclusions: NIV treatment for COPD with type II respiratory failure avoids intubation, reduces complications and should be considered as first line therapy instead of ET intubation. Lower mMRC grade, lesser hospitalizations, lesser emergency visits, higher BMI, symptoms like cough, can have a positive predictive value for the outcome of NIV.

scholarly journals Variants in HNRNPDL and SETX Not Necessarily Indicate Familial Amyotrophic Lateral Sclerosis or Limb Girdle Muscular Dystrophy 1G in Acute Muscular Respiratory Failure

2020 ◽  
Vol 11 (02) ◽  
pp. 353-354
Author(s):  
Josef Finsterer ◽  
Claudia Stöllberger ◽  
Hans Keller ◽  
Franco Laccone
Keyword(s):  
Respiratory Failure ◽  
Variants Of Unknown Significance ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Unknown Significance ◽  
History Of ◽  
History Of Epilepsy ◽  
Diagnostic Work ◽  
Conclusive Diagnosis ◽  
Work Up

AbstractGenetic work-up is useful for the identification of a primary myopathy. However, even sophisticated genetic methods may fail to detect the underlying cause of myopathy as in the following case. The patient is a 52-year-old female with a history of epilepsy, arterial hypertension, atrial flutter requiring cardioversion, ablation, and anticoagulation, coronary heart disease, hyperlipidemia, and hyper-CKemia. At age 52 years, she was referred for heart failure due to ischemic cardiomyopathy requiring appropriate medication and implantation of an ICD. During hospitalization she developed acute muscular respiratory failure requiring mechanical ventilation. Genetic panels for myopathy, neuropathy, and cardiomyopathy revealed variants of unknown significance in the HNRNPDL and SETX genes respectively. Clinical presentation and muscle biopsy, however, suggested metabolic myopathy. Acute muscular respiratory failure may require traditional diagnostic work-up for primary myopathy and long-term invasive and non-invasive ventilation. Panel investigations not necessarily lead to a conclusive diagnosis. The multisystem nature of the condition rather suggests a metabolic defect than LGMD-1G or fALS as genetic findings suggested.

scholarly journals Use of Non Invasive Ventilation in Patients with Respiratory Failure in Nepal

2012 ◽  
Vol 9 (4) ◽  
pp. 256-259 ◽  
Author(s):  
R Pandey ◽  
R Chokhani ◽  
N B K C
Keyword(s):  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Arterial Blood ◽  
Non Invasive Ventilation

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59

Lung transplantation for silicosis: a case study

2019 ◽  
Vol 28 (Volume 28 Issue 2) ◽  
pp. 13-17
Author(s):  
Kate McEwen ◽  
Lyndell Brodie
Keyword(s):  
Lung Transplantation ◽  
Medication Management ◽  
Social Situation ◽  
Non Invasive ◽  
Transplantation Surgery ◽  
Non Invasive Ventilation ◽  
The Social ◽  
End Stage

Lung transplantation has become a well-established treatment for a variety of end-stage pulmonary diseases. Silicosis is a rare indication for lung transplantation; however, there is currently no other treatment available for the disease in its end stages. This case study presents a 52-year-old man who presented with silicosis for lung transplantation. His in-hospital recovery journey is examined and discussion is provided about his experience of complications, including type 2 respiratory failure and non-compliance with non-invasive ventilation therapy. The patient education and support provided, particularly related to medication management following transplantation surgery, if of key importance during the transplant recipient’s recovery. The social situation and its implications for both the patient and their family should also be considered. Both these aspects are also explored in the context of the case presented.

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