Point-of-care ultrasound (POCUS) as the keystone investigation in undifferentiated dyspnoea

2020 ◽  
Vol 13 (6) ◽  
pp. e234602
Author(s):  
Sara Montemerani ◽  
Valeria Donati ◽  
Nicola Di Pietra ◽  
Giovanni Iannelli
Keyword(s):  
Respiratory Failure ◽  
Point Of Care ◽  
High Rate ◽  
Chronic Obstructive ◽  
Subjective Perception ◽  
Point Of Care Ultrasound ◽  
Obstructive Pulmonary Disease ◽  
Require Time ◽  
Non Invasive ◽  
Common Causes

Dyspnoea is defined as a subjective perception of laboured breathing. It is a common cause of access to the emergency department (ED), it has a high rate of intensive care unit admission and a high mortality. The most common causes of dyspnoea in the adult include pneumonia, heart failure, chronic obstructive pulmonary disease, pulmonary embolism and asthma. Due to the high variety of dyspnoea’s causes, the need for a rapid and accurate diagnosis puts the emergency physician in trouble. Moreover, standard tests such as chest radiography, B-type natriuretic peptide and d-dimer require time and may be less useful in patients with respiratory failure who require urgent therapy. Point-of-care ultrasound (POCUS) is rapid, non-invasive, repeatable and a useful tool in evaluating patients with acute and severe dyspnoea. This case report demonstrates the usefulness of POCUS in a patient with undifferentiated respiratory failure presenting to the ED.

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 Building toolkits for COPD exacerbations: lessons from the past and present

Thorax ◽  
2019 ◽  
Vol 74 (9) ◽  
pp. 898-905 ◽  
Author(s):  
Elizabeth Sapey ◽  
Mona Bafadhel ◽  
Charlotte E Bolton ◽  
Thomas Wilkinson ◽  
John R Hurst ◽  
...  
Keyword(s):  
Point Of Care ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
History Of ◽  
Additional Therapy ◽  
Acute Event

In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.An ECOPD is ‘an acute worsening of respiratory symptoms that results in additional therapy’. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.

The Role of Invasive Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease Causing Respiratory Failure.

2006 ◽  
Vol 5 (3) ◽  
pp. 86-90
Author(s):  
Cristopher Kosky ◽  
◽  
Charles Turton ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Exacerbation Of Copd

Acute hypercapnic respiratory failure in chronic obstructive pulmonary disease can usually be managed initially with medical treatment and non- invasive ventilation. In circumstances where non- invasive ventilation cannot be used or has failed, intubation and invasive ventilation may be lifesaving. The outcome of patients with an exacerbation of COPD requiring invasive ventilation is better than often thought, with a hospital survival of 70-89%. Decisions regarding invasive ventilation made by physicians and patients with COPD are unpredictable and vary with the individual. This article reviews the role of invasive ventilation in exacerbations of COPD to assist decision making.

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