A Case of Cytomegalovirus-Induced Oral Ulcer in an Older Adult Patient with Nephrotic Syndrome due to Membranous Nephropathy

We report a case of cytomegalovirus- (CMV-) induced buccal ulcer in a patient with nephrotic syndrome. An 82-year-old man with membranous nephropathy was on immunosuppressive therapy presented with an ulcer in the oral cavity and was hospitalized. Intraoral examination revealed an inflamed and painful ulcer on the left buccal mucosa. Blood test results showed CMV positivity, and histopathological examination confirmed the diagnosis. Anti-CMV therapy (ganciclovir) was initiated from the third day of hospitalization. However, he developed dyspnea on the 14th day. Computed tomography images of the chest revealed the presence of ground-glass opacities, and noninvasive positive pressure ventilation was initiated under the provisional diagnosis of pneumocystis pneumonia caused by ganciclovir-associated myelosuppression and/or steroid-induced immunocompromised state. The patient died of pneumocystis pneumonia on the 21st day. The patient had received immunosuppressive therapy for renal dysfunction. Immunocompromised patients with CMV infection should be treated with caution, as drugs for CMV may themselves cause myelosuppression, deteriorating the prognosis of the patient.

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Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

Global Pediatric Health ◽

10.1177/2333794x21991531 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199153

Author(s):

Ameer Al-Hadidi ◽

Morta Lapkus ◽

Patrick Karabon ◽

Begum Akay ◽

Paras Khandhar

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Noninvasive Positive Pressure Ventilation ◽

Pediatric Intensive Care ◽

Nasal Cannula ◽

Respiratory Support ◽

Positive Pressure ◽

P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

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Prognostic impact of high flow nasal cannula compared to noninvasive positive-pressure ventilation in the treatment of acute pulmonary edema

Revista Portuguesa de Cardiologia ◽

10.1016/j.repc.2021.04.004 ◽

2021 ◽

Author(s):

Williams Hinojosa ◽

Carolina Iglesias ◽

Silvio Vera ◽

Marta Marcos ◽

Aitor Uribarri ◽

...

Keyword(s):

Pulmonary Edema ◽

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

High Flow ◽

Nasal Cannula ◽

Acute Pulmonary Edema ◽

Positive Pressure ◽

Prognostic Impact ◽

High Flow Nasal Cannula

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Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211004235 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110042

Author(s):

Xiaoke Shang ◽

Yanggan Wang

Keyword(s):

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Abdominal Distension ◽

Apache Ii ◽

Positive Pressure ◽

Apache Ii Score ◽

Subgroup Ii ◽

Significant Difference ◽

Group A ◽

Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

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