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

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.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Oxygenation failure after cardiac surgery: early re-intubation versus treatment by nasal continuous positive airway pressure (NCPAP) or non-invasive positive pressure ventilation (NPPV)

2016 ◽  
Vol 70 (2) ◽  
Author(s):  
Muhammed Kurt ◽  
Udo Boeken ◽  
Jens Litmathe ◽  
Peter Feindt ◽  
Emmeran Gams
Keyword(s):  
Cardiac Surgery ◽  
Respiratory Failure ◽  
Oxygen Transfer ◽  
Airway Pressure ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Positive Pressure ◽  
Non Invasive ◽  
Group A ◽  
Group B

Background: Due to an increasing incidence of respiratory failure after cardiac surgery we wanted to study whether nasal continuous positive airway pressure (NCPAP) may improve pulmonary oxygen transfer and may avoid reintubation after coronary operations. Additionally, we compared this protocol to non-invasive positive pressure ventilation (NPPV). Methods: For a period of 2 years we analyzed all patients that were extubated within 12 hours after coronary surgery, and in whom oxygen transfer (PaO2/FIO2) deteriorated without hypercapnia so that all these patients met predefined criteria for reintubation: group A=immediate reintubation (n=88), group B=NCPAP-treatment (n=173), group C=NPPV(n=18). Results: 25,4% of group B- and 22,2% of group C-patients were also intubated after a period of NCPAP or NPPV. All other patients of groups B and C could be weaned from these devices (B = 34.3 ± 5.9 hours; C = 26.4 ± 4.4 h; p&lt;0.05) and were well oxygenated by face mask at ambient pressure (Ratio PaO2/FIO2: B, 138 ± 13; C, 140 ± 13). In group A we found a higher mortality (7.95%) compared to group B (4.04%) and group C (5.55%). NCPAP-patients suffered more frequently from an impaired sternal wound healing (A = 4.5%, B = 8.6%; p&lt;0.05). Conclusions: We conclude that reintubation after cardiac operations should be avoided since NCPAP and NPPV are safe and effective to improve arterial oxygenation in most patients with non hypercapnic respiratory failure.

scholarly journals Fecal Calprotectin as early predictor for screening and relapse in pediatric chronic diarrhea in India

2021 ◽  
Vol 7 (4) ◽  
pp. 178-184
Author(s):  
Gujjarlapudi Deepika ◽  
Namburu Veeraiah ◽  
Syed Hassan Naveed ◽  
D. Nageshwar Reddy
Keyword(s):  
Fecal Calprotectin ◽  
Inflammatory Disorder ◽  
Group I ◽  
Subgroup Ii ◽  
Significant Difference ◽  
Group A ◽  
Group Ii ◽  
Hs Crp ◽  
Group B ◽  
Early Predictor

: IBS and IBD are two abdomen ailments commonly seen in children. IBD is a life-long disorder that includes two major forms of chronic illness UC and CD, IBS may occur when the bowel is sensitive to specific foods or other triggers like stress. The aims of the study is to investigate clinical usefulness of FC as early predictor for screening and differentiating IBD and IBS and to monitor the treatment for relapse and remission in pediatric Indian population. This was hospital based observational cohort study, conducted over a period of twelve months from January 2019 to December 2019 Total 325 patients attending OPD were included in the study, in children between 1-18years in which FC was measured using commercially available CLIA kit. HB, ESR, Hscrp were also assessed, these patients were followed up. Patients were grouped asGroup I: IBS: 115(50:65M/F), Group II: 185 IBD, had Subgroup I:116 CD(48:68M/F);Group A: 62.7% presented with relapse Group B: 37.3% had disease in remission Subgroup II: 69 patients had UC(31:38 M/F); Group A: 60.9% had relapse and Group B: 39.1% in remission after follow up. Subgroup III: Others were 25(7.7%). In Study I: Levels of FC were significantly lower in patients with group I when compared to group II. In Subgroup I & Subgroup II Group A had higher FC levels when compared to group B. In Study II: A significant difference (P&#60;0.001) and lower values of the FC, ESR, Hs-crp, frequency of stools in IBS than in CD and UC patients were observed. In Study III: FC in IBD has positive correlation (p&#60;0.01), with the activity of the inflammatory disorder, HB, ESR, Hs-CRP and with increased frequency of diarrhea. In Study IV Fecal calprotectin value of ≥100 ug/g was diagnostic of IBD with sensitivity of 94.1%, specificity of 82.2%, PPV of 86.32%, NPV of 80.39%. The present study showed that the determination of FC assists to differentiate between IBD and IBS also useful in monitoring of remission and in early prediction of relapse in pediatric IBD.

scholarly journals Outcomes of Noninvasive Positive Pressure Ventilation in Acute Respiratory Distress Syndrome and Their Predictors: A National Cohort

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Ahmed Taha ◽  
Eneko Larumbe-Zabala ◽  
Ashraf Abugroun ◽  
Assad Mohammedzein ◽  
M. Tarek Naguib ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Liver Disease ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Positive Pressure Ventilation ◽  
Distress Syndrome ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Rationale. Although noninvasive positive pressure ventilation (NIPPV) is increasingly used in acute respiratory distress syndrome (ARDS) to avoid invasive mechanical ventilation (IMV), the data supporting its benefit for this indication are lacking. Objectives. To analyze the all-cause in-hospital mortality rate and length of stay (LOS) for ARDS patients who received NIPPV in the United States (US) compared to those who were initially intubated. Our secondary outcome of interest was to determine the predicting factors for NIPPV failure. Methods. We used the 2016 National Inpatient Sample database to identify 4,277 adult records with ARDS who required positive pressure ventilation. We divided the cohort into initial treatment with IMV or NIPPV. Then, the NIPPV group was further subdivided into NIPPV failure or success. We defined NIPPV failure as same-patient use of NIPPV and IMV either on the same day or using IMV at a later date. We analyzed the in-hospital mortality, LOS, and NIPPV failure rate. Linear regression of log-transformed LOS and logistic regression of binary outcomes were used to test for associations. Results. The NIPPV success group had the lowest mortality rate (4.9% [3.8, 6.4]) and the shortest LOS (7 days [6.6, 7.5]). The NIPPV failure rate was 21%. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure (adjusted OR: 4.47, 2.65, and 2.23, respectively). There was no significant difference between NIPPV failure and IMV groups in-hospital mortality (26.9% [21.8, 32.8] vs. 25.1% [23.5, 26.9], p=0.885) or LOS (16 [14, 18] vs. 15.6 [15, 16.3], p=0.926). Conclusions. NIPPV success in ARDS exhibits significantly lower hospital mortality rates and shorter LOS compared with IMV, and NIPPV failure exhibits no significant difference in hospital mortality or LOS compared with patients who were initially intubated. Therefore, an initial trial of NIPPV may be considered in ARDS. Sepsis, pneumonia, and chronic liver disease were associated with higher odds of NIPPV failure; these factors should be used to stratify patients to the most suitable ventilation modality.

scholarly journals Assessment of post-operative pain with use of rotary and conventional root canal instruments in single and multiple visit root canal treatment

2021 ◽  
Vol 2 (2) ◽  
pp. 216-224
Author(s):  
Sheenam Markan ◽  
Gurvanit Kaur Lehl
Keyword(s):  
Root Canal ◽  
Root Canal Treatment ◽  
Single Visit ◽  
Post Operative Pain ◽  
Subgroup Ii ◽  
Multiple Visit ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Post Hoc

Aim: To compare the post-operative pain after the use of rotary and conventional root canal instruments in single and multiple visit root canal treatment Materials and Method: 168 patients requiring Root Canal Treatment [RCT] in maxillary and mandibular 1st molar were involved in the study. On the basis of vitality and radiographic features two groups were made, multiple visit (Group A n=72), single visit (Group B n=96). Then the patients were randomly divided into 4 subgroups. Subgroup I n=36 (multiple visit conventional RCT), Subgroup II n=36 (multiple visit rotary RCT), Subgroup III n=48 (single visit Conventional RCT) and Subgroup IV n=48 (single visit rotary RCT). In subgroup I & Subgroup III Canal preparation was done with stainless steel K files in step back manner. In subgroup II & Subgroup IV, rotary Protaper Next was used. Irrigation was done with 3 % NaOCl and Ethylenediamine tetraacetic acid (EDTA) alternatively followed by obturation. The postobturation pain was recorded at 6hr, 12hr, 24hr, 1 week using visual analogue scale. Statistical Analysis was done using Tukey HSD Post Hoc Test and ANOVA Test. Results: Within 24 hours there was statistically significant difference between the groups (p< 0.05) but after 7 days no statistically significant difference was there (p>0.05). Conclusion: Patients in the groups either in single and multiple visit experience less postobturation pain if the canal preparation was done with the rotary files at all the time intervals (6hrs, 12hrs, 24hrs ) but after 7 days no statistical difference was found.

scholarly journals Primary abdomen closure (using sheath relaxation) versus staged closure (using modified Bogota) following laparotomy in secondary peritonitis: a comparative study

2020 ◽  
Vol 8 (1) ◽  
pp. 278
Author(s):  
Anupam Das ◽  
Ajay Kumar Singh
Keyword(s):  
Primary Closure ◽  
Rectus Sheath ◽  
Secondary Peritonitis ◽  
Apache Ii ◽  
Intraabdominal Pressure ◽  
Apache Ii Score ◽  
Complication Rates ◽  
Gender Inclusion ◽  
Group A ◽  
Group B

Background: Primary closure or open laparostomy after laparotomy for peritonitis have their own morbidities. In this study, rectus sheath relaxation was used as an alternative to conventional primary closure and compared to the modified Bogota technique in patients of peritonitis.Methods: We included 60 patients of peritonitis with two of the following criteria: APACHE II score 10-20, Mannheim peritonitis index (MPI) 20-30 or post-resuscitation intraabdominal pressure (IAP) >15 mmHg and randomized them to group A (Sheath relaxation technique) and group B (modified Bogota). Outcome criteria studied included procedure failure, complications, pain, mortality and duration of ICU and hospital stay.Results: Both groups were comparable in terms of age, gender, inclusion criteria, ICU stay and mortality. The success rate in group A was 63.33% while in group B, was 53.33% with complication rates of 37% and 46.67% respectively. The pain and duration of hospital stay were significantly less in group A.Conclusions: We concluded that primary abdomen closure using rectus sheath relaxation in select patients was an easy, feasible and better alternative than the staged closure using modified Bogota technique following laparotomy in patients of severe secondary peritonitis. Patients with higher APACHE II and MPI scores may be better managed primarily by modified Bogota technique, while those with lower APACHE II and MPI do well with primary closure with sheath relaxation. The pre- operative APACHE II, MPI and post resuscitation IAP either individually or in combination, could, therefore, predict the wound failure rates, choice of closure techniques.

scholarly journals Effect of Modified Dachengqi Decoction Soup on Retention of Intestinal Peristalgia in Patients with Hepatic Biliary Surgery

1970 ◽  
Vol 1 (1) ◽  
Author(s):  
Lin Huai De
Keyword(s):  
Gastrointestinal Motility ◽  
Abdominal Distension ◽  
The Body ◽  
Hepatobiliary Surgery ◽  
Biliary Surgery ◽  
Retention Enema ◽  
Dachengqi Decoction ◽  
Significant Difference ◽  
Group A ◽  
Group B

To evaluate the effect of Modified Dachengqi Decoction Soup on retention of gastrointestinal motility in patients with hepatobiliary surgery after an enema. 100 patients with hepatobiliary surgery were randomly divided into group A and group B (n = 50). A group of postoperative parenteral nutrition, fasting and gastrointestinal decompression and other conventional treatment, B group on the basis of group A plus Modified Dachengqi Soup retention enema, compared the two groups of gastrointestinal motility. The time of first exhaust, abdominal distension disappeared and bowel sounds recovered in group B was significantly shorter than that in group A, which was statistically significant (P <0.05). There was no significant difference between the two groups (P > 0.05). The levels of motilin in group B were significantly higher than those in group A at 2 days after the operation, and there was a significant difference between group A and group B, P < 0.05. The patients with hepatobiliary surgery can not only promote the recovery of the postoperative organs, but also can significantly improve the level of motilin in the body, and thus improve the patient’s gastrointestinal motility.

scholarly journals Correlates of Morbidity and Mortality in Severe Necrotizing Pancreatitis

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
K. M. Pal ◽  
Pashtoon Murtaza Kasi ◽  
Mohammad Tayyeb ◽  
S. M. Faisal Mosharraf ◽  
Zafar Fatmi
Keyword(s):  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Apache Ii ◽  
Morbidity And Mortality ◽  
Apache Ii Score ◽  
High Morbidity ◽  
Unit Increase ◽  
Group A ◽  
Score Apache ◽  
Group B

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus 40%) was significantly higher in group B. The rate of organ dysfunction also rose along with the rates of other morbidities and variables that were related to a patient’s hospital stay. Only APACHE II significantly correlated with the degree of necrosis, wherein the chances of substantial necrosis rose by 20% with each unit increase of APACHE II score. APACHE II Score could be employed and studied further prospectively to help identify patients with pancreatic necrosis.

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

Effect of short-term use of oral contraceptive pills on intraocular pressure

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Tayyaba Gul Malik ◽  
Hina Nadeem ◽  
Eiman Ayesha ◽  
Rabail Alam
Keyword(s):  
Oral Contraceptive ◽  
Childbearing Age ◽  
Short Term ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age.   Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21.   Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

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