scholarly journals Clinical impact of pneumothorax in patients with Pneumocystis jirovecii pneumonia and respiratory failure in an HIV-negative cohort

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ji Soo Choi ◽  
Se Hyun Kwak ◽  
Min Chul Kim ◽  
Chang Hwan Seol ◽  
Sung Ryeol Kim ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Care Center ◽  
Tertiary Care ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Mechanical Ventilator ◽  
Mechanical Ventilators ◽  
Related Factors ◽  
Weaning Failure

Abstract Background Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis. Methods We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Results During follow up duration, twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) was related with occurrence of pneumothorax in multivariate analysis. And development of pneumothorax was not associated with need for tracheostomy and mortality. Furthermore, analysis of survivor after 28 days in ICU, patients without pneumothorax were significantly more successful in weaning from mechanical ventilator than the patients with pneumothorax (44% vs. 13.3%, p = 0.037). PCP patients without pneumothorax showed successful home discharges compared to those who without pneumothorax (p = 0.010). Conclusions The development of pneumothorax increased in PCP patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

scholarly journals Clinical Impact of Pneumothorax in Patients with Pneumocystis Jirovecii Pneumonia and Respiratory Failure in An HIV-Negative Cohort

2021 ◽  
Author(s):  
Ji Soo Choi ◽  
Se Hyun Kwak ◽  
Min Chul Kim ◽  
Chang Hwan Seol ◽  
Sung Ryeol Kim ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Survival Data ◽  
Care Center ◽  
Tertiary Care ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Mechanical Ventilators ◽  
Related Factors ◽  
Weaning Failure

Abstract Background: Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis.Methods: We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment ina medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019.Results: The 28-day survival rate was 62.2% (N=74). Twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiringa tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p=0.013) was related with occurrence of pneumothorax. Of 74 patients with 28-day survival data, 15 (20.3%) developed pneumothorax. In those patients, five survived (p=0.048) and only two were successfully weaned from mechanical ventilation (p=0.037).Conclusions: Patients with PCP and acute respiratory failure who developed pneumothorax did not have increased 28-day mortality, however pneumothorax increased in patient with cytomegalovirus co-infection, pneumothoraxmight have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

scholarly journals Clinical Impact of Pneumothorax in Patients With Pneumocystis Jirovecii Pneumonia and Respiratory Failure in An HIV-Negative Cohort

2021 ◽  
Author(s):  
Ji Soo Choi ◽  
Se Hyun Kwak ◽  
Min Chul Kim ◽  
Chang Hwan Seol ◽  
Sung Ryeol Kim ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Survival Data ◽  
Care Center ◽  
Tertiary Care ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Mechanical Ventilators ◽  
Related Factors ◽  
Weaning Failure

Abstract Background: Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis.Methods: We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019.Results: The 28-day survival rate was 62.2% (N=74). Twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p=0.013) was related with occurrence of pneumothorax. Of 74 patients with 28-day survival data, 15 (20.3%) developed pneumothorax. In those patients, five survived (p=0.048) and only two were successfully weaned from mechanical ventilation (p=0.037).Conclusions: Patients with PCP and acute respiratory failure who developed pneumothorax did not have increased 28-day mortality, however pneumothorax increased in patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

Pneumocystis Jirovecii Pneumonia as A Cause of Acute Respiratory Failure In Childhood Acute Lymphoblastic Leukemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4876-4876
Author(s):  
Mukta Kumar ◽  
William Keough
Keyword(s):  
Respiratory Failure ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Respiratory Failure ◽  
Lymphoblastic Leukemia ◽  
Pneumocystis Jirovecii ◽  
Ground Glass ◽  
Pneumocystis Jirovecii Pneumonia ◽  
X Ray ◽  
Chest X Ray ◽  
The Uk

Abstract Abstract 4876 Pneumocystis jirovecii is an opportunistic pathogen responsible for severe pneumonia in immunocompromised patients. Management of this pneumonia remains a major challenge for all physicians caring for immunosuppressed patients. The prognosis of Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure is traditionally known to be poor. We report a case of PCP in a child with recently diagnosed childhood Precursor B cell Acute Lymphoblastic Leukemia (ALL). Course was complicated with acute respiratory failure showing hypoxemia, respiratory failure requiring intubation and reduced compliance resembling ARDS. Our Patient, 8 weeks into chemotherapy for newly diagnosed ALL, presented with high grade fevers and poor activity. Patient was admitted 3 weeks prior for Bacillus cereus bacteremia. Additionally the patient had been on broad spectrum antibiotics on 2 occasions for febrile neutropenia episodes within the past 2 weeks. Patient had minimal respiratory symptoms at this presentation and recovered from pancytopenia at the time of this presentation. CT scans and chest x-ray (Figures 1 and 2) showed diffuse marked ground glass opacities with dependent consolidation in the lungs. On day 3 of admission, bronchoalveolar lavage (BAL) was preformed and empiric trimethoprim-sulfamethoxazole was initiated in addition to broad spectrum antibacterial, antifungal and antiviral medications. Within 24 hours, patient rapidly deteriorated with significant respiratory distress and hypoxemia requiring intubation. Clinical and radiologic findings were suggestive of ARDS. Patient required significant ventilatory support, fluid restriction, diuretics, and steroids. PCR testing of BAL fluid was reported as positive for Pneumocystis jirovecii. By hospital day 6 the patient was still requiring a fair amount of respiratory support. Corticosteroids had been added but concern amongst some members of the team surrounded possible lack of efficacy of trimethoprim-sulfamethoxazole. Review of published case reports suggested that addition of caspofungin provided salvage therapy in cases where trimethoprim-sulfamethoxazole was believed to be suboptimal. Caspofungin was added to this patient's treatment. However, liver trans-aminases experienced a 2–3 fold increase within 72 hours after initiating caspofungin. Caspofungin was withdrawn but the patient's condition gradually improved and was extubated 7 days later. Also of note, there have been wide spread regional and national shortages of intravenous trimethoprim-sulfamethoxazole preparations. We were forced to convert to oral therapy several days after extubation. The patient continued to improve and had no signs of complications or increased morbidity from this conversion; however, this was a continued concern during his treatment. A Pub Med review of the literature reveals very little failure of trimethoprim-sulfamethoxazole prophylaxis in the non-HIV immunocompromised population. Further, studies in Denmark, Italy, and the UK reveal that trimethoprim-sulfamethoxazole prophylaxis in children with ALL also decreases the number of febrile and bacteremic incidents. Trimethoprim-sulfamethoxazole also has advantages over other prophylactic choices against Pneumocystis jirovecii with fewer side effects such as methemoglobinemia induced by dapsone for example. Other studies from the UK, US, and Denmark stress that the early diagnosis and treatment with appropriate antimicrobials and possibly corticosteroids has a better outcome in this frequently fatal complication of immunosupressed patients. This case stresses the need for continued patient education regarding adherence to prophylactic regimens, early diagnosis and suspicion of opportunistic organisms such as Pneumocystis jirovecii, and prompt diagnosis and treatment of the same.Figure 1.Ground Glass Opacities on CT ChestFigure 1. Ground Glass Opacities on CT ChestFigure 2.Chest x-ray infiltratesFigure 2. Chest x-ray infiltrates Disclosures: No relevant conflicts of interest to declare.

The Use of Noninvasive Ventilation in Acute Respiratory Failure at a Tertiary Care Center

CHEST Journal ◽  
2004 ◽  
Vol 126 (1) ◽  
pp. 165-172 ◽  
Author(s):  
Elizabeth S. Paus-Jenssen ◽  
John K. Reid ◽  
Donald W. Cockcroft ◽  
Karen Laframboise ◽  
Heather A. Ward
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals The Use of Dexmedetomidine in the Emergency Department: A Cohort Study

2021 ◽  
Vol 22 (5) ◽  
pp. 1202-1209
Author(s):  
Joseph Sinnott ◽  
Christopher Holthaus ◽  
Enyo Ablordeppey ◽  
Brian Wessman ◽  
Brian Roberts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Adverse Events ◽  
Acute Respiratory Failure ◽  
Tertiary Care ◽  
Multivariable Logistic Regression Model ◽  
Non Invasive Ventilation ◽  
Improved Outcomes

Introduction: Management of sedation, analgesia, and anxiolysis are cornerstone therapies in the emergency department (ED). Dexmedetomidine (DEX), a central alpha-2 agonist, is increasingly being used, and intensive care unit (ICU) data demonstrate improved outcomes in patients with respiratory failure. However, there is a lack of ED-based data. We therefore sought to: 1) characterize ED DEX use; 2) describe the incidence of adverse events; and 3) explore factors associated with adverse events among patients receiving DEX in the ED. Methods: This was a single-center, retrospective, cohort study of consecutive ED patients administered DEX (January 1, 2017–July 1, 2019) at an academic, tertiary care ED with an annual census of ~90,000 patient visits. All included patients (n= 103) were analyzed for characterization of DEX use in the ED. The primary outcome was a composite of adverse events, bradycardia and hypotension. Secondary clinical outcomes included ventilator-, ICU-, and hospital-free days, and hospital mortality. To examine for variables associated with adverse events, we used a multivariable logistic regression model. Results: We report on 103 patients. Dexmedetomidine was most commonly given for acute respiratory failure, including sedation for mechanical ventilation (28.9%) and facilitation of non-invasive ventilation (17.4%). Fifty-four (52.4%) patients experienced the composite adverse event, with hypotension occurring in 41 patients (39.8%) and bradycardia occurring in 18 patients (17.5%). Dexmedetomidine was stopped secondary to an adverse event in eight patients (7.8%). Duration of DEX use in the ED was associated with an increase adverse event risk (adjusted odds ratio, 1.004; 95% confidence interval, 1.001, 1.008). Conclusion: Dexmedetomidine is most commonly administered in the ED for patients with acute respiratory failure. Adverse events are relatively common, yet DEX is discontinued comparatively infrequently due to adverse events. Our results suggest that DEX could be a viable option for analgesia, anxiolysis, and sedation in ED patients.

scholarly journals Pneumocystis jirovecii Pneumonia in Patients with Rheumatic Diseases: Risk Assessment and Prophylaxis

2022 ◽  
pp. 1-7
Author(s):  
Matthew Shing Him Lee ◽  
Shirley Chiu Wai Chan
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Rheumatic Diseases ◽  
Immunosuppressive Agents ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
International Guideline ◽  
Related Factors ◽  
Factors Associated ◽  
Disease Specific

Pneumocystis jirovecii pneumonia (PJP) is an uncommon opportunistic infection in patients with rheumatic diseases with high mortality. Unlike other non-HIV conditions, international guideline for PJP prophylaxis in rheumatic diseases is currently lacking. Recent evidence regarding the risk of PJP and effectiveness of prophylaxis has been accumulating. This Review provides an update on the information about risk factors associated with PJP in patients with rheumatic diseases based on rheumatic diagnoses, use of immunosuppressive agents and other disease-related factors. The second part of the article summarizes evidence regarding the effectiveness of PJP prophylaxis by considering both disease-related and therapy-related factors. Finally, the Review outlined the currently available disease-specific recommendations and local guidelines, and appreciate the factors that influence physicians’ decision.

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