Correlation between chest x-ray findings and outcomes of patients with mechanical ventilation

Background Most infants and children admitted to the pediatricintensive care unit (PICU) have respiratory distress and pulmonarydisease as underlying conditions. Mechanical ventilation may beused to limit morbidity and mortality in children with respiratoryfailure.Objective To assess a correlation between chest x-ray findingsand outcomes of patients with mechanical ventilation.Methods This retrospective study was held in Dr. KariadiHospital, Semarang, Indonesia. Data was collected from themedical records of children admitted to the PICU from Januaryto December 2010, who suffered from respiratory distress andused mechanical ventilation. We compared chest x-ray findings tothe outcomes of patients. Radiological expertise was provided byradiologists on duty at the time. Chi-square and logistic regressiontests were used for statistical analysis.Results There were 63 subjects in our study, consisting of 28 malesand 35 females. Patient outcomes were defined as survived or died,43 subjects ( 68%) and 20 subjects (3 2%), respectively. Chest x-rayfindings revealed the following conditions: bronchopneumonia48% (P=0.298; 95%CI 0.22 to 1.88), pleural effusion 43%(P=0.280; 95%CI 0.539 to 4.837) , pulmonary edema 6%(P=0.622; 95%CI 0.14 to 14.62) and atelectasis 3% (P=0.538;95%CI 0.03 to 7 .62). None of the chest x-ray findings significantlycorrelated to patient outcomes.Conclusion Chest x-ray findings do not correlate to patientoutcomes in pediatric subjects with mechanical ventilation inthe PICU of Dr. Kariadi Hospital, Semarang, Indonesia.

Download Full-text

Chest x-ray findings and outcomes of children with suspected ventilator .. associated pneumonia

Paediatrica Indonesiana ◽

10.14238/pi52.4.2012.233-8 ◽

2012 ◽

Vol 52 (4) ◽

pp. 233

Author(s):

Neni Sumarni ◽

Muhammad Sholeh Kosim ◽

Mohammad Supriatna ◽

Eddy Sudijanto

Keyword(s):

Retrospective Study ◽

Patient Outcomes ◽

Pulmonary Infection ◽

Ventilator Associated Pneumonia ◽

Chi Square ◽

X Ray ◽

Chest X Ray ◽

Hospital Acquired ◽

Pediatric Icu ◽

The Relationship

Background Ventilator􀁖associated pneumonia (VAP) is anosocomial infection in patients who have received mechanicalventilation (MV), either by endotracheal intubation ortracheostomy, for more than 48 hours. YAP represents 80% ofall hospital􀁖acquired pneumonias. VAP incidence varies from5.1 %􀁖33.3%. The modified clinical pulmonary infection scoreis a criteria for diagnosing suspected YAP and typically includesradiographic evidence. YAP is associated with significantmorbidity and mortality.Objective To determine the relationship between chest x􀁖rayfindings and outcomes in children Mth suspected VAP.Methods This retrospective study was held in Dr. Kariadi Hospitalfrom January - December 2010. Data was collected from medicalrecords of pediatric ICU (PICU) patients with suspected VAP.Chest x􀁖ray findings and patient outcomes were recorded. X􀁖rayfindings were assessed by the on􀁖duty radiologist. Chi square testwas used for statistical analysis.Results Subjects were 30 children consisting of 14 males and 16females. Patient outcomes were 23 patients survived and 7 patientsdied. Chest x􀁖ray findings were categorized into the followinggroups and compared to patient survivability: diffuse infiltrates76.7% (OR􀁗0.694; P􀁗0.532; 95% CI 0.102 to 4.717), localhedinfiltrates 13.3% (OR􀁗4.200; P􀁗 0.225; 95% CI 0.470 t037.49),and no infiltrates 10% (OR􀁗 1.222; P􀁗 0.436; 95% CI 0.593 to0.926). None of the x􀁖ray findings had a significant correlationto patient outcomes.Conclusion There was no significant relationship between chestx􀁖ray findings and outcomes in children with suspected VAP.[Paediatr rndones. 2012;52:233-8].

Download Full-text

Acute Pulmonary Edema after Polyethylene Glycol Intestinal Lavage in a Child

Annals of Pharmacotherapy ◽

10.1177/106002809302700905 ◽

1993 ◽

Vol 27 (9) ◽

pp. 1044-1047 ◽

Cited By ~ 14

Author(s):

Christopher M. Paap ◽

Robert Ehrlich

Keyword(s):

Polyethylene Glycol ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Ventilatory Support ◽

Gastrointestinal Symptoms ◽

Acute Pulmonary Edema ◽

Severe Respiratory Distress ◽

X Ray ◽

Chest X Ray ◽

Outpatient Settings

OBJECTIVE: To report the case of an eight-year-old girl, without preexisting cardiac or renal disease, who developed acute pulmonary edema and severe respiratory distress after balanced electrolyte with polyethylene glycol (BE-PEG) intestinal lavage. CASE SUMMARY: During the nasogastric infusion of a one-liter dose of BE-PEG (OCL, Abbott), the patient experienced abdominal discomfort, gagging, vomiting, and coughing. After the nasogastric infusion, the patient again had emesis, developed tachypnea, intercostal retractions, and acute respiratory distress. She received oxygen and subsequently required intubation and ventilatory support. Physical examination revealed pulmonary congestion bilaterally but no signs of cardiac failure or sepsis. Chest X-ray revealed bilateral pulmonary edema. Ventilatory support was continued for 36 hours and the patient was extubated after two days. DISCUSSION: Enteral BE-PEG may have caused acute pulmonary edema secondary to aspiration or systemic fluid overload. Although the exact cause remains unknown, the close temporal onset of pulmonary edema after BE-PEG administration in an otherwise healthy child suggests a causal relationship. CONCLUSIONS: This case should alert clinicians to the potential for significant morbidity with BE-PEG solutions, particularly if used in outpatient settings. Patients who receive BE-PEG should be closely observed and monitored for potential aspiration, excessive infusion rates, and gastrointestinal symptoms to optimize efficacy and reduce morbidity.

Download Full-text

Computerized Ventilation

PEDIATRICS ◽

10.1542/peds.79.2.315a ◽

1987 ◽

Vol 79 (2) ◽

pp. 315-316

Author(s):

RAN D. ANBAR

Keyword(s):

Mechanical Ventilation ◽

Clinical Trials ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Blood Gas ◽

Arterial Blood Gas ◽

X Ray ◽

Arterial Blood ◽

Chest X Ray

To the Editor.— Carlo et al1 report an "expert system" based on an algorithm for mechanical ventilation of infants with respiratory distress syndrome which would have corrected arterial blood gas derangements in 89% of 106 clinical trials. This algorithm was applied to additional trials using an independently designed computer-generated ventilation simulation program (VSP). Written in BASIC, VSP expects its user to manage a randomly "created" infant with respiratory distress syndrome by monitoring arterial blood gas values, physical examination findings, and chest x-ray film findings.2

Download Full-text

Explosive Pleuritis

Canadian Journal of Infectious Diseases ◽

10.1155/2001/656097 ◽

2001 ◽

Vol 12 (2) ◽

pp. 104-107 ◽

Cited By ~ 1

Author(s):

Jasdeep K Sharma ◽

Thomas J Marrie

Keyword(s):

Computed Tomography ◽

Pleural Effusion ◽

Respiratory Distress ◽

Pleural Fluid ◽

Case Definition ◽

Pulmonary Tissue ◽

X Ray ◽

Mediastinal Shift ◽

Chest X Ray ◽

The Right

The objective of the present paper is to describe the clinical and computed tomography features of 'explosive pleuritis', an entity first named by Braman and Donat in 1986, and to propose a case definition. A case report of a previously healthy, 45-year-old man admitted to hospital with acute onset pleuritic chest pain is presented. The patient arrived at the emergency room at 15:00 in mild respiratory distress; the initial chest x-ray revealed a small right lower lobe effusion. The subsequent clinical course in hospital was dramatic. Within 18 h of admission, he developed severe respiratory distress with oxygen desaturation to 83% on room air and dullness of the right lung field. A repeat chest x-ray, taken the morning after admission, revealed complete opacification of the right hemithorax. A computed tomography scan of the thorax demonstrated a massive pleural effusion with compression of pulmonary tissue and mediastinal shift. Pleural fluid biochemical analysis revealed the following concentrations: glucose 3.5 mmol/L, lactate dehydrogenase 1550 U/L, protein 56.98 g/L, amylase 68 U/L and white blood cell count 600 cells/mL. The pleural fluid cultures demonstrated light growth of coagulase-negative staphylococcus and viridans streptococcus, and very light growth ofCandida albicans. Cytology was negative for malignant cells. Thoracotomy was performed, which demonstrated a loculated parapneumonic effusion that required decortication. The patient responded favourably to the empirical administration of intravenous levofloxacin and ceftriaxone, and conservative surgical methods in the management of the empyema. This report also discusses the patient's rapidly progressing pleural effusion and offers a potential case definition for explosive pleuritis. Explosive pleuritis is a medical emergency defined by the rapid development of a pleural effusion involving more than 90% of the hemithorax over 24 h, which causes compression of pulmonary tissue and mediastinal shift to the contralateral side.

Download Full-text

Hubungan antara Luas Lesi pada Foto Toraks Penderita TB Paru Dewasa yang Memiliki Riwayat Diabetes Melitus dengan Indeks Massa Tubuh di Rumah Sakit Hasan Sadikin Bandung

Jurnal Radiologi Indonesia ◽

10.33748/jradidn.v1i3.18 ◽

2016 ◽

Vol 1 (3) ◽

pp. 138-144

Author(s):

Ina Edwina ◽

Rista D Soetikno ◽

Irma H Hikmat

Keyword(s):

Chest Radiograph ◽

Chi Square ◽

Pulmonary Tb ◽

X Ray ◽

Consecutive Sampling ◽

Close Relationship ◽

Chi Square Test ◽

Chest X Ray ◽

The Relationship ◽

Diabetes Melitus

Background: Tuberculosis (TB) and diabetes mellitus (DM) prevalence rates are increasing rapidly, especially in developing countries like Indonesia. There is a relationship between TB and DM that are very prominent, which is the prevalence of pulmonary TB with DM increased by 20 times compared with pulmonary TB without diabetes. Chest X-ray picture of TB patients with DM is atypical lesion. However, there are contradictories of pulmonary TB lesion on chest radiograph of DM patients. Nutritional status has a close relationship with the morbidity of DM, as well as TB.Objectives: The purpose of this study was to determine the relationship between the lesions of TB on the chest radiograph of patients who su?er from DM with their Body Mass Index (BMI) in Hasan Sadikin Hospital Bandung.Material and Methods: The study was conducted in Department of Radiology RSHS Bandung between October 2014 - February 2015. We did a consecutive sampling of chest radiograph and IMT of DM patients with clinical diagnosis of TB, then the data was analysed by Chi Square test to determine the relationship between degree of lesions on chest radiograph of pulmonary TB on patients who have DM with their BMI.Results: The results showed that adult patients with active pulmonary TB with DM mostly in the range of age 51-70 years old, equal to 62.22%, with the highest gender in men, equal to 60%. Chest radiograph of TB in patients with DM are mostly seen in people who are obese, which is 40% and the vast majority of lesions are minimal lesions that is equal to 40%.Conclusions: There is a signifcant association between pulmonary TB lesion degree with BMI, with p = 0.03

Download Full-text

Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

Journal of Neonatology ◽

10.1177/09732179211023763 ◽

2021 ◽

Vol 35 (2) ◽

pp. 93-94

Author(s):

Jyotsna Bhushan ◽

Shagufta Iqbal ◽

Abhishek Chopra

Keyword(s):

Respiratory Distress ◽

Conservative Management ◽

Preterm Neonate ◽

Late Preterm ◽

Intravenous Fluids ◽

X Rays ◽

Blood Gas ◽

X Ray ◽

Spontaneous Pneumomediastinum ◽

Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

Download Full-text

Acute Mitral Regurgitation: an important cause of respiratory distress

Acute Medicine Journal ◽

10.52964/amja.0598 ◽

2016 ◽

Vol 15 (1) ◽

pp. 30-32

Author(s):

Legate Philip ◽

◽

Neil Andrews ◽

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Respiratory Distress ◽

Severe Mitral Regurgitation ◽

Shortness Of Breath ◽

Valve Repair ◽

X Ray ◽

Clinical Presentations ◽

Acute Mitral Regurgitation ◽

Chest X Ray

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

Download Full-text

CHEST X RAY SCORE AND CLINICAL SEVERITY IN COVID-19 PATIENTS

10.36106/ijsr/2506669 ◽

2021 ◽

pp. 31-32

Author(s):

Sheeba Rana ◽

Vicky Bakshi ◽

Yavini Rawat ◽

Zaid Bin Afroz

Keyword(s):

Retrospective Study ◽

Medical Records ◽

Scoring Systems ◽

Clinical Severity ◽

X Rays ◽

Antigen Test ◽

X Ray ◽

Classi Cation ◽

Chest X Ray ◽

Male Subjects

INTRODUCTION: Various chest X-ray scoring systems have been discovered and are employed to correlate with clinical severity, outcome and progression of diseases. With, the coronavirus outbreak, few chest radiograph classication were formulated, like the BSTI classication and the Brixia chest X-ray score. Brixia CXR scoring is used for assessing the clinical severity and outcome of COVID-19. This study aims to compare the Brixia CXR score with clinical severity of COVID-19 patients. MATERIAL& METHODS:This was a retrospective study in which medical records of patients aged 18 years or above, who tested for RTPCR or st st Rapid Antigen Test (RAT) for COVID positive from 1 February 2021 to 31 July 2021 (6 months) were taken. These subjects were stratied into mild, moderate and severe patients according to the ICMR guidelines. Chest X Rays were obtained and lesions were classied according to Brixia scoring system. RESULTS: Out of these 375 patients, 123 (32.8%) were female and 252 (67.2%) were male subjects. The average brixia score was 11.12. Average Brixia CXR score for mild, moderate and severe diseased subjects were 5.23, 11.20, and 14.43 respectively. DISCUSSION:The extent of chest x-ray involvement is proportional to the clinical severity of the patient. Although, a perplexing nding was that the average Brixia score of the female subjects were slightly higher than their male counterparts in the same clinical groups. CONCLUSION: Brixia CXR score correlates well with the clinical severity of the COVID-19.

Download Full-text

Clozapine-Induced Myocarditis or Acute Coronary Syndrome? Optical Coherence Tomography to the Rescue

Case Reports in Cardiology ◽

10.1155/2018/5026107 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Ayodeji Dina ◽

Peter Barlis ◽

William van Gaal

Keyword(s):

Acute Coronary Syndrome ◽

Patient Outcomes ◽

Myocardial Perfusion Scintigraphy ◽

Underlying Mechanism ◽

Perfusion Scintigraphy ◽

Troponin Elevation ◽

X Ray ◽

Coronary Syndrome ◽

Coronary Syndromes ◽

Chest X Ray

Chest pain and troponin elevation may be due to an acute coronary syndrome, myocarditis, acute cardiomyopathy, or other less common conditions. Management differs depending on the aetiology, and the pathophysiologic diagnosis has direct implications on treatment and patient outcomes. History and clinical examination is supplemented by selected investigations including the electrocardiogram, chest X-ray, echocardiography, coronary angiography, and even myocardial perfusion scintigraphy or cardiac magnetic resonance imaging. Intravascular imaging can provide important insights into the underlying mechanism of acute coronary syndromes, especially when angiography is ambiguous.

Download Full-text