scholarly journals Predicting the need for ventilatory support in organophosphorous compound poisoning

2018 ◽  
Vol 6 (12) ◽  
pp. 4015
Author(s):  
Sudha Mary Philip
Keyword(s):  
Respiratory Rate ◽  
Organophosphorus Compound ◽  
District Hospital ◽  
Ventilatory Support ◽  
Respiratory Illness ◽  
Organophosphorous Compound ◽  
Gcs Score ◽  
Group Sex ◽  
Accessory Muscles ◽  
Severe Grade

Background: Organophosphorus compound poisoning is one of the most common poisonings often requiring ICU care and ventilatory support. Hence this study was undertaken to identify the factors, which predict the need for ventilation in these patients.Methods: All the patients who were diagnosed to have consumed organophosphorus compound poison admitted in RLJ Hospital and SNR District Hospital Kolar, Karnataka, India who presented within 24hours of consumption were included in the study. Patients with concomitant respiratory illness, double poisoning and those treated outside were excluded from the study.Results: A total number of 50 patients were studied. 30(60%) were males and 20 (40%) were females. 18 patients required ventilation. 100% of patients with respiratory rate>25 breaths/minute and 55% of patients with a fasciculation score of >4 required ventilation. Ventilation was required by 84.6% of patients who has a GCS Score of <10. 21.7% of patients with mild and 33.3% with moderate poisoning required ventilation. In contrast 66.6% of patients with severe poisoning required ventilation. Of the patients admitted to the hospital >4hours after consumption of poison, 36% required ventilation. Of the 19 patients who had oxygen saturation levels <89%, 18 patients (94.7%) required ventilation. Patients who were ventilated required a higher dose of atropine within 48hours of admission as compared to those who were not ventilated.Conclusions: Patients who presented with higher respiratory rate, accessory muscles of respiration in action, higher fasciculation score, GCS score of 10, greater lag time between consumption of poison and admission to hospital (4hours), severe grade of poisoning and O2 saturation <89% were more likely to require ventilation. There is no relationship between the age group, sex, pulse rate, pupil size and type of organophosphorous compound consumed with the need for ventilation.

A Rare Case of Acute Interstitial Pneumonia Diagnosed at Autopsy

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S153-S154
Author(s):  
E Conner ◽  
D Troxclair ◽  
H Khokhar ◽  
W Beversdorf
Keyword(s):  
Respiratory Failure ◽  
Interstitial Pneumonia ◽  
Diffuse Alveolar Damage ◽  
Ventilatory Support ◽  
Respiratory Illness ◽  
High Dose ◽  
Atypical Pneumonia ◽  
Acute Interstitial Pneumonia ◽  
Diagnostic Role ◽  
History Of

Abstract Introduction/Objective Acute interstitial pneumonia (AIP) is a rare disease clinically characterized by rapidly progressing respiratory failure in individuals with no history of respiratory illness or other inciting factors. While most often diagnosed in middle-aged adults, it may present in any age group. Initial presentation is described as influenza- like, and respiratory failure requiring ventilatory support often progresses within weeks to months. Prognosis is poor, with an estimated mortality rate approaching 80% without treatment. Methods We present the case of a 44-year-old male nonsmoker with no significant medical history, who presented in 2018 with 1.5 months of dyspnea and headache initially diagnosed as atypical pneumonia. Chest imaging revealed bilateral opacities; however, microbial workup revealed no evidence of infectious etiology. Autoimmune serology studies were likewise unrevealing. Despite aggressive supportive and medical management, he deteriorated to respiratory failure and succumbed. Results At autopsy, the lungs were symmetrically congested and edematous (combined weight 2,340 g) but free of evident consolidation or discrete lesions. Microscopic examination revealed diffuse alveolar damage with extensive hyaline membrane formation, interstitial edema, and fibroblastic proliferation. The vasculature was severely congested, and the alveoli contained hemorrhage and scattered macrophages. No fungal or mycobacterial elements were identified by staining. Based on the histologic features and clinical context, the diagnosis of AIP was made. Conclusion AIP is a rare, aggressive, and diagnostically challenging disease that includes a broad range of both clinical and histologic differentials. Timely recognition and intervention with aggressive respiratory support and high- dose glucocorticoids are the mainstays of clinical management. The diagnostic role of histology is significant, but hinges on early clinical consideration of AIP as disease progression may later preclude the biopsy procedure. We share this case to raise awareness of this rapidly progressive and diagnostically troubling interstitial lung disease while emphasizing the importance of clinicopathologic correlation.

Abstract 108: Work of Breathing Scale to Assess Need of Intubation in Covid-19 Pneumonia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Raul J Gazmuri ◽  
Mylene Apigo ◽  
Philip Fanapour ◽  
Amin Nadeem
Keyword(s):  
Respiratory Rate ◽  
Work Of Breathing ◽  
Invasive Mechanical Ventilation ◽  
Lung Compliance ◽  
Respiratory Physiology ◽  
High Flow Nasal Cannula ◽  
Radiographic Evidence ◽  
Multiple Risk Factors ◽  
Rate Score ◽  
Accessory Muscles

COVID-19 pneumonia presents in most patients with significant hypoxemia but without substantial impairment of lung compliance that would increase the work of breathing (WOB) to levels requiring invasive mechanical ventilation. Thus, the ability to assess the WOB independent of the oxygen needs could help guide management and possibly avoid intubation. We previously developed and implemented in our ICU a WOB scale based on respiratory physiology ranging from 1 to 7 by assigning points to the respiratory rate level and the use of respiratory accessory muscles. We analyzed the use of our WOB scale in 10 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease with significant hypoxemia and multiple risk factors associated with poor outcome. Hypoxemia was successfully managed using high-flow nasal cannula. The WOB level was measured every 4 hours. The maximum WOB was 4.3 ± 0.9, contributed primarily by the respiratory rate with a score of 3.6 ± 0.5 but with infrequent use of respiratory accessory muscles. All 10 patients survived without need of intubation. For comparison, three other patients who needed intubation had a maximal work of breathing within the preceding 24 hours of 5.3 ± 1.2 with a respiratory rate score of 3.7 ± 0.6, as in non-intubated patients, but with more often use of respiratory accessory muscles. Our data suggest that patients with COVID-19 pneumonia can be supported for extended periods using HFNC despite tachypnea provided there is only infrequent use of respiratory accessory muscles, corresponding to a WOB scale ≤ 4, prompting closer assessment for possible intubation when WOB > 4. This approach would be especially advantageous under conditions of high disease intensity when avoidance of intubation is likely to result in a better outcome.

scholarly journals Predictors of In-hospital Mortality of Acute Ischemic Stroke in Adult Population

2017 ◽  
Vol 08 (04) ◽  
pp. 591-594 ◽  
Author(s):  
Bhupendra Shah ◽  
Bijay Bartaula ◽  
Janak Adhikari ◽  
Hari Shankar Neupane ◽  
Birendra Prasad Shah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Acute Ischemic Stroke ◽  
Pulse Rate ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Predictors Of Mortality ◽  
Gcs Score

ABSTRACT Introduction: Stroke is the second most common cause of mortality worldwide. Data regarding the predictors of mortality of acute ischemic stroke are widely discordant. Identifying the predictors and providing the utmost care to a high-risk patient is still an unmet need in middle- to low-income countries. We did this study to identify the predictor of in-hospital mortality of acute ischemic stroke. Materials and Methods: We conducted a retrospective study of patients with acute ischemic stroke presented to the tertiary care center in eastern Nepal from January 2012 to December 2016. We enrolled patients of age 18 years and older with acute ischemic stroke in this study. The primary outcome of the study was in-hospital mortality of enrolled patients. Predictors of mortality were analyzed by comparing the patients with acute ischemic stroke who had mortality with those who survived. Results: The mean age of enrolled patients was 66 years. Among 257, the in-hospital mortality rate was 20.5%. The patients with in-hospital mortality had lower Glasgow coma scale (GCS) score (9 vs. 12, P < 0.001) compared to those who survived. During admission, a patient with in-hospital mortality had significantly lower arterial oxygen saturation (92 vs. 95, P < 0.001), higher pulse rate (91 vs. 83, P =0.009), and higher respiratory rate (24 vs. 21, P < 0.001) than those patients with acute ischemic stroke who survived. Conclusion: Lower GCS score, baseline higher pulse rate, higher respiratory rate, and lower arterial oxygen saturation are the predictors of in-hospital mortality of adult with acute ischemic stroke.

scholarly journals Geographical variation in demand, utilization, and outcomes of hospital services for COVID-19 in Brazil: A descriptive serial cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257643
Author(s):  
Claudia Cristina de Aguiar Pereira ◽  
Mônica Martins ◽  
Sheyla Maria Lemos Lima ◽  
Carla Lourenço Tavares de Andrade ◽  
Fernando Ramalho Gameleira Soares ◽  
...  
Keyword(s):  
Geographical Variation ◽  
Ventilatory Support ◽  
Secondary Data ◽  
Respiratory Illness ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Region ◽  
The North ◽  
Public Data

Objective To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021. Methods Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil. Results There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively. Conclusion The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes.

scholarly journals Combating a Case of COVID Pneumonia with ARDS – a Physiotherapist’s Standpoint

2021 ◽  
pp. 412-417
Author(s):  
Chaithanya Ratheesh ◽  
Aishwarya Nair
Keyword(s):  
Case Report ◽  
Ventilatory Support ◽  
Treatment Protocol ◽  
Respiratory Illness ◽  
Supplemental Oxygen ◽  
Multiple Organ ◽  
Vital Role ◽  
Correct Identification ◽  
Physiotherapy Treatment ◽  
Organ Systems

Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, affecting multiple organ systems. The disease usually presents as mild to moderate respiratory illness but in many cases has progressed to development of pneumonia and ARDS ultimately requiring ventilatory support and prolonged ICU stay. Prolonged immobilization itself is a harbinger of various complications drastically altering a patient’s functional status. Physiotherapy plays a vital role in the management of COVID-19 symptoms as well as in the prevention of complications.  Case Study: This case report describes the progress of a 44-year old female patient diagnosed with COVID-19 presenting with subsequent pneumonia and ARDS. The patient was started with medical management and supplemental oxygen therapy. In combination to the above-mentioned protocols, physiotherapy treatment was also initiated. After 2 weeks of rehabilitation and drug therapy, the patient displayed improved respiratory function at room air and was able to independently ambulate with minimal breathing difficulty. Discussion: This case report aims to highlight the importance of early intervention of physiotherapy in COVID-19 patients. The scope of physiotherapy treatment in patients with COVID-19 pneumonia is vast. The treatment protocol adapted for this patient are in tune with the various research articles analysed to ensure evidence-based care. This will enable the healthcare professionals to ensure timely referral and early initiation of Physiotherapy treatment. Conclusion: As per the findings and results of this case report, it is evident that the patient benefited from the timely advent of physiotherapy intervention. The key factor was the correct identification of the problematic areas and accurate prioritization based on the clinical presentation and investigation findings

scholarly journals PREDICTING THE NEED FOR VENTILATORY SUPPORT IN ORGANOPHOSPHORUS COMPOUND POISONING

2016 ◽  
Vol 5 (66) ◽  
pp. 4716-4721
Author(s):  
Peddi Bhaskar ◽  
Rajendra Prasad P ◽  
Srikanth Reddy P
Keyword(s):  
Organophosphorus Compound ◽  
Ventilatory Support

Non-invasive ventilation as a prehospital intervention for acute COPD exacerbation

2019 ◽  
Vol 11 (9) ◽  
pp. 376-380
Author(s):  
Samuel McCreesh
Keyword(s):  
Hospital Admissions ◽  
Ventilatory Support ◽  
Respiratory Illness ◽  
Pharmacological Therapy ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Prehospital Treatment ◽  
Non Invasive ◽  
Non Invasive Ventilation

Chronic obstructive pulmonary disease (COPD) is the second most common respiratory illness in the UK, affecting over 1 million people. Acute exacerbations of COPD are a common presentation to the ambulance service and account for thousands of hospital admissions annually. Acute respiratory failure accompanies approximately 20% of exacerbations. Current prehospital treatment focuses on oxygen and pharmacological therapy to treat the underlying causes. Non-invasive ventilation (NIV) is a method of ventilatory support that does not require endotracheal intubation, avoiding significant risks associated with intubation and sedation. While some UK ambulance services have introduced NIV, UK guidelines primarily focus on hospital use. International trials have shown prehospital NIV to be more effective than standard treatment in terms of reducing the need for intubation and invasive ventilation in hospital. However, further research is necessary before NIV is introduced widely in UK prehospital paramedic practice.

scholarly journals A prospective study on the predictors of mechanical ventilation in organophosphate poisoning

2020 ◽  
Vol 8 (4) ◽  
pp. 1357
Author(s):  
Aravind Varma Datla ◽  
Rosaiah Duddu ◽  
Pravin Gulab Rao Maske
Keyword(s):  
Mechanical Ventilation ◽  
Glasgow Coma Scale ◽  
Lung Diseases ◽  
Ventilatory Support ◽  
Organophosphate Poisoning ◽  
Medical Sciences ◽  
Chronic Lung Diseases ◽  
Organophosphorus Poisoning ◽  
Gcs Score ◽  
A Prospective Study

Background: Organophosphorus poisoning is one of the most common poisonings often requiring ICU care and ventilatory support. The objective and aim of this study are to identify the factors which predict the need for ventilation in these patients.Methods: 50 patients who were diagnosed to have consumed organophosphorus compound poison admitted in Konaseema Institute of Medical Sciences and Research Foundation who presented within 24 hours of consumption are included in the study. Patients with double poisonings, concomitant illnesses, chronic lung diseases and those treated outside are excluded from the study.Results: A total number of 50 patients were studied. 18(36%) patients required ventilation. Generalized fasciculations was a discernible feature in 66% of cases in this study. 69.2% of patients with a fasciculation score of ≥4 required ventilation. Ventilation was needed by 55% of patients who had a Glasgow Coma Scale score of ≤10.Conclusions: Patients who presented with higher fasciculation scores and/or lower GCS scores were more likely to require ventilation. Using GCS scores as a predictor for the requirement of ventilatory support in organophosphate poisoning, a GCS score ten or less was significantly associated with an increased need for ventilatory support.

scholarly journals VENTILATORY SUPPORT WITH THE USE OF NIV, NON-REBREATHABLE MASK AND PRONE VENTILATION IN A COVID PATIENT

2020 ◽  
pp. 16-17
Author(s):  
K. Arun Vishnu ◽  
Athul.C. Angaj ◽  
Trinath Dash
Keyword(s):  
Risk Factors ◽  
Respiratory Function ◽  
Ventilatory Support ◽  
Respiratory Illness ◽  
Invasive Ventilation ◽  
The Past ◽  
Icu Stay ◽  
Prolonged Icu Stay

VENTILATORY SUPPORT HAS BEEN GAINING IMPORTANCE AND MOMENTUM IN THE PAST DUE TO RESPIRATORY ILLNESS LIKE COPD, ASTHMA AND ALSO IN THE PRESENT IN VIEW OF THE CURRENT ON GOING PANDEMIC WHERE MAINTAINING THE RESPIRATORY FUNCTION WITH OPTIMUM OXYGENATION IN A PATIENT HAS BEEN A LOT CHALLENG DUE TO VARIOUS RISK FACTORS. WE HEREBY ARE GOING TO DISCUSS ABOUT A CASE OF COVID 19 AND LATER DEVELOPED POST-COVID FIBROSIS. HE WAS MANAGED WITH VARIOUS MODES OF VENTILATORY SUPPORTS OF A PROLONGED ICU STAY WITH OUT INVASIVE VENTILATION, AND LATER DISCHARGED.

Sign in / Sign up

Export Citation Format

Share Document