Hypoxemia and Respiratory Failure: Clinical Conditions and Pathophysiological Approaches

Neonates with acute respiratory failure and certain other clinical conditions may require emergency endotracheal intubation. During the procedure, one periodically encounters laryngospasm with the vocal cords tightly apposed to each other, resisting passage of the endotracheal tube. We have encountered four such neonates during the past 12 months. Two neonates suffered from severe birth asphyxia and required intubation in the delivery room. A third infant was intubated because of progressive hypoxemia and hypercarbia secondary to hyaline membrane disease, and the fourth was intubated for an elective surgical procedure. A brief period of forced expiration produced by a depression of the sternum, a modification of the Heimlich maneuver,1 opened the vocal cords, enabling a smooth, relatively atraumatic intubation in all four infants.

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Noninvasive ventilation for acute respiratory failure: state of the art (I part)

Italian Journal of Medicine ◽

10.4081/itjm.2009.201 ◽

2013 ◽

pp. 201-211

Author(s):

Federico Lari ◽

Fabrizio Giostra ◽

Gianpaolo Bragagni ◽

Nicola Di Battista

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Blood Gases ◽

Chronic Obstructive ◽

Arterial Blood Gases ◽

Early Application ◽

Acute Cardiogenic Pulmonary Edema ◽

General Medical Ward ◽

Arterial Blood ◽

Clinical Conditions

Background: In the last years Non-Invasive Ventilation (NIV) has been playing an important role in the treatment of Acute Respiratory Failure (ARF). A lot of trials have shown improvements in clinical features (respiratory rate, neurological score), pH and arterial blood gases. Methods: In particular clinical conditions, such as Acute Cardiogenic Pulmonary Edema (ACPE) and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), systematic reviews and meta-analysis show a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. In other clinical conditions, such as acute asthma, Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) and severe pneumonia, NIV does not show significant improvements in term of avoided intubations or mortality rate. Although the first important data on NIV comes from studies performed in Intensive Care Units (ICUs), subsequently these methodologies of ventilation have been used with increasing frequency in Emergency Departments (ED) and medical wards. Results: Studies developed in ICU sometimes report slightly worse outcomes compared to studies performed in general wards due to the need to treat more severe patients in ICU. Aetiology remains one of the most important factor determining prognosis: different pathological mechanisms substain different clinical conditions and not in all cases the application of positive pressures to the airways is useful. NIV for ARF due to COPD and ACPE is feasible, safe and effective also in a general medical ward if selection of patients, staff training and monitoring are appropriate: its early application improves clinical parameters, arterial blood gases, prevents endotracheal intubation, decreases mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting.

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Out-of-hospital helmet CPAP in acute respiratory failure reduces mortality: a study led by nurses

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2010.283 ◽

2016 ◽

Vol 73 (4) ◽

Author(s):

G. Garuti ◽

G. Bandiera ◽

M.S. Cattaruzza ◽

L. Gelati ◽

J.F. Osborn ◽

...

Keyword(s):

Respiratory Failure ◽

Length Of Stay ◽

Acute Respiratory Failure ◽

Emergency Room ◽

Medical Therapy ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Standard Medical Therapy ◽

Clinical Conditions

Background and Aim. Acute respiratory failure (ARF) is a condition that must be treated as quickly as possible. Continuous Positive Airway Pressure (CPAP) is a common method used to treat ARF in hospital. The main objective of our study was to investigate the effect of CPAP prior to admission to the emergency room, on the reduction of endotracheal intubation, in-hospital mortality and on the length of stay in hospital (HLOS). Methods. A prospective, observational (non-randomised) study with a historical control group. Data from 3 groups of patients with ARF, irrespective of cause, was collected: pre-hospital CPAP (PHCPAP) group, i.e. 35 patients treated with a helmet CPAP in the ambulance, by trained nurses (mean age, years 80.1±7.9 SD; 14 males); hospital CPAP (HCPAP) group, i.e. 46 patients treated with helmet CPAP in the hospital emergency room (mean age 78.6±6.9 SD; 27 males), and a historical control group of 125 patients treated with medical therapy only (mean age 76.7±5.5 SD; 52 males). CPAP was delivered via a helmet interface. Results. Compared with standard medical therapy, helmet CPAP (pre and in-hospital) reduced mortality by 77 % (p=0.005), while pre-hospital helmet CPAP reduced it by 94% (p=0.011), after adjustment for age, sex, severity of clinical conditions at entry and diagnosis upon admission. HLOS was reduced, compared with standard medical therapy, by 63.5% and by 66% (adjusting for age, sex, severity of clinical conditions at entry and diagnosis at admission) with helmet CPAP (pre and in-hospital) and with helmet CPAP in the ambulance, respectively (p<0.0001). Conclusions. Treating patients with ARF of any cause, with CPAP by trained nurses, before hospital admission, is safe, reduces mortality and the length of stay needed in hospital.

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Neuromuscular Disease in the Neuroscience Intensive Care Unit

10.1093/med/9780197512166.003.0062 ◽

2021 ◽

pp. 511-518

Author(s):

Maximiliano A. Hawkes ◽

Eelco F. M. Wijdicks

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Neuromuscular Disease ◽

Clinical Symptoms ◽

Critical Illness Polyneuropathy ◽

Inpatient Setting ◽

Medical Intensive Care ◽

Neuroscience Intensive Care Unit ◽

Clinical Conditions

Neurologists may meet patients with neuromuscular disease and subsequent respiratory failure in the inpatient setting. Common clinical conditions include Guillain-Barré syndrome (GBS) and myasthenia gravis (MG). Recognition of impending respiratory failure for such patients is of great importance. This chapter describes general features of neuromuscular weakness and neuromuscular respiratory failure. In addition, it reviews the clinically important aspects of GBS, MG, and botulism. Finally, the chapter outlines the clinical symptoms, diagnosis, and treatment of critical illness polyneuropathy, a commonly encountered condition in the medical intensive care unit.

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Rituximab treatment in a case of anti- synthetase syndrome with severe interstitial lung disease and acute respiratory failure

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2011.439 ◽

2019 ◽

Vol 6 ◽

Author(s):

Maria Cristina Zappa ◽

Tiziana Trequattrini ◽

Francesco Mattioli ◽

Rosario Rivitti ◽

Rossana Vigliarolo ◽

...

Keyword(s):

Respiratory Failure ◽

High Resolution ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Pulmonary Function ◽

Interstitial Pneumonitis ◽

Pulmonary Function Tests ◽

Severe Form ◽

Anti Cd20 ◽

Clinical Conditions

We present a case of severe interstitial pneumonitis, mild polyarthritis and polymyositis, and Raynaud's syndrome with the presence of anti-Jo-1 antibodies, which had been diag- nosed as anti-synthetase syndrome. The presence, however, of anti-Ro/SSA antibodies led us to understand that we were dealing here with a more severe form of interstitial lung dis- ease. The patient was treated for acute respiratory failure but he showed resistance to glucocorticoids and cyclosporine. Thus, he was treated with infusions of anti-CD20 therapy (rituximab): his clinical conditions improved very rapidly and a significant decrease in the activity of pulmonary disease was detected using high-resolution computerized tomogra- phy (HRCT) of the thorax and pulmonary function tests.

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