scholarly journals Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

2020 ◽  
Vol 148 (3-4) ◽  
pp. 211-215
Author(s):  
Jelena Kascak ◽  
Sladjana Andjelic
Keyword(s):  
Early Recognition ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Modern Society ◽  
Diagnostic Procedures ◽  
Hospital Treatment ◽  
Symptomatic Therapy ◽  
Sleep Study ◽  
Pickwickian Syndrome ◽  
Line Of Therapy

Introduction. Pickwickian syndrome (PS), also known as hypoventilation syndrome in adults, consists of three factors: obesity [Body Mass Index (BMI) > 30 kg/m2], daytime hypercapnia and sleep-disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. Timely recognition of PS is of utmost importance because such patients have significant morbidity and mortality. However, recent data indicate that PS is under-recognized and under-treated. We report a case of early-identified PS prehospitally with a favorable outcome after hospital treatment. Case outline. A 67-year-old female patient was diagnosed prehospitally, and the diagnosis was later confirmed in hospital. Diagnostic criteria were as follows: BMI > 45,7 kg/m2 (height 170 cm, weight 132 kg), hypercapnia, hypoxemia and respiratory acidosis (pCO2 ? 41 mmHg, pO2 ? 56 mmHg, pH 7.45) in the absence of other causes of hypoventilation. During hospitalization, the following diagnostic procedures were performed: standard laboratory analyses, chest radiography, electrocardiography, abdomen and heart echocardiography. An attempted sleep study (polysomnography) was interrupted due to a drop in oxygen saturation levels. Non-invasive mechanical ventilation and a diet were used as the first line of therapy. However, due to the development of a global respiratory insufficiency, the patient was intubated and placed on a mechanical ventilator. After 30 days of hospital treatment, the patient was released in a satisfactory general condition with recommendations for weight reduction and symptomatic therapy. Conclusion. As obesity is becoming an epidemic of modern society, early recognition and treatment of PS is of crucial importance.

Ambulatory care of non-invasive mechanical ventilation in COPD patients with global decompensated respiratory acidosis

Pneumologie ◽  
2017 ◽  
Vol 71 (S 01) ◽  
pp. S1-S125
Author(s):  
EJ Soto Hurtado ◽  
P Gutiérrez Castaño ◽  
JJ Torres ◽  
MD Jiménez Fernández ◽  
M Pérez Soriano ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ambulatory Care ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Non Invasive ◽  
Copd Patients

Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study)

2021 ◽  
pp. 1-10
Author(s):  
Guglielmo Consales ◽  
Lucia Zamidei ◽  
Franco Turani ◽  
Diego Atzeni ◽  
Paolo Isoni ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Multiorgan Failure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Kidney Injury ◽  
Protective Ventilation ◽  
Retrospective Observational Study ◽  
Organ Support ◽  
Chronic Obstructive

<b><i>Background:</i></b> Critically ill patients with acute respiratory failure frequently present concomitant lung and kidney injury, within a multiorgan failure condition due to local and systemic mediators. To face this issue, extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) systems have been integrated into continuous renal replacement therapy (CRRT) platforms to provide a combined organ support, with efficient clearance of CO<sub>2</sub> with very low extracorporeal blood flows (&#x3c;400 mL/min). <b><i>Objectives:</i></b> To evaluate efficacy and safety of combined ECCO<sub>2</sub>R-CRRT support with PrismaLung®-Prismaflex® in patients affected by hypercapnic respiratory acidosis associated with AKI in a second level intensive care unit. <b><i>Methods:</i></b> We carried out a retrospective observational study enrolling patients submitted to PrismaLung®-Prismaflex® due to mild to moderate acute respiratory distress syndrome (ARDS) or acute exacerbation of chronic obstructive pulmonary disease (aeCOPD). The primary endpoints were the shift to protective ventilation and extubation of mechanically ventilated patients and the shift to invasive mechanical ventilation of patients receiving noninvasive ventilation (NIV). Clinical-laboratoristic data and operational characteristics of ECCO<sub>2</sub>R-CRRT were recorded. <b><i>Results:</i></b> Overall, 12/17 patients on mechanical ventilation shifted to protective ventilation, CO<sub>2</sub> clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 patients. No treatment-related complications were recorded. <b><i>Conclusion:</i></b> ECCO<sub>2</sub>R-CRRT was effective and safe in patients with aeCOPD and ARDS associated with AKI.

scholarly journals Management of severe acute exacerbations of COPD: an updated narrative review

2018 ◽  
Vol 13 ◽  
Author(s):  
Antoni Torres ◽  
Ernesto Crisafulli ◽  
Enric Barbeta ◽  
Antonella Ielpo
Keyword(s):  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Narrative Review ◽  
New Drugs ◽  
Rapid Decline ◽  
Chronic Obstructive ◽  
Main Body ◽  
Pharmacological Treatments ◽  
Icu Patients

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body: In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion: Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.

FC04-02 - Traumatic experiences as a risk factor for suicide in adolescence

2011 ◽  
Vol 26 (S2) ◽  
pp. 1829-1829
Author(s):  
M. Delalle ◽  
K. Dodig-Ćurković ◽  
P. Filaković
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Early Recognition ◽  
Child And Adolescent Psychiatry ◽  
University Hospital ◽  
Traumatic Experience ◽  
Traumatic Experiences ◽  
Hospital Treatment ◽  
Control Group ◽  
Significant Difference

IntroductionToday, the general interpretation of the etiology of various psychopathological symptoms in adolescence does not talk about causes, but the risk factors.AimWe tried to determine whether traumatic experiences among adolescents represent a risk factor for suicide.MethodsThe study was conducted at the University Department for Child and Adolescent Psychiatry, University Hospital Osijek in 2006. and 2007. years.In the study period we included 100 patients, the experimental group consisted of 50 patients who were admitted to the department for attempted suicide in the order of admission to hospital treatment, the control group consisted of 50 patients admitted to the department for other psychiatric disorders, also in the order of admission to treatment / diagnosed according to DSM IV/.ResultsAge range of 13–18 years. There was no statistically significant difference between the two groups of subjects according to age (χ2 = 5289, df = 5, p = .382) and according to sex (χ2 = .694, df = 1, p = .405). In the suicidal group 38 patients (76%) reported traumatic experiences /most in family context/ while in nonsuicidal group 27 patients (54%) what is statistical difference (χ2 = 5319, df = 1, p = .021).ConclusionIn daily psychiatric work we must focus on adolescents who have experienced traumatic experiences and is therefore extremely important in anamnesis always ask for the lived traumatic experience. Family practitioners, specialists in educational institutions, parents and adolescents themselves have a role in early recognition of these risk factors.

scholarly journals Unusual Respiratory Manifestations of Ankylosing Spondylitis – A Case Report

2016 ◽  
Vol 17 (4) ◽  
pp. 357-360
Author(s):  
Ivan Cekerevac ◽  
Vojislav Cupurdija ◽  
Ljiljana Novkovic ◽  
Zorica Lazic ◽  
Marina Petrovic ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ankylosing Spondylitis ◽  
Obstructive Sleep Apnoea ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Sleep Apnoea ◽  
Hla Typing ◽  
Clinical Criteria ◽  
Obstructive Sleep ◽  
Global Respiratory Failure

Abstract A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. The diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verified the existence of severe obstructive sleep apnoea (AHI =73). This was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. Thee patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night.

scholarly journals Recurrent Pneumothorax with CPAP Therapy for Obstructive Sleep Apnea

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Kartikeya Rajdev ◽  
Pretty Sara Idiculla ◽  
Shubham Sharma ◽  
Susanna G. Von Essen ◽  
Peter J. Murphy ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Diaphragmatic Hernia ◽  
Invasive Mechanical Ventilation ◽  
Positive Pressure ◽  
Cpap Therapy ◽  
Pulmonary Barotrauma ◽  
Sleep Study ◽  
Pressure Therapy ◽  
Obstructive Sleep

Pulmonary barotrauma such as pneumothorax (PTX) is a known complication of invasive mechanical ventilation. However, it is uncommonly reported with the use of noninvasive positive pressure ventilation (NPPV) and CPAP (continuous positive airway pressure) therapy. We present a case of a 66-year-old female who presented with chronic dyspnea on exertion secondary to right-sided diaphragmatic hernia. The patient also underwent a home sleep study which suggested obstructive sleep apnea (OSA) for which she was initiated on CPAP. She then underwent surgical repair of her right diaphragmatic hernia. The patient developed pneumothorax three times over the course of the following several months, once on the right side and twice on the left side. The patient’s incidences of PTX had a temporal association with the CPAP initiation. Her CPAP therapy was discontinued permanently after the third occurrence of PTX. With this case report, we highlight the risk of barotrauma with the use of CPAP for OSA. There are very few reported cases of PTX in association with NPPV therapy for OSA. The lung-protective ventilation strategies and limiting the positive airway pressures can help reduce the risk of pulmonary barotrauma with CPAP.

scholarly journals Advancing convergent mixed methods design using the Diamond Approach for clinical multiple case studies: an example using data on time to treatment in aneurysmal subarachnoid haemorrhage

2021 ◽  
Author(s):  
Thuy P Nguyen ◽  
Christine Stirling ◽  
Gemma Kitsos ◽  
Kim Jose ◽  
Linda Nichols ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Quantitative Data ◽  
Early Recognition ◽  
Hospital Treatment ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Time To Treatment ◽  
Study Approach ◽  
Multiple Case ◽  
Timely Treatment

Backgrounds and aims: Delays in treatment of aSAH appear common but the causes are not well understood. We explored facilitators and barriers to timely treatment of aSAH. Methods: We used a mixed-methods multiple case study approach including in-depth interviews with stakeholders involved in individual aSAH cases, focusing on events from onset to treatment. Quantitative data were extracted from medical records including date and times. Within-case analysis identified barriers and facilitators in 4 phases (pre-hospital, presentation, transfer, in-hospital), which then being triangulated with the quantified time in each phase to determine significant influencing factors. Finally, we conducted thematic analysis across cases in early (<12h) and delayed (>12h) treatment group using a case-study matrix. Results: Twenty-seven cases (74.1% female) with 89 interviewees were included. Median (IQR) time to treatment was 15.1 (9.0, 24.1) hours. Only 37% of cases had treatment within 12 hours of onset. Qualitative and quantitative data triangulation identified key themes influencing timely treatment of aSAH. Early recognition of aSAH and good coordination during pre-hospital and diagnosis phases, and availability of resources for treatment during in-hospital period were main facilitators for treatment within 12 hours from onset. Lack of recognition of aSAH at onset and lack of resources for immediate in-hospital treatment were major barriers for more delayed treatment. Conclusions: Using a robust mixed-methods approach, we identified the most significant factors affecting more timely treatment within 12 hours from onset of aSAH. The factors are potentially modifiable and may improve timely treatment of aSAH.

scholarly journals Respiracijske transfuzijske reakcije

2017 ◽  
Vol 86 (9-10) ◽  
Author(s):  
Ivica Marić ◽  
Polona Mlakar ◽  
Irena Bricl
Keyword(s):  
Clinical Picture ◽  
Early Recognition ◽  
Common Knowledge ◽  
Invasive Mechanical Ventilation ◽  
Treatment Strategies ◽  
Volume Overload ◽  
Basal Membrane ◽  
The Elderly ◽  
The One ◽  
Transfusion Reactions

Respiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. Tis article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI - transfusion-related acute lung injury, TACO – transfusion-associated circulatory overload, and TAD - transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient’s preexisting diseases. Although the transfusion-related reactions are not very common, knowledge about them can prevent serious consequences. On the one hand preventive measures should be sought, and on the other early recognition is beneficial, so that proper treatment can take place.

scholarly journals MATERNALAND FOETAL OUTCOME IN SEVERE PREECLAMPSIAAND ECLAMPSIA IN A TERTIARY CARE RURAL HOSPITAL, KARNATAKA, INDIA.

2020 ◽  
pp. 1-4
Author(s):  
Ravindra S Pukale ◽  
Anushree Patel
Keyword(s):  
Early Recognition ◽  
Tertiary Care ◽  
Severe Preeclampsia ◽  
Research Centre ◽  
Hospital Treatment ◽  
Multisystem Disorder ◽  
Microsoft Excel ◽  
Health Care Centre ◽  
Mortality And Morbidity ◽  
Foetal Outcome

INTRODUCTION: Preeclampsia and eclampsia are a multisystem disorder occurring during pregnancy, complicating 3-8% of pregnancies accounting 10-15% of maternal and neonatal mortality and morbidity. AIMS AND OBJECTIVES: The aim is to study severe preeclampsia and eclampsia and associated maternal and foetal outcomes at a rural tertiary health care centre. MATERIALS AND METHODS: This is a prospective cohort study conducted at Sri Adichunchanagiri Institute of Health Sciences and Research Centre, B.G Nagara, Karnataka from July 2018 to December 2019. Patients included in the study will be as per inclusion and exclusion criteria. Patients with severe preeclampsia and eclampsia will be included by thorough history taking and data will be entered in Microsoft Excel and outcomes will be analysed using Epi Info software. RESULTS: Out of 3068 deliveries conducted, 157 cases were diagnosed with severe preeclampsia and eclampsia. Incidence of severe preeclampsia being 4.7%(n=146), and that of eclampsia (n=11, 0.3%). Majority belonged to age group 21-25years (47.1%), 90(57.3%) were Primigravida. Preterm deliveries before 32 weeks accounted 21.6%(n=34), while before 34 weeks were 29.9%(n=47). A total of 29.4% preterm deliveries (n=109) were observed. Onset of eclampsia was noted mostly in antepartum period accounting 54.54%(n=6) of total eclampsia case report, 47.13% (n=74) were started on Pritchard’s regimen. Caesarean section was undertaken in 36.9%(n=58) patients with IUGR being common indication (n=19, 32.7%). IUD was noted in 7.6%, LBW in 75.15% CONCLUSION: The importance of continued efforts in monitoring and reviewing the line of treatment with better antenatal care, early recognition and hospital treatment of patients can decrease the incidence rate of severe preeclampsia and eclampsia.

scholarly journals Epidemics of the central nervous system infections caused by West Nile virus in the territory of the South Backa District, Vojvodina, Serbia

2015 ◽  
Vol 72 (12) ◽  
pp. 1098-1104
Author(s):  
Sinisa Sevic ◽  
Sandra Stefan-Mikic ◽  
Dragana Sipovac ◽  
Vesna Turkulov ◽  
Vesna Milosevic ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Rna Virus ◽  
Statistical Significance ◽  
Complete Recovery ◽  
Elisa Test ◽  
Hospital Treatment ◽  
Symptomatic Therapy ◽  
West Nile ◽  
Serological Tests ◽  
Transmission Cycle

Background/Aim. West Nile virus (WNV) is a neurotropic RNA virus particle which belongs to the Flaviviridae family, genus Flavivirus. It is sustained in arthropods within the transmission cycle between the mosquitoes and birds. Most commonly (80% of cases) WNV infections are asymptomatic among people. Less than 1% of patients develop neuroinvasive forms of the disease - meningitis, encephalitis, or acute flaccid paralysis. The aim of the research is to determine most common clinical and laboratory manifestations, to emphazise the presence of comorbidities and outcomes of treatment among patients with WNV infection. Methods. This retrospective study, which was conducted in the period from January 1, 2012 to December 31, 2013, evaluated 32 patients who were diagnosed with WNV infection based on clinical findings, laboratory, and serological tests. To assess statistical significance we used ?2, and t-test. Results. The study involved 22 (69%) males and 10 (31%) females aged from 31 to 65 years. On admission, there were 16 (50%) febrile individuals, 27 (84.4%) with positive meningeal signs, 17 (53.2%) with pathological neurological signs, and 10 (31.3%) with consciousness disorders. WNV infection was confirmed by the method enzyme linked immuno sorbent assay (ELISA) in all the patients, while Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was positive in 3 (30%) of the tested patients. Cardiovascular comorbidities dominated in 7 (21.9%) of the cases. Full recovery was accomplished in 87.5 % of the cases. Conclusion. The results of our study show that the absence of meningeal signs and fever on the day 7 of hospital treatment are indicators of good course and prognosis of neuroinvasive forms of WNV infection. Comorbidities do not increase the risk of disease. ELISA test is a sovereign diagnostic method. In most cases, after the administered symptomatic therapy, the complete recovery of patients was achieved.

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