scholarly journals Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management

2021 ◽  
Author(s):  
Kristina Jacobsen
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Respiratory Distress ◽  
Conservative Management ◽  
Endoscopic Treatment ◽  
Pulmonary Resection ◽  
Bronchopleural Fistula ◽  
Patient Characteristics ◽  
Pleural Space ◽  
Life Threatening

Bronchopleural fistula (BPF) after a pulmonary resection is rare with some of the most life-threatening consequences and a high mortality rate. Contamination of the pleural space resulting in empyema and spillage of the infected fluid into the remaining lung leading to respiratory distress remain the biggest concerns with BPF postoperatively. There are many patient characteristics and risk factors that can be evaluated to decrease the chance of a postoperative BPF. Presentation of BPF can be early or late with the late BPF more difficult to diagnosis and manage. Many options to treat BPF include surgical repair, conservative management, and endoscopic treatment.

scholarly journals A National Strategy to Diagnose Coronavirus Disease 2019–Associated Invasive Fungal Disease in the Intensive Care Unit

2020 ◽  
Author(s):  
P Lewis White ◽  
Rishi Dhillon ◽  
Alan Cordey ◽  
Harriet Hughes ◽  
Federica Faggian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Respiratory Distress ◽  
Antifungal Therapy ◽  
Invasive Fungal Disease ◽  
Chronic Respiratory Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Severe Respiratory Distress

Abstract Background Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. Methods An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. Results One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis. Conclusions Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.

Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management

2019 ◽  
Vol 28 (2) ◽  
pp. 89-96
Author(s):  
Harmouchi Hicham ◽  
Issoufou Ibrahim ◽  
Sani Rabiou ◽  
Lakranbi Marouane ◽  
Ouadnouni Yassine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Wall ◽  
Bronchopleural Fistula ◽  
Pleural Space ◽  
Late Period ◽  
Considerable Time ◽  
Goals Of Care ◽  
Acute Period ◽  
Diagnosis And Management ◽  
Contralateral Lung

Postpneumonectomy empyema is a collection of pus in the pleural space after removal of the underlying lung. Postpneumonectomy empyema is a serious complication responsible for high rates of morbidity and mortality. Several risk factors for the development of postpneumonectomy empyema have been highlighted in the literature. The association of postpneumonectomy empyema with a bronchopleural fistula increases the rate of mortality by flooding the remaining lung. The management of postpneumonectomy empyema depends on the timing of presentation and the presence or absence of a bronchopleural fistula. The goals of care in the acute period are mainly preservation of the contralateral lung and sterilization of the pleural space, which may take a considerable time. The aims in the late period are closure of the bronchopleural fistula, obliteration of the pleural space, and closure of the chest wall.

scholarly journals Emphysematous cystitis: mortality, risk factors, and pathogens of a rare disease

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Andreas Schicho ◽  
Christian Stroszczynski ◽  
Philipp Wiggermann
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Mortality Rate ◽  
Mortality Risk ◽  
Conservative Management ◽  
Mortality Rates ◽  
Emphysematous Pyelonephritis ◽  
Emphysematous Cystitis ◽  
The Mean ◽  
High Degree

Although high mortality rates have been reported for emphysematous pyelonephritis (EP), information on emphysematous cystitis (EC), which is less common, is sparse. Here, we report one new case of severe EC and 136 cases of EC that occurred between 2007 and 2016, and review information about the characteristics, diagnosis, treatment and mortality of these patients, and the pathogens found in these patients. The mean age of the 136 patients was 67.9±14.2 years. Concurrent emphysematous infections of other organs were found in 21 patients (15.4%), with emphysematous pyelonephritis being the most common of these infections. The primary pathogen identified was <em>Escherichia coli</em> (54.4%). Patients were mainly treated by conservative management that included antibiotics (n=105; 77.2%). Ten of the 136 patients with EC died, yielding a mortality rate of 7.4%. Despite the relatively low mortality rate of EC compared with that of EP, a high degree of suspicion must be maintained to facilitate successful and conservative management.

Risk Factor Analysis Of Non-Hodgkin Lymphoma-Associated Hemophagocytic Syndromes: A Multicenter Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1778-1778
Author(s):  
Hirozumi Sano ◽  
Ryoji Kobayashi ◽  
Junji Tanaka ◽  
Satoshi Hashino ◽  
Shuichi Ota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Nk Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Patient Characteristics ◽  
Eb Virus ◽  
Non Hodgkin Lymphoma

Abstract Hemophagocytic lymphohistiocytosis (HLH) is often associated with malignant diseases, mainly B-cell or T/NK-cell lymphoma. However, to date, few studies have examined lymphoma-associated hemophagocytic syndrome (LAHS). Our aim was to clarify the risk factors and prognostic factors of LAHS. A total of 1,181 patients with non-Hodgkin lymphoma were analyzed at 12 institutions in Hokkaido prefecture between April 2007 and December 2011 to assess the incidence, prognosis, and risk factors of LAHS. To evaluate the risk factors for developing LAHS, patient characteristics including age, gender, and histopathology were compared between patients with and without LAHS. The cumulative incidence rate of LAHS was 3.0% (35/1,181). The mortality rate of patients with LAHS was 69% (24/35), which was significantly higher than that of patients without LAHS (29%, P<0.001). The frequency of LAHS was higher in patients with T/NK-cell lymphoma than in patients with B-cell lymphoma (11.6 vs 1.8%, P<0.001). No significant differences were observed in age or gender between patients with and without LAHS. Patient characteristics including age, gender, histopathology, clinical symptoms, treatment for LAHS, EB virus serology, and laboratory data were subsequently compared between alive and dead patients to evaluate the prognostic factor of LAHS. The results obtained showed that the mortality rate was significantly higher in patients with T/NK-cell lymphoma than in patients with B-cell lymphoma (88 vs 53%, P=0.035). The frequency of liver dysfunction, including elevated total bilirubin (T.Bil) and liver enzymes [glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT)], was higher in fatal cases than in alive cases (T.Bil, median 1.35mg/dl, range 0.6-12.7mg/dl vs median 0.9mg/dl, range 0.5-6.1mg/dl, P=0.069; GOT, median 85.5IU/L, range 16-1,076IU/L vs median 40.0IU/L, range 10-651IU/L, P=0.076; GPT, median 62.5IU/L, range 11-910IU/L vs median 31.0IU/L, range 6-362IU/L, P=0.038). Moreover, the mortality rate of patients who did not respond to initial treatments including corticosteroids was higher than that of good responders (95 vs 54%, P=0.049). EB virus serology had no significant clinical impact on the prognosis of LAHS. In conclusion, patients with T/NK-cell lymphoma showed not only higher complication rates of LAHS than those of patients with B-cell lymphoma, but also higher mortality rates after developing LAHS. Further preclinical and clinical studies are required to understand the detailed pathogenesis of LAHS and improve the prognosis of patients developing LAHS. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Spontaneous retroperitoneal hematoma in a COVID-19 patient

2021 ◽  
Vol 2 (4) ◽  
pp. 377-385
Author(s):  
Ana Sekulić ◽  
Olivera Marinković ◽  
Davor Mrda ◽  
Borislav Tošković ◽  
Marija Zdravković ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Mortality Rate ◽  
Anticoagulant Therapy ◽  
Psoas Muscle ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Life Threatening ◽  
The Right ◽  
Radiological Examinations

Introduction: The infection caused by the SARS-CoV-2 virus is known to cause a hypercoagulable condition resulting in acute thrombotic events. Thromboembolic events occur in as many as 21.0% of cases with a mortality rate of about 74.0% in persons infected with COVID-19. Anticoagulant therapy is used in severe COVID-19 infections in order to prevent thrombosis and has been shown to reduce mortality. The use of anticoagulants is not without risks. Bleeding complications can range from mild to severe or even life-threatening, such as retroperitoneal bleeding into the psoas muscle. Case report: We present a case of a patient who developed a complication of bleeding into the retroperitoneal space during the treatment of bilateral bronchopneumonia caused by the SARS-CoV-2 virus. After the diagnosis was established, on the basis of a clinical examination, laboratory and radiological examinations, and after initial conservative treatment at the UHMC Bežanijska kosa, the patient underwent embolization of the left lumbar arteries from the right inguinal fossa, during procedural analgosedation. After the radiological procedure, the recovery was satisfactory, but due to the impossibility of resorption of an encapsulated hematoma with a zone of central necrosis, a mini left lumbotomy and evacuation of the hematoma were performed. The patient was discharged from the hospital on the 23rd day of admission in stable general condition. Conclusion: The effect of anticoagulant therapy, especially in patients with existing risk factors, early diagnosis, and prompt therapy of spontaneous retroperitoneal hematomas is imperative to reduce mortality from this severe complication, in patients with the COVID-19 infection.

scholarly journals Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

2021 ◽  
Author(s):  
Lixia ZHU ◽  
Lulu Wang ◽  
Yuping Zhang ◽  
Rongrong Chen ◽  
Xueying Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Stenotrophomonas Maltophilia ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Hematologic Diseases ◽  
Hemorrhagic Pneumonia ◽  
Life Threatening ◽  
High Level ◽  
Clinical Records

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. The 30-day mortality rate was significantly higher in patients with hemorrhagic pneumonia than those without hemorrhagic pneumonia (85.2% and 50.0%, respectively, P = 0.003). Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin. Multivariate analysis showed that neutropenia, high levels of procalcitonin, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Hematologic patients with SM bacteremia who have neutropenia, high level of procalcitonin and prior tigecycline therapy within 1 month should be early treated with combined effective antibiotics and best supportive interventions to avoid life-threatening hemorrhagic pneumonia.

Intrathoracic transposition of the omentum

2021 ◽  
Keyword(s):  
Mortality Rate ◽  
Fungal Infection ◽  
Medical Treatment ◽  
Female Patient ◽  
Pleural Space ◽  
Bronchial Fistula ◽  
Life Threatening ◽  
Vertebral Bodies ◽  
Lung Infections ◽  
Complex Cases

Complex chest and lung infections with bronchial fistula are life-threatening situations with a mortality rate of up to 20%. If medical treatment fails, these patients require aggressive procedures to heal. Transposition of the omentum is a valuable, nonstandard option in these complex cases with aggressive infection involving the pleural space, with or without a bronchial fistula, when medical treatment is unsuccessful. We present a 29-year-old female patient diagnosed with primary immunodeficiency and invasive fungal infection with involvement of the left upper lobe and mediastinal and vertebral bodies treated with a lobectomy and intrathoracic transposition of the omentum.

Abstract 034: Rapid Response Activation and In-hospital Mortality

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kinan Kassar ◽  
Dorothy Pusateri ◽  
Anastasios Kapetanos
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Respiratory Distress ◽  
Mental Status ◽  
Medical Emergency Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Medical Emergency ◽  
Emergency Team ◽  
Healthcare Improvement

Introduction: The institute for Healthcare Improvement (IHI) encouraged the implementation of rapid response teams (RRT) in hospitals with the aim of early detection of patient deterioration. The rapid response system (formerly Medical Emergency Team (MET)) has been in place at our institution since 2005; however, data regarding its utilization and outcomes are scarce. Methods: Data regarding patient characteristics and reasons for activating RRTs were collected from hospital telephone operator records and patient medical records. The study was IRB exempt. Results: During a 2 month period (08/09/16 to 10/09/16), the RRT was activated 96 times on 93 patients. Of those, 31 RRT activations (32%) took place within 24 hours of admission to the hospital. The average age of these patients was 64, and 59% were male. Fifty-four RRT activations (56%) were called during the daytime shift (from 7 am to 7 pm). The reason for calling the RRT was mentioned in the hospital operators paging message in 67/96 cases. The most common reasons for activating the system were: Respiratory distress 34/67 (51%), mental status changes 9/67 (13%), and tachycardia 9/67 (13%). Other less common causes were seizures 3/67 (4.5%), chest pain 3/67 (4.5%), hypotension 3/67 (4.5%), and falls 2/67 (3%). Twenty patients (22%) on whom an RRT was called, died during the same hospital admission. The mortality rate of those patients was 6 folds higher than the general In-hospital mortality rate. The average age of the patients who died was 63. Respiratory distress was the most common cause of RRT activation among patients who died 10/20 (50%). Conclusion: Patients admitted to the hospital who had an RRT activation had a six fold risk of dying during the same admission. The majority of RRT activations were for respiratory distress, mental status changes, and tachycardia, and one-third occurred within the first 24 hours of admission. Routine review of RRT data can help target areas for improvement, specifically, factors contributing to in-hospital mortality.

scholarly journals Analysis of risk factors in bronchopleural fistula after pulmonary resection for primary lung cancer

2000 ◽  
Vol 18 (5) ◽  
pp. 519-523 ◽  
Author(s):  
Makoto Sonobe ◽  
Masatsugu Nakagawa ◽  
Masutaro Ichinose ◽  
Naoyuki Ikegami ◽  
Miyuki Nagasawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Pulmonary Resection ◽  
Bronchopleural Fistula ◽  
Primary Lung Cancer

scholarly journals Soliris to Stop Immune-Mediated Death in COVID-19 (SOLID-C19)—A Compassionate-Use Study of Terminal Complement Blockade in Critically Ill Patients with COVID-19-Related Adult Respiratory Distress Syndrome

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2429
Author(s):  
Thomas C. Pitts
Keyword(s):  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Standard Of Care ◽  
Mechanically Ventilated ◽  
Immune Mediated ◽  
Threatening Condition ◽  
Life Threatening ◽  
Terminal Complement

Eculizumab, a terminal complement (C5)-inhibiting monoclonal antibody, was administered in five mechanically ventilated patients in life-threatening condition due to COVID-19-related acute respiratory distress syndrome (ARDS) between 23 March 2020 and 3 April 2020. Their clinical progress was monitored. The primary endpoint was mortality. One patient was excluded while two passed away. The remaining two patients survived. At the time of this study, the mortality rate in mechanically ventilated COVID-19 patients suffering from ARDS receiving the standard of care as their therapeutic regimen was reportedly as high as 97%. This pilot study demonstrates a 50% mortality rate in patients receiving eculizumab therapy.

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