Chest medicine

Symptoms of respiratory disease, Pneumonia, Atypical pneumonia, Legionnaires' disease, Recurrent pneumonia, Nosocomial pneumonia, Aspiration pneumonia, Management of pneumonia: adults, Viral pneumonia SARS and HN, Management of pneumonia: children, Paediatric acute respiratory, infections: epiglottitis, Acute laryngotracheobronchitis: croup, Bacterial tracheitis, Bronchiolitis, Whooping cough, Lymphocytic interstitial pneumonitis, Diphtheria, Pleural effusion, Lung abscess, Fungal pulmonary infections, Paragonimiasis lung flukes, Tropical pulmonary eosinophilia, Asthma, Acute severe asthma, Chronic obstructive pulmonary disease, Bronchiectasis, Lung cancer, Interstitial lung disease, Acute respiratory distress syndrome, Pulmonary embolism, Pneumothorax

Acute Severe Asthma: Changes in Patient Characteristics, Management, and Outcomes over a Period of 20 Years (1997 to 2017), Insights from Cub-Réa Network.

Background: While acute severe asthma (ASA) is the leading cause of emergency department visits and the third cause of hospitalization in children younger than 18 years old, there is a lack of data regarding adult patients admitted in intensive care units (ICU) for ASA. We aimed to describe the evolutions in epidemiology, management, and outcomes of ASA in adult patients, over a period of twenty years in the Greater Paris area ICUs (CUB-Réa Database). Methods: Demographics, severity and supportive treatments were collected from the CUB-Réa Database. The primary endpoint was the prevalence of ASA by periods of 5 years. The secondary endpoints were in-ICU survival, in-hospital survival, use of mechanical ventilation including non-invasive and invasive and catecholamine. Multivariate analysis was performed to assess correlating factors of ICU Mortality. Results: Of the 475 357 ICU admissions from January 1997 to January 2016, 7049 were admitted for ASA with a decreasing prevalence over time, respectively 2.8%, 1.7%, 1.1%, and 1.1% of total ICU admissions (p <0.001). The median age was 46 years old [IQR: 25%-75%: 32-59], 3906 (55%) were female, the median SAPS II was 20 [IQR: 13-28], and 1501 (21%) had mechanical ventilation. Over time, age, the SAPSII and the Charlson Comorbidity Index tended to increase. The use of invasive and non-invasive mechanical ventilation increased (p < 0.001), whereas the use of catecholamine decreased (p <0.001). The in-ICU survival rate improved from 97% to 99% (p=0.008). In the multivariate analysis, factors associated with in-ICU mortality were SAPSII (p < 0.001), renal replacement therapy (p < 0.001), catecholamine (p < 0.001), cardiac arrest (p < 0.001), pneumothorax (p < 0.001), ARDS (p < 0.001), sepsis (p < 0.001) and IMV (p < 0.001). Conclusion: ICU admission for ASA remains uncommon and decreases over time. Despite an increasing severity of patients and the use of mechanical ventilation, the use of catecholamine decreases with high in-ICU survival rate which could be related to a better management of mechanical ventilation.

Comparison of the effects of intravenous magnesium sulphate versus intravenous aminophylline in acute attack of asthma in Pediatric Emergency Department, Lahore General Hospital, Lahore

In children acute severe asthma is a serious condition. The inhaled route for drug delivery is not appropriate when only small respiratory gas volumes are shifted; the i.v. route may be associated with greater side effects. Magnesium sulphate IV has a place in acute asthma management because it is a mild bronchodilator, and has a stabilizing effect on the atria. Objective: To compare the effectiveness of intravenous magnesium sulphate versus intravenous aminophylline in acute attack of asthma. Study Design: Randomized control trial. Setting: Emergency Department of pediatric Duration: April 2017 to October 2017.Material & Methods: 60 cases were included in the study. They were randomly divided in two comparable groups. Children in group A ware treated with intravenous magnesium sulphate and group B with intravenous aminophylline. The efficacy of the drug was judged by the improvement in the sign observed like respiratory rate (less than 40 per minute), pulse rate(<100), oxygen saturation( above 90 %) assessed after the time period of three hours. Results: Effectiveness of intravenous magnesium sulphate in acute attack of asthma was found in 28 cases in Group A (93.33%) and in 22 cases in Group B (73.33%) with p-value 0.03. However, 6.67% cases (2 cases) in Group A and 26.67% cases (8 cases) in Group B did not show effectiveness. Conclusion: The clinical efficacy of intravenous magnesium sulphate in managing case of acute severe asthma was better when compared with intravenous aminophylline.