- Breathlessness worsened by haemodialysis. [Journal Article]
- RMRespir Med Case Rep 2019; 26:6-8
- A 54 year old lady with underlying chronic lung disease on long term oxygen therapy and end stage renal disease of unknown aetiology on regular haemodialysis for two years started developing progress...
A 54 year old lady with underlying chronic lung disease on long term oxygen therapy and end stage renal disease of unknown aetiology on regular haemodialysis for two years started developing progressive shortness of breath during her routine haemodialysis. She was unable to tolerate her haemodialysis sessions which had to be terminated prematurely in view of her symptoms despite adjustment of her dry weight and treatment of anaemia. She was not in chronic fluid overload and her symptoms always worsened after initiation of haemodialysis and improved after termination of haemodialysis. She was admitted to hospital for further investigations and initially treated for a lung infection but her symptoms did not improve. A computed tomography pulmonary angiography did not reveal any evidence of pulmonary embolism, and was consistent with chronic fibrotic changes. Her hypoxemia was concluded to be due to her underlying chronic lung disease, worsened by alveolar hypoventilation during haemodialysis. Her symptoms improved slightly with supplemental oxygen during her routine haemodialysis but we had to shorten her haemodialysis duration to 3 hours.
- An unusual case of hypercapnic respiratory failure. [Journal Article]
- RMRespir Med Case Rep 2018; 25:327-329
- Asphyxiating thoracic dystrophy (ATD also known as Jeune syndrome) is a very rare disorder with an incidence in the United States of 1 case per 100,000-130,000 live births. Chronic alveolar hypoventi...
Asphyxiating thoracic dystrophy (ATD also known as Jeune syndrome) is a very rare disorder with an incidence in the United States of 1 case per 100,000-130,000 live births. Chronic alveolar hypoventilation leading to concurrent hypoxia is the main cause of morbidity and mortality in these patients due to its complications. A 22-year-old male with past medical history of ATD and severe kyphoscoliosis presented with progressively worsening shortness of breath for several days. Past surgical history was significant for multiple reconstructive sternal surgeries, his first surgery was at the age of two. His chest exam was without wheezing and was notable for symmetrically decreased breath sounds. Arterial blood gas showed PH 7.17, PCO2 155, PO2 95 and O2 saturation of 97% on 2 L nasal cannulae. PA and lateral chest xrays showed a long and severely narrow thoracic cavity. 2D echocardiography showed left ventricular ejection fraction of 55% and evidence of severe pulmonary hypertension. CT chest angiography showed severe dilatation of the pulmonary artery in comparison to ascending aorta and significant right ventricular enlargement. Right heart catheterization confirmed these findings with a mean pulmonary arterial pressure of 61 mmHg. Within several days of hospitalization, patient developed acute worsening of his chronic hypercapnic respiratory failure thought to be due to worsening of pulmonary arterial hypertension with right heart failure. This in return was attributed to underlying ventilatory failure secondary to severe thoracic dystrophy. ATD is an autosomal recessive genetic disorder. Mutations in the IFT80 gene, which encode for an intraflagellar protein, cause this protein to be defective. Clinically, ATD is characterized by a small, narrow chest and variable limb shortness. While ATD is compatible with life, respiratory failure and infections are often fatal during infancy. Patients that survive past the age of 2 have seen respiratory complications resolve due to less pronounced thoracic malformations, but in our case the main cause of worsening pulmonary function was the degree of pulmonary arterial hypertension and right heart failure. Patients with ATD usually develop progressive hypercapnic respiratory failure due to an abnormally small thorax. Surgical options include lateral thoracic expansion or sternal and chest wall reconstruction. However, these surgeries only add a few years to survival without a definitive cure.
- Non-invasive ventilation and hypercapnia-associated symptoms in amyotrophic lateral sclerosis. [Journal Article]
- ANActa Neurol Scand 2018 Nov 05
- CONCLUSIONS: Our data show that NIV improves hypercapnia-associated symptoms within the first 3 months after initiation in spinal as well as bulbar patients, and that beneficial effects are long-lasting.
- Diagnostic accuracy of simple tools in monitoring patients with chronic hypoventilation treated with non-invasive ventilation; a prospective cross-sectional study. [Journal Article]
- RMRespir Med 2018; 144:30-35
- CONCLUSIONS: In patients treated with long term NIV, screening test panel, nocturnal SpO2 and daytime ABG all failed to accurately detect NH, underlining the importance of nocturnal monitoring of CO2. AHIsoftware accurately identified obstructive events and can be used to modify NIV settings.
- Obstructive sleep apnea in patients surviving acute hypercapnic respiratory failure is best predicted by static hyperinflation. [Journal Article]
- PlosPLoS One 2018; 13(10):e0205669
- CONCLUSIONS: In AHRF survivors, static hyperinflation is negatively associated with the apnea-hypopnea index in both COPD and non-COPD patients. Measuring static hyperinflation in addition to classic predictors may help to increase the recognition of obstructive sleep apnea as common screening tools are of limited value in this specific population.
- Intranasal Leptin Relieves Sleep Disordered Breathing in Mice with Diet Induced Obesity. [Journal Article]
- AJAm J Respir Crit Care Med 2018 Oct 12
- CONCLUSIONS: In mice with diet-induced obesity, intranasal leptin bypassed leptin resistance and significantly attenuated sleep-disordered breathing, independently of body weight.
- Optimizing Care for Trauma Patients with Obesity. [Review]
- CCureus 2018 Jul 22; 10(7):e3021
- Obesity is a growing epidemic that has been contributing to the increasing cost of healthcare. Its prevalence is now approximately 37%. Morbid obesity is associated with increased morbidity and morta...
Obesity is a growing epidemic that has been contributing to the increasing cost of healthcare. Its prevalence is now approximately 37%. Morbid obesity is associated with increased morbidity and mortality in trauma patients. An increased recognition of obesity as a chronic disease and a better understanding of its pathophysiology can allow for proper preparation and accommodative measures to improve resuscitation and subsequent care, thereby improving trauma outcomes. The aim of this review is to provide an overview of the scope of the problem. This review also provides evidence-based recommendations for the optimal resuscitation sequence for obese patients.
- Inflammatory Markers in Patients Using Domiciliary Non-invasive Mechanical Ventilation: C Reactive Protein, Procalcitonin, Neutrophil Lymphocyte Ratio. [Journal Article]
- FPFront Public Health 2018; 6:245
- Aim: Early identification and treatment of infections in patients using domiciliary non-invasive mechanical ventilation (NIMV) due to chronic respiratory failure (CRF) can reduce hospital admissions...
Aim: Early identification and treatment of infections in patients using domiciliary non-invasive mechanical ventilation (NIMV) due to chronic respiratory failure (CRF) can reduce hospital admissions. We assessed C-reactive protein (CRP), procalcitonin, and neutrophil lymphocyte ratio (NLR) as indicators of infection/inflammation. Methods: The study was designed as a retrospective, observational, cross-sectional study, and was performed in 2016 in an intensive care unit outpatient clinic in patients using NIMV. Patients who came to the outpatient clinic with dyspnea, increased sputum, increased prothrombin, and who had hemogram, procalcitonin, and serum CRP, NLR, and PLT/MPV levels assessed, were enrolled into the study. Demographic characteristics, co-morbid diseases, respiratory symptoms, hemogram, biochemistry, CRP, and procalcitonin values in stable and acute attack patients were recorded from patient files. The descriptive statistics and CRP, NLR, and procalcitonin values were assessed. Results: During the study period, 49 patients (24 female) with chronic obstructive pulmonary disease (COPD, n = 24), obesity hypoventilation syndrome (OHS, n = 15), or interstitial lung disease, n = 10), and having had three inflammatory markers assessed, were included in the study. Their mean age was 67 (SD ± 12). Stable patients vs. those who had an acute attack was 41 vs. eight, and within 7 days of outpatient admission four patients were hospitalized. CRP, NLR, and PLT/MPV values were similar in patients' who had sputum purulence, and an increase in dyspnea and sputum, but procalcitonin was significantly higher in patients who had an acute attack. Procalcitonin was not correlated with CRP, NLR, and PLT/MPV. Conclusions: Patients with CRF had similar levels of CRP and NLR during a stable and acute attack state. Procalcitonin may be a better marker for therapeutic decisions in advanced chronic inflammatory diseases.
- A case scenario study for the assessment of physician's behavior in the management of COPD: the WHY study. [Journal Article]
- IJInt J Chron Obstruct Pulmon Dis 2018; 13:2751-2758
- CONCLUSIONS: Management of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians' clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.
New Search Next
- Risk factors associated with obstructive sleep apnea-hypopnea syndrome in Chinese children: A single center retrospective case-control study. [Journal Article]
- PlosPLoS One 2018; 13(9):e0203695
- Pediatric obstructive sleep apnea-hypopnea syndrome is caused by multiple factors. The present study aimed to investigate the potential risks of pediatric obstructive sleep apnea hypopnea syndrome (O...
Pediatric obstructive sleep apnea-hypopnea syndrome is caused by multiple factors. The present study aimed to investigate the potential risks of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their correlation with the disease severity. A total of 338 pediatric patients with OSAHS (polysomnography (PSG) diagnosis) were enrolled between June 2008 and October 2010. These pediatric patients were divided into mild, moderate and severe subgroups according to the obstructive apnea index (OAI) and/or apnea hypoventilation index (AHI). A total of 338 pediatric patients with vocal nodules who were without obstruction of the upper respiratory tract were enrolled as the control group. The patients were analyzed retrospectively. The average number of upper respiratory tract infections each year and tonsil hypertrophy, adenoid hypertrophy, positive serum tIgE, chronic sinusitis, nasal stenosis, craniofacial features and obesity were significantly higher in OSAHS compared with controls (P<0.01). The parameters the average number of upper respiratory tract infections each year (OR: 1.395, 95% CI: 1.256-1.550), adenoid hypertrophy (OR: 8.632, 95% CI: 3.990-18.672), tonsil hypertrophy (OR: 9.138, 95% CI: 4.621-18.073), nasal stenosis (8.023, 95% CI: 3.633-17.717) and chronic sinusitis (OR: 27.186, 95% CI: 13.310-55.527) were independent factors of pediatric OSAHS (P<0.01). The distribution of chronic sinusitis, nasal stenosis, craniofacial features and obesity indicated a gradual increasing trend in the severity of OSAHS (P<0.01). Number of upper respiratory tract infections per year, adenoid hypertrophy, tonsil hypertrophy, chronic sinusitis, nasal stenosis, infections, allergic reactions, craniofacial features and obesity may be potential risk factors of pediatric OSAHS.