- Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. [Journal Article]
- JAMAJAMA 2018 Feb 20; 319(7):698-710
- CONCLUSIONS: The Berlin definition of acute respiratory distress syndrome addressed limitations of the American-European Consensus Conference definition, but poor reliability of some criteria may contribute to underrecognition by clinicians. No pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and management remains supportive with lung-protective mechanical ventilation. Guidelines on mechanical ventilation in patients with acute respiratory distress syndrome can assist clinicians in delivering evidence-based interventions that may lead to improved outcomes.
- [LUNG ULTRASOUND IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES AND ACUTE RESPIRATORY FAILURE DUE TO PNEUMONIA.] [Journal Article]
- ARAnesteziol Reanimatol 2017; 61:183-189
- CONCLUSIONS: LUS is high sensitivity and specificity method to detect lung lesions in patients with ARF.
- Full percutaneous biventricular support with two Impella pumps: the Bi-Pella approach. [Case Reports]
- EHESC Heart Fail 2018 Feb 21
- Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until re...
Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation. We report the first case of mechanical circulatory supported with Impella CP on the left and Impella RP on the right (Abiomed Inc., Danvers, MA) for acute biventricular failure due to suspected acute myocarditis in the context of thrombolytic therapy for ischaemic stroke.
- A young puerperal woman presenting to emergency department with severe dyspnea. [Journal Article]
- TJTurk J Emerg Med 2017; 17(4):154-156
- Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months fo...
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of HF is found. The symptoms and signs of this rare disorder mimic those of the physiological changes of pregnancy or other cardiovascular diseases. Consequently, its diagnosis is frequently delayed, which worsens an already poor prognosis. Here, we report a young adult who was diagnosed with PPCM, early, with the help of focused cardiac ultrasonography, performed after presenting to the emergency department with nonspecific respiratory complaints, including dyspnea and hemoptysis, which suggested at first pulmonary embolism.
- A Peculiar Case of InvasiveStreptococcus pneumoniae. [Journal Article]
- CRCase Rep Infect Dis 2017; 2017:1530507
- Patients commonly present to the emergency department with acute respiratory distress; however, the differentials are broad and at times difficult to distinguish. We describe a case of severe communi...
Patients commonly present to the emergency department with acute respiratory distress; however, the differentials are broad and at times difficult to distinguish. We describe a case of severe community-acquired pneumonia (CAP) secondary to invasiveStreptococcus pneumoniae. The patient was intubated within 3 h of presentation and suffered multiorgan failure within 72 h of intensive care unit (ICU) admission. This case is a stark illustration of how the most common bacteria associated with CAP can be fatal and highlights the associated markers of severity. It also outlines other potential complications including a very rare phenomenon of cardiomyopathy with myocarditis associated withS.pneumoniaebacteraemia.
- Use of high-dose intermittent systemic glucocorticoids and the risk of fracture in patients with chronic obstructive pulmonary disease. [Journal Article]
- BONEBone 2018 Feb 17
- CONCLUSIONS: Intermittent high-dose GCs was not associated with an increased risk of any, osteoporotic, hip or clinically symptomatic vertebral fractures in patients with COPD. Current GC use was however associated with an increased risk of hip and clinically symptomatic vertebral fractures. Therefore, emphasis on prophylactic treatment of fractures may not be essential in patients with COPD receiving intermittent dose of GCs, whereas this should be considered for high-dose long-term users with advanced COPD disease stage, postmenopausal women and men over 40 years.
- Aerobic exercise inhibits acute lung injury: from mouse to human evidence Exercise reduced lung injury markers in mouse and in cells. [Journal Article]
- EIExerc Immunol Rev 2018; 24:36-44
- Acute respiratory distress syndrome (ARDS) is defined as hypoxemic respiratory failure with intense pulmonary inflammation, involving hyperactivation of endothelial cells and neutrophils. Given the a...
Acute respiratory distress syndrome (ARDS) is defined as hypoxemic respiratory failure with intense pulmonary inflammation, involving hyperactivation of endothelial cells and neutrophils. Given the anti-inflammatory effects of aerobic exercise (AE), this study investigated whether AE performed daily for 5 weeks would inhibit extra-pulmonary LPS-induced ARDS. C57Bl/6 mice were distributed into Control, Exercise, LPS and Exercise+LPS groups. AE was performed on a treadmill for 5x/week for four weeks before LPS administration. 24hours after the final AE physical test, animals received 100ug of LPS intra-peritoneally. In addition, whole blood cell culture, neutrophils and human endothelial cells were preincubated with IL-10, an anti-inflammatory cytokine induced by exercise. AE reduced total protein levels (p<0.01) and neutrophil accumulation in bronchoalveolar lavage (BAL) (p<0.01) and lung parenchyma (p<0.01). AE reduced BAL inflammatory cytokines IL-1β, IL-6 and GM-CSF (p<0.001), CXCL1/KC, IL-17, TNF-alpha and IGF-1 (p<0.01). Systemically, AE reduced IL-1β, IL-6 and IFN-gamma (p<0.001), CXCL1/KC (p<0.01) and TNF-alpha (p<0.05). AE increased IL-10 levels in serum (p<0.001) and BAL (p<0.001). Furthermore, AE increased superoxide dismutase SOD (p<0.01) and decreased superoxide anion accumulation in the lungs (p<0.01). Lastly, pre-incubation with IL-10 significantly reduced LPS-induced activation of whole blood cells, neutrophils and HUVECs, as observed by reduced production of IL-1β, IL-6, IL-8 and TNF-alpha. Our data suggest that AE inhibited LPS-induced lung inflammation by attenuating inflammatory cytokines and oxidative stress markers in mice and human cell culture via enhanced IL-10 production.
- Case 251: Nontraumatic Drug-associated Rhabdomyolysis of Head and Neck Muscles. [Journal Article]
- RRadiology 2018; 286(3):1088-1092
- History A 21-year-old man with a history of abuse of multiple drugs and mild cognitive impairment who initially underwent treatment for excited delirium developed respiratory arrest shortly after adm...
History A 21-year-old man with a history of abuse of multiple drugs and mild cognitive impairment who initially underwent treatment for excited delirium developed respiratory arrest shortly after admission and was successfully resuscitated. Unenhanced computed tomography (CT) of the head and neck and contrast material-enhanced CT of the chest, abdomen, pelvis, and complete spine were performed shortly after the initial treatment. Head and neck magnetic resonance (MR) imaging was performed 24 hours after admission. No other abnormalities were noted. There were no fractures, and there was no vascular injury in the head and neck region. The patient had no external neck injuries, congestion, or petechiae suggesting neck compression. He had no history of chronic or recurrent pain or skin rash. Urine testing was positive for cocaine, cannabis, and methamphetamine. Serum creatine kinase level was initially high (31 117 U/L [520 μkat/L]; normal, 1000 U/L [16.7 μkat/L]). Corrected calcium level was 2.22 mmol/L, and ionized calcium level was 1.09 mmol/L (lower end of the normal range). There was no acute renal failure at the initial phase, but serum creatinine levels reached 180 µmol/L 24 hours after admission, and creatine kinase peaked at 61 000 U/L [1019 μkat/L]. Urine was initially red, but the patient was not tested for myoglobinuria.
- The Evolution of Extracorporeal Membrane Oxygenation for Adult Respiratory Failure. [Journal Article]
- AAAnn Am Thorac Soc 2018; 15(Supplement_1):S57-S60
- The use of extracorporeal membrane oxygenation to support patients with cardiac and respiratory failure has increased substantially in the last decade. Although the evidence base for its use in adult...
The use of extracorporeal membrane oxygenation to support patients with cardiac and respiratory failure has increased substantially in the last decade. Although the evidence base for its use in adults with respiratory failure is growing, many questions remain to be answered. Ongoing research is aimed at clarifying the role of extracorporeal membrane oxygenation, as well as extracorporeal carbon dioxide removal, in various forms of hypoxemic and hypercapnic respiratory failure, and at defining the optimal techniques for its use. This, of course, is a moving target, as advances in the technology of extracorporeal membrane oxygenation, and the potential development of a true artificial lung, continue at a brisk pace.
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- Distribution Pattern and Outcome of the Patients in the Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University: A Short Term Analysis. [Journal Article]
- MMMymensingh Med J 2018; 27(1):159-167
- The aim of the study was to describe the characteristics of patients admitted to intensive care unit and their outcome in Bangabandhu Sheikh Mujib Medical University, Bangladesh. This retrospective, ...
The aim of the study was to describe the characteristics of patients admitted to intensive care unit and their outcome in Bangabandhu Sheikh Mujib Medical University, Bangladesh. This retrospective, descriptive study was conducted in the intensive care unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2016 to June 2016. Data was retrieved from hospital records of all admitted patients regarding age, gender, admission source, reason for admission, length of ICU stay, requirement of mechanical ventilation, number of organ failure and their outcome. During this study period, the total number of patients admitted was 225; most of them were males (148, 65.7%). Among the 225 patients, the highest number of admission was comprised of intracranial haemorrhage (22.6%), followed by sepsis (12.4%), acute respiratory distress syndrome (10.2%), acute renal failure (9.3%) malignancy (8.8%) and ischemic stroke (8.0%). Mean age of the patient was 54±18 years and mean length of ICU stay was 6.8±3 days. Out of 225 patients, 87 expired (38.6%). Majority of the patients required mechanical ventilation (69.3%) and had multi organ failure (59.8%). Most of the expiries were due to intracranial haemorrhage (24.1%); followed by acute respiratory distress syndrome (12.6%), malignancy (12.6%) and sepsis (11.4%). Elderly age (>65 years), requirement of mechanical ventilation and multiorgan failure had significant relationship (p<0.05) with overall ICU mortality. Intracranial haemorrhage, sepsis, acute respiratory distress syndrome were the main reasons for admissions in ICU, while mortality was highest for intracranial haemorrhage. Developing a well equipped neurological ICU with adequately trained staff will help to improve the outcome of patients.