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Inhalation Toxicity of Metal Particles and Vapors
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Cadmium is highly toxic because there is no homeostatic control and Cd has a propensity for binding with thiol groups. The basic action is enzyme inactivation but it may also bind to DNA and RNA. The major nonindustrial exposure results from smoking. Inhalation of cadmium compounds can give rise to both acute and chronic effects in the respiratory system. The severe acute effects from inhalation of cadmium fumes, mainly cadmium oxide, are well established and have been known for a long time (Bulmer et al., 1938). Symptoms may not appear until 24 hours after exposure has terminated, which may cause difficulties in obtaining the proper diagnosis (Friberg et al., 1974). The predominant symptoms and signs are shortness of breath, general weakness, fever, and in some cases respiratory insufficiency with shock and death (Lucas et al., 1980). The initial symptoms are similar to metal fume fever, a benign condition which may result from exposure to zinc fumes (Stokinger, 1963). The cadmium-induced acute pulmonary disorder that develops later is a chemical pneumonitis or sometimes a pulmonary edema. Death may occur several days after exposures. If survival occurs, delayed lung effects such as perivascular and peribronchial fibrosis accompanied by emphysema may remain.
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
7.21. The ultimate outcome in healthy children who survive staphylococcal pneumonia is usuallyrecurrent spontaneous pneumothoraces.chronic respiratory insufficiency.chronic lung abscesses and emphysema,persistent pneumatocoeles.complete resolution,
Acute respiratory insufficiency
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Respiratory insufficiency represents the final common pathway of pathologies that brings disequilibrium between respiratory needs of the organism and performance of the respiratory apparatus. The clinical translation will depend on the specific pathology and its rapidity of onset.
Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19
Published in Logopedics Phoniatrics Vocology, 2023
Emel Tahir, Esra Kavaz, Senem Çengel Kurnaz, Fatih Temoçin, Aynur Atilla
The prevalence of dysphonia in the common cold or influenza is less than 20% [25]. In a multicenter European study, 26.8% of the patients reported dysphonia as a COVID-19 symptom [4]. However, they did not utilize a validated dysphonia-specific survey that assesses the extent of voice handicap, as we did in our study. They also included smokers, with a higher prevalence of smokers in patients with dysphonia. We excluded smokers since smoking is a substantial confounding factor in all types of voice measures. Only dyspnoea was significantly linked with the extent of voice impairment and deteriorated perceived voice quality among all COVID-19 symptoms. Physical score is the most affected score in voice handicap, while breathiness is the most affected score in auditory-perceptual voice evaluation. Breathiness and physical incapacitation may aggravate respiratory insufficiency. According to our findings, respiratory issues are the main reason for the vocal handicap and auditory-perceptual decline of voice quality seen in COVID-19. The regression analysis revealed a substantial impact of dyspnoea and pulmonary comorbidities on both overall scores. The findings of both analyzes also confirm each other.
Use of dornase alfa in pediatric patients without cystic fibrosis
Published in Hospital Practice, 2023
Krishna C. Daiya, Caroline M. Sierra
Respiratory insufficiency often presents as airway obstruction or inflammation and can lead to hypoxia requiring respiratory support. Atelectasis is often a complication of asthma, pneumonia, acute respiratory distress syndrome, or chronic lung disease [9]. Treatment includes chest physiotherapy, often considered first line, or bronchoscopy, positive airway pressure and use of surfactant [9,10]. Although there are no pharmacologic agents approved by the Food and Drug Administration for atelectasis, several mucolytic agents are used to promote airway clearance, including n-acetylcysteine, DNase, and hypertonic or normal saline [9,11]. However, there is limited high-quality evidence for the efficacy of these agents. The American Association for Respiratory Care recommends against the routine use of DNase in adult and pediatric patients without CF given the inconclusive evidence for its efficacy [12]. Additionally, given the high cost of therapy and unclear clinical benefits, the place in therapy of DNase for other respiratory conditions needs to be further explored.
Effects of high-flow nasal oxygen cannula versus other noninvasive ventilation in extubated patients: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Respiratory Medicine, 2022
Kaiyuan Guo, Gang Liu, Wei Wang, Guancheng Guo, Qi Liu
As for the present study’s results, the reintubation rate (or extubation failure rate) was 15.94% in the HFNC group and 14.8% in the NIV group. These findings were consistent with a previous study of ICU patients who recovered from ARF [34] but lower than rates reported in patients after general anesthesia for elective surgery [35]. The target population in this study included two types of patients with respiratory insufficiency – patients who needed therapeutic respiratory support and patients at high risk of post-extubation failure. The pooled reintubation rate indicated that HFNC was noninferior to NIV. The role of HFNC in the peri-extubation period for critically ill patients is not to be a substitute for NIV, the practically significance may be the complementarity between HFNC and NIV. In patients at high risk of extubation failure, the use of HFNC with NIV immediately after extubation significantly reduced the rate of reintubation, compared with the use of HFNC alone [36]. A post hoc analysis indicated that this effect is not restricted only to patients at high risk of extubation failure but also applies to patients with chronic obstructive pulmonary disease (COPD) [37]. These studies suggest that NIV strengthens the breathing supportive ability of HFNC. Another important question is whether HFNC may also enhance NIV’s function of respiratory support, and trials should be conducted to compare the effect of NIV plus HFNC with that of NIV alone.