Four Cases of Mers-Cov
Meera Chand, John Holton in Case Studies in Infection Control, 2018
A second unrelated UK case was identified on February 8, 2013 (Figure 14.2, case 1). The male patient was admitted to intensive care unit in the West Midlands and gave a history of recent travel to Saudi Arabia and Pakistan, 10 days prior to symptom onset. He had spent time in Mecca and Medina on a pilgrimage and returned to the UK on January 28, 2013. Prior to his return, he developed a fever and upper respiratory tract symptoms on January 24. By January 30, his symptoms had progressed and, following a visit to his general practitioner, he was admitted to hospital on January 31. The patient deteriorated and required invasive mechanical ventilation. The patient showed no sign of improvement and on February 5 was transferred to a tertiary centre in Manchester for ECMO treatment of ARDS. Influenza A(H1N1)pdm09 was detected in respiratory tract samples on February 1. Despite intensive care, administration of neuraminidase inhibitors to treat influenza, and empirical antibiotics, he failed to improve. Therefore, MERS-CoV infection was considered. On February 7, MERS-CoV was detected in a throat swab by reverse transcription polymerase chain reaction (RT-PCR), and confirmed by the reference laboratory on February 8. ECMO continued for 51 days, when the patient died of MERS-CoV pneumonitis with ARDS.
Thoracic Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
Pain reduces the patient’s tidal volume, leading to inadequate ventilation of the basal segments, resulting in atelectasis. Pain also inhibits coughing, allowing secretions to obstruct bronchi and cause acute respiratory failure. Effective pain relief is therefore essential and may include the application of intercostal nerve or paravertebral blockade (see later), although these techniques are most appropriately performed in a hospital setting. Even a small flail may be a devastating injury in the frail elderly patient. Splinting is not an effective management as this will reduce respiratory movement and exacerbate the ventilatory compromise. Operative fixation of rib fractures is occasionally indicated, but its place in management has not been definitively established. In severe cases the patient will require intubation and mechanical ventilation. The use of non-invasive ventilation may also be considered.
The neonate
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
Preterm birth before 30 weeks disrupts the developmental programme of the lungs. This shows as bronchopulmonary dyplasia, otherwise known as chronic lung disease of prematurity (CLD). Babies with bronchopulmonary dyplasia have abnormal lung architecture and reduced gas exchange. This is managed by administering oxygen and positive pressure. There are a number of ways of delivering positive pressure, some of which are invasive (ETT and continuous mandatory ventilation) and others are non-invasive (CPAP, biphasic positive airway pressure and variations on this). Over a number of weeks the development programme modifies lung architecture changes and gas exchange improves. This improvement is manifest as a reduced oxygen requirement and reduction in the extent of positive pressure. Once the need for invasive ventilation is over, further ventilation aid can be given using nasal CPAP, high-flow oxygen, nasal cannula or ambient oxygen, among other methods. During the recovery from bronchopulmonary dyplasia supplemental oxygen and positive pressure are gradually reduced. Recovery may take weeks or months and can be interrupted by intercurrent infection. Diuretics and/or corticosteroids may be used to accelerate the clinical features of improvement.
Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study
Published in Journal of Asthma, 2023
J. L. Robinson, K. L. Gatford, C. P. Hurst, V. L. Clifton, J. L. Morrison, M. J. Stark
We analyzed the following neonatal outcomes: fetal sex, plurality (single, twin, ≥3 babies), gestational age, mode of delivery, any resuscitation or for respiratory support (aspiration, facial O2, ventilation), birth weight, LBW (<2500 g), SGA, large for gestational age (LGA), intrauterine growth restriction (IUGR), NICU or special care baby unit (SCBU) admission, RDS, TTN, congenital malformations, and perinatal death. Gestational age was treated as a categorical variable (<28, 28 to <32, 32 to <34, 34 to <37, >37 weeks). Preterm birth was defined as <37 weeks and very preterm birth as ≤32 weeks’ gestation at delivery. SGA was defined as below the 10th centile of birth weight and IUGR as below the 3rd centile of birth weight. Birth weight centiles were calculated using the UK Perinatal Institute’s Customized Centile Calculator (GROW v8.0.6.1, 2020. Gestation Network) based on maternal height, maternal weight, ethnicity, parity, neonatal sex, gestation and birth weight. Perinatal death was defined as either stillbirth (mortality after 20 weeks’ gestation) or neonatal death (mortality within the first 28 days after delivery). Resuscitation by ventilation included intermittent positive pressure ventilation with a bag and mask, Neopuff, or intubation. Invasive ventilation was defined as intermittent mechanical ventilation or high frequency oscillating ventilation. Noninvasive ventilation was defined as continuous positive airway pressure (CPAP) ventilation or nasal high flow ventilation.
High-flow nasal cannula versus conventional oxygen therapy in patients with dyspnea and hypoxemia before hospitalization
Published in Expert Review of Respiratory Medicine, 2020
Qi Liu, Changju Zhu, Chao Lan, Rongchang Chen
This review was performed according to the PRISMA-P guidelines [13], which state that ethical approval and patient consent are not required for meta-analyses. Eligible studies were those involving adult patients in emergency departments, with hypoxemia or dyspnea receiving HFNC compared with COT independent of the method of delivery. The inclusion criteria for the studies were: (i) adult patients (≥16 years of age) who presented to the emergency department because of dyspnea or hypoxemia; (ii) randomized controlled trials (RCTs); (iii) studies comparing the effect of HFNC with COT as the main purpose; and (iv) at least one outcome could be extracted numerically. The exclusion criteria were: (i) patients younger than 16 years of age; (ii) assisted ventilation modalities including noninvasive and invasive ventilation; (iii) conference papers or abstracts; (iv) crossover studies; (v) editorials, case reports, letters, reviews, news, comments, guidelines, or meta-analyses; (vi) outcomes presented in figures that prevented data being extracted; and (vii) no response after contacting the corresponding author to obtain the full text. The primary outcome in this review was the rate of requiring more advanced ventilation therapy including noninvasive ventilation and intubation aiming to correct hypoxemia and relieve dyspnea. The secondary outcomes were respiratory rate, dyspnea scale score or rate of dyspnea improvement, disposition from the emergency department (hospital and ICU admission rate), and prognosis evaluated as intubation rate, hospital mortality.
The use of single balloon enteroscopy in Crohn’s disease and its impact on clinical outcome
Published in Scandinavian Journal of Gastroenterology, 2018
Grainne Holleran, Giorgio Valerii, Annalisa Tortora, Franco Scaldaferri, Silvia Conti, Arianna Amato, Antonio Gasbarrini, Guido Costamagna, Maria Elena Riccioni
While discussing the benefits of SBE it is important not to overlook the risks associated with the procedure. Although no complications were reported in our cohort, the procedure carries the risk of perforation, bleeding and mucosal injury, and in our practice, requires the use of deep sedation, although generally not mechanical ventilation as described in some studies using DBE [28]. The limitations of our study must also be acknowledged. Although our cohort is one of the largest reports of stricture dilatation using BAE in CD patients, our overall cohort is small. In addition, the lack of a control group makes the overall clinical impact difficult to interpret and may either over, or underestimate the value of stricture dilatation in preventing the rate of progression to surgery. Finally as a retrospective study, not all of the desired information impacting clinical course could be readily obtained, e.g., it is not known whether non-medical interventions, e.g., dietary modifications or smoking status may have contributed to disease activity.
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