CLINICAL FEATURES OF CHYLOTHORAX Presenting symptoms
Prem Puri in Newborn Surgery, 2Ed, 2003
Tachypnea, dyspnea, retraction of chest and cyanosis mark the onset of chylothorax, with dullness and diminution of breath sounds on the affected side and displacement of the heart and mediastinum to the opposite side. In cases of congenital chylothorax, symptoms of respiratory distress may be noted shortly after birth or at any time up to 2 weeks of life. In contrast, the interval between surgery and the occurrence of acquired chylothorax can vary from 1-25 days. The time is shortest when there is a direct injury to the duct (5-7 days) and longest when there is high pressure or thrombosis of the vena cava (10-14 days). Chyle may accumulate in the mediastinum for several days before extravasating into the pleural space.
High altitude pulmonary edema
James Milledge, John West, Robert Schoene in High Altitude Medicine and Physiology, 2007
High altitude pulmonary edema (HAPE) is a potentially lethal form of mountain sickness which, like acute mountain sickness (AMS), affects previously healthy persons who go rapidly to high altitude. A few hours after arrival patients suffer the usual symptoms of AMS but then become more breathless than their companions. Over the next few hours the breathlessness increases, a cough develops which is first dry but later productive of frothy white sputum. The sputum may become blood-tinged. The signs of obvious pulmonary edema are found and cyanosis may be detected. Some patients literally drown in their own secretions and become comatose and can die if no action is taken. Patients have tachycardia and tachypnea with mild pyrexia and leucocytosis and a characteristic X-ray appearance. The pathology, in fatal cases, is of patchy edema of the lungs.
High altitude pulmonary edema
John West, Robert Schoene, Andrew Luks, James Milledge in High Altitude Medicine and Physiology 5E, 2013
High altitude pulmonary edema (HAPE) is a potentially lethal form of mountain sickness which, like acute mountain sickness (AMS), affects previously healthy people who go rapidly to high altitude. A few hours after arrival, patients most commonly suffer the usual symptoms of AMS, but then become more breathless than their companions. Over the next few hours, the breathlessness increases, a cough develops which is first dry but later productive of frothy white sputum. The sputum may become blood-tinged. The signs of obvious pulmonary edema are found, and cyanosis may be detected. Some patients literally drown in their own secretions and become comatose and can die if no action is taken. Patients have tachycardia and tachypnea with mild pyrexia and leukocytosis and a characteristic x-ray appearance. The pathology, in fatal cases, is of patchy edema of the lungs.
Transient tachypnea of the newborn and congenital pneumonia: a comparative study
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2012
Sandra Costa, Gustavo Rocha, Andreia Leitão, Hercília Guimarães
Objective: Identify perinatal risk factors for transient tachypnea and pneumonia in neonates, and compare the outcome of these clinical conditions during the Neonatal Intensive Care Unit (NICU) stay. Methods: Retrospective review of newborns admitted to a level III NICU, comparing patients with transient tachypnea, pneumonia and a control group of healthy neonates. Results: We included 202 patients with transient tachypnea, 29 with pneumonia and 498 controls. Perinatal infectious risk factors were more frequent in patients with pneumonia than in transient tachypnea (p < 0.001), but the two were identical in terms of the remaining perinatal variables. Patients with pneumonia were admitted for a longer period (p < 0.001) and required supplemental oxygen and ventilatory support more frequently and for a longer period. Comparing with controls, Apgar score at one and five minutes was higher in controls than in patients with pneumonia (p0.032 and p < 0.001) or transient tachypnea (p < 0.001 and p < 0.001). Conclusion: In most cases, newborns with transient tachypnea and pneumonia are indistinguishable at presentation but clinical evolution is significantly different. The presence of perinatal infectious risk supports the diagnosis of pneumonia. Low Apgar score at one and five minutes was associated with both diseases, suggesting that etiologic factors may already be present at birth.
Time Course and Degree of Hyperinflation with Metronome-Paced Tachypnea in COPD Patients
Published in COPD: Journal of Chronic Obstructive Pulmonary Disease, 2008
S. Samuel Weigt, Marlon Abrazado, Eric C. Kleerup, Donald P. Tashkin, Christopher B. Cooper
In COPD patients, tachypnea should increase (dynamic) hyperinflation by shortening expiratory time. We developed a method to evaluate the time course and degree of dynamic hyperinflation during metronome-paced tachypnea. Fourteen patients with stable COPD (FEV1 43 ± 13% predicted) were studied. Inspiratory capacity (IC) was measured breathing through a flow transducer. Subjects paced their respiratory rate (fR) at 20/min, 30/min and 40/min for 60-second periods in response to audible tones generated by a computer. IC measurements were obtained at baseline and after 30 and 60 seconds at each fR. End-tidal carbon dioxide was monitored and fR was allowed to return to baseline between periods of tachypnea. Tachypnea produced reductions in IC of 200 ± 240 ml, 380 ± 330 ml and 540 ± 300 ml after 30 seconds at 20/min, 30/min and 40/min, respectively. IC reduction at 60 seconds was similar to 30 seconds for each fR. In patients with moderate-to-severe COPD, the dynamic hyperinflation induced by metronome-paced tachypnea was shown to occur rapidly and be complete by 30 seconds for a given fR. Controlled increments in fR produced stepwise increases in dynamic hyperinflation. This standardized method could be a useful and easier method of assessing dynamic hyperinflation in COPD patients before and after therapeutic interventions.
A hierarchical logistic regression predicting rapid respiratory rates from post-exertional malaise
Published in Fatigue: Biomedicine, Health & Behavior, 2020
Joseph Cotler, Ben Z. Katz, Corine Reurts-Post, Ruud Vermeulen, Leonard A. Jason
ABSTRACT Background Past research has found high rates of hyperventilation in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), but hyperventilation can be influenced by psychological factors. Clinical respiratory rates have been less frequently assessed. Aim This study aimed to identify the predictors of rapid respiratory rates in patients referred an outpatient clinic specializing in ME/CFS. Methods Adults (n = 216) referred to an outpatient clinic specializing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) participated in a two-day cardiopulmonary exercise test. As part of that evaluation, subjects had resting respiratory rates measured on two consecutive days. The current study used questionnaires to assess the relationship between tachypnea (rapid respiratory rates) and a variety of domains including post-exertional malaise (PEM), a common complaint in patients with ME/CFS, and psychiatric/somatic symptoms, using hierarchical logistic regression analysis. Results PEM was a significant predictor of tachypnea, while psychological/somatic assessments and sedentary behaviors were not significantly predictive of tachypnea. Conclusions These findings suggest that respiratory rate may be useful as an objective clinical metric of PEM, and potentially ME/CFS.
Related Knowledge Centers
- Hyperventilation
- Hypoventilation
- Physical Exercise
- Pregnancy
- Caesarean Section
- Hyperpnea
- Respiratory Rate