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Refractory respiratory failure

Whittney A Warren, Domingo Franco-Palacios, Christopher S King, Oksana A Shlobin, Steven D Nathan, Shalika B Katugaha, Haresh Mani, A Whitney Brown
A 24-year-old woman with ΔF508/Y1092X cystic fibrosis (CF) complicated by severe obstructive lung disease (FEV1 of 30% predicted) was admitted for IV antibiotics for planned sinus surgery resulting from severe chronic sinusitis causing frequent exacerbations and declining lung function. She had persistent airway infection with multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and growth of a fungus presumed to be an airway colonizer, identified as Stephanoascus ciferrii 1 year before presentation...
March 2018: Chest
Antônio Aurélio de Paiva Fagundes Júnior, Renato Bueno Chaves, Amanda Robassini Dos Santos, Humberto Alves de Oliveira, Marcello Henrique Paschoal
Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival...
March 1, 2018: Revista Brasileira de Terapia Intensiva
Kevin J Li, Ronald J Gurrera, Lynn E Delisi
Clozapine has been shown to be the most efficacious therapy for treatment resistant schizophrenia, estimated at one third of all schizophrenia cases. There is significant morbidity and mortality associated with clozapine including risk of agranulocytosis, aspiration pneumonia, bowel ischemia, myocarditis, seizures, and weight gain. Here we present a case of a 62-year-old man with chronic paranoid schizophrenia refractory to numerous antipsychotics who was started on clozapine therapy during an acute inpatient psychiatric admission...
March 1, 2018: Schizophrenia Research
P Burgueño, C González, A Sarralde, F Gordo
Extracorporeal membrane oxygenation (ECMO) support is indicated in patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. Physician experience and quantity of necessary resources are reasons why regionalization could benefit patients of this kind, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and inter-territorial approach...
March 1, 2018: Medicina Intensiva
G Skalley, S Rodríguez-Villar
Threatening refractory metabolic acidosis due to short-term starvation nondiabetic ketoacidosis is rarely reported. Severe ketoacidosis due to starvation itself is a rare occurrence, and more so in pregnancy with a concomitant stressful clinical situation. This case report presents a nondiabetic woman admitted in intensive care for respiratory failure type 1 during the third trimester of pregnancy with a severe metabolic acidosis refractory to medical treatment. We diagnosed the patient with acute starvation ketoacidosis based on her history and the absence of other causes of high anion gap metabolic acidosis after doing a rigorous analysis of her acid-base disorder...
February 27, 2018: Revista Española de Anestesiología y Reanimación
Sandra Pereira, Mariana Adrião, Mafalda Sampaio, Margarida Ayres Basto, Esmeralda Rodrigues, Laura Vilarinho, Elisa Leão Teles, Isabel Alonso, Miguel Leão
INTRODUCTION: Combined oxidative phosphorylation deficiency 20 (COXPD20) is a mitochondrial respiratory chain complex (RC) disorder, caused by disease-causing variants in the VARS2 gene, which encodes a mitochondrial aminoacyl-tRNA synthetase. Here we describe a patient with fatal mitochondrial encephalopathy caused by a homozygous VARS2 gene missense variant. CASE REPORT: We report the case of a girl, the first child of non-consanguineous and healthy parents, born from an uneventful term pregnancy, who presented, in the neonatal period, major hypotonia and microcephaly...
February 25, 2018: JIMD Reports
Federico Pappalardo, Anna Mara Scandroglio, Azeem Latib
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...
February 21, 2018: ESC Heart Failure
Darryl Abrams, A Reshad Garan, Akram Abdelbary, Matthew Bacchetta, Robert H Bartlett, James Beck, Jan Belohlavek, Yih-Sharng Chen, Eddy Fan, Niall D Ferguson, Jo-Anne Fowles, John Fraser, Michelle Gong, Ibrahim F Hassan, Carol Hodgson, Xiaotong Hou, Katarzyna Hryniewicz, Shingo Ichiba, William A Jakobleff, Roberto Lorusso, Graeme MacLaren, Shay McGuinness, Thomas Mueller, Pauline K Park, Giles Peek, Vin Pellegrino, Susanna Price, Erika B Rosenzweig, Tetsuya Sakamoto, Leonardo Salazar, Matthieu Schmidt, Arthur S Slutsky, Christian Spaulding, Hiroo Takayama, Koji Takeda, Alain Vuylsteke, Alain Combes, Daniel Brodie
Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices...
February 15, 2018: Intensive Care Medicine
Jesús Villar, Domingo Martínez, Fernando Mosteiro, Alfonso Ambrós, José M Añón, Carlos Ferrando, Juan A Soler, Raquel Montiel, Anxela Vidal, Luís A Conesa-Cayuela, Jesús Blanco, Regina Arrojo, Rosario Solano, Lucía Capilla, Rafael Del Campo, Belén Civantos, María Mar Fernández, César Aldecoa, Laura Parra, Andrea Gutiérrez, Chanel Martínez-Jiménez, Jesús M González-Martín, Rosa L Fernández, Robert M Kacmarek
OBJECTIVES: Overall mortality in patients with acute respiratory distress syndrome is a composite endpoint because it includes death from multiple causes. In most acute respiratory distress syndrome trials, it is unknown whether reported deaths are due to acute respiratory distress syndrome or the underlying disease, unrelated to the specific intervention tested. We investigated the causes of death after contracting acute respiratory distress syndrome in a large cohort. DESIGN: A secondary analysis from three prospective, multicenter, observational studies...
February 7, 2018: Critical Care Medicine
J L Parker-Cote, J Rizer, J P Vakkalanka, S V Rege, C P Holstege
OBJECTIVE: The aim of this systematic review was to identify isolated acute cyanide poison cases and to identify reported signs, symptoms, and laboratory findings. METHODS: We searched MEDLINE, Cochrane Reviews, and Web of Science case reports and series using a number of MeSH descriptors pertaining to cyanide, toxicity, and poisonings. We excluded studies on plants, laboratory analyses, smoke inhalation poisonings, animals as well as non-English language articles and those in which data were not available...
February 8, 2018: Clinical Toxicology
Y Hirata, Y Sanada, T Urahashi, Y Ihara, N Yamada, N Okada, T Katano, S Otomo, K Ushijima, K Mizuta
BACKGROUND: Antibody drugs have been used to treat steroid-resistant rejection (SRR) after liver transplantation. Although anti-thymocyte globulin has been used for SRR after liver transplantation in place of muromonab-CD3 since 2011 in Japan, the effectiveness of anti-thymocyte globulin after pediatric living-donor liver transplantation (LDLT) has not yet been reported. The aim of this study was to evaluate the effectiveness of antibody drug treatment for SRR after pediatric LDLT in our single center...
January 2018: Transplantation Proceedings
Anupam Kumar, Basem Abdelmalak, Yoshikazu Inoue, Daniel A Culver
Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that results from the accumulation of lipoproteinaceous material in the alveoli and alveolar macrophages due to abnormal surfactant homoeostasis. Identification of the granulocyte-macrophage colony-stimulating factor (GM-CSF) as an indispensable mediator of macrophage maturation and surfactant catabolism was the key discovery leading to the current understanding of the pathogenesis of most forms of PAP. Impaired GM-CSF bioavailability due to anti-GM-CSF autoimmunity is the cause of approximately 90% of adult PAP cases...
January 31, 2018: Lancet Respiratory Medicine
Courtney D DiNardo, Keith W Pratz, Anthony Letai, Brian A Jonas, Andrew H Wei, Michael Thirman, Martha Arellano, Mark G Frattini, Hagop Kantarjian, Relja Popovic, Brenda Chyla, Tu Xu, Martin Dunbar, Suresh K Agarwal, Rod Humerickhouse, Mack Mabry, Jalaja Potluri, Marina Konopleva, Daniel A Pollyea
BACKGROUND: Elderly patients (aged ≥65 years) with acute myeloid leukaemia have poor outcomes and no effective standard-of-care therapy exists. Treatment with hypomethylating agents such as azacitidine and decitabine is common, but responses are modest and typically short-lived. The oral anti-apoptotic B-cell lymphoma 2 protein inhibitor, venetoclax, has shown promising single-agent activity in patients with relapsed or refractory acute myeloid leukaemia and preclinical data suggested synergy between hypomethylating agents and venetoclax, which led to this combination phase 1b study...
January 12, 2018: Lancet Oncology
Yolanda Ballestero, Jimena De Pedro, Nancy Portillo, Otilia Martinez-Mugica, Eunate Arana-Arri, Javier Benito
OBJECTIVES: To assess the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and safety in children with asthma and moderate respiratory failure in the emergency department (ED). STUDY DESIGN: This was a prospective randomized pilot trial of children (aged 1-14 years) presenting to a tertiary academic pediatric ED with moderate-to-severe asthma exacerbations between September 2012 and December 2015. Patients with a pulmonary score (PS) ≥6 or oxygen saturation <94% with a face mask despite initial treatment (salbutamol/ipratropium bromide and corticosteroids) were randomized to HFNC or to conventional oxygen therapy...
January 11, 2018: Journal of Pediatrics
Mohammed S Alshahrani, Anees Sindi, Fayez Alshamsi, Awad Al-Omari, Mohamed El Tahan, Bayan Alahmadi, Ahmed Zein, Naif Khatani, Fahad Al-Hameed, Sultan Alamri, Mohammed Abdelzaher, Amenah Alghamdi, Faisal Alfousan, Adel Tash, Wail Tashkandi, Rajaa Alraddadi, Kim Lewis, Mohammed Badawee, Yaseen M Arabi, Eddy Fan, Waleed Alhazzani
BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia...
January 10, 2018: Annals of Intensive Care
Gabriela Gonçalves-Venade, Nuno Lacerda-Príncipe, Roberto Roncon-Albuquerque, José Artur Paiva
Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial lung disease with rapid progressive respiratory failure and high mortality. In the present report, three cases of AIP complicated by refractory respiratory failure supported with extracorporeal membrane oxygenation (ECMO) are presented. One male and two female patients (ages 27-59) were included. Venovenous ECMO support was provided using miniaturized systems, with two-site femoro-jugular circuit configuration. Despite lung protective ventilation, prone position and neuromuscular blockade, refractory respiratory failure of unknown etiology supervened (ratio of arterial oxygen partial pressure to fractional inspired oxygen 46-130) and ECMO was initiated after 3-7 days of mechanical ventilation...
January 11, 2018: Artificial Organs
Burhan Mahmood, Debra Newton, Eugenia K Pallotto
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with respiratory and cardiac failure refractory to maximal medical management. The extracorporeal life support organization registry is the largest available resource for describing the population and outcomes of patients treated with this therapy. The use of ECMO for neonatal patients is decreasing in proportion to the total annual ECMO runs most likely due to advancements in medical management. Although the overall survival for neonatal ECMO has decreased, this is likely a reflection of the increasingly complex neonatal patients treated with this therapy...
March 2018: Seminars in Perinatology
Nicolas Bréchot, Ciro Mastroianni, Matthieu Schmidt, Francesca Santi, Guillaume Lebreton, Anne-Marie Hoareau, Charles-Edouard Luyt, Juliette Chommeloux, Marina Rigolet, Said Lebbah, Guillaume Hekimian, Pascal Leprince, Alain Combes
OBJECTIVE: Mobile extracorporeal membrane oxygenation (ECMO) retrieval teams (MERTs) assure ECMO implantation and under-ECMO retrieval of patients with most severe acute respiratory failure (ARF) to experienced ECMO centers. Although described as feasible, mobile ECMO has only been poorly evaluated in comparison with on-site implantation. This study was undertaken to compare the indications, characteristics, and outcomes of MERT-implanted patients with venovenous (VV)-ECMO versus those implanted on site in our intensive care unit (ICU)...
November 8, 2017: Journal of Thoracic and Cardiovascular Surgery
Christopher T Towe, Frances V White, R Mark Grady, Stuart C Sweet, Pirooz Eghtesady, Daniel J Wegner, Partha Sen, Przemyslaw Szafranski, Pawel Stankiewicz, Aaron Hamvas, F Sessions Cole, Jennifer A Wambach
OBJECTIVE: To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. STUDY DESIGN: We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital...
March 2018: Journal of Pediatrics
Alessandro Galazzi, Alessandra Brambilla, Giacomo Grasselli, Antonio Pesenti, Roberto Fumagalli, Alberto Lucchini
INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is a technique used in the treatment of patients with severe respiratory failure. A lot of studies in the literature investigated the survival rate of patients treated with ECMO, but few are those that assess the long-term outcomes and the quality of life (QoL) of survivors. MATERIALS AND METHODS: A retrospective observational study with prospective QoL assessment through administration of the questionnaire EuroQol-5 Dimension was conducted in acute respiratory distress syndrome patients who h ad ECMO as a rescue therapy for reversible refractory hypoxemia from January 2013 until December 2015 in an Italian referral ECMO center...
January 2018: Dimensions of Critical Care Nursing: DCCN
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