An unknown second tracheoesophageal fistula: a rare cause of postoperative respiratory failure
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Abstract:
The case of a 6-year-old boy who developed complications following gastric interposition surgery for severe, recurrent esophageal stricture is reported. Investigation of his pleural effusion revealed a rare and unexpected complication.Keywords:
Tracheoesophageal Fistula
Acute respiratory failure
Objective To investigate the effect of artificial controlled mechanical ventilation in the treatment of patients with acute life-threatening respiratory failure.Methods 36 patients with acute life-threatening respiratory failure were treated with artificial controlled mechanical ventilation.Results In all patients, 29 patients successfully received, 7 patients died, 5 patients occurred complication. Conclusion Artificial controlled mechanical ventilation is an effective method in the treatment of patients with acute life-threatening respiratory failure.
Acute respiratory failure
Artificial ventilation
Life saving
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Acute respiratory failure
Positive pressure ventilation
Noninvasive Ventilation
Chronic respiratory failure
Pressure support ventilation
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The authors report results of transthoracic drainage of enlarging emphysematous bullae in patients with acute respiratory failure and chronic lung disease. In two cases, patients survived the acute failure. Respectively six months and one year later, bulla was smaller than before the failure and respiratory symptoms and function tests were improved.
Acute respiratory failure
Bulla (seal)
Chronic respiratory failure
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Background and Aims: Patients with respiratory failure requiring assisted ventilation form a large diagnostic group among critically ill patients. The outcome of patients with acute respiratory failure (ARF) as compared to those with acute on chronic respiratory failure (ACRF), may be different. The present study was designed to evaluate the clinical and acid base profile at presentation, hospital course and outcome in patients with ARF and ACRF requiring ventilatory support and to define factors that influence the outcome of these two groups of patients. Materials and Methods : Fifty patients with respiratory failure {ACRF (n=27) and ARF (n=23)} who required invasive mechanical ventilation, were included in a prospective fashion. Clinical data including APACHE II score, blood gas analysis and renal and liver functions were recorded at presentation and for the next three days. Survival to hospital discharge was the primary outcome measure. Various parameters were compared between ARF and ACRF, as well as between survivors and non-survivors to define predictors of mortality. Results: Patients with ARF were significantly younger (41.5 versus 64.4 years, P P P =0.009). For the whole study group, APACHE II score and serum creatinine, 48 hrs after admission, were independent predictors of mortality. Conclusions: Although patients with ARF and ACRF may appear equally ill at presentation, mortality is higher for patients with ARF. A higher incidence of complications such as development of non-pulmonary organ failure during the hospital course in patients with ARF, seems to be responsible for this increased mortality.
Acute respiratory failure
Chronic respiratory failure
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Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients.Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure.Our study included 204 (148 men and 56 women; mean age 43.0.4 ± 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit.Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.
Atelectasis
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Acute respiratory failure is an uncommon initial presentation of myasthenia gravis. We present a case of unrecognised myasthenia gravis. She initially presented with dysphonia and was managed by speech therapy and ENT surgeons for a year. The diagnosis was finally made after the patient presented with acute respiratory failure.
Acute respiratory failure
Presentation (obstetrics)
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Acute respiratory failure
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Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients.URGENT was a prospective multicenter trial designed to address these issues.Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement.Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients.Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients.The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients.By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea.The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours. P2
Acute respiratory failure
Noninvasive Ventilation
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Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.
Neuromyelitis Optica
Plasmapheresis
Acute respiratory failure
Refractory (planetary science)
Demyelinating disease
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We present a case of a 66-year-old man who suffered from acute respiratory failure due to desquamative interstitial pneumonia. The pneumonitis was resistant to steroids, but responded promptly to cyclophosphamide, with immediate relapse upon withdrawal of the drug
Acute respiratory failure
Interstitial pneumonitis
Pneumonitis
Hypersensitivity pneumonitis
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