The Earlier the Better: Timing of Transfer Is Associated With Improved Outcomes in Patients With Acute Respiratory Failure
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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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Respiratory failure is the most common cause of death in children with neuromuscular disease (NMD). This article provides a conceptual framework for understanding failure of the respiratory pump in these children. Pump failure can be attributed to faulty control of respiration, to mechanical defects, and to respiratory muscle fatigue. In most patients with NMD, respiratory drive is intact. Mechanical defects can be due to either an abnormal pump or an excessive respiratory load on which the pump must operate. In patients with NMD, the weak respiratory muscles cannot generate normal respiratory pressures. Furthermore, inefficient chest wall motion leads to increased work for the respiratory system. Abnormalities of lung and chest wall compliance increase respiratory load. The combination of a weak, inefficient respiratory pump and an abnormally high elastic load can predispose these patients to respiratory muscle fatigue. Respiratory muscle rest with nocturnal assisted ventilation, therefore, provides a rational approach to the treatment of chronic respiratory failure in patients with NMD. Areas of future research that may prove useful in the care of children with respiratory failure due to NMD include: the development of better ways of assessing respiratory muscle fatigue; studies to increase understanding of the role of mechanical ventilation in improving chest wall and respiratory pump function; and studies delineating the role of respiratory muscle training in these patients.
Neuromuscular disease
Respiratory physiology
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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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The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO<sub>2</sub> seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.
Pathophysiology
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Acute respiratory failure
Extracorporeal
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Data from a drug surveillance programme were analysed to estimate the frequency with which patients with a diagnosis of respiratory failure had been exposed to CNS-depressing drugs. Eleven out of 37 patients with respiratory failure had received such medication. A detailed comparison of these patients and controls admitted to hospital because of respiratory disease who did not develop respiratory failure failed to reveal significant differences in drug usage. This unexpected finding suggests that patients with respiratory disease of equal severity may vary greatly in their tendency to develop carbon dioxide retention following administration of drugs with respiratory depressant properties.
Acute 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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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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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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