Recent predictive parameters for successful weaning from mechanical ventilation in critically Ill patients

Background: Removal of patients from mechanical ventilation (MV) has been termed liberation, discontinuation, withdrawal and most commonly weaning. Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Although weaning from MV is successful in most cases, the first attempt fails in 20% of patients. In addition, weaning accounts for over 40% of the total MV time, the proportion varying in function of the etiology of respiratory failure. Objective: The aim of this study was to evaluate the recent protocols of successful weaning from mechanical ventilation of critically ill patients, depending on central venous oxygen saturation, ultrasonographic assessment of diaphragmatic movement, and serial arterial blood gases to assess failure rate 48 hours after weaning. Patients and methods: This prospective randomized study included a total of 90 mechanically ventilated Egyptian patients of both sexes, ASA (I-II) attending at least for 48 hours at intensive care unit, AlAzhar University Hospitals. The included subjects were divided into three groups depending on method of monitoring; group A: serial arterial blood gases, group B: Central venous oxygen saturation and group C: Ultrasonographic assessment of diaphragmatic movement pre and post spontaneous breathing trial. All patients were subjected to daily monitoring of the following weaning parameters: static and dynamic compliances and inspiratory resistance, intrinsic positive end expiratory pressure (Auto PEEP) and Maximum inspiratory pressure (MIP). Results: There is highly statistically significant difference between patients as regard weaning outcome. As the group depended on normal ultrasonographic assessment of diaphragmatic movement, had the largest number of patients with successful weaning. Conclusion: Normal ultrasonographic assessment of diaphragmatic movement proved to be the most important criteria for successful weaning from mechanical ventilation

Keeping our heads above water: A systematic review of fatal drowning in South Africa

Background. Drowning is defined as the process of experiencing respiratory impairment from submersion/immersion in liquid, and can have one of three outcomes ­ no morbidity, morbidity or mortality. The World Health Organization African region accounts for approximately 20% of global drowning, with a drowning mortality rate of 13.1 per 100 000 population. The strategic implementation of intervention programmes driven by evidence-based decisions is of prime importance in resource-limited settings such as South Africa (SA).Objective. To review the available epidemiological data on fatal drowning in SA in order to identify gaps in the current knowledge base and priority intervention areas. Methods. A systematic review of published literature was conducted to review the available epidemiological data describing fatal drowning in SA. In addition, an internet search for grey literature, including technical reports, describing SA fatal drowning epidemiology was conducted.Results. A total of 13 published research articles and 27 reports obtained through a grey literature search met the inclusion and exclusion criteria. These 40 articles and reports covered data collection periods between 1995 and 2016, and were largely focused on urban settings. The fatal drowning burden in SA is stable at approximately 3.0 per 100 000 population, but is increasing as a proportion of all non-natural deaths. Drowning mortality rates are high in children aged <15 years, particularly in those aged <5. Conclusions. This review suggests that SA drowning prevention initiatives are currently confined to the early stages of an effective injury prevention strategy. The distribution of mortality across age groups and drowning location differs substantially between urban centres and provinces. There is therefore a need for detailed drowning surveillance to monitor national trends and identify risk factors in all SA communities

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd­5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy

Dilatations des bronches révélant une mucoviscidose chez un adulte

La dilatation des bronches est une maladie d'étiologies diverses. La mucoviscidose est l'une des causes de cette pathologie. Cette cause congénitale est la plus fréquente en occident mais rare dans la population non caucasienne. Observation : Nous rapportons l'observation d'une patiente âgée de 25 ans, célibataire, diabétique type 1, bronchorrhéique chronique depuis 8ans, hospitalisée pour bilan étiologique de dilatation des bronches diffuses avec un hippocratisme digital. L'indice de masse corporelle était à 11,53kg/m2. Le test de la sueur était positif à deux reprises (86 mmol/l, 94 mmol/l). La tomodensitométrie du thorax objectivait l'image de dilatation des bronches prédominantes aux lobes supérieures. La tomodensitométrie des sinus montrait une sinusite maxillaire. La patiente était mise sous bi-antibiothérapie, sous oxygénothérapie et une ventilation non invasive. L'évolution était favorable.Conclusion: A travers cette observation, le diagnostic de la mucoviscidose n'est pas aisé dans la population non caucasienne. Malgré l'âge des patients, il faut y penser à la mucoviscidose comme étiologie de dilatation des bronches

Profil demographique et radio-clinique des patients decedes dans le service de PPH du CHU de Cocody de 2002 a 2004

BUTS: *Evaluer le taux de mortalite; *Decrire les principales images radiologiques retrouvees; *Identifier les principales pathologies en cause; *Apprecier la prise en charge therapeutique. MATERIEL ET METHODES : Il s'agit d'une etude retrospective; transversale et descriptive dans l'unite d'hospitalisation de PPH du CHU de Cocody portant sur l'analyse de 366 dossiers de malades decedes de 2002 a 2004. RESULTATS : *Le taux de mortalite global est de 22;14pour cent. *Le sexe masculin est le plus touche (56pour cent) avec un sex-ratio de 1;3. *Les adultes jeunes (25-54 ans) paient le lourd tribut (77;3 1pour cent). *La seroprevalence de l'infection a VIH chez les patients testes est de 92;86pour cent. *Les deces surviennent surtout des la premiere semaine d'hospitalisation (60;38pour cent) et entre 18heures et 08heures du matin (51;09pour cent). *Les circonstances de deces sont dominees par l'insuffisance respiratoire (34;97pour cent) et les troubles neurologiques (22;95pour cent). *Les images de pneumopathie interstitielle predominaient a la fois dans le groupe des patients sans signes d'immunodepression (49;45pour cent) et le groupe de patients avec signes d'immunodepression (50;55pour cent). *Les diagnostics retenus reposaient sur les elements de presomption dans 64;58pour cent des cas. *La tuberculose reste la premiere cause de deces (48;44pour cent); suivie des pneumopathies aigues (43;23pour cent); de la pathologie tumorale (6;25pour cent); des BPCO (1;30pour cent) et autres (0;78pour cent). *Les atteintes neurologiques sont associees aux pathologies rencontrees dans 34;15pour cent des cas. *Les traitements preconises n'ont ete mis en route que dans 68;31pour cent des cas. CONCLUSION : Ayant ainsi apprehende le profil des patients qui decedent en Pneumophtisiologie; nous pouvons; grace au concours des pouvoirs publics; nos confreres medecins; les structures sanitaires peripheriques et les patients eux-memes; ameliorer la qualite de vie de nos populations; et partant de la reduire le taux de mortalite

Care giver's knowledge; beliefs; attitudes and practices on case management of acute respiratory illnesses in a rural district in Ethiopia

A survey was conducted in three randomly selected farmer's associations in Sululta District; around Chancho town out of which; 540 households were selected randomly. Mothers and other care givers of children under-five were interviewed regarding their knowledge; beliefs; attitudes and practices in case management of acute respiratory illness. The study showed that 406 (75 percent) of the care givers have favorable practice; whereas 483 (89.4 percent); 497 (92 percent) and 334 (61.9 percent) of the care givers have unfavorable attitudes; knowledge and beliefs; respectively. Care givers' age is significantly associated with their practices; attitudes and knowledge whereas care givers' education and presence of grand parents in the neighbourhood affected significantly their attitude; knowledge and belief