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Objective:To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH) treated by pulmonary endarterectomy(PEA).Methods:45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled, including 25 females and 20 males. The mean age of operation was 51.2(25-70) years old. 24(53.5%) patients were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ. The mean PVR before operation was 923(461-2 711) dyn·s·cm -5. All patients’ data were entered in a prospective database, divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC). To assess risk factors for postoperative respiratory complications and its effect on short term outcomes. Results:There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg) and PVR(from 923 dyn·s·cm -5 to 293 dyn·s·cm -5) in the entire group. The in-hospital mortality rate was 4.4%(2 cases), died due to postoperative cardiogenic circulatory failure, even with VA-ECMO treatment and mediastinal infection, respectively. Postoperative respiratory complications occurred in 32 patients(71.1%). The most common complications were reperfusion pulmonary edema 44.4%(20 cases) and residual pulmonary hypertension 11.1%(5 cases). The WRC group showed a tendency to have longer periods of mechanical ventilation, longer ICU stays and more ICU costs. Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months( OR=12.2, 95% CI: 2.1-70.7, P=0.005)and six-minute walking distance<300 m( OR=12.6, 95% CI: 1.1-138.0, P=0.0038). Conclusion:Pulmonary endarterectomy is an effective and safe treatment for CTEPH. Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status. Patients with CTEPH should consider PEA surgery early.
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Background: Goiter refers to a diffuse enlargement of thyroid gland. It has a high prevalence in adult population in endemic areas where iodized salt is not part of the regular diet.Aim: We report the clinical profile of giant goiters seen in a tertiary hospital in Northwestern Nigeria.Methods: A prospective study of all surgically operated cases of goiter carried out in a tertiary health hospital in Northwestern Nigeria, over a period of 6 years between January 2011 and December 2016. Bio data, duration of goiter, symptoms, geographical location, thyroid function tests, radiological reports and treatment were recorded and analyzed.Results: Ninety-Seven patients were operated for goitre during the study period. Out of these 19 (19.6%) were giant goitres weighing between 900g-3200g. There were 13 (68.4%) females and 6 (31.6%) males with M: F ratio of 1:2.2. Age range was between 39 –71 years with a mean age of 53.2 years. Prevalence was high in the 41-60 year age group. Duration of goiter in 13 (68.4%) of patients was between 11-20years. Retrosternal extension was observed in 7 (36.8%) patients. Tracheal deviation was the most common risk factor for respiratory complication in all the patients followed by tracheomalacia in 8(42.1%). Postoperative temporary Tracheostomy was carried out in 4(21.1%) of patients. Recurrent laryngeal nerve injury occurred in 2(10.5%). No mortality was recorded.Conclusion: Respiratory complications are commonly associated withgiant goiters, a pathology that is entirely preventive if diagnosed and managed at an early stage
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In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.
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Adult , Female , Humans , Male , Middle Aged , Bronchiolitis , Diagnosis , Dengue , Virology , Dengue Virus , Physiology , Respiratory Distress Syndrome , DiagnosisABSTRACT
Objective To review our experience in the diagnosis and management of paralysis of the right hemidiaphragm after liver transplantation. Methods 60 adult patients received liver transplantation from February 2001 to March 2007 in Sun Yat-sen Memorial Hospital were retrospectively analyzed. The pathophysiologic changes, clinical progress, and management of serious respiratory complications caused by post-transplant paralysis of the right hemidiaphragm were studied. Results Among 60 patients, 40 developed postoperative respiratory complications, and 5 were due to paralysis of the right hemidiaphragm. The 5 patients presented with paradoxical respiration and the ventilator supporting times were 14, 16, 34, 45, and 60 days, respectively. Tracheostomy was performed in 4. These patients developed pneumonia in 5, atelectasis in 4, acute respiratory distress syndrome (ARDS) in 4, hepatopulmonary syndrome in 4, and pulmonay interstitial edema in 3. Among the 5 patients, 4 patients survived and 1 patient died of ARDS and multiple organs failure 31 days after the transplantation. Conclusions After liver transplantation, strict monitoring of the respiratory function and timely use of a respirator for patients with the paralysis of the hemidiaphragm is very important. For patients with suspicious hemidiaphragm paralysis, tracheostomy should be decisively performed.
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Maoto has been reported to be effective in controlling fever caused by influenza. But Maoto's effects on respiratory complications of influenza have been unknown so far. We performed a comparative study on the respiratory complication (bronchitis, pneumonia, asthma attack) rates of pediatric cases of influenza after the administration of Maoto (n = 80), Oseltamivir or Zanamivir (n = 166). Rate of using other respiratory medication at the same time is higher in Oseltamivir/Zanamivir group (64/166 = 39%) than Maoto one (12/80 = 15%) (P < 0.01). Respiratory complication rates were equal between Maoto group (34/166 = 21%) and Oseltamivir/Zanamivir one (9/80 = 11%) (P = 0.07). In the patients who had not history of bronchial asthma, respiratory complication rate is higher in Oseltamivir/Zanamivir group (19/107 = 18%) than Maoto one (4/67 = 6%) (P = 0.045). In the patients who had history of bronchial asthma and age under10, respiratory complication rate is higher in Maoto group (4/5 = 80%) than Oseltamivir/Zanamivir one (15/57 = 26%) (P = 0.047).
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BACKGROUND: Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.