Non-invasive ventilation for the treatment of acute respiratory failure following ovarian hyperstimulation syndrome: report of two cases and a brief review of the literature.

The ovarian hyperstimulation syndrome (OHSS) is a serious but rarely fatal complication of medical interventions that seek to induce fertility; it is typically encountered in women who undergo controlled ovarian hyperstimulation, but there are very rare patients who have genetic defects who present with OHSS. In recent years, its pathogenesis has been elucidated; this knowledge will decrease the frequency of this syndrome. Clinical signs may include any or all of the following: rapid weight gain, ascites, oliguria, hemoconcentration, leukocytosis, along with intravascular hypovolemia, hyponatremia, and hyperkalemia. If the patient is not diagnosed early, ascites, pleural and more rarely pericardial effusions, severe respiratory failure and ARDS, hypercoagulability with tromboembolism and multiple organ system failure can occur. Due to the increased use of therapeutic strategies for infertility (particularly those using human chorionic gonadotropin), the systemic, particularly the pulmonary, complications of this syndrome must be identified early to allow appropriate diagnosis and management. We describe two cases of women with extremely severe OHSS presenting bilateral pleural effusions, and severe respiratory failure (paO2/FiO2 < 200) treated with non-invasive ventilation (NIV). The severe form of OHSS varies between 0.5% and 5%, depending on the population studied: intensive care may be required for management of tromboembolic complications, renal failure and severe respiratory failure. The diagnosis of severe OHSS was made, largely based on bedside ultrasonography showing increased ovarian size, mild ascites and bilateral pleural effusions. Owing to severe respiratory failure the patients were admitted to Respiratory Intermediate Care. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and in more severe cases assisted ventilation. There are only a few studies in English that describe severe respiratory failure treated with non-invasive ventilation, but all of them have had good outcomes.

Disability in COPD and its relationship to clinical and patient-reported outcomes.

OBJECTIVE: To assess the presence of disability in chronic obstructive pulmonary disease (COPD) patients and its relationships with disease severity, comorbidities, and patient-reported outcomes. RESEARCH DESIGN AND METHOD: COPD outpatients completed validated questionnaires designed to investigate illness perception, well-being, quality of life, and stress, while physicians collected data concerning disability, dyspnea, and comorbidities (Charlson Index). RESULTS: Of 164 patients, 37.3% exhibited a degree of disability and 67.7 % of them reported the loss of at least one relevant function in daily life (mean 2.34 ± 2.41). Although disability was associated with disease severity (χ(2) = 8.292; p < 0.016), disability was present to some degree in all disease stages and in 44.9% of patients with moderate COPD. Barthel Index scores were related to MRC scores (r = 0.529; p < 0.001), GOLD stage (r = 0.223; p < 0.006), and Charlson Index (r = 0.163; p < 0.032). Disabled patients had a lower mean FEV(1) value (50.96 ± 20.99 vs. 65.00 ± 23.63; p < 0.001) than self-sufficient patients (p < 0.001). The stepwise regression analysis showed that the MRC score was the most relevant factor in inducing COPD patient disability (F = 56.5; p = 0.001). Compared to self-sufficient patients, disabled patients reported lower levels of well-being and health status, increased levels of distress, and a different illness perception. CONCLUSIONS: Disability can be identified in each disease stage, with dyspnea serving as the most relevant inducing factor. Since disability substantially impacts patient perception of and experience with COPD, its presence must be taken into account during disease management. The cross-sectional nature of the study and the characteristics of the sample size represent a limitation in the possibility to generalize the results.