High-flow nasal oxygen therapy versus noninvasive ventilation in chronic interstitial lung disease patients with acute respiratory failure

Background High-flow nasal oxygen therapy (HFNOT) may be a suitable alternative for noninvasive ventilation (NIV) in chronic interstitial lung disease (ILD) during an episode of acute respiratory failure (ARF). Patients and methods Consecutive ILD patients who had ARF and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) of 300 mmHg or less were randomly assigned to NIV or HFNOT. The primary outcome was the need for intubation. Secondary outcomes were in-hospital mortality and ventilator-free days. Results A total of 70 patients with ILD were included. The rate of intubation was 20.6% (seven of 34 patients) in the HFNOT group and 22.2% (eight of 36) in the NIV group (P=0.87). The ventilator-free days at day 28 was higher in the HFNOT group (20±5 vs. 16±7 days in the NIV group; P=0.008). The rate of in-hospital mortality was 26.5% in the HFNOT group versus 30.6% in the NIV group (P=0.71). Conclusion HFNOT improved patient comfort and the ventilator-free days in patients with ILD and ARF, despite no difference in the rate of intubation when compared with NIV

Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt

AbstractBackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) are both common and often fatal. Lack of an accurate prognostic tool that can accurately predict inhospital mortality and help clinicians triaging patients to the appropriate level of care is a challenge. Toward this aim, the Dyspnea, Esinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) Score is needed to be assessed against other available scores.Patients and methodsTwo hundred patients with primary diagnosis of AECOPD were included. They were subjected to thorough medical history taking, full clinical examination, plain chest X-ray, routine laboratory investigations, ECG, ABGs analysis, assessment of DECAF Score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, COPD and Asthma Physiology Score (CAPS) and CURB-65 score. Inhospital mortality was recorded.ResultsTwenty-five (12.5%) patients died in hospital. The DECAF Score showed an excellent discrimination for inhospital mortality (AUROC=0.83) and performed significantly better for the prediction of inhospital mortality than: APACHE II Score (AUROC=0.68, DECAF vs APACHE II p=0.03); and the COPD and Asthma Physiology Score (CAPS) (AUROC=0.65, p=0.01). Furthermore, DECAF was a significantly stronger predictor of inhospital mortality than CURB-65 for the subgroup of patients with radiological consolidation (AUROC=0.87 vs 0.65, p=0.02).ConclusionThe DECAF Score is a simple and effective clinical tool that can risk stratify hospitalized patients with AECOPD and could therefore help clinicians managing this fatal condition

Serum eosinophilic cationic protein and high sensitive C-reactive protein as alternative parameters for differentiation of severity stages and monitoring control in bronchial asthma patients

AbstractBackgroundHigh sensitive C-reactive protein (hs-CRP) and eosinophilic cationic protein (ECP) have been shown to be associated with asthma in recent studies. However, the relationship between hs-CRP and the control of asthma has not been clearly identified yet.Patients and methodsThirty patients with newly-diagnosed bronchial asthma and 20 healthy individuals were enrolled in this study. In addition to medical history and physical examination, asthma was assessed according to the Global Initiative for Asthma (GINA) guidelines. Respiratory function tests (RFT), serum hs-CRP and ECP levels, serum total IgE levels, circulating eosinophil count (CE) and asthma control test (ACT) were performed for all subjects.ResultsSerum ECP, serum hs-CRP, serum total IgE and CE were significantly higher (p<0.01, 0.01, 0.05 and 0.05, respectively), while forced expiratory volume in 1s (FEV1 %) and ACT were significantly lower (p<0.05) in asthmatic patients compared to the control group. In all patients with bronchial asthma, serum levels of hs-CRP and ECP showed significant positive correlations with asthma severity (hs-CRP, rs=0.59, p<0.01; ECP, rs=0.63, p<0.01, respectively) but, significant negative correlations with ACT (hs-CRP, rs=−0.53, p<0.05; ECP, rs=−0.62, p<0.01, respectively) and FEV1 % (hs-CRP, rs=−0.46, p<0.05; ECP, rs=−0.57, p<0.01, respectively). Serum ECP and hs-CRP levels showed significant fall (p<0.01and p<0.05, respectively), while, FEV1 % and ACT showed significant increase (p<0.05) in asthmatic patients who were followed up after 2months of therapy.ConclusionCoupling measurements of serum levels of both ECP and hs-CRP may add a benefit in determining the severity and monitoring of the control of bronchial asthma

Pulmonary rehabilitation slows the decline in forced expiratory volume in 1 second and improves body mass index in patients with Chronic Obstructive Pulmonary Disease

AbstractBackgroundChronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation that is usually progressive leading to disability with an increasing burden to the patient, his family and to the health services. Pulmonary rehabilitation (PR) is used as a complementary evidence-based effective treatment option for patients with COPD. This study was carried out to evaluate the effects of PR on the rate of forced expiratory volume in 1 second (FEV1) decline in patients with stable COPD.Patients and methodsEighty five COPD patients completed the study, 60 with a mean age of 63±7years underwent PR for 3years and 25 with a mean age of 62±5.4 received only pharmacological treatment according to guidelines. Pulmonary function testing and body mass index (BMI) were carried out for all patients upon enrollment and at 1year intervals for 3years.ResultsThe FEV1 decreased from 1246.8ml (46.9% of predicted value) to 1192.8ml (44.8% of predicted) in the PR group, while in the control group the FEV1 decreased from 1224.6ml (45.4% of predicted) to 1060ml (39.3% of predicted) (i.e., FEV1 declined 54ml versus 164.6, respectively, p=0.008). Also, the PR group showed an improvement in BMI, while in the control group a decreased BMI was noticed (p=0.001).ConclusionPulmonary rehabilitation resulted in slowing down the decline in FEV1, as well as improving BMI in patients with stable COPD

Clinical characteristics and outcome of ICU admitted MERS corona virus infected patients

AbstractMiddle East Respiratory Syndrome (MERS) is a novel respiratory illness firstly reported in Saudi Arabia in 2012. It is caused by a new corona virus, called MERS corona virus (MERS-CoV). Most people who have MERS-CoV infection developed severe acute respiratory illness.Aim of the workThis work is done to determine the clinical characteristics and the outcome of intensive care unit (ICU) admitted patients with confirmed MERS-CoV infection.Patients and methodsThis study included 32 laboratory confirmed MERS corona virus infected patients who were admitted into ICU. It included 20 (62.50%) males and 12 (37.50%) females. The mean age was 43.99±13.03years. Diagnosis was done by real-time reverse transcription polymerase chain reaction (rRT-PCR) test for corona virus on throat swab, sputum, tracheal aspirate, or bronchoalveolar lavage specimens. Clinical characteristics, co-morbidities and outcome were reported for all subjects.ResultsThe main symptoms among the included patients were: fever (96.87%), cough (93.75%), dyspnea (90.62%), sore throat (75%), runny nose (75%), sputum (50%), headache (43.75%), myalgia (40.62%), chest pain (37.50%), hemoptysis (37.50%), nausea and vomiting (34.37%), abdominal pain (21.87%) and diarrhea (15.62%). The presence of abdominal symptoms is significantly (P<0.05) associated with bad prognosis. Out of the included 32 patients, 18 patients (56.25%) survived and 14 patients (43.75%) expired. There was a statistically significant difference in the duration of symptoms before hospitalization, mechanical ventilation and ICU and total hospital stay between the expired group and survivors (P<0.01). Current smoking and smoking severity were statistically significantly (P<0.01) higher in the expired group compared to survivors. Also, there was a statistically (P<0.05) significant positive correlation between mortality and smoking severity (r=0.640). Most of the expired patients presented with bilateral pulmonary infiltrates or unilateral infiltrates, but most of the survivors presented with normal radiology or increased bronchovascular markings, and this difference in the results was statistically highly significant (P<0.01). There were statistically highly significant (P<0.01) differences in the mean values of APACHE II score (21.11±3.70 vs 24.21±3.82), SOFA score (5.83±2.64 vs 8.85±2.17) and CPIS (7.55±1.14 vs 8.64±1.39) between the expired group and survivors respectively. Also, there was a statistically significant decrease in PH, PaO2, O2 saturation and HCO3 (P<0.05) among the expired group in comparison with the survivors, but no statistical difference regarding PaCO2 (P>0.05). There was a statistically significant positive correlation between mortality and old age (r=0.633), obesity (r=0.712), diabetes mellitus (r=0.685), renal failure (r=0.705), chronic heart diseases (0.591), COPD (r=0.523), malignancy (r=0.692), kidney transplantation (r=0.644) and liver cirrhosis (r=0.525) (P<0.05). There was a statistically (P<0.05) positive correlation between the number of associated co-morbidities and mortality (r=0.735).ConclusionsMost MERS corona patients present with fever, cough, dyspnea, sore throat, runny nose and sputum. The presence of abdominal symptoms may indicate bad prognosis. Prolonged duration of symptoms before patients’ hospitalization, prolonged duration of mechanical ventilation and hospital stay, bilateral radiological pulmonary infiltrates, and hypoxemic respiratory failure were found to be strong predictors of mortality in such patients. Also, old age, current smoking, smoking severity, presence of associated co-morbidities like obesity, diabetes mellitus, chronic heart diseases, COPD, malignancy, renal failure, renal transplantation and liver cirrhosis are associated with a poor outcome of ICU admitted MERS corona virus infected patients

Awareness of obstructive sleep apnea among critical care physicians in Sharkia Governorate, Egypt

Abstract Background Patients with symptoms of obstructive sleep apnea (OSA) present to nearly all physicians irrespective of their specialties. A basic knowledge of OSA is considered essential to identify those patients for appropriate referral and treatment. This study aimed to assess the knowledge and attitude of Sharkia Governorate Critical Care physicians regarding OSA using a standard validated questionnaire. Results This cross-sectional survey study was performed on a sample of Sharkia Governorate physicians, from all critical care units in tertiary and secondary hospitals including the following specialties: chest, internal medicine, neurology, cardiology, pediatric, and anesthesia. The OSA knowledge and attitudes (OSAKA) questionnaire that consists of 18 knowledge assessment questions and the OSA attitude questionnaire that consists of 6 attitude assessment questions were used. A total of 231, out of 296 invited physicians, completed the given questionnaire with a response rate of 78%. The mean score for knowledge assessment was 10.05 ± 2.3 with a 33.3% adequate response, while the mean score for attitude assessment was 3.75 ± 1.22 with a 59.3% adequate response. The mean OSA knowledge (12.5 ± 2.42) and attitude (5 ± 0.78) scores were highest among chest physicians when compared to physicians from other specialties (p &lt; 0.001). A significant positive correlation between knowledge and attitude scores was found among Sharkia Governorate critical care physicians (r = 0.55, p &lt; 0.001). Conclusions The level of knowledge of OSA among Sharkia Governorate critical care physicians was far from optimal whereas the attitude regarding OSA was acceptable. </jats:sec

Arterial stiffness can occur early in mild-to-moderate chronic obstructive pulmonary disease

Abstract Background Chronic obstructive pulmonary disease (COPD) is a well-known respiratory system disorder impacting patient’s morbidity and mortality. Many COPD patients die from cardiovascular diseases. Criteria of arterial stiffness might be the early clue for cardiovascular affection in COPD patients. This study aimed to evaluate the occurrence of arterial stiffness as an early subclinical change in stable mild to moderate COPD patients. Results This cross-sectional study included 80 mild-to-moderate COPD patients and another 80 healthy controls. The carotid-femoral pulse wave velocity (cf-PWV) and the heart rate adjusted augmentation index (AIx75) were statistically significantly higher (13.8 ± 2.6 and 23.9 ± 10.8, respectively) among studied mild-to-moderate COPD patients when compared to healthy controls (10.7 ± 1.1 and 18.1 ± 8.9, respectively) (p &lt; 0.001). FEV1 (forced expiratory volume in 1 s) % of predicted correlated negatively with both AIx75 (r = − 0.84, p &lt; 0.001) and cf-PWV (r = − 0.85, p &lt; 0.001), while BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index correlated positively with both AIx75 (r = 0.58, p &lt; 0.001) and cf-PWV (r = 0.52, p &lt; 0.001) in patients with mild-to-moderate COPD. Conclusions Pulse wave velocity and augmentation index correlated with FEV1% of predicted and BODE index in patients with mild-to-moderate COPD. </jats:sec

Value of plasma and pleural effusion fibulin-3 levels in the diagnosis of malignant pleural mesothelioma effusions

AbstractBackgroundMalignant pleural mesothelioma (MPM) is a highly aggressive tumor that arises from the surface cells of the pleura with a poor survival rate. Fibulin-3 is a protein biomarker found in blood and pleural fluid of patients with mesothelioma and can reliably predict the presence, or absence, of mesothelioma cancer cells. The possible role of fibulin-3 in diagnosis of MPM was studied.Patients and methodsSixty patients were included in the study, 30 with pleural effusions due to MPM and another 30 with non mesothelioma malignant pleural effusion (MPE). Plasma and pleural effusion fibulin-3 levels were estimated for all patients using an enzyme-linked immunosorbent assay (ELIZA).ResultsPlasma and pleural effusion fibulin-3 levels were significantly higher in patients with MPM (113±3.7ng/ml and 594.2±65.7ng/ml, respectively) compared to those with non mesothelioma MPE (44.4±7.1ng/ml and 187.3±14.5ng/ml, respectively) (P<0.001). Plasma and effusion fibulin-3 levels discriminated significantly between patients with MPM and those with non mesothelioma MPE, with area under receiver operating characteristic (ROC) curves of 0.98 and 0.94, respectively, at cut-off values of 54.3ng/ml for plasma fibulin-3 and 520ng/ml for effusion fibulin-3, with sensitivity of 100% and 90%, specificity of 96.7% for both, positive predictive value (PPV) of 96.8% and 96.4% and negative predictive value (NPV) of 100% and 90.6%, respectively.ConclusionPlasma and effusion fibulin-3 levels can differentiate mesothelioma effusions from other malignant effusions

Platelet count as a predictor of outcome of hospitalized patients with community-acquired pneumonia at Zagazig University Hospitals, Egypt

Abstract Background Platelets play an essential role in both coagulation system and the host immune defenses against infection including community-acquired pneumonia (CAP). This work aimed to study the possibility of using platelet count as an additional criterion to predict the outcome of hospitalized patients with CAP. Results This prospective cohort study included 250 patients hospitalized with CAP. According to platelet count at admission, 15 (6%) patients showed thrombocytopenia (group I) and 202 (80.8%) showed normal platelet count (group II), while 33 (13.2%) patients showed thrombocytosis (group III). CAP patients with thrombocytosis had more significant respiratory complications including lung abscess (p = 0.02), empyema (p &lt; 0.001), and pleural effusion (p = 0.01). Severe sepsis and septic shock were significantly encountered among CAP patients with thrombocytopenia (p = 0.02 and 0.03, respectively). CAP patients with thrombocytopenia significantly needed mechanical ventilation either invasive (p = 0.017) or even non-invasive (p = 0.047). Both CAP patients with thrombocytopenia or thrombocytosis had significant 30 days readmission (p = 0.034) and significant 30 days mortality (p = 0.016) when compared to CAP patients with normal platelet count. Both thrombocytopenia (p = 0.012) and thrombocytosis (p = 0.029) were independent predictors of 30 days mortality among hospitalized patients with CAP. Conclusions Both thrombocytosis and thrombocytopenia are linked to adverse outcomes among hospitalized patients with CAP. </jats:sec

Characteristics of gastro-esophageal reflux in patients with idiopathic pulmonary fibrosis

AbstractBackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic fibrotic lung disease with a median survival rate ranging from 2 to 3years from diagnosis. Recent data have illustrated the role of gastro-esophageal reflux (GER) in the pathogenesis and potential management of IPF patients. Although it is recognized that GER is increased among IPF patients, its prevalence and characteristics had been poorly defined.Patients and methodsForty patients were recruited; 20 with a diagnosis of IPF and the other, 20 with interstitial lung disease other than IPF (non IPF patients). All patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal esophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration.ResultsSeventeen (85%) patients out of 20 with IPF had an abnormal distal acid exposure, compared with 7 (35%) out of 20 non IPF patients (p=0.003). Percentage total acid exposure time (AET) with pH<4 was significantly higher in IPF compared with non IPF patients (median (range) 10.1 (5.1–16.3) versus 3 (1.2–8.3), respectively; p<0.0001). In IPF patients the total (both acid and weakly acidic) numbers of reflux episodes [80 (45–99)], acid reflux [46 (25–57)] and weakly acidic reflux [35 (20–45)] were significantly higher than those of non IPF patients (45 (29–70), 28 (18–40) and 19 (10–30), respectively; p<0.0001). Also, more reflux episodes reached the proximal esophagus [54 (28–69)] in IPF patients than non-IPF patients [18 (8–32); p<0.0001]. In IPF patients there was a significant positive correlation between degree of pulmonary fibrosis (HRCT score) and total number of reflux episodes in both the distal (r2=0.57, p=0.008) and proximal (r2=0.61, p=0.004) esophagus. In contrast, in non IPF patients a non significant correlation was found between degree of pulmonary fibrosis and total number of reflux episodes in both the distal (r2=0.17, p=0.48) and proximal (r2=0.23, p=0.34) esophagus.ConclusionIPF patients have greater GER rate compared to non IPF ones. Not only acid reflux, but also weakly acidic reflux is significantly increased among IPF patients