1.Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study.
Amit KANSAL ; Shekhar DHANVIJAY ; Andrew LI ; Jason PHUA ; Matthew Edward COVE ; Wei Jun Dan ONG ; Ser Hon PUAH ; Vicky NG ; Qiao Li TAN ; Julipie Sumampong MANALANSAN ; Michael Sharey Nocon ZAMORA ; Michael Camba VIDANES ; Juliet Tolentino SAHAGUN ; Juvel TACULOD ; Addy Yong Hui TAN ; Chee Kiang TAY ; Yew Woon CHIA ; Duu Wen SEWA ; Meiying CHEW ; Sennen J W LEW ; Shirley GOH ; Jonathan Jit Ern TAN ; Kollengode RAMANATHAN ; Amartya MUKHOPADHYAY ; Kay Choong SEE
Annals of the Academy of Medicine, Singapore 2021;50(6):467-473
INTRODUCTION:
Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC.
METHODS:
We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC.
RESULTS:
Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days,
CONCLUSION
Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult
;
Airway Extubation
;
Cannula
;
Critical Care
;
Female
;
Humans
;
Intensive Care Units
;
Male
;
Middle Aged
;
Respiratory Insufficiency/therapy*
;
Singapore/epidemiology*
2.Diagnosis of Ankylosing Spondylitis: Do not let the spine bites the eye
Liza-Sharmini Ahmad Tajudin ; Chew Chia Chee ; Chin Ju Juen ; Wan Hazabbah Wan Hitam ; Chong Mei Fong
Malaysian Family Physician 2021;16(2):73-77
Background: A diagnosis of ankylosing spondylitis (AS) is challenging and often delayed despitebpatients being symptomatic. Low back pain is the most common initial symptom, appearing in the second and third decades of life. Acute anterior uveitis (AAU) occurs much later in the course of the disease, often when the destruction of the spine is already debilitating.
Objective: Here, we report three cases of AS that were diagnosed after the patients developed AAU.
Methods: A case series illustrated AAU leading to the diagnosis of AS years after the initial episode of low back pain. A comparison of the clinical presentation, diagnosis, and outcomes was also illustrated.
Result: We report three cases of acute anterior uveitis (AAU)-associated AS diagnosed only after many visits to the primary health care provider with the complaint of chronic low back pain. All three patients had irreversible radiological changes upon diagnosis of AS. The AAU resolved with topical steroids, and one patient developed cataract.
Conclusion: A high index of suspicion of AS in a young adult with chronic back pain before the development of AAU may prevent further functional loss and provide a better prognosis. Diagnosis of AS following AAU is not only associated with dependency but also may rob the vision of a young adult.
3.Optic Neuritis in Herpes Zoster Ophthalmicus: A Rare Manifestation of a Common Malady
Chia-Chee Chew ; Nurul Ain Masnon ; Liza Sharmini Ahmad Tajudin ; Wan Hazabbah Wan Hitam
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):434-436
Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). It is a potentially blinding condition. We report a case of an immunocompetent patient with HZON following keratouveitis during
the course of treatment. A 33-year-old gentleman presented with left eye (LE) worsening of visual acuity (6/9 reduced
to 6/24) despite on treatment for HZO keratouveitis. It was associated with pain on ocular movement and central
scotoma. He was on systemic acyclovir and topical corticosteroids prior to current complaint. Fundoscopy showed
left optic disc swelling with impaired optic nerve functions. Diagnosis of left optic neuritis secondary to HZO was established in view of close temporal relationship with occurrence of cutaneous herpes zoster. Systemic corticosteroids
was commenced. The patient had obtained good visual outcome at two months. Early referral for ophthalmology
assessment is crucial to establish diagnosis of HZON and prompt initiation of treatment may preserve vision.