OBJECTIVETo identify the causes of respiratory complications following liver transplantation (LT) and to discuss the management of these complications.

METHODSOne hundred and twenty four cases with pulmonary complications in the first two weeks after LT were identified among 163 patients admitted to the First Affiliated Hospital, College of Medicine, Zhejiang University from February, 1999 to March, 2003.

RESULTSThe incidence rate of complications was 76%(124/163) with the total cure rate of 92%(114/124). The cure rates of the various complications were as follows: pleural effusion 100%(113/113), pneumonia 92%(76/83), respiratory insufficiency 91%(59/65), pulmonary hypertension 98%(101/103), pulmonary edema 98(58/59), atelectasis 100%(4/4) and pneumothorax 100%(2/2).

CONCLUSIONTo drainage the pleural effusion with an unicameral venous catheter is safety and effective. To cure or prevent pneumonia and atelectasis, aseptic manipulating, aspiration of sputum and keeping respiratory channel open were the key measurements of treatment. Restrictive ventilatory functional disturbance (RVFD) and dysfunction of ventilation are two major types of respiratory insufficiency in early stage of post-transplantation. The causes of pulmonary hypertension and edema are associated with pulmonary angiotasis and blood flow volume, and the vasodilator and diuretic often introduced in the therapy.

Female ; Humans ; Hypertension, Pulmonary ; etiology ; therapy ; Liver Transplantation ; adverse effects ; Male ; Pleural Effusion ; etiology ; therapy ; Pneumonia ; etiology ; therapy ; Postoperative Complications ; etiology ; therapy ; Pulmonary Atelectasis ; etiology ; therapy ; Pulmonary Edema ; etiology ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Respiratory Tract Diseases ; etiology ; therapy

Calcium Compounds ; Foreign Bodies ; complications ; etiology ; Humans ; Infant ; Male ; Oxides ; Respiratory Insufficiency ; etiology ; therapy ; Treatment Outcome

OBJECTIVETo evaluate the value of noninvasive intermittent positive-pressure ventilation (NIPPV) in treatment of patients with pneumoconiosis combined with respiratory failure.

METHODThree were 46 inpatients with pneumoconiosis combined with respiratory failure. Twenty-six inpatients treated with conventional therapy and NIPPV were categorized as treatment group; Twenty inpatients just treated by conventional therapy served as control group. Compared with the changes of HR, RR and arterial blood gas index (PH, PaCO2, PaO2) in two groups after treatment.

RESULTSThe effective ratio of treatment group was 88.5%, control group was 60%, which had significant difference (P < 0.05); The HR in treatment group after treatment was (95.38 +/- 10.75) beats per minute, control group was [(103.00 +/- 12.56) beats per minute; The RR in treatment group was (21.69 +/- 1.37) breaths per minute, control group was [(22.60 +/- 1.57) breaths per minute]; The PaCO2 in treatment group was (52.88 +/- 10.75)mm Hg, control group was [(59.66 +/- 11.49)mm Hg]; All of those were significantly decreased than those in control group (P < 0.05). The PaO2 in treatment group was (100.77 +/- 25.3) mm Hg, control group was [(71.82 +/- 17.94) mmHg]; Compared with the control group, PaO2 in the treatment group increased significantly (P < 0.05).

CONCLUSIONNIPPV is beneficial to pneumoconiosis combined with respiratory failure in different degrees.

Adult ; Aged ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; complications ; therapy ; Positive-Pressure Respiration ; Respiratory Insufficiency ; etiology ; therapy

In neuromuscular disease (NMD) patients with progressive muscle weakness, respiratory muscles are also affected and hypercapnia can increase gradually as the disease progresses. The fundamental respiratory problems NMD patients experience are decreased alveolar ventilation and coughing ability. For these reasons, it is necessary to precisely evaluate pulmonary function to provide the proper inspiratory and expiratory muscle aids in order to maintain adequate respiratory function. As inspiratory muscle weakening progresses, NMD patients experience hypoventilation. At this point, respiratory support by mechanical ventilator should be initiated to relieve respiratory distress symptoms. Patients with adequate bulbar muscle strength and cognitive function who use a non-invasive ventilation aid, via a mouthpiece or a nasal mask, may have their hypercapnia and associated symptoms resolved. For a proper cough assist, it is necessary to provide additional insufflation to patients with inspiratory muscle weakness before using abdominal thrust. Another effective method for managing airway secretions is a device that performs mechanical insufflation-exsufflation. In conclusion, application of non-invasive respiratory aids, taking into consideration characterization of respiratory pathophysiology, have made it possible to maintain a better quality of life in addition to prolonging the life span of patients with NMD.
Respiratory Insufficiency/etiology/*rehabilitation/*therapy ; Respiration, Artificial ; Neuromuscular Diseases/complications/*rehabilitation ; Humans ; Breathing Exercises

In neuromuscular disease (NMD) patients with progressive muscle weakness, respiratory muscles are also affected and hypercapnia can increase gradually as the disease progresses. The fundamental respiratory problems NMD patients experience are decreased alveolar ventilation and coughing ability. For these reasons, it is necessary to precisely evaluate pulmonary function to provide the proper inspiratory and expiratory muscle aids in order to maintain adequate respiratory function. As inspiratory muscle weakening progresses, NMD patients experience hypoventilation. At this point, respiratory support by mechanical ventilator should be initiated to relieve respiratory distress symptoms. Patients with adequate bulbar muscle strength and cognitive function who use a non-invasive ventilation aid, via a mouthpiece or a nasal mask, may have their hypercapnia and associated symptoms resolved. For a proper cough assist, it is necessary to provide additional insufflation to patients with inspiratory muscle weakness before using abdominal thrust. Another effective method for managing airway secretions is a device that performs mechanical insufflation-exsufflation. In conclusion, application of non-invasive respiratory aids, taking into consideration characterization of respiratory pathophysiology, have made it possible to maintain a better quality of life in addition to prolonging the life span of patients with NMD.
Respiratory Insufficiency/etiology/*rehabilitation/*therapy ; Respiration, Artificial ; Neuromuscular Diseases/complications/*rehabilitation ; Humans ; Breathing Exercises

OBJECTIVE: To evaluate the application of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with severe respiratory failure by investigating the appearance of pulmonary-infection-control-window. METHODS: From November 2001 to October 2004, 76 case of COPD patients with severe respiratory failure due to pulmonary infection were intubated and recruited in the study. When the pulmonary infection was significantly controlled (the time of pulmonary infection control was called PIC window) by the antibiotic and comprehensive therapy, all cases were randomized into noninvasive veatiation group (NIV) and control group. The early extubation was conducted and followed by noninvasive mechanical ventilation via facial mask with bilevel positive airway pressure mode immediately in the NIV group. Conventional invasive synchronized intermittent mandatory ventilation (SIMV) plus pressure support ventilation (PSV) was used as the weaning technique in the control group. RESULTS: Thirty eight cases among 76 patients were in the NIV group, and the rest in the control group. The NIV group and the control group had similar age, sex, APACHE scores, RR, HR, MAP, PaO2 and PaCO2 at the time of commencement and PIC window (P > 0.05). The time of PIC window was (7.5 +/- 1.9) d in the NIV group, and (8.0 +/- 2.5) d in the control group (P > 0.05). In the NIV group, the durations of invasive mechanical ventilation (MV) and total MV were (7.5 +/- 1.9) d and (12.5 +/- 4.0) d respectively, while the durations were (23.5 +/- 9.5) d in the control group (P < 0.05). The durations of RICU stay and hospital stay were shorter than that in the control group. The incidence of ventilation associated pneumonia (VAP) was 18.4% (7/38) in the NIV group, 39.5% (15/38) in the control group respectively (P < 0.05). The incidence of reintubation was 13.2% (5/38) in the NIV group, 34.2% (13/38) in the control group respectively (P < 0.05). Hospital mortality was 7.9% (3/38) in the NIV group, and 28.9% (11/38) in the control group (P < 0.05). CONCLUSION In those COPD patients requiring intubation and mechanical ventilantion who have severe respiratory failure due to pulmonary infection, sequential noninvasive following invasive mechanical ventilation at the appearance of PIC window can significantly reduce the MV duration, the length of RICU stay and hospital stay, and decrease the occurrence of VAP, reintubation and hospital mortality as well. So it is an efficient strategy to be generalized.
Aged ; Female ; Humans ; Male ; Middle Aged ; Pneumonia ; etiology ; therapy ; Pulmonary Disease, Chronic Obstructive ; complications ; therapy ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; etiology ; therapy

OBJECTIVETo observe the effect of early bronchoscopic sputum suction in elderly patients with acute heart and lung failure due to aspiration pneumonia.

METHODSComprehensive treatments were administered for 52 elderly patients with acute heart and lung failure resulting from aspiration pneumonia, and in 27 of the patients, bronchoscopic sputum suction was performed with the other 25 serving as the control group. The indices of the heart and lung functions (central venous pressure, left ventricular ejection fraction, arterial blood partial pressures of oxygen and carbon dioxide) were measured after the treatment and compared between the two groups.

RESULTSPatients receiving bronchoscopic suction showed faster recovery of normal central venous pressure and left ventricular ejection fraction and more rapid increment of arterial partial pressure of oxygen and reduction of carbon dioxide partial pressure than those without the suction (P<0.01).

CONCLUSIONEarly bronchoscopic sputum suction can be one of the effective emergency measures for rescuing acute heart and lung failure due to aspiration pneumonia.

Aged ; Aged, 80 and over ; Bronchoscopy ; Cerebral Infarction ; complications ; Female ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Pneumonia, Aspiration ; complications ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Sputum ; Suction ; methods

Although it is well known that the respiratory failure is a major cause of death in most patients with chronic neuromuscular disease, predominant respiratory dysfunction without severe involvement of limb muscles is an unusual complication of mitochondrial myopathy in adult age. We experienced two cases of mitochondrial myopathy with severe involvement of respiratory function and only mild involvement of limb muscles. One is a 16 year old female and another is a 22 year old male. The diagnosis is based on morphologic characteristics of "ragged red fibers" under the light microscope and abnormal mitochondrias on the electron microscope in the muscle biopsy.
Adolescent ; Adult ; Electromyography ; Female ; Human ; *Mitochondria, Muscle/ultrastructure ; Muscular Diseases/*complications ; Respiration, Artificial ; Respiratory Insufficiency/*etiology/therapy

OBJECTIVETo explore the clinical features of respiratory failure secondary to hypothyroidism.

METHODWe retrospectively analyzed the clinical data of 4 patients with respiratory failure secondary to hypothyroidism.

RESULTSRespiratory failure secondary to hypothyroidism usually happened in the aged patients, presenting as myxedema, disturbance of consciousness, anemia, and hyponatrium. Respiratory symptoms were rare. Type II respiratory failure might occur as disease progressed. The clinical presentation of hypothyroidism was atypical and easily neglected. The hypoxia and hypercapnia ameliorated after thyroid hormone therapy.

CONCLUSIONHypothyroidism is a rare reason of respiratory failure. The prognosis is good after hormone therapy and mechanical ventilation.

Aged ; Aged, 80 and over ; Female ; Humans ; Hypothyroidism ; complications ; drug therapy ; therapy ; Male ; Middle Aged ; Respiratory Insufficiency ; drug therapy ; etiology ; therapy ; Thyroid Hormones ; therapeutic use

INTRODUCTIONThe aim of this study was to evaluate the feasibility of non-invasive positive pressure ventilation through a new interface helmet in the treatment of cardiogenic pulmonary oedema due to scorpion sting envenomation in children.

CLINICAL PICTUREThree patients presented with fever, and respiratory distress following scorpion sting. Their cardiac enzymes were abnormal. Electrocardiogram (ECG) of 3 patients showed features of myocardial strain with ST elevation. Bedside chest X-ray taken in emergency showed marked bilateral infiltrates suggestive of pulmonary oedema. M-mode, two-dimensional colour-flow Doppler echocardiogram showed left ventricular dysfunction.

TREATMENT AND OUTCOMEAt paediatric intensive care unit admission, they were treated with antivenom, prazosin (0.03 mg/kg/dose), dopamine (15 mcg/kg/ min), dobutamine (10 mcg/kg/min) and nitroprussid (1 mcg/kg/min). Epinephrine (0.1 mcg/kg/ min) were added later. They were hypoxic and dyspnoeic. A slight sedation was induced with ketamine and/or midazolam. Non-invasive pressure support ventilation (NPSV) was delivered via the helmet by means of an intensive care unit ventilator. We evaluated the effect of NPSV delivered by helmet on oxygenation, respiratory rate, haemodynamics, complications and outcome. An improvement of oxygenation was observed within 2 hours of treatment.The helmet was well tolerated by all the children. No complications occurred in the 3 patients.

CONCLUSIONThis new approach of delivering NPSV through a helmet allows the successful treatment of cardiogenic pulmonary oedema in children with scorpion sting envenomation, assuring a good tolerance without complications. Future studies are needed before recommending the extensive application of this technique in all cases of cardiogenic pulmonary oedema due to scorpion sting envenomation.

Animals ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Positive-Pressure Respiration ; instrumentation ; methods ; Pulmonary Edema ; etiology ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Scorpion Stings ; complications ; therapy ; Scorpions ; Ventricular Dysfunction, Left ; etiology ; therapy