Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

Pulmonary contusion complicated with endobronchial hemorrhage is potentially life-threatening, particularly in patients with tracheobronchial tree disruption and severe airway bleeding after blunt trauma, and pose a high mortality risk. In such cases, extracorporeal membrane oxygenation (ECMO) can be used as a salvage treatment modality. However, the use of ECMO for moribund trauma patients with respiratory failure may be limited for several reasons, such as intractable bleeding. In this case report, we describe a patient with severe bilateral pulmonary contusions with tracheobronchial tree disruption that was successfully treated using heparin-free venovenous ECMO.
Bronchi ; Contusions* ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Heparin ; Humans ; Lung Injury ; Mortality ; Respiratory Insufficiency ; Salvage Therapy ; Trees

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active* ; Extracorporeal Membrane Oxygenation* ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Salvage Therapy

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active ; Extracorporeal Membrane Oxygenation ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii ; Pneumocystis ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Salvage Therapy

When ventilatory support becomes necessary in patients with acute respiratory failure, there is an associated increase in complications. We reviewed the charts of acute respiratory failure patients with the ventilatory support retrospectively who were admitted to the General Intensive Care Unit, Yonsei University College of Medicine, Seoul, Korea for the 6 months period, from March through August, 1990. The data included incidence of complications, morbidity and mortality, and reasons for and the duration of the ventilatory support. Of 269 patients receiving the ventilatory support, 107 patients (39.8%) developed 159 complications including alveolar hyperventilation (56 times), premature extubation (20 times) and right bronchial intubation (16 times). A single complication was associated with mortality rate of 19.5%, while with two or more complications, mortality rate was 60%, giving an average mortality rate of 29% when the complications were identified. The highest incidence of complications was in patients with multiple organ failure (80%). The highest mortality rate (50%) occurred in patients with heart failure. Patients with the ventilatory support less than one day had 23% incidence of complications and 2.7% mortality, while those with support for more than one month, these figures were 90.0% and 40.0% respectively (p<0.05).
Acute Disease ; Adult ; Female ; Human ; Intensive Care Units ; Male ; Respiration, Artificial/*adverse effects/mortality ; Respiratory Insufficiency/*therapy ; Retrospective Studies

PURPOSE: The efficacy of helmet continuous positive airway pressure (CPAP) in hypoxemic acute respiratory failure (hARF) remains unclear. The aim of this meta-analysis was to critically review studies that investigated the effect of helmet CPAP on gas exchange, mortality, and intubation rate in comparison with standard oxygen therapy. MATERIALS AND METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) by searching the PubMed, Embase, Cochrane library, OVID, and CBM databases, and the bibliographies of the retrieved articles. Studies that enrolled adults with hARF who were treated with helmet CPAP and measured at least one of the following parameters were included: gas exchange, intubation rate, in-hospital mortality rate. RESULTS: Four studies with 377 subjects met the inclusion criteria and were analyzed. Compared to the standard oxygen therapy, helmet CPAP significantly increased the PaO2/FiO2 [weighted mean difference (WMD)=73.40, 95% confidence interval (95% CI): 43.92 to 102.87, p<0.00001], and decreased the arterial carbon dioxide levels (WMD=-1.92, 95% CI: -3.21 to -0.63, p=0.003), intubation rate [relative risk (RR)=0.21, 95% CI: 0.11 to 0.40, p<0.00001], and in-hospital mortality rate (RR=0.22, 95% CI: 0.09 to 0.50, p=0.0004). CONCLUSION: The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces mortality and intubation rates in hARF. However, the significant clinical and statistical heterogeneity of the literature implies that large RCTs are needed to determine the role of helmet CPAP in different hypoxemic ARF populations.
Acute Disease ; Adult ; *Continuous Positive Airway Pressure ; Hospital Mortality ; Humans ; *Oxygen Inhalation Therapy ; Randomized Controlled Trials as Topic ; Respiratory Insufficiency/mortality/*therapy

Diffuse alveolar hemorrhage (DAH) is an uncommon complication in patients with systemic lupus erythematosus (SLE), and mortality remains high. In recent years, cases of DAH due to SLE treated with extracorporeal membrane oxygenation (ECMO) have rarely been reported. The authors present a case of a 43-year-old woman with SLE who had rapidly aggravating dyspnea and hemoptysis. She was diagnosed as having DAH with refractory respiratory failure and was successfully managed with veno-venous ECMO. We propose ECMO as a useful salvage therapy in patients with alveolar hemorrhage secondary to SLE who are failing conventional ventilatory support.
Adult ; Dyspnea ; Extracorporeal Membrane Oxygenation* ; Female ; Hemoptysis ; Hemorrhage* ; Humans ; Lupus Erythematosus, Systemic* ; Mortality ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Salvage Therapy

Diffuse alveolar hemorrhage (DAH) is an uncommon complication in patients with systemic lupus erythematosus (SLE), and mortality remains high. In recent years, cases of DAH due to SLE treated with extracorporeal membrane oxygenation (ECMO) have rarely been reported. The authors present a case of a 43-year-old woman with SLE who had rapidly aggravating dyspnea and hemoptysis. She was diagnosed as having DAH with refractory respiratory failure and was successfully managed with veno-venous ECMO. We propose ECMO as a useful salvage therapy in patients with alveolar hemorrhage secondary to SLE who are failing conventional ventilatory support.
Adult ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Female ; Hemoptysis ; Hemorrhage ; Humans ; Lupus Erythematosus, Systemic ; Mortality ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Salvage Therapy

BACKGROUND: Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation. METHODS: We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003. RESULTS: The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16). CONCLUSIONS: Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.
Aged ; Aged, 80 and over ; Community-Acquired Infections/complications/mortality/therapy ; Female ; Hospital Mortality ; Humans ; Hypercapnia ; Male ; Middle Aged ; Pneumonia, Bacterial/complications/*diagnosis/*mortality/therapy ; Predictive Value of Tests ; Prognosis ; Respiration, Artificial ; Respiratory Insufficiency/*diagnosis/etiology/*mortality/therapy ; Retrospective Studies ; Treatment Outcome

INTRODUCTION: Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU. MATERIALS AND METHODS: A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records. RESULTS: Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively. CONCLUSION Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes.
APACHE ; Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; complications ; mortality ; therapy ; Critical Care ; organization & administration ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; complications ; mortality ; therapy ; Respiration, Artificial ; Respiratory Insufficiency ; mortality ; therapy ; virology ; Retrospective Studies ; Singapore