Daptomycin-Induced Eosinophilic Pneumonia Treated With Intravenous Corticosteroids

2015 ◽  
Vol 28 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Shao-Yu Chiu ◽  
Andrew C. Faust ◽  
Hemant M. Dand
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Noninvasive Positive Pressure Ventilation ◽  
Eosinophilic Pneumonia ◽  
Positive Pressure ◽  
Drug Induced ◽  
First Case ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
High Level

Objective: To describe 2 cases of drug-induced eosinophilic pneumonia in patients with variable exposure to daptomycin. Report: In our first case, a 77-year-old male was transferred to our facility for hypoxic respiratory failure, which occurred 1 day after completing a course of daptomycin. There was high clinical suspicion for daptomycin-induced eosinophilic pneumonia, thus the patient was started on intravenous methylprednisolone 40 mg every 6 hours. Within 72 hours, he was liberated from mechanical ventilation, as he experienced dramatic clinical improvement in regard to his oxygenation and radiographs. Approximately 6 weeks after case 1, a second case of eosinophilic pneumonia related to daptomycin was diagnosed. This case occurred in a 74-year-old female who developed respiratory failure requiring noninvasive positive pressure ventilation 72 hours after initiation of a second course of daptomycin. She was treated with methylprednisolone 60 mg every 6 hours and avoided the need for endotracheal intubation and mechanical ventilation. Conclusion: Since this potentially life-threatening adverse effect of daptomycin appears more common than previously reported, clinicians should have a high level of suspicion in any patient with recent daptomycin exposure who presents with pulmonary symptoms. In many cases, this process is highly responsive to prompt initiation of corticosteroid therapy.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

scholarly journals Rule-Based Cohort Definitions for Acute Respiratory Failure: Electronic Phenotyping Algorithm

10.2196/18402 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e18402 ◽  
Author(s):  
Patrick Essay ◽  
Jarrod Mosier ◽  
Vignesh Subbian
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
High Flow ◽  
Positive Pressure ◽  
Rule Based ◽  
Research Questions

Background Acute respiratory failure is generally treated with invasive mechanical ventilation or noninvasive respiratory support strategies. The efficacies of the various strategies are not fully understood. There is a need for accurate therapy-based phenotyping for secondary analyses of electronic health record data to answer research questions regarding respiratory management and outcomes with each strategy. Objective The objective of this study was to address knowledge gaps related to ventilation therapy strategies across diverse patient populations by developing an algorithm for accurate identification of patients with acute respiratory failure. To accomplish this objective, our goal was to develop rule-based computable phenotypes for patients with acute respiratory failure using remotely monitored intensive care unit (tele-ICU) data. This approach permits analyses by ventilation strategy across broad patient populations of interest with the ability to sub-phenotype as research questions require. Methods Tele-ICU data from ≥200 hospitals were used to create a rule-based algorithm for phenotyping patients with acute respiratory failure, defined as an adult patient requiring invasive mechanical ventilation or a noninvasive strategy. The dataset spans a wide range of hospitals and ICU types across all US regions. Structured clinical data, including ventilation therapy start and stop times, medication records, and nurse and respiratory therapy charts, were used to define clinical phenotypes. All adult patients of any diagnoses with record of ventilation therapy were included. Patients were categorized by ventilation type, and analysis of event sequences using record timestamps defined each phenotype. Manual validation was performed on 5% of patients in each phenotype. Results We developed 7 phenotypes: (0) invasive mechanical ventilation, (1) noninvasive positive-pressure ventilation, (2) high-flow nasal insufflation, (3) noninvasive positive-pressure ventilation subsequently requiring intubation, (4) high-flow nasal insufflation subsequently requiring intubation, (5) invasive mechanical ventilation with extubation to noninvasive positive-pressure ventilation, and (6) invasive mechanical ventilation with extubation to high-flow nasal insufflation. A total of 27,734 patients met our phenotype criteria and were categorized into these ventilation subgroups. Manual validation of a random selection of 5% of records from each phenotype resulted in a total accuracy of 88% and a precision and recall of 0.8789 and 0.8785, respectively, across all phenotypes. Individual phenotype validation showed that the algorithm categorizes patients particularly well but has challenges with patients that require ≥2 management strategies. Conclusions Our proposed computable phenotyping algorithm for patients with acute respiratory failure effectively identifies patients for therapy-focused research regardless of admission diagnosis or comorbidities and allows for management strategy comparisons across populations of interest.

scholarly journals Efficacy of Noninvasive Positive Pressure Ventilation in Limiting Re-Intubation of COPD Patients After Extubation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G A A Elkady ◽  
A H Rabie ◽  
A H Hamza ◽  
M N Mohamed
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Intensive Care Units ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Study Groups ◽  
Positive Pressure ◽  
Arterial Blood ◽  
Copd Patients

Abstract Background Mechanical ventilation is the most widely used supportive therapy in intensive care units (ICU). Several forms of external support for respiration have been described to assist the failing ventilator pump and had constituted a major advance in the management of patients with respiratory distress. More recently, new noninvasive positive pressure ventilation (NIPPV) techniques, using patient/ ventilator interfaces in the form of facial masks, have been designed. Noninvasive ventilation (NIV) is one of the most important developments in respiratory medicine over the past 15 years and is increasingly used in many countries, but with a highly variable frequency of use. Objective The aim of this study is to clarify the role of non-invasive ventilation in preventing re-intubation if was used immediately following planned extubation in patients suffered respiratory failure in COPD patients and requiring invasive mechanical ventilation for 5 to 7 days. Methodology Forty consecutive patients, who are invasively mechanically ventilated and classified as difficult to wean from the ventilator in the intensive care units of Ain Shams main university hospital between the 1st April and 1st of September 2018, were included. The mean age in the present study for oxygen group was 56.20±5.56 years, while in NIV group was 57.75±5.17 years, 70% of patients in this present study were males. Results APACHE II score, PaO2 and mean arterial blood pressure which might have a role in respiratory failure showed no statistically significant differences between both study groups. Meanwhile, respiratory rate, pulse rate and arterial blood gases showed high significance between both study groups Conclusion The use of NIV is associated with a marked reduction in the need for endotracheal intubation after planned extubation.

scholarly journals Noninvasive ventilation in acute respiratory failure: which recipe for success?

2018 ◽  
Vol 27 (149) ◽  
pp. 180029 ◽  
Author(s):  
Raffaele Scala ◽  
Lara Pisani
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Multiple Organ ◽  
Positive Pressure ◽  
Haemodynamic Instability ◽  
Artificial Airway ◽  
Life Threatening ◽  
Therapeutic Tools

Noninvasive positive-pressure ventilation (NPPV) to treat acute respiratory failure has expanded tremendously over the world in terms of the spectrum of diseases that can be successfully managed, the locations of its application and achievable goals.The turning point for the successful expansion of NPPV is its ability to achieve the same physiological effects as invasive mechanical ventilation with the avoidance of the life-threatening risks correlated with the use of an artificial airway.Cardiorespiratory arrest, extreme psychomotor agitation, severe haemodynamic instability, nonhypercapnic coma and multiple organ failure are absolute contraindications for NPPV. Moreover, pitfalls of NPPV reduce its rate of success; consistently, a clear plan of what to do in case of NPPV failure should be considered, especially for patients managed in unprotected setting. NPPV failure is likely to be reduced by the application of integrated therapeutic tools in selected patients handled by expert teams.In conclusion, NPPV has to be considered as a rational art and not just as an application of science, which requires the ability of clinicians to both choose case-by-case the best “ingredients” for a “successful recipe” (i.e.patient selection, interface, ventilator, interface,etc.) and to avoid a delayed intubation if the ventilation attempt fails.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Shih Yea Sylvia Wu ◽  
Bridget Faire ◽  
Edward Gane
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Final Diagnosis ◽  
Community Acquired Pneumonia ◽  
Drug Induced ◽  
First Case ◽  
Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

Noninvasive Positive Pressure Ventilation in Patients with Respiratory Failure due to Severe Acute Pancreatitis

Respiration ◽  
2006 ◽  
Vol 73 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Samir Jaber ◽  
Gérald Chanques ◽  
Mustapha Sebbane ◽  
Farida Salhi ◽  
Jean-Marc Delay ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Severe Acute Pancreatitis ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure
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