Severe barium sulphate aspiration: a report of two cases and review of the literature

Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into the lung. Certain conditions affecting the anatomical and functional integrity of the oropharynx and oesophagus suggest predisposing factors. Aspiration of barium sulphate is not expected to cause severe lung injury due to its relatively non-irritant matter. On the other hand, acute inflammation or even death attributed either to high or low density preparations of barium sulphate, have been reported. We present two patients, both with a history of schizophrenia, who developed acute respiratory failure requiring mechanical ventilation, following aspiration of large amounts of barium, during an upper gastrointestinal radiographic contrast study. One patient died following massive aspiration which led to multiple organ dysfunction syndrome, while the other, although sub- acutely complicated by pneumonia, was successfully treated. Beside presentation of cases, several aspects of investigation, differential diagnosis, treatment and prevention are discussed. Complications of barium sulphate aspiration depend upon the density and quantity of the aspirated solution, the extent of tracheobronchial distribution and the general physical condition of the patient. In severe cases, early treatment and close follow up with high-resolution computed tomography are mandatory to prevent progression towards fibrosis. Patients with psychiatric disorders, apart from other conditions predisposing to aspiration, should be dealt with particular caution, when performing the above-mentioned procedures

Severe barium sulphate aspiration: a report of two cases and review of the literature

Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into the lung. Certain conditions affecting the anatomical and functional integrity of the oropharynx and oesophagus suggest predisposing factors. Aspiration of barium sulphate is not expected to cause severe lung injury due to its relatively non-irritant matter. On the other hand, acute inflammation or even death attributed either to high or low density preparations of barium sulphate, have been reported. We present two patients, both with a history of schizophrenia, who developed acute respiratory failure requiring mechanical ventilation, following aspiration of large amounts of barium, during an upper gastrointestinal radiographic contrast study. One patient died following massive aspiration which led to multiple organ dysfunction syndrome, while the other, although sub- acutely complicated by pneumonia, was successfully treated. Beside presentation of cases, several aspects of investigation, differential diagnosis, treatment and prevention are discussed. Complications of barium sulphate aspiration depend upon the density and quantity of the aspirated solution, the extent of tracheobronchial distribution and the general physical condition of the patient. In severe cases, early treatment and close follow up with high-resolution computed tomography are mandatory to prevent progression towards fibrosis. Patients with psychiatric disorders, apart from other conditions predisposing to aspiration, should be dealt with particular caution, when performing the above-mentioned procedures

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Επίδραση παραμέτρων του αναπνευστήρα στην αποτελεσματικότητα των βρογχοδιασταλτικών φαρμάκων σε μηχανικά αεριζόμενους ασθενείς με χρόνια αποφρακτική πνευμονοπάθεια

The delivery of bronchodilators with metered dose inhaler (MDI) in mechanically ventilated patients has received considerable interest in recent years. This is because the use of MDI has several advantages over the nebu-lizer, such as reduced cost, ease of administration, less personnel time, reli-ability of dosing and a lower risk of contamination. A spacer devise is fun-damental in order to demonstrate the efficacy of the bronchodilatory therapy delivered by MDI. Application of an end-inspiratory pause, increasing the Vt by at least 50 %, the flow/time profile and the flow rate, did not have any ad-ditional bronchodilation effect. Provided that the technique of administration is proper (use of a high volume spacer and actuation at the beginning of in-spiration), significant bronchodilation can be achieved without modification of the ventilator settings. Thus, MDIs are as effective as nebulizers, despite a significantly lower dose of bronchodilator given by the MDI.Η χορήγηση των βρογχοδιασταλτικών με δοσιμετρική συσκευή (ΔΣ) σε μηχανικά αεριζόμενους ασθενείς έχει αποκτήσει ιδιαίτερο ενδιαφέρον τα τελευταία χρόνια. Συγκριτικά με τους νεφελοποιητές (που μέχρι τώρα αποτε-λούσαν τη συνήθη οδό χορήγησης βρογχοδιασταλικών σε αυτούς τους ασθε-νείς) οι ΔΣ πλεονεκτούν σημαντικά. Έχουν μικρότερο κόστος, είναι εύχρη-στες, απαιτούν λιγότερο χρόνο απασχόλησης προσωπικού, αποδίδουν στα-θερή δόση φαρμάκου ενώ επιπλέον σχετίζονται με μικρότερο κίνδυνο επινέ-μησης μικροβίων στο κατώτερο αναπνευστικό. Η χρήση αεροθαλάμου μεγά-λου όγκου με ΔΣ αυξάνει σημαντικά το αποτέλεσμα της βρογχοδιασταλτι-κής θεραπείας που επιτυγχάνεται μέσω αυτών. Η προσθήκη τελικο-εισπνευστικής παύσης, η αύξηση του αναπνεόμενου όγκου τουλάχιστον κατά 50 %, το σχήμα και το μέγεθος της εισπνευστικής ροής δεν έχουν καμμία ε-πίδραση στη βρογχοδιασταλτική απάντηση. Με την προυπόθεση δε, ότι η τε-χνική χορήγησης είναι σωστή (χρήση αεροθαλάμου μεγάλου όγκου και χορή-γηση του νεφελώματος αμέσως πριν την έναρξη της εισπνευστικής ροής από τον αναπνευστήρα) επιτυγχάνεται σημαντική βρογχοδιαστολή χωρίς τροπο-ποίηση των παραμέτρων του αναπνευστήρα Έτσι, ο συνδυασμός ΔΣ και αε-ροθαλάμου είναι εξίσου αποτελεσματικός με τους νεφελοποιητές, παρά το ότι χορηγείται σημαντικά χαμηλότερη δόση φαρμάκου

COVID-19-associated pulmonary aspergillosis in patients with severe SARS-CoV-2 infection: A single-center observational study from Greece

INTRODUCTION: COVID-19-associated pulmonary aspergillosis (CAPA) is a serious complication affecting patients with severe SARS-CoV-2 infection, and is associated with increased mortality. OBJECTIVE: The objective of this study was to investigate potential risk factors, and to estimate the incidence and mortality in patients diagnosed with CAPA. METHODS: A single-center retrospective observational study was conducted on patients admitted to the intensive care unit (ICU) with severe COVID-19 from October 2020 to May 2022. Patients with deterioration of their clinical status were evaluated with serum galactomannan (GM) for probable CAPA. Baseline demographic patient characteristics, vaccination status, and time period during which each patient was infected with SARS-CoV-2 were obtained, and risk stratification according to underlying comorbidities was performed in an effort to assess various risk factors for CAPA. The incidence of CAPA in the entire cohort was measured, and mortality rates in the CAPA and non-CAPA groups were calculated and compared. RESULTS: Of 488 patients admitted to the ICU, 95 (19.4%) had deterioration of their clinical status, which prompted testing with serum GM. Positive serum testing was observed in 39/95 patients, with an overall CAPA incidence in the entire study cohort reaching 7.9% (39/488). The mortality rate was 75% (42/56) in the non-CAPA group that was tested for serum GM, and 87.2% (34/39) in the CAPA group (P = 0.041). Multivariable Cox regression hazard models were tested for 28- and 90-day survival from ICU admission. An invasive pulmonary aspergillosis (IPA) risk-stratified cox regression model corrected for the SARS-CoV-2 variant of the patient identified the diagnosis of probable CAPA and elevated procalcitonin (PCT) levels measured at least 10 days after ICU admission, as significantly associated with death in the IPA-risk subgroup only, with hazard ratio (HR): 3.687 (95% confidence interval [CI], 1.030–13.199, P = 0.045) for the diagnosis of probable CAPA, and HR: 1.022 (95% CI, 1.003–1.042, P = 0.026) for every 1 ng/mL rise in PCT. CONCLUSIONS: Patients in the IPA-risk subgroup that were diagnosed with CAPA had a lower 90-day survival when compared to patients in the same group without a CAPA diagnosis

Influenza A/H1N1 septic shock in a patient with systemic lupus erythematosus. A case report

Abstract Background Immunocompromised patients, such as systemic lupus erythematosus (SLE) sufferers have an increased risk of mortality, following influenza infection. In the recent pandemic, influenza A H1NI virus caused 18449 deaths, mainly because of adult respiratory distress syndrome or bacterial co-infections. Case Presentation In this case report, an SLE patient with viral-induced septic shock, without overt pulmonary involvement, is discussed. The patient was administered oseltamivir and supportive treatment, including wide-spectrum antibiotics, vasopressors and steroids, according to the guidelines proposed for bacterial sepsis and septic shock. She finally survived and experienced a lupus flare soon after intensive care unit (ICU) discharge. Conclusions To our knowledge, this is the first case to report severe septic shock from influenza A/H1N1 virus, without overt pulmonary involvement.</p