Respirology

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Respirology

Resources for managing respirology patients

17  articles in this collection
Written by Angie Shen, Laurie-Anne Duquette, Audrey Mathieu, Ali Sotoudeh, 

Impact on Patients with Cystic Fibrosis

Impacts of an infection on patients with cystic fibrosis : Despite minimal data on the subject, SARS-CoV-2 infection seems to have no apparent effect on the severity of a cystic fibrosis disease. Impacts of the pandemic on patients with cystic fibrosis : Routine cystic fibrosis appointments and clinics might be cancelled, which can potentially have […]

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04/27/2020

Management of Asthmatic Patients

Patients should continue to take their inhaled medication as prescribed by their physicians. If a patient presents an acute asthma attack : He/she should take a short course of oral corticosteroids as instructed by their doctor ; Nebulisers should be avoided due to the increased risk of viral transmission ; Pressurized metered dose inhaler (pMDI) […]

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04/27/2020

Potential Effect of Complement Pathways in Thrombotic Microvascular Injury

Based on pulmonary and cutaneous biopsy and autopsy samples, some critically ill patients present a generalized thrombotic microvascular injury. Cutaneous manifestation consistent with a thrombotic microvascular injury included retiform purpura or livedo racemose. Histological findings suggest that some of the severe cases of COVID-19 would have thrombotic injuries mediated by a systemic activation of the […]

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05/22/2020

Presentation and evolution of positive COPD patients

Systemic symptoms such as fever and fatigue are often predominant compared to an acute exacerbation where cough, sputum and dyspnea appear first6. People older than 60 years with comorbidity like COPD are more susceptibility to contract SARS-CoV-21. According to a meta analysis of 3403 cases, COPD is one of the most prevalent underlying diseases among […]

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05/20/2020

Is High PEEP Really Helping?

Patients with COVID-19 induced ARDS had a low lung recruitability (measured by R/I ratio) with high PEEP, questionning the necessity of high peep in COVID-19 associated ARDS. R/I ratio is a simplified one-breath bedside way of measuring lung recruitability. Alternating body position (prone and supine) was associated with a better lung recruitability.  ARDSnet Recommandations for […]

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04/18/2020

ARDS and Death Risk Factors

Older age, neutrophilia, hepatic and coagulation dysfunction (eg, higher LDH, higher D-dimer) increase risk of developping ARDS and death.  Diabetes and Hypertension increase risk of developping ARDS without any impact on death. High temperature (more than 39°C) increase risk of developping ARDS, but improve chance of survival Among ARDS patients, methylprednisolone seemed to reduce the risk […]

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04/04/2020

Influenza Virus Co-Infection

Key Points Influenza virus and COVID-19 co-infection clinical diagnostic may be difficult as they appear to have similar transmission patterns, clinical manifestations and radiological aspect1. Nasal congestion (Nasal tampon) and pharyngalgia, which are not common symptoms of COVID-19, were more prone to appear with co-infected patients1. Co-infected patients seemed to have similar outcomes1. There is no significant […]

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03/28/2020

Effects of Smoking

Key Points Smokers are more susceptible to the most recent species of Coronavirus infections3,5. History of smoking may also impact disease progression1,3. Smokers were 1.4 times more prone to develop severe symptoms1. They also had 2.4 times greater likelihood to be admitted to the ICU,  need mechanical ventilation or die1. Current  smokers have a significantly higher ACE-2 gene expression levels than non-smokers2,5,6. Suggesting an increased risk […]

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03/29/2020

Pulmonary Pathology of SARS-CoV-2 Pneumonia

Pathologic findings of early stage COVID-19 pneumonia may include1: Edema Proteinaceous exudate Globule and focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration Multinucleated giant cells No prominent hyaline membranes No prominent neutrophil infiltration Possible pathologic features of later stage COVID-19 pneumonia2-4 : Alveolar exudative inflammation Interstitial inflammation Focal hemorrhage Interstitial fibrosis Diffuse destruction […]

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04/16/2020

Outpatient Management of COPD

Fundamental facts of interest for COPD management: The upregulation of ACE-2 is seen in smoker and COPD patients2. Gene expression levels of ACE-2 are also inversely related to individual’s forced expiratory volume in 1 second (FEV1)2. ACE-2 could protect animals from severe lung injury. This has been shown in a study using mice in a […]

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05/05/2020

Ventilation phenotypes specific considerations

Mechanical ventilation strategy to COVID-19 is the one typically applied to severe ARDS: low tidal volume ventilation1 Some patients with COVID-19 pneumonia and «ARDS» present with an atypical form of the syndrome described by a high lung compliance A conceptual model, based on respiratory physiology, leads to the development of a time-related disease spectrum within […]

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05/05/2020

Overview of Treatment Strategy for ARDS

Using high-flow nasal oxygen for patients with moderately severe hypoxemia might reduce the need for intubation.  For mechanically-ventilated patient:  Tidal volume: 6mL/kg per predicted bodyweight  Plateau airway pressure: Less than 30 cm H2O Respiratory rates: Increase to 35 bpm as needed  In case of ventilator dyssynchrony, increased airway pressure and hypoxaemia, deep sedation should be […]

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04/07/2020

Clinical Characteristics of ICU-Admitted Patients

ICU patients were older than non-ICU patients ICU patients had more comorbidities like hypertension and chronic liver disease In-hospital complications include ARDS, acute infection, acute cardiac injury, arrythmia, acute kidney and liver injuries Mortality of ICU patients is three times higher than non-ICU ones   This data comes from retroactive cases series involving 102 adult […]

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03/29/2020

Effects of Corticosteroids in Lung Injury

Theoretically, corticosteroids suppress lung inflammation in acute lung injury and acute respiratory distress syndrome (ARDS). However, by inhibiting host immune responses they also inhibit pathogen clearance. Possible harm was shown with its use in other respiratory infections including: Delayed viral clearance (SARS-CoV and MERS-CoV) Increased secondary infection (influenza) Increased mortality and length of stay in […]

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04/01/2020

Hypercapnia in Mechanically Ventilated ARDS

Among COVID-19 related ARDS patients, low tidal volume (6.0 mL/kg) frequently induced hypercapnia.   Ventilation Ratio is a simple bedside index of impaired efficiency of ventilation. Intermediate tidal volume (7-8 mL/kg predicted body weight) for COVID-19 related ARDS patients lowered Ventilation Ratio without a major impact on driving or plateau pressure.   This data come from […]

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03/28/2020

High-Flow Nasal-Oxygenation-Assisted Fiberoptic Tracheal Intubation

The intubation time in the high-flow nasal oxygenation (HFNO) group was significantly shorter than in the standard mask oxygenation (SMO) group (69 seconds versus 76 seconds) There was a lower use of rescue face-mask ventilation in the HFNO group than in the SMO group (4% versus 27%) The desaturation rates (SpO2)  were lower in the HFNO group […]

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03/27/2020

Limiting Transmission During O2 Delivery

Oxygen delivery through nasal catheter mask or non-invasive ventilation (NIV) increases dispersion of the virus due to substantial exhaled air released Use of high-flow nasal cannula (HFNC), NIV through the mask, optimised vent holes or helmet with a double-limb circuit lowers the risk of airborne transmission Patients should wear a mask when receiving oxygen therapy […]

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03/29/2020