Background
Screening of post-intubation stenosis can allow early diagnosis, early management of stenosis, and possible prevention of progress. Fiberoptic bronchoscope is the gold standard for diagnosis of tracheal stenosis. Other imaging modalities as computed tomography can be considered but are not available in intensive care unit.
Purpose of the study
To evaluate the validity of ultrasound (US) as a bedside test for early diagnosis of post-intubation stenosis compared to multidetector computed tomography (MDCT) and fiberoptic bronchoscope (FOB).
Results
Out of the 50 included patients, 12 patients were found to have definite stenosis by FOB. Compared to CT, significant positive correlation was found between all ultrasound parameters (laryngeal width, tracheal diameter) and corresponding CT parameters (r = 0.798, p < 0.001; r = 0.714, p < 0.001 respectively). Compared to FOB results, the yield of MDCT chest for diagnosis of stenosis had 91.6% sensitivity and 100% specificity, while the yield of US detected by mucosal irregularity as a diagnostic tool for tracheal stenosis had comparable sensitivity (91.6%) but lower specificity (88.9%).
Conclusion
Due to its high sensitivity, US could help in detection of possible post-intubation laryngotracheal stenosis in critically ill MV patients.
Background
The prognosis of mechanically ventilated interstitial lung disease (ILD) patients was controversial in previous studies. Identifying the factors associated with mortality could guide therapy and allow good use of ICU resources.
Aim
The aim was to study the outcome of ILD mechanically ventilated patients admitted to the respiratory ICU and to demonstrate the possible factors associated with mortality in these patients.
Patients and methods
The observational prospective study was carried out on ILD patients undergoing mechanical ventilation, either invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV). Clinical, radiological, and outcome assessments were done for all enrolled patients. For outcome assessment, patients were classified into either survivors or nonsurvivors.
Results
Twenty-one (70%) of the patients were subjected to NIV, whereas nine (30%) of them were subjected to IMV. The overall mortality rate was 53.3%. However, the mortality rate was 35% in patients with NIV, but 100% in patients with IMV. Severity assessment scores were significantly higher in nonsurvivors compared with survivors. Nonsurvivors also presented significantly with lower pH and higher PaCO2 compared with survivors. Acute Physiology and Chronic Health Evaluation-II score greater than or equal to 18.5, Simplified Acute Physiology Score greater than or equal to 27.5, Glasgow coma scale score less than 12.5 and PaO2/ FiO2 less than 161.5 were associated with increased risk of mortality of ILD patients.
Conclusion
Mechanically ventilated ILD patients had a poor outcome. However, the survival rate of ILD patients was better on NIV than IMV. Severity assessment scores and PaO2/FiO2 could predict the risk of mortality in ILD patients.
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