The two Chinese physicians who saw the first recognized case of severe acute respiratory syndrome (SARS) on December 22, 2002, have published a paper describing the patient, and offered background on diagnosis and treatment for the new disease. A 41-year-old Chinese businessman was admitted to a local hospital for the evaluation of a cough. He was placed in a room with another patient who later died from what was termed "atypical pneumonia." Within 3 days, the businessman suddenly developed high fever, chills, malaise, and diffuse muscle pain. Quickly, he was transferred to the respiratory institute where the physicians practice. His fever persisted and he showed x-ray features of pneumonia in his lower left lung. He did not respond to antibiotics and his condition worsened significantly. Next, his doctors gave him supplemental oxygen by mask. As his condition continued to deteriorate, he had a breathing tube placed in his trachea, followed by mechanical ventilation. Because of his persistent fever and the similarity of his illness to acute respiratory distress syndrome, his physicians decided to give him high doses of corticosteroids. As a result, after a few days, there was considerable improvement in his condition. Following prolonged ventilator support, his doctors finally removed his breathing tube on February 17, 2003, and he was discharged on March 5. The doctors also describe other aspects of treatment and diagnosis in their article, which appears in the first issue for July 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Potential new treatment for pulmonary hypertension in sickle cell patients
Oral arginine, a non-toxic nutritional supplement with few side effects, reduced pulmonary hypertension by 15 percent after 5 days of therapy in 10 sickle cell patients. The researchers who studied the supplement point out that the enzyme arginase was elevated almost two-fold in patients with pulmonary hypertension. They believe that this factor may limit arginine bioavailability in such cases. Sickle cell disease, an inherited condition that affects black persons almost exclusively, is characterized by sickle-shaped red blood cells and chronic anemia. Pulmonary hypertension, a serious condition for sickle cell patients, involves an increase in blood pressure within the pulmonary circulation. Its presence is an independent predictor of mortality in sickle cell disease. The one patient who was found to be noncompliant with the study medication, arginine, did not show improvement in their pulmonary hypertension level. The study appears in the first issue for July 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
Noninvasive ventilation leads to faster spontaneous breathing after mechanical ventilation and drastically reduces hospital stays
Investigators demonstrated that, in a group of intensive care unit (ICU) patients who had repeatedly failed to breathe spontaneously after being taken off mechanical ventilation, early removal of the breathing tube from their trachea, plus noninvasive ventilation, reduced the duration of their ventilatory support, led to a much shorter ICU and hospital stay, lowered their incidence of hospital-based pneumonia and septic shock, and improved their survival. Spanish researchers studied 43 mechanically ventilated patients who had failed a weaning trial 3 consecutive days. They wanted to assess the efficacy of noninvasive ventilation in order to determine whether earlier removal of a patient's breathing tube from the trachea (extubation), plus noninvasive ventilation, would reduce the complications of prolonged mechanical ventilation and improve survival. They wanted to compare the strategy with a conventional weaning approach that consisted of once-daily removal from the ventilator to determine if spontaneous breathing would occur. Twenty-one patients were randomly assigned to be extubated and provided with noninvasive ventilation. Within this group, 4 patients were ventilated with nasal masks and 17 with face masks. Twenty-two patients were assigned to the conventional weaning section and remained on mechanical ventilation. For the noninvasive ventilation patients, as compared with the conventional weaning group, the mean duration of invasive ventilation was reduced by 11 days, the total period of ventilatory support by 9 days, the ICU stay by 11 days, and the hospital stay by 13 days. The study appears in the first issue for July 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org.
Journal
American Journal of Respiratory and Critical Care Medicine