Journal articles: 'Patient self-Inflicted lung injury'

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Carteaux, Guillaume, Mélodie Parfait, Margot Combet, Anne-Fleur Haudebourg, Samuel Tuffet, and Armand Mekontso Dessap. "Patient-Self Inflicted Lung Injury: A Practical Review." Journal of Clinical Medicine 10, no. 12 (June 21, 2021): 2738. http://dx.doi.org/10.3390/jcm10122738.

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Patients with severe lung injury usually have a high respiratory drive, resulting in intense inspiratory effort that may even worsen lung damage by several mechanisms gathered under the name “patient-self inflicted lung injury” (P-SILI). Even though no clinical study has yet demonstrated that a ventilatory strategy to limit the risk of P-SILI can improve the outcome, the concept of P-SILI relies on sound physiological reasoning, an accumulation of clinical observations and some consistent experimental data. In this review, we detail the main pathophysiological mechanisms by which the patient’s respiratory effort could become deleterious: excessive transpulmonary pressure resulting in over-distension; inhomogeneous distribution of transpulmonary pressure variations across the lung leading to cyclic opening/closing of nondependent regions and pendelluft phenomenon; increase in the transvascular pressure favoring the aggravation of pulmonary edema. We also describe potentially harmful patient-ventilator interactions. Finally, we discuss in a practical way how to detect in the clinical setting situations at risk for P-SILI and to what extent this recognition can help personalize the treatment strategy.

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Su, Po-Lan, Zhanqi Zhao, Yen-Fen Ko, Chang-Wen Chen, and Kuo-Sheng Cheng. "Spontaneous Breathing and Pendelluft in Patients with Acute Lung Injury: A Narrative Review." Journal of Clinical Medicine 11, no. 24 (December 15, 2022): 7449. http://dx.doi.org/10.3390/jcm11247449.

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Acute respiratory distress syndrome (ARDS) is characterized by acute-onset rapid-deteriorating inflammatory lung injury. Although the preservation of spontaneous breathing may have physiological benefits in oxygenation, increasing evidence shows that vigorous spontaneous breathing may aggravate lung injury (i.e., patient self-inflicted lung injury). Increased lung stress and pendelluft, which is defined as intrapulmonary gas redistribution without a significant change in tidal volume, are important mechanisms of patient self-inflicted lung injury. The presence of pendelluft may be considered a surrogate marker of vigorous inspiratory effort, which can cause the dependent lung to overstretch. In this review, we summarized three major methods for electrical impedance tomography–based pendelluft monitoring. Future studies are warranted to compare and validate the different methods of pendelluft estimation in patients with ARDS.

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Carteaux, G., F. Perier, T. Maraffi, K. Razazi, N. De Prost, and A. Mekontso Dessap. "Patient self-inflicted lung injury : ce que le réanimateur doit connaître." Médecine Intensive Réanimation 28, no. 1 (January 2019): 11–20. http://dx.doi.org/10.3166/rea-2019-0087.

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Sklienka, Peter, Michal Frelich, and Filip Burša. "Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options." Journal of Personalized Medicine 13, no. 4 (March 28, 2023): 593. http://dx.doi.org/10.3390/jpm13040593.

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Patient self-inflicted lung injury (P-SILI) is a life-threatening condition arising from excessive respiratory effort and work of breathing in patients with lung injury. The pathophysiology of P-SILI involves factors related to the underlying lung pathology and vigorous respiratory effort. P-SILI might develop both during spontaneous breathing and mechanical ventilation with preserved spontaneous respiratory activity. In spontaneously breathing patients, clinical signs of increased work of breathing and scales developed for early detection of potentially harmful effort might help clinicians prevent unnecessary intubation, while, on the contrary, identifying patients who would benefit from early intubation. In mechanically ventilated patients, several simple non-invasive methods for assessing the inspiratory effort exerted by the respiratory muscles were correlated with respiratory muscle pressure. In patients with signs of injurious respiratory effort, therapy aimed to minimize this problem has been demonstrated to prevent aggravation of lung injury and, therefore, improve the outcome of such patients. In this narrative review, we accumulated the current information on pathophysiology and early detection of vigorous respiratory effort. In addition, we proposed a simple algorithm for prevention and treatment of P-SILI that is easily applicable in clinical practice.

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Tobin, Martin J., Amal Jubran, and Franco Laghi. "Respiratory Drive Measurements Do Not Signify Conjectural Patient Self-inflicted Lung Injury." American Journal of Respiratory and Critical Care Medicine 203, no. 1 (January 1, 2021): 142–43. http://dx.doi.org/10.1164/rccm.202009-3630le.

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Marongiu, Ines, Douglas Slobod, Marco Leali, Elena Spinelli, and Tommaso Mauri. "Clinical and Experimental Evidence for Patient Self-Inflicted Lung Injury (P-SILI) and Bedside Monitoring." Journal of Clinical Medicine 13, no. 14 (July 10, 2024): 4018. http://dx.doi.org/10.3390/jcm13144018.

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Patient self-inflicted lung injury (P-SILI) is a major challenge for the ICU physician: although spontaneous breathing is associated with physiological benefits, in patients with acute respiratory distress syndrome (ARDS), the risk of uncontrolled inspiratory effort leading to additional injury needs to be assessed to avoid delayed intubation and increased mortality. In the present review, we analyze the available clinical and experimental evidence supporting the existence of lung injury caused by uncontrolled high inspiratory effort, we discuss the pathophysiological mechanisms by which increased effort causes P-SILI, and, finally, we consider the measurements and interpretation of bedside physiological measures of increased drive that should alert the clinician. The data presented in this review could help to recognize injurious respiratory patterns that may trigger P-SILI and to prevent it.

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Fang, Xiaorong, Changjiang Yu, and Fan He. "The Self-Inflicted Multiple Organs Injury with Nail Gun." Heart Surgery Forum 24, no. 6 (December 17, 2021): E1049—E1051. http://dx.doi.org/10.1532/hsf.4201.

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We report the case of a patient with injuries to multiple organs as a result of attempted suicide with a nail gun. The patient shot 12 nails into his chest, causing damage to multiple organs, including the heart, lungs, and stomach. With timely emergency surgery, we successfully removed all the nails, and the patient was discharged from the hospital two weeks after surgery.

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Patel, Bhakti K., Krysta S. Wolfe, Jesse B. Hall, and John P. Kress. "A Word of Caution Regarding Patient Self-inflicted Lung Injury and Prophylactic Intubation." American Journal of Respiratory and Critical Care Medicine 196, no. 7 (October 2017): 936. http://dx.doi.org/10.1164/rccm.201702-0410le.

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Nguyen, Trinh, and Sumedh Hoskote. "PATIENT SELF-INFLICTED LUNG INJURY: THE CASE AGAINST EARLY SPONTANEOUS VENTILATION IN ARDS." Chest 156, no. 4 (October 2019): A1279. http://dx.doi.org/10.1016/j.chest.2019.08.1150.

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Yoshida, Takeshi, Domenico L. Grieco, Laurent Brochard, and Yuji Fujino. "Patient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing." Current Opinion in Critical Care 26, no. 1 (February 2020): 59–65. http://dx.doi.org/10.1097/mcc.0000000000000691.

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Moellhoff, Nicholas, Philipp Groene, Ludwig Ney, and Daniela Hauer. "Entwicklung einer Riesenbulla unter Spontanatmung durch „patient self-inflicted lung injury“ bei COVID-19-Pneumonie." Der Anaesthesist 71, no. 4 (November 22, 2021): 303–6. http://dx.doi.org/10.1007/s00101-021-01072-w.

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ZusammenfassungSARS-CoV‑2 und die damit assoziierte COVID-19-Erkrankung stellen Gesundheitssysteme weltweit vor große Herausforderungen. Fast täglich werden neue Erkenntnisse zu Diagnostik, Klinik und Therapie der Erkrankung publiziert. Dieser Fallbericht beschreibt den letalen Krankheitsverlauf eines 81-jährigen Patienten ohne pulmonale Vorerkrankungen, der als Komplikation der COVID-19-Pneumonie unter nichtinvasiver High-Flow-Sauerstofftherapie eine Riesenbulla entwickelte. Pathophysiologisch kommen/kommt eine virusbedingte diffuse Zerstörung des Alveolargewebes und/oder die „patient self-inflicted lung injury“ in Betracht.

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Battaglini, Denise, Chiara Robba, Lorenzo Ball, Pedro L. Silva, Fernanda F. Cruz, Paolo Pelosi, and Patricia R. M. Rocco. "Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review." British Journal of Anaesthesia 127, no. 3 (September 2021): 353–64. http://dx.doi.org/10.1016/j.bja.2021.05.024.

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Kouch, Michael, and Laura Evans. "Is Time-of-Flight Ready for Take Off to Measure Patient Self-Inflicted Lung Injury?*." Critical Care Medicine 50, no. 1 (December 16, 2021): 168–70. http://dx.doi.org/10.1097/ccm.0000000000005237.

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Brochard, Laurent, Arthur S. Slutsky, and Antonio Pesenti. "Reply: “A Word of Caution Regarding Patient Self-inflicted Lung Injury and Prophylactic Intubation” and “Hyperventilation (Not Ventilator)-induced Lung Injury”." American Journal of Respiratory and Critical Care Medicine 196, no. 7 (October 2017): 937–38. http://dx.doi.org/10.1164/rccm.201704-0780le.

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RIZKALLAH ALVES, BEATRIZ, PATRICK L. GORDAN, KATELYN HORTON, ARIANE PAZ Y MINO, RICAURTE CRESPO TREVINO, and AHMAD MASHLAH. "SPONTANEOUS PNEUMOMEDIASTINUM IN A NON-MECHANICALLY VENTILATED PATIENT WITH PROLONGED COVID-19: PATIENT SELF-INFLICTED LUNG INJURY (P-SILI)?" CHEST 164, no. 4 (October 2023): A3487—A3488. http://dx.doi.org/10.1016/j.chest.2023.07.2267.

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Gattinoni, Luciano, John J. Marini, and Luigi Camporota. "Reply to Tobin et al.: Respiratory Drive Measurements Do Not Signify Conjectural Patient Self-inflicted Lung Injury." American Journal of Respiratory and Critical Care Medicine 203, no. 1 (January 1, 2021): 143–44. http://dx.doi.org/10.1164/rccm.202009-3692le.

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Cutuli, Salvatore Lucio, Domenico Luca Grieco, Teresa Michi, Melania Cesarano, Tommaso Rosà, Gabriele Pintaudi, Luca Salvatore Menga, et al. "Personalized Respiratory Support in ARDS: A Physiology-to-Bedside Review." Journal of Clinical Medicine 12, no. 13 (June 21, 2023): 4176. http://dx.doi.org/10.3390/jcm12134176.

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Acute respiratory distress syndrome (ARDS) is a leading cause of disability and mortality worldwide, and while no specific etiologic interventions have been shown to improve outcomes, noninvasive and invasive respiratory support strategies are life-saving interventions that allow time for lung recovery. However, the inappropriate management of these strategies, which neglects the unique features of respiratory, lung, and chest wall mechanics may result in disease progression, such as patient self-inflicted lung injury during spontaneous breathing or by ventilator-induced lung injury during invasive mechanical ventilation. ARDS characteristics are highly heterogeneous; therefore, a physiology-based approach is strongly advocated to titrate the delivery and management of respiratory support strategies to match patient characteristics and needs to limit ARDS progression. Several tools have been implemented in clinical practice to aid the clinician in identifying the ARDS sub-phenotypes based on physiological peculiarities (inspiratory effort, respiratory mechanics, and recruitability), thus allowing for the appropriate application of personalized supportive care. In this narrative review, we provide an overview of noninvasive and invasive respiratory support strategies, as well as discuss how identifying ARDS sub-phenotypes in daily practice can help clinicians to deliver personalized respiratory support and potentially improve patient outcomes.

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Tsolaki, Vasiliki, George E. Zakynthinos, Maria-Eirini Papadonta, Fotini Bardaka, George Fotakopoulos, Ioannis Pantazopoulos, Demosthenes Makris, and Epaminondas Zakynthinos. "Neuromuscular Blockade in the Pre- and COVID-19 ARDS Patients." Journal of Personalized Medicine 12, no. 9 (September 19, 2022): 1538. http://dx.doi.org/10.3390/jpm12091538.

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Acute respiratory distress syndrome (ARDS) accounts for a quarter of mechanically ventilated patients, while during the pandemic, it overwhelmed the capacity of intensive care units (ICUs). Lung protective ventilation (low tidal volume, positive-end expiratory pressure titrated to lung mechanics and oxygenation, permissive hypercapnia) is a non-pharmacological approach that is the gold standard of management. Among the pharmacological treatments, the use of neuromuscular blocking agents (NMBAs), although extensively studied, has not yet been well clarified. The rationale is to minimize the risk for lung damage progression, in the already-injured pulmonary parenchyma. By abolishing rigorous spontaneous efforts, NMBAs may decrease the generation of high transpulmonary pressures that could aggravate patients’ self-inflicted lung injury. Moreover, NMBAs can harmonize the patient–ventilator interaction. Recent randomized controlled trials reported contradictory results and changed the clinical practice in a bidirectional way. NMBAs have not been documented to improve long-term survival; thus, the current guidance suggests their use only in patients in whom a lung protective ventilation protocol cannot be applied, due to asynchrony or increased respiratory efforts. In the present review, we discuss the published data and additionally the clinical practice in the “war” conditions of the COVID-19 pandemic, concerning NMBA use in the management of patients with ARDS.

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Giustivi, Davide, Francesco Bottazzini, and Mirko Belliato. "Respiratory Monitoring at Bedside in COVID-19 Patients." Journal of Clinical Medicine 10, no. 21 (October 26, 2021): 4943. http://dx.doi.org/10.3390/jcm10214943.

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The SARS-CoV-2 (COVID-19) pandemic has forced some reflections to be had surrounding the ventilatory support to be applied to certain types of patients. The model of two phenotypes, set out by Professor Gattinoni and colleagues, suggests that adequate monitoring of respiratory effort may play a key role in the treatment of respiratory failure due to COVID-19. An insufficient control of the patient’s respiratory efforts could lead to an aggravation of lung damage, mainly due to the possibility of generating Patient Self-Inflicted Lung Injury (PSILI) with a consequent aggravation of the pathological picture. Nevertheless, effectively monitoring the patient’s respiratory work, especially in nonintensive settings, is not easy. This article briefly describes some methods that allow the assessment of respiratory effort, such as the use of ultrasound and respiratory tests, which can be performed in nonintensive settings.

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Kondili, Eumorfia, Demosthenes Makris, Dimitrios Georgopoulos, Nikoletta Rovina, Anastasia Kotanidou, and Antonia Koutsoukou. "COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning." Journal of Personalized Medicine 11, no. 11 (October 28, 2021): 1109. http://dx.doi.org/10.3390/jpm11111109.

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The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical characteristics and respiratory system mechanics with ARDS of other origins. Therefore, mechanical ventilation in these patients should be based on strategies aiming to mitigate ventilator-induced lung injury. Assisted mechanical ventilation should be applied early in the course of mechanical ventilation by considering evaluation and minimizing factors associated with patient-inflicted lung injury. Extracorporeal membrane oxygenation should be considered in selected patients with refractory hypoxia not responding to conventional ventilation strategies. This review highlights the current and evolving practice in managing mechanically ventilated patients with ARDS related to COVID-19.

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Gattinoni, Luciano, Simone Gattarello, Irene Steinberg, Mattia Busana, Paola Palermo, Stefano Lazzari, Federica Romitti, et al. "COVID-19 pneumonia: pathophysiology and management." European Respiratory Review 30, no. 162 (October 20, 2021): 210138. http://dx.doi.org/10.1183/16000617.0138-2021.

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Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. The underlying mechanism is primarily altered lung perfusion. The anatomical prerequisites for PEEP (positive end-expiratory pressure) to work (lung oedema, atelectasis, and therefore recruitability) are lacking. In the high-dependency unit: the disease starts to worsen either because of its natural evolution or additional patient self-inflicted lung injury (P-SILI). Oedema and atelectasis may develop, increasing recruitability. Noninvasive supports are indicated if they result in a reversal of hypoxaemia and a decreased inspiratory effort. Otherwise, mechanical ventilation should be considered to avert P-SILI. In the intensive care unit: the primary characteristic of the advance of unresolved COVID-19 disease is a progressive shift from oedema or atelectasis to less reversible structural lung alterations to lung fibrosis. These later characteristics are associated with notable impairment of respiratory mechanics, increased arterial carbon dioxide tension (PaCO2), decreased recruitability and lack of response to PEEP and prone positioning.

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STARKMAN, ADAM E., DENA H. TRAN, MARC KAI, and WILLIAM GRIER. "DON'T PSILI WITH COVID! A CASE OF COVID-19 RESPIRATORY FAILURE AND MYASTHENIA GRAVIS EXACERBATION RESULTING IN PATIENT SELF-INFLICTED LUNG INJURY." CHEST 164, no. 4 (October 2023): A2530. http://dx.doi.org/10.1016/j.chest.2023.07.1686.

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Mostafa, Maha, Mina Adolf Helmy, Lydia Magdy Milad, and Ahmed Hasanin. "Patient self-induced lung injury risk in severe COVID-19." Anaesthesia Critical Care & Pain Medicine 41, no. 2 (April 2022): 101018. http://dx.doi.org/10.1016/j.accpm.2021.101018.

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Takahashi, Kazuhiro, Hiroaki Toyama, Yutaka Ejima, Jinyou Yang, Kenji Kikuchi, Takuji Ishikawa, and Masanori Yamauchi. "Endotracheal tube, by the venturi effect, reduces the efficacy of increasing inlet pressure in improving pendelluft." PLOS ONE 18, no. 9 (September 14, 2023): e0291319. http://dx.doi.org/10.1371/journal.pone.0291319.

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In mechanically ventilated severe acute respiratory distress syndrome patients, spontaneous inspiratory effort generates more negative pressure in the dorsal lung than in the ventral lung. The airflow caused by this pressure difference is called pendelluft, which is a possible mechanisms of patient self-inflicted lung injury. This study aimed to use computer simulation to understand how the endotracheal tube and insufficient ventilatory support contribute to pendelluft. We established two models. In the invasive model, an endotracheal tube was connected to the tracheobronchial tree with 34 outlets grouped into six locations: the right and left upper, lower, and middle lobes. In the non-invasive model, the upper airway, including the glottis, was connected to the tracheobronchial tree. To recreate the inspiratory effort of acute respiratory distress syndrome patients, the lower lobe pressure was set at -13 cmH2O, while the upper and middle lobe pressure was set at -6.4 cmH2O. The inlet pressure was set from 10 to 30 cmH2O to recreate ventilatory support. Using the finite volume method, the total flow rates through each model and toward each lobe were calculated. The invasive model had half the total flow rate of the non-invasive model (1.92 L/s versus 3.73 L/s under 10 cmH2O, respectively). More pendelluft (gas flow into the model from the outlets) was observed in the invasive model than in the non-invasive model. The inlet pressure increase from 10 to 30 cmH2O decreased pendelluft by 11% and 29% in the invasive and non-invasive models, respectively. In the invasive model, a faster jet flowed from the tip of the endotracheal tube toward the lower lobes, consequently entraining gas from the upper and middle lobes. Increasing ventilatory support intensifies the jet from the endotracheal tube, causing a venturi effect at the bifurcation in the tracheobronchial tree. Clinically acceptable ventilatory support cannot completely prevent pendelluft.

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Vesovic, Natasa, Aleksandar Ristanovic, Vlado Cvijanovic, Dejan Stojkovic, Nebojsa Maric, Vanja Kostovski, Ljubinko Djenic, and Aleksandar Nikolic. "Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report." Vojnosanitetski pregled 77, no. 3 (2020): 330–34. http://dx.doi.org/10.2298/vsp170904053v.

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Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.

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Pérez Nieto, Orlando. "Lesión pulmonar autoinducida por el paciente (P-SILI)." Perspectiva de un residente de medicina crítica y medicina de urgencias. 2 (November 23, 2023): 1–8. http://dx.doi.org/10.58281/ccem23120701.

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The article reviews the scientific literature on Patient Self-Induced Lung Injury (P-SILI) in patients with Acute Respiratory Distress Syndrome (ARDS). It begins with a history since 1985, highlighting events of pulmonary edema related to hyperventilation in diabetic patients and advances in the understanding of pulmonary mechanics. Experimental studies in sheep and humans are detailed that show lung damage due to hyperventilation, highlighting the importance of spontaneous ventilation and alveolar damage. In addition, studies on alveolar hemorrhage post-intense exercise in animals and high-performance athletes are mentioned. The text explores the relationship between Invasive Mechanical Ventilation (IMV) and lung injury, addressing therapeutic strategies such as neuromuscular blockade and the impact of positive end-expiratory pressure (PEEP). The theoretical mechanisms of P-SILI are delved into, highlighting pulmonary overdistension, increased pulmonary perfusion and patient-ventilator asynchronies. The clinical impact of P-SILI, especially in patients with COVID-19 and ARDS, is discussed, and management strategies such as high-flow oxygen therapy are highlighted. The article concludes by highlighting the need for more studies to standardize the monitoring of inspiratory efforts, understand its implication in prognosis and guide appropriate therapy, recognizing that the optimal approach is still the subject of debate.

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Okuda, Nao, Miyako Kyogoku, Yu Inata, Kanako Isaka, Kazue Moon, Takeshi Hatachi, Yoshiyuki Shimizu, and Muneyuki Takeuchi. "Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study." PLOS ONE 16, no. 3 (March 1, 2021): e0247360. http://dx.doi.org/10.1371/journal.pone.0247360.

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Background It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. Methods The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Results Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, − -2.6 ± 1.4, and − -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). Conclusions ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.

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Pylypenko, M. M., and O. Yu Khomenko. "Modern strategies of adaptation to the respiratory support as a way to reduce self-induced lung injury (SILI)." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 243–44. http://dx.doi.org/10.32902/2663-0338-2020-3.2-243-244.

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Background. The success of respiratory support depends on the effectiveness of improving gas exchange, reducing lung damage, and adaptation of the respirator. Reduction of lung damage has previously been reported in the context of ventilator-associated injury: barotrauma in case of high plateau pressure and driving pressure, volume trauma in case of large tidal volume, atelectasis trauma due to the cyclic collapse of lungs on exhalation and opening on inspiration. Objective. To describe the features of lung damage during mechanical lung ventilation (MLV) and the possibility of its prevention. Materials and methods. Analysis of literature sources on this topic. Results and discussion. The main causes of “air hunger” breathing type and shortness of breath include hypoxia, acidosis, increased anatomical and functional dead space, psychomotor agitation and fear. Metabolic acidosis is compensated by hyperventilation and respiratory alkalosis, but it is treated by improving oxygenation. High-flow oxygenation helps to leach CO2 from the dead space. Psychomotor agitation and pain aggravate shortness of breath, so all components of these processes should be influenced by effective analgesia, providing the patient with a comfortable body position (especially obese people), ensuring the absence of hunger and thirst, creating conditions for night sleep and more. If all these measures are taken, but the patient’s agitation is maintained, sedation should be considered. Propofol and dexmedetomidine are increasingly used for short-term sedation. Approaches to sedation have been changing abroad in recent years. First, non-pharmacological methods are used and only then – pharmacological ones. First of all, it is recommended to achieve analgesia, and then – sedation. It is advisable to maintain moderate sedation (from 0 to -2 on the RASS scale) and avoid deep sedation (from -3 to -5 points on the RASS scale). Sedation should be stopped each morning for the wake-up test and the respirator quitting test. To improve the immediate consequences of treatment (duration of MLV and stay in the intensive care unit), it is advisable to minimize the use of benzodiazepines and prefer propofol or dexmedetomidine. The depth of sedation should be constantly monitored, however, even experienced physicians may not always be able to detect asynchrony and excessive sedation. Asynchrony is associated with the increased mortality and prolonged weaning. To assess the intensity of the patient’s respiratory effort, the index of rapid shallow breathing, the maximum vacuum in the airways and the pressure in 0.1 second after the start of the breathing attempt are used. If the latter exceeds 3.5 cm H2O, it indicates the excessive respiratory effort of the patient (Telias I. et al., 2020). Conclusions. 1. The term “self-induced lung injury” has become widely used in the practice of anesthesiologists. 2. The need for respiratory support is determined primarily by the patient’s breathing efforts. 3. The ability to timely identify and respond to asynchrony helps to avoid self-induced lung damage.

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Yamaguchi, Teppei, Junichi Shimizu, Yuko Oya, Yoshitsugu Horio, and Toyoaki Hida. "Drug-Induced Liver Injury in a Patient with Nonsmall Cell Lung Cancer after the Self-Administration of Fenbendazole Based on Social Media Information." Case Reports in Oncology 14, no. 2 (June 17, 2021): 886–91. http://dx.doi.org/10.1159/000516276.

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Fenbendazole is a benzimidazole anthelmintic agent, with a broad antiparasitic range in animals such as dogs and pigs. The agent is also reported to exert antitumor effects and inhibit microtubule-associated tubulin polymerization, but its safety and tolerability profile in humans remains unclear. An 80-year-old female patient with advanced nonsmall cell lung cancer (NSCLC) was started on pembrolizumab monotherapy. The patient experienced severe liver injury 9 months later. An interview with her and her family revealed that she had been taking fenbendazole for a month, solely based on social media reports suggesting its effectiveness against cancer. After discontinuation of the self-administration of fenbendazole, the patient’s liver dysfunction spontaneously resolved. The antitumor inhibitory effects of fenbendazole have been reported; however, she did not experience tumor shrinkage. This is the first case report of a patient with advanced NSCLC who self-administered the anthelmintic, fenbendazole. Twitter and Facebook are online social media platforms which have been constructively used to exchange information among cancer patients. However, sources of medical information on these platforms are often unproven, and it is difficult for nonmedical professionals to accurately select and filter complex medical information. Physicians should enquire patients about self-administration of orally ingested products, including dietary supplements, herbs, or bioactive compounds, in cases of unexpected adverse reactions.

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Koryakin, A. G., A. V. Vlasenko, E. P. Rodionov, and E. A. Evdokimov. "Asynchronies during respiratory support." Medical alphabet, no. 17 (September 8, 2022): 50–61. http://dx.doi.org/10.33667/2078-5631-2022-17-50-61.

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Asynchronies (desynchronies, dyssynchrony) is a disturbance of the harmonious interaction between the patient’s respiratory system and а ventilator. Asynchronies occur as a result of various reasons and with any form of respiratory support (non-invasive, assisted or fully controlled mechanical ventilation). Asynchrony is a significant cause of biomechanics and gas exchange disorders in the development of both self-injury and ventilator-induced lung injury, an increase of the respiratory support duration and mortality in patients with respiratory failure. Understanding the mechanisms of the asynchrony pathogenesis and assessment of the patient’s respiratory system condition make it possible to timely identify and resolve disturbance of the patient-ventilator interactions. The article presents a classification, the main causes of development, diagnostic and correction methods of different variants of desynchronies in patients with respiratory disorders during of respiratory support.

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Matta, Simran. "Challenges and controversies in COVID-19 respiratory failure." Southwest Respiratory and Critical Care Chronicles 8, no. 35 (July 23, 2020): 29–35. http://dx.doi.org/10.12746/swrccc.v8i35.743.

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COVID-19 pneumonia presents distinctive questions and challenges traditional conventions of management of respiratory failure. The trajectory of recommendations on customary intubation practices has undertaken significant paradigm shifts. This review will discuss the role of high flow nasal cannula oxygenation in mitigating respiratory distress in SARS-COV2 pneumonia and will explore the indices that can aid in the timely recognition of failure of non-invasive respiratory support modalities and escalation to mechanical ventilation. The work of breathing is a valuable yardstick for understanding increasing lung elastance. Quantifying work of breathing, though, has its own unique challenges. This article also discusses the emerging controversial proposals of employing high tidal volumes and low PEEP in mechanical ventilation of COVID-19 pneumonia and will review the key concepts of lung stress and strain and the implications of “static” versus “dynamic” strain in ventilator induced lung injury. It considers the established facts of inducing lung strain with larger dynamic deformations caused by high tidal volumes and the benefit of high PEEP in homogenizing the strain distribution. The review suggests that the isolated ground glass opacities could pose as “stress raisers.” The effects of these regional lung homogeneities in amplifying local and global lung stress are also discussed as well as the benefits of PEEP beyond its effect as a pressure barrier against alveolar filling and its utility in lungs with near normal compliance. A physiologic approach is presented to counter the non-uniform and heterogeneous presentations of this unique disease rather than conforming to rigid protocols. One size probably does not fit all. Keywords: Covid-19, early intubation, patient self-induced lung injury (P-SILI), pendelluft, lung stress/strain, H and L phenotypes, high tidal volume, low PEEP

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Petitjeans, Fabrice, Sandrine Leroy, Cyrille Pichot, Marco Ghignone, Luc Quintin, Dan Longrois, and Jean-Michel Constantin. "Improved understanding of the respiratory drive pathophysiology could lead to earlier spontaneous breathing in severe acute respiratory distress syndrome." European Journal of Anaesthesiology Intensive Care 2, no. 5 (2023): e0030. http://dx.doi.org/10.1097/ea9.0000000000000030.

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Optimisation of the respiratory drive, as early as possible in the setting of severe acute respiratory distress syndrome (ARDS) and not its suppression, could be a new paradigm in the management of severe forms of ARDS. Severe ARDS is characterised by tachypnoea and hyperpnoea, a consequence of a high respiratory drive. Some patients require endotracheal intubation, controlled mechanical ventilation (CMV) and paralysis to prevent overt ventilatory failure and self-inflicted lung injury. Nevertheless, intubation, CMV and paralysis do not address per se the high respiratory drive, they only suppress it. Optimisation of the respiratory drive could be obtained by a multimodal approach that targets attenuation of fever, agitation, systemic and peripheral acidosis, inflammation, extravascular lung water and changes in carbon dioxide levels. The paradigm we present, based on pathophysiological considerations, is that as soon as these factors have been controlled, spontaneous breathing could resume because hypoxaemia is the least important input to the respiratory drive. Hypoxaemia could be handled by combining positive end-expiratory pressure (PEEP) to prevent early expiratory closure and low pressure support to minimise the work of breathing (WOB). ‘Cooperative’ sedation with alpha-2 agonists, supplemented with neuroleptics if required, is the pharmacological adjunct, administered immediately after intubation as the first-line sedation regimen during the multimodal approach. Given relative contraindications (hypovolaemia, auriculoventricular block, sick sinus syndrome), alpha-2 agonists can help attenuate or moderate fever, increased oxygen consumption VO2, agitation, high cardiac output, inflammation and acidosis. They may also help to preserve microcirculation, cognition and respiratory rhythm generation, thus promoting spontaneous breathing. Returning the physiology of respiratory, ventilatory, circulatory and autonomic systems to normal will support the paradigm of optimised respiratory drive favouring early spontaneous ventilation, at variance with deep sedation, extended paralysis, CMV and use of the prone position as therapeutic strategies in severe ARDS. GLOSSARY Glossary and Abbreviations_SDC, http://links.lww.com/EJAIC/A55

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Kuzkov, V. V., K. S. Lapin, E. V. Fot, and M. Yu Kirov. "Ventilator-associated lung injury in the intensive care unit and operating room – what's new?" Messenger of ANESTHESIOLOGY AND RESUSCITATION 17, no. 5 (November 2, 2020): 47–61. http://dx.doi.org/10.21292/2078-5658-2020-17-5-47-61.

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The prophylaxis of ventilator-associated lung injury (VALI) and postoperative pulmonary complications (PPC) is of utmost importance to reduce complications both in the perioperative period of major surgery and in the intensive care unit (ICU).Protective approach to mechanical ventilation comprises a wide range of measures reducing the damage of the lung tissue associated with the stress and strain phenomena. The implementation of the strategy of high positive end-expiratory pressure (PEEP) in combination with alveolar recruitment maneuver has numerous limitations and requires further personalized approaches.When lung injury is self-induced by a patient, it becomes an important contributor to VALI and should be timely diagnosed and prevented both before initiation of mechanical support and during the restoration of spontaneous breathing. This review highlights the key mechanisms of VALI and current understanding of protective ventilation. The concept of damaging energy as well as approaches to the personalized optimization of respiratory settings are discussed in detail. Particular attention is paid to the prognostication of the risk factors of VALI and PPC.

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Al-Sadek, Tabet A., Desislav Niklev, Ahmed Al-Sadek, and Lina Al-Sadek. "Scapular Fractures in Blunt Chest Trauma – Self-Experience Study." Open Access Macedonian Journal of Medical Sciences 4, no. 4 (November 16, 2016): 688–91. http://dx.doi.org/10.3889/oamjms.2016.135.

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AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries.MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed.RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema.CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

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María Tirado Patiño and Daniel Paz Martín. "¿Cuál es el volumen tidal ideal en pacientes ingresados en UCI sin SDRA que requieren ventilación mecánica más de 24 horas?" Revista Electrónica AnestesiaR 11, no. 8 (September 2, 2019): 3. http://dx.doi.org/10.30445/rear.v11i8.768.

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La protección pulmonar en los pacientes críticos sometidos a ventilación mecánica, es uno de los objetivos que persiguen los facultativos cuando utilizan esta herramienta terapéutica; que, pese a todos sus beneficios y su uso extendido, no está exenta de efectos adversos. El apoyo ventilatorio en el Síndrome de Distrés Respiratorio Agudo (SDRA) consta de una serie de medidas, entre las que se incluye el volumen tidal (VT) bajo. Pero, ¿qué ocurre con aquellos pacientes que precisan más de 24 horas de ventilación mecánica sin criterios de SDRA? ¿Cuál es su VT recomendado? La evidencia científica apoya que la ventilación con VT bajo se asocia a la disminución del número de complicaciones respiratorias en comparación con VT alto (si bien, los ensayos clínicos preexistentes comparaban volúmenes bajos de 6 ml/kg vs volúmenes muy altos, de más de 10 ml/kg) (1)(2). Por contra, los VT bajos pueden incrementar la necesidad de sedación, aumentan la tasa de asincronía entre el paciente y el ventilador e incluso algunos trabajos hablan de que podría aumentar el riesgo de delirio.(3) El objetivo principal del estudio fue determinar si una estrategia de ventilación con VT bajo es más efectiva que una estrategia de VT intermedio en función del número de días libres de ventilación en el día 28 en los pacientes vivos tras la aleatorización. ABSTRACT Which is the ideal tidal volume for patients in ICU without ARDS who need mechanical ventilation more than 24h? Invasive ventilation, one of the most frequently applied strategies in the intensive care unit (ICU), is increasingly recognized as a potentially harmful intervention. There is evidence that lung-protective ventilation using low tidal volumes improves survival in patients with acute respiratory distress syndrome (ARDS), but it is less certain whether tidal volume restriction benefits patients without ARDS. Two randomized clinical trials found tidal volume reduction to be associated with a lower number of pulmonary complications in patients without ARDS, and 2 individual patient data meta-analyses suggested that tidal volume reduction may shorten the time spent on the ventilator and duration of stay in the ICU and hospital. However, the use of low tidal volumes could lead to an in- creased need for sedation because of higher respiratory rate or patient-ventilator asynchrony and, possibly, self- inflicted lung injury due to compensatory injurious inspiratory efforts. In addition, it has been suggested that low tidal volumes may increase the risk of delirium. The Protective Ventilation in Patients Without ARDS (PReVENT) trial was conducted to test whether a ventilation strategy using low tidal volumes is superior to a ventilation strategy using intermediate tidal volumes with respect to the number of ventilator-free days and alive at day.

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Gulati, Uday, Christine Medeiros, Ananya Nanduri, Jack Kanoff, Samson Zarbiv, Michael Bonk, and Adam Green. "Understanding Pneumomediastinum as a Complication in Patients With COVID-19: A Case Series." Journal of Investigative Medicine High Impact Case Reports 10 (January 2022): 232470962211271. http://dx.doi.org/10.1177/23247096221127117.

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Pneumomediastinum is a rare complication among non-coronavirus patients but has been published with increased incidence in patients positive for SARS-CoV-2 infection. Most of these studies report patients on mechanical ventilation and an understanding of mechanisms causing this remains limited. We aim to use an increasing occurrence in patients not on mechanical ventilation to further explore mechanisms that predispose patients to pneumomediastinum and to assess characteristics potentially related to poor outcomes. We report a case series of 37 patients diagnosed with COVID-19 and pneumomediastinum at a 2-hospital institution between January 1, 2020 and April 30, 2021. At 28 days after diagnosis of pneumomediastinum, 19 (51.4%) were dead and mortality was significantly higher among those who were older ( t = 2.147, P = .039), female (χ2 = 10.431, P = .015), body mass index ≥30 (χ2 = 6.0598, P = .01), intubated (χ2 = 4.937, P = .026), and had pre-existing lung disease (χ2 = 4.081, P = .043). Twenty-three patients (62.2%) were identified to have pneumomediastinum without receiving invasive mechanical ventilation, of which 11 (47.8%) were diagnosed without receiving noninvasive ventilation. The increased diagnosis of pneumomediastinum in patients with COVID-19 while not on mechanical ventilation, in this case series and in comparable studies, may attribute to mechanisms aside from positive pressure ventilation such as patient self-induced lung injury and pulmonary frailty.

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Gregori, Ninel Z., Louis Cai, and Yasman Moshiri. "Self-Inflicted Laser-Induced Retinopathy." Diagnostics 14, no. 4 (February 7, 2024): 361. http://dx.doi.org/10.3390/diagnostics14040361.

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This photo essay details a patient with self-inflicted laser-induced retinal injury progressing to full-thickness macular holes in both eyes. A 40-year-old patient presented after a self-inflicted injury by a handheld class 3 blue laser (450 nm) he purchased on the internet. The patient reported shining the laser through a window, which reflected the beam back into his eyes. Visual acuity was measured at 20/400 in both eyes. The initial fundus photographs revealed vitreous and preretinal hemorrhages in the right eye, and multiple yellow-white fresh laser burns in the macula of the left eye. Optical coherence tomography (OCT) showed preretinal hemorrhage in the right eye and retinal disruption with preretinal hyper-reflective lesion in the left eye. After one month, his vision deteriorated to finger counting in each eye. He developed a full-thickness macular hole and hyperfluorescent curvilinear streaks in the superior maculae in both eyes. OCT images showed retinal pigment epithelium clumping and outer retinal atrophy in curvilinear streak areas in both eyes, which point to self-inflicted injury. This case illustrates laser-pointer-induced retinopathy and reinforces the necessity of public education on the dangers of utilizing handheld lasers without eye protection.

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MCQUINN, MICHELLE W., LAURA L. KIMBERLY, BRENDAN PARENT, J. RODRIGO DIAZ-SISO, ARTHUR L. CAPLAN, AILEEN G. BLITZ, and EDUARDO D. RODRIGUEZ. "Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation." Cambridge Quarterly of Healthcare Ethics 28, no. 3 (July 2019): 450–62. http://dx.doi.org/10.1017/s0963180119000379.

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Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.

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Colman, Ian, Niko Yiannakoulias, Don Schopflocher, Lawrence W. Svenson, Rhonda J. Rosychuk, and Brian H. Rowe. "Population-based study of medically treated self-inflicted injuries." CJEM 6, no. 05 (September 2004): 313–20. http://dx.doi.org/10.1017/s148180350000957x.

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ABSTRACTObjective:Self-inflicted injury is commonly seen in emergency departments (EDs). It may be a precursor to death by suicide. The objective of this study was to examine the epidemiology of self-inflicted injury presentations to EDs in the province of Alberta.Methods:Self-inflicted injury records for the 3 fiscal years 1998/99 to 2000/01 were accessed from the Ambulatory Care Classification System, a database that captures all ED encounters in the province of Alberta. Available data for each case included demographic details, location and time of visit, diagnoses and procedures.Results:There were 22 396 self-inflicted injury presentations to Alberta EDs during the study period. Self-inflicted injury rates were higher in females, younger patients, those on social services and those with Aboriginal treaty status. There were higher rates of return visits in the year following the self-inflicted injury than in other patient groups. Data showed regional variation. Trends could be seen in the timing of self-inflicted injury presentations by hour of day, day of week, and month of year.Conclusions:Self-inflicted injury is common, with particularly high rates demonstrated among marginalized populations. This study provides comprehensive data on those who present with self-inflicted injuries, and can be used to guide further treatment, research and evaluation for this population.

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Peterson, Cora, Likang Xu, Ruth W. Leemis, Deborah M. Stone, and Michael F. Ballesteros. "Non-fatal self-inflicted versus undetermined intent injuries: patient characteristics and incidence of subsequent self-inflicted injuries." Injury Prevention 25, no. 6 (October 23, 2018): 521–28. http://dx.doi.org/10.1136/injuryprev-2018-042933.

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BackgroundNon-fatal self-inflicted (SI) injuries may be underidentified in administrative medical data sources.ObjectiveCompare patients with SI versus undetermined intent (UI) injuries according to patient characteristics, incidence of subsequent SI injury and risk factors for subsequent SI injury.MethodsTruven Health MarketScan was used to identify patients’ (aged 10–64) first SI or UI injury in 2015 (index injury). Patient characteristics and subsequent SI within 1 year were assessed. A logistic regression model examined factors associated with subsequent SI.ResultsAmong analysed patients (n=44 806; 36% SI, 64% UI), a higher proportion of patients with SI index injury were female, had preceding comorbidities (eg, depression), Medicaid (vs commercial insurance), treatment in an ambulance or hospital and cut/pierce or poisoning injuries compared with patients with UI index injury. Just 1% of patients with UI had subsequent SI≤1 year vs 16% of patients with SI. Among patients with UI index injury, incidence of and risk factors for subsequent SI injury were similar across assessed age groups (10–24 years, 25–44 years, 45–64 years). Severe injuries (eg, treated in emergency department), cut/pierce or poisoning injuries, mental health and substance use disorder comorbidities and Medicaid (among adult patients) were risk factors for subsequent SI among patients with UI index injuries.ConclusionsRegardless of circumstances that influence clinicians’ SI vs UI coding decisions, information on incidence of and risk factors for subsequent SI can help to inform clinical treatment decisions when SI injury is suspected as well as provide evidence to support the development and implementation of self-harm prevention activities.

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Ho, Che-Fang, Yuan-Yun Tam, and Chia-Chen Wu. "Pneumocephalus Following Self-Inflicted Penetrating Brain Injury." Case Reports in Otolaryngology 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/7878646.

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Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

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Liu, Tom, Thomas J. Deiss, Matthew W. Lippi, Alejandra Jauregui, Kathryn Vessel, Serena Ke, Annika Belzer, et al. "Alternative Tobacco Product Use in Critically Ill Patients." International Journal of Environmental Research and Public Health 17, no. 23 (November 24, 2020): 8707. http://dx.doi.org/10.3390/ijerph17238707.

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Background: Alternative tobacco product (ATP) use has bee linked to critical illness, however, few studies have examined the use of these substances in critically ill populations. We sought to examine ATP use within critically ill patients and to define barriers in accurately assessing use within this population. Methods: We prospectively studied 533 consecutive patients from the Early Assessment of Renal and Lung Injury study, enrolled between 2013 and 2016 at a tertiary referral center and a safety-net hospital. ATP use information (electronic cigarettes, cigars, pipes, hookahs/waterpipes, and snus/chewing tobacco) was obtained from the patient or surrogate using a detailed survey. Reasons for non-completion of the survey were recorded, and differences between survey responders vs. non-responders, self- vs. surrogate responders, and ATP users vs. non-users were explored. Results: Overall, 80% (n = 425) of subjects (56% male) completed a tobacco product use survey. Of these, 12.2% (n = 52) reported current ATP use, while 5.6% reported using multiple ATP products. When restricted to subjects who were self-responders, 17% reported ATP use, while 10% reported current cigarette smoking alone. The mean age of ATP users was 57 ± 17 years. Those who did not complete a survey were sicker and more likely to have died during admission. Subjects who completed the survey as self-responders reported higher levels of ATP use than ones with surrogate responders (p < 0.0001). Conclusion: ATP use is common among critically ill patients despite them being generally older than traditional users. Survey self-responders were more likely than surrogate responders to report use. These findings highlight the importance of improving our current methods of surveillance of ATP use in older adults in the outpatient setting.

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Aksaray, gökay, sıdıka Erol, and Cem Kaptanoğlu. "Self-inflicted bilateral eye injury by a schizophrenic patient." General Hospital Psychiatry 22, no. 3 (May 2000): 215–16. http://dx.doi.org/10.1016/s0163-8343(00)00070-0.

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Cronn, Susan E., Jacey M. Kant, Amber Brandolino, Sara Kohlbeck, Terri deRoon-Cassini, Nathan Emerson, and Andrew Schramm. "Suicide Data in Trauma Centers: Implications of Imprecision." Journal of Trauma Nursing 30, no. 5 (September 2023): 255–60. http://dx.doi.org/10.1097/jtn.0000000000000739.

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BACKGROUND: Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied. OBJECTIVE: This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury. METHODS: We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent. RESULTS: During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm). CONCLUSION: We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.

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Chakravarty, Esha. "MALE BREAST CANCER IN OLDER ADULTS BELONGING TO THE LOWER-INCOME GROUP." Innovation in Aging 7, Supplement_1 (December 1, 2023): 764–65. http://dx.doi.org/10.1093/geroni/igad104.2471.

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Abstract Male breast cancer is a rare type of cancer constituting around 1% of male malignancies. Cases of 21 elderly (aged>60) patients diagnosed with breast cancer were studied with respect to age of onset, treatment choices, access to care, ability to perform activities of daily living (ADL) from CMIG, resource centre on ageing in east India. All 21 patients belonged to lower income group in society and the study was conducted over a 5 year period of 2018-2022. Primary symptom leading to diagnosis was self-detection of lump and the median time of diagnosis from onset of symptoms was 6 months. Twenty of the 21 patients were diagnosed with Stage III or Stage IV breast cancer and 1 patient was diagnosed with Stage I cancer. The average age of diagnosis of the patients was found to be 69 years. The main method of treatment was surgery for patient diagnosed in Stage I and surgery followed by chemotherapy and radiation therapy for the rest. None of the patients underwent hormone therapy and information regarding presence of hormone receptors was not available in all cases. Five of the 21 cases reported metastasis- 4 in bone and 1 in lung. Spouse or adult children were found to be caregivers with no access to trained caregivers or counsellors. All patients showed moderate decline in motor function and ADL after surgery alongwith susceptibility to fall or injury. Free hand exercises showed slight improvement. Further studies can attract state funding and influence heath policies for lower income groups.

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Çınar, Güle. "Heart transplant recipient survivor from COVID-19: The first case of Turkey." Turkish Journal of Thoracic and Cardiovascular Surgery 28, no. 4 (October 22, 2020): 674–79. http://dx.doi.org/10.5606/tgkdc.dergisi.2020.20291.

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Any highly infectious and rapidly spreading disease is a primary concern for immunocompromised solid organ transplant recipients. The number of data about the spectrum of clinical illness, the treatment modalities, and the outcomes of COVID-19 in this vulnerable population is scant and still remains empirical. Herein, we report the first COVID-19 case of a heart transplant recipient in Turkey who presented with fever, postnasal discharge, and myalgias for two days. The possibility of lung involvement was ruled out by thoracic computed tomography. Despite stable vital signs, we reduced the intensity of immunosuppressive therapy and maintained home self-isolation promptly. We also commenced a five-day course of hydroxychloroquine 200 mg q12h initially. After confirmation of real-time reverse-transcriptase-polymerase-chain-reaction testing of the nasopharyngeal swab positive for COVID-19, the patient was hospitalized. After a loading dose of favipiravir 1,600 mg b.i.d., the patient received a five-day course of favipiravir 600 mg q12h. He was discharged with cure after 23 days of hospital isolation and treatment. In conclusion, treatment process can be affected by the daily electrocardiography, hand-held portable echocardiography, myocardial injury markers, and pulse oximeter for self-monitoring in the follow-up of previous heart transplant recipients suffering from COVID-19. The lack of treatment protocols in the solid organ transplant recipients with COVID-19 infection and the controversies about the protective effect of immunosuppression invite a global and update discussion.

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Naura, Amarjit, Kunal Kapoor, Esha Singla, and Bijayani Sahu. "PARP inhibitor, olaparib ameliorates acute lung injury by modulating oxidative stress and NF-κB mediated inflammatory response in mice (HUM1P.265)." Journal of Immunology 194, no. 1_Supplement (May 1, 2015): 52.14. http://dx.doi.org/10.4049/jimmunol.194.supp.52.14.

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Abstract We have previously shown that poly (ADP-ribose) polymerase (PARP)-1 gene deletion in mice provide robust protection against lung inflammation in the context of asthma and acute lung injury. Olaparib is a potent new generation PARP inhibitor that has been approved for human testing in cancer patients. The present work was designed to evaluate its beneficial potential against LPS-induced acute lung injury upon intra-tracheal administration of the endotoxin in mice. Administration of olaparib at different doses, 30 min after LPS treatment showed that single injection of the drug effectively reduced the total number of inflammatory cells particularly neutrophils in the lungs. This was associated with reduced pulmonary edema as the total protein content in bronchoalveolar fluid was found to be decreased substantially. The drug restored the LPS mediated oxidative stress toward normal in lungs as assessed by measuring malondialdehyde and GSH levels. Finally, RT-PCR data revealed that olaparib downregulates the LPS induced expression of NF-κB dependent genes namely TNF-α, IL-1β and VCAM-1 in the lungs without altering the expression of total p65NF-κB. Overall, the data suggests that olaparib possesses a strong therapeutic potential against LPS induced lung injury in mice. Given the fact that olaparib is approved by FDA for human testing, our findings can pave the way for testing of the drug on humans inflicted with acute lung injury.

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Shimizu, Norihiro, Takayuki Baba, Yoshihiro Watanabe, and Shuichi Yamamoto. "Self-inflicted transorbital injury by chopstick in patient with schizophrenia." BMJ Case Reports 13, no. 12 (December 2020): e239721. http://dx.doi.org/10.1136/bcr-2020-239721.

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Rajasekar, MK, and Malarvizhi R. Sankar. "A Rare Case of Pediatric Self-inflicted Meningoencephalocele." An International Journal Clinical Rhinology 9, no. 3 (2016): 143–45. http://dx.doi.org/10.5005/jp-journals-10013-1289.

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ABSTRACT Cerebrospinal fluid (CSF) rhinorrhea is common in traumatic penetrating nasal injuries. In the pediatric age group, we often encounter self-inflicted foreign body injuries of blunt type, which rarely leads to any complications. We came across a case of CSF rhinorrhea due to self-inflicted penetrating nasal injury, after 7 years of initial injury. In this case, the sharp end of a screw nail had injured the fovea ethmoidalis and caused a meningoencephalocele on removal, which had been asymptomatic until 4 years ago, when the patient came with CSF rhinorrhea. Miraculously, there were no complications in the period before presentation and after surgical correction. How to cite this article Rajasekar MK, Sankar MR. A Rare Case of Pediatric Self-inflicted Meningoencephalocele. Clin Rhinol An Int J 2016;9(3):143-145.

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Neetz, Benjamin, Thomas Flohr, Felix J. F. Herth, and Michael M. Müller. "„Patient self-inflicted lung injury“ (P-SILI)." Medizinische Klinik - Intensivmedizin und Notfallmedizin, May 7, 2021. http://dx.doi.org/10.1007/s00063-021-00823-2.

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