Tanaffos Respiration Journal
Volume:18 Issue: 4, Autumn 2019

Tracheostomy is common among intensive care unit (ICU) patients. Reconsideration of tracheostomy indications in patients can be effective in modifying and reducing irrevocable patient complaints. The present study aimed to analyze the prevalence of tracheostomy indications and to estimate the prevalence of tracheostomy in Iran.

In this systematic review and meta-analysis, scientific databases were searched from January 1990 to April 2018. The inclusion criteria were as follows: 1) use of the term “tracheotomy” in the title; and 2) studies conducted in Iran. On the other hand, the exclusion criteria were: 1) studies that did not specify the type of mechanical ventilation; 2) studies that did not quantitatively report the indications; 3) studies without access to the full-text; and 4) case studies, letters to the editor, and/or prefaces. Data were extracted from published reports. Our preliminary results included estimations of tracheostomy indications in Iran.

In the preliminary search, a total of 325 articles were found, 24 of which were considered eligible. Among 2860 patients who had undergone tracheostomy, 21 indications were identified. Decreased mental status, respiratory disease, and tumors were the most frequent indications. The prevalence of tracheostomy was 40.59% in Iran, with the highest and lowest rates reported in Birjand and Ardabil, respectively (136.50 and 6.63 in 100,000 people, respectively) based on the random effects model.

The most prevalent indications in Iran are different from those reported in other countries. This difference may be due to the lack of trained medical personnel and available technologies.

The relationship between dietary pattern and the risk of chronic obstructive pulmonary disease (COPD) has been described; however, the exclusive role of dietary factors remains controversial. Hence, we conducted this systematic meta-analysis to clarify the role of some nutrients and antioxidant vitamins in the risk of COPD.

PubMed, Embase, and Scopus databases were searched for studies evaluating the associations between COPD outcome measures, symptoms, and mortality, and intake of fruits and vegetables, fiber, fish, n-3 or n-6 fatty acids, and antioxidant vitamins in adults. The randomeffect model meta-analyses were used to pool the results.

Ten cohort, six case-control, and 20 cross-sectional studies were identified. The pooled relative risks (RRs) of the COPD and confidence intervals (CIs) for the highest intake group compared with the lowest intake group were 0.74 (95% CI: 0.65-0.85) for fruit, 0.65 (95% CI: 0.55-0.78) for dietary fiber, 0.71 (95% CI: 0.58-0.85) for fish, and 0.89 (95% CI: 0.76-0.99) for vitamin C. No association was observed between the risk of COPD and the intake of vegetables, n-3 fatty acids, vitamin E, and β-carotene; however, it was associated with n-6 fatty acids 1.06 (95% CI: 0.87-1.30).

The results suggested that a higher intake of fruits, probably dietary fiber, and fish reduce the risk of COPD.

Massive hemoptysis is a potentially life threatening medical condition and one major problem for both patients and physicians. Choosing the appropriate treatment for the patients is crucial in order to decrease the complications and increase the success rate. Hence, in this study the outcomes and complications of bronchial angioembolization (BAE) were determined in patients with massive hemoptysis.

In this prospective cohort, 189 consecutive patients with moderate and severe hemoptysis who had referred to two large cardiovascular centers were enrolled. The Chest X Ray, CT Scan, Fiberoptic Bronchoscopy, Selective and Nonselective Bronchial Angiography were performed in patients. The outcomes with 20-month follow-up were compared.

The immediate success rate was 97.3%. In 79.7% there were no complications. Temporary chest pain, subintimal dissection, temporary dysphagia, and pancreatitis were seen in 12.3, 2.4, 5.1, and 0.5%, respectively, without any major complication. The in-hospital mortality rate was 1.1% and mortality during 20-month follow-up was 9.6%, and recurrence rate was 28.3% on total.

Our case series showed that BAE is a safe and effective method in treating patients with hemoptysis. Compared to surgery, the procedure is faster and less invasive and might be used both as first line or bridging therapy. Importantly, no major complications have been detected.

This study aimed to assess the outcomes of bi-level positive airway pressure (BIPAP) therapy among patients with obesity hypoventilation syndrome (OHS).

In this prospective observational study, a total of 30 patients with OHS, who were subjected to BIPAP therapy, were included. The peripheral capillary oxygen saturation (SPO2), partial pressure of carbon dioxide (PCO2), body mass index (BMI), and body composition indices, including total body fat (TBF), total body protein (TBP), total body mineral (TBM), and total body water (TBW), were measured using standard procedures at baseline and one week, one month, and six months after the onset of treatment. Changes in the variables over time were evaluated using repeated measures analysis of variance (ANOVA). The correlation between changes in the body composition indices and changes in gas exchange was also assessed by Pearson’s correlation coefficient test at three time points from the baseline.

The results revealed that all study variables, except for TBF, changed significantly during the study in both males and females (P<0.001). There was a significant positive association between changes in PCO2 and changes in TBM after six months (r=0.4, P<0.05), whereas a significant inverse correlation was found between changes in PCO2 and changes in TBW after six months (r=-0.39, P<0.05). However, no significant correlation was found between changes in gas exchange and changes in BMI or other body composition indices after six months.

The present results indicated no significant association between the improvement of gas exchange and changes in BMI, TBP, and TBF during the study. However, further large-scale studies are required to examine the effects of BIPAP therapy on body composition in patients with OHS.

Asthma is a complex chronic inflammatory airway disease affecting millions of people worldwide. The prevalence of asthma attacks in most regions of the world, including the developing countries, increases due to urbanization, industrialization, and lifestyle.

The present study aimed at investigating the prevalence of asthma and asthma symptoms in five provinces of Iran using the stratified cluster sampling method and the European Community Respiratory Health Survey (ECRHS) questionnaire.

A total of 4918 subjects were enrolled in the study. The prevalence of nocturnal cough was 27.4% (95% confidence interval (CI): 26%-28%); it was the most common asthma symptom followed by nocturnal shortness of breath (19.6%; 95%CI: 18-21%). For participants aged 20-44 years, the most prevalent symptoms were coughing attacks (37.7%), shortness of breath (26.5%), and nasal allergies (22.7%), respectively.

There was a significant association among gender, age, and nasal allergy. Relevant studies should be conducted to figure out the countrywide distribution and the real burden of the disease.

Many pharmacological and behavioral therapies have been investigated to improve oxygenation in the intensive care unit (ICU). In patients with chronic obstructive pulmonary disease (COPD), the purpose of therapy is to correct the ventilation perfusion (V/Q) mismatch. Agents, such as calcium blockers, can affect both ventilation and vasculature. The inhalation route allows a more rapid achievement of therapeutic effects with few systemic side effects. Therefore, the present study aimed to investigate the effect of nebulized verapamil on oxygenation in COPD patients.

In this double-blind, randomized clinical trial, twenty hypoxic COPD patients, admitted to ICU, were treated with 10 mg of verapamil twice daily for three days. Also, twenty patients with COPD, who were matched in terms of age, sex, and severity of the disease, were enrolled in the control group and received nebulized normal saline. The oxygenation parameters were compared using an arterial blood gas (ABG) test before and after the intervention.

The mean oxygen saturation was 91.2%±12.15 before verapamil inhalation, which increased to 95.75%±14.57 after receiving nebulized verapamil (P<0.05). Also, correction of blood pH, blood oxygen pressure, and oxygen ratio (PaO2/FIO2) were higher in patients receiving verapamil, compared to the control group. The length of hospital stay was similar in the two groups. During the first three days, 30% of patients in the verapamil group and 20% of patients in the control group were intubated.

Our results indicated that verapamil inhalation increased oxygen saturation and accelerated extubation in patients with COPD.

Continuing medical education (CME) is an integral part of nursing professionalization, which can be effective in the development of nursing behavior. E-learning can play an important role in CME programs. This study aimed to evaluate the effectiveness of an E-learning program in increasing the nurses’ knowledge and behavior regarding care for venous thromboembolism (VTE) patients.

One-hundred nurses were selected via convenience sampling method and divided into E-learning and traditional education groups. All nurses had access to the Internet, as well as adequate Internet literacy. Each nurse in the E-learning group received three didactic files during the intervention (four weeks), which focused on the VTE risk assessment, methods of prophylaxis, prophylaxis guidelines, diagnosis, pharmacological and non-pharmacological treatments, and patient education. On the other hand, nurses in the traditional education group were taught traditionally by an expert lecturer, who used audiovisual materials for teaching. A pretest-posttest analysis and a checklist were used to evaluate the impact of interventions in the groups. Chi-square and Mann-Whitney tests were also used to analyze the data.

The comparison of knowledge level between the groups showed that E-learning is not superior to traditional learning methods. The mean changes in the nurses’ behavior was 3.16±1.49 in the E-learning group and 2.77±1.26 in the conventional education group. Statistical analysis showed a significant relationship between the score changes and E-learning.

Integration of E-learning in CME programs, besides attendance of traditional courses, can be an effective learning method. We suggest that future studies compare the effects of these methods.

Automobile spray painting is considered a high-risk occupation for respiratory diseases. The present survey aimed to assess the effects of automobile paint vapors on spirometric parameters among workers of a painting workshop in a large automobile manufacturing plant in Iran.

This cross-sectional study was conducted on 820 workers of an automobile manufacturing plant, including 431 spray painters (case group) and 389 assembly line workers (control group). Spirometry was conducted for all participants under standard conditions, according to the American Thoracic Society (ATS) Clinical Practice Guidelines. The forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75) were reported.

Painters with more than ten years of work experience had significantly lower predicted values of FEV1/FVC (P= 0.005), FEV1 (P=0.008), and FEF25-75 (P=0.003), compared to the control group. Also, painters who were exposed to solvent-based paints were not significantly different from those exposed to water-based paints in terms of spirometric parameters (P>0.05).

The results indicated the impact of automobile spray painting on the spirometric parameters. A slight decrease in the mean values of these parameters calls for attention to occupational safety, regular medical examinations, and effective measures.

In mechanically ventilated patients, portable chest radiography (CXR) can provide important information for selecting the optimal therapeutic approach. This study aimed to determine the diagnostic and therapeutic efficacies of portable recruited chest radiography with maximum inspiratory volume and pause in comparison with conventional portable radiography.

This diagnostic accuracy study was conducted on 75 mechanically ventilated patients admitted to the intensive care unit (ICU) of Imam Khomeini Hospital in Sari, Iran, during 2013-2015. For every patient, in addition to conventional portable CXR, another CXR was performed with mechanical ventilator adjustments (tidal volume up to 10-12 ml/kg to maintain the inspiratory plateau pressure below 35 cmH2O and inspiratory time of 2-3 seconds). CXR was performed after 5-10 respiratory cycles, synchronized with the inspiratory pause. The radiographs were acquired using a Shimadzu portable radiography system in the anteroposterior supine position and randomly presented to two radiologists for reporting.

The mean age of the patients was 63.5±14 years. Overall, 43 (57.3%) patients were male, and 32 (42.7%) were female. Therapeutic interventions were performed for only 8% of cases with conventional CXR versus 21.3% of cases with recruited CXR; the difference was found to be statistically significant (P<0.05). The diagnostic efficacy of portable recruited CXR versus conventional portable CXR was 45% versus 18.6%. Also, the therapeutic efficacy of portable recruited CXR versus conventional portable CXR was 21.3% versus 8%.

Portable recruited CXR seems to be a valuable diagnostic approach for clinical decision-making, with higher diagnostic and therapeutic efficacies in mechanically ventilated patients.

Thymoma is relatively rare tumor. Prognosis and patients' outcome vary across different studies. We aimed to study the predisposing factors causing tumor recurrence in thymoma patients.

A total of 43 thymoma or thymic carcinoma patients treated at the National Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital from September 2005 to January 2017 were evaluated. The primary endpoint was the progression free survival (PFS). The relation of predisposing factors to PFS was studied.

Median age was 55 years old. The mean of follow-up duration was 22.9 months. The most prevalent pathology was thymoma unspecified. Pure red cell aplasia (n=3, 6.9%) was the most prevalent Para neoplastic syndrome. Most of the patients (n=23, 54%) were in stage III and IV Masaoka-Koga staging system. Disease progression was observed in 17 patients (39. 5%). Most recurrences occurred locally. None of demographic characteristics differed between patients who experienced disease recurrence and those who did not. After univariate and multivariate analysis, predisposing factor for disease progression was only Masaoka-Koga stage (P- value=0.015 and 0.031 respectively).

In this study, among different probable predisposing factors, only Masaoka-Koga stage had significant effect on disease recurrence. Large casecontrol studies may be required for better evaluation of risk factors.

Sternal fracture is an uncommon injury, which is managed conservatively in most patients. In case of failure of non-surgical management or severely displaced fractures, open reduction and internal fixation should be considered. In this case report, we present the technical details of open reduction and internal fixation for a severely displaced sternal fracture in a bicyclist. The sternal fracture was successfully treated, and the patient benefited from the rapid control of symptoms, early mobilization, and good cosmetic outcome.

Open surgical treatment of a sternal fracture, when indicated, can be performed safely, with rapid control of symptoms, low risk of non-union, and good cosmetic outcome.

Massive hemoptysis refers to bleeding from the sputum exceeding 100 ml/day. This condition is known to have a poor prognosis. Although foreign body aspiration is not as common as other risk factors, it may result in massive hemoptysis. In the current study, we presented a case of massive hemoptysis due to the aspiration of a toothpick.

The patient was a 49-year-old woman who was primarily suspected of having tuberculosis. After observing blood in the sputum, interventions, including chest computed tomography (CT) scan and conservative management, were performed. The CT scan showed no malignancy, and paraclinical investigations were negative. However, hemoptysis was progressing into an acute phase; therefore, a surgical intervention was performed for the patient. After the surgery, the cause of the lesion was found to be a toothpick. The patient was under intensive care after surgery and was discharged from the hospital in a good general condition. The morphological evaluation of the lesion showed a bronchial wall with ulceration, besides granulation tissue formation, hematoma, and fibrinoid necrosis due to foreign body aspiration into the lung, resulting in inflammatory reactions.

In this case report, foreign body aspiration resulted in massive hemoptysis. Our primary attempts to diagnose the cause of lesion were unsuccessful, and surgery was performed due to the life-threatening condition of the patient. Overall, unexplained hemoptysis may occur following a serious accident due to foreign body aspiration.