Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory.

A 32-year-old woman with histiocytic lymphoma was in complete clinical remission after two courses of chemotherapy, when peripheral neuropathy developed fulminantly. Abnormalities included facial nerve paralysis, dysphagia, quadriparesis, myalgia, and incontinence. She died 10 days after onset of these symptoms. Postmortem examination revealed infiltration of peripheral nerves by lymphomatous cells with no involvement of meninges, brain, lymph nodes, or other organs. Differences in the blood-brain barrier of peripheral and central nervous system are suggested: The peripheral barrier may be more penetrable by malignant histiocytes or less permeable to cytotoxic drugs. Intrathecal chemotherapeutic drug instillation and irradiation may be beneficial.

The use of NIV in very old patients was effective in many cases. Endotracheal intubation after NIV failure was not efficacious in either group.

BACKGROUND: Open mouthpiece ventilation is efficacious in patients with neuromuscular disease. We used this ventilation technique in patients with exacerbations of COPD with mild to moderate acidosis. METHODS: The study was performed in 2 respiratory monitoring care units. Fifty subjects with exacerbations of COPD, breathing frequency > 25, P aCO 2 > 45, and pH between 7.25 and 7.30, as well as Kelly scale < 2 were enrolled. Subjects were randomly assigned to receive noninvasive ventilation (NIV) via nasal mask or mouthpiece ventilation. The primary outcome was improvement in arterial blood gases. Arterial blood gases and breathing frequency were recorded 2 h after the start of the enrollment and then after 12, 24, and 48 h. The duration of NIV, hospital stay, and acceptability of the interface (mouthpiece or nasal mask) using a Likert scale were assessed. RESULTS: No subjects had deterioration of gas exchange. The 2 groups had similar trends in arterial blood gases and breathing frequency. No differences in duration of NIV or hospital stay were noted. However, a significant difference in acceptability was found: subjects preferred mouthpiece ventilation (P < .01). CONCLUSIONS: Open mouthpiece ventilation is a useful technique and may prevent further deterioration of gas exchange in COPD patients with mild to moderate acidosis (similar to traditional NIV delivered by a nasal mask). www.chictr.org registration ChiCTR-TRC-12002672.

The use of non-invasive ventilation (NIV) in severe hypoxemic respiratory failure (PaO 2 /FIO 2 ≤250) due to H1H1 virus pneumonia is controversial. In this prospective study, we aimed to assess the efficacy of NIV in avoiding endotracheal intubation and to identify predictors of success or failure. Nineteen patients with H1N1 viral pneumonia had severe respiratory failure (PaO 2 /FIO 2 ratio ≤250). Five patients with PaO 2 /FIO 2 lower than 150 and simplified acute physiology score (SAPS II) lower than 34 underwent NIV and were admitted to the Intensive Care Unit and received NIV as first-line therapy. NIV failed in 2 of the 14 patients but had a good outcome in 12. None of the patients treated with NIV died. The duration of NIV was 5.0±1.9 days and the hospital stay was 11.3±1.2 days. The average PaO 2 /FIO 2 ratio after 1 h of NIV was 239.1+38.7. No patient had multi-organ failure. PaO 2 /FIO 2 ratio after 1 h and SAPS II at admission were independent variables correlated with the success of NIV. In our study, NIV was successful in 12 of the 14 patients (85.7%) and this is one of the highest success rates in the literature. In our opinion, the reason for these results is the strict selection of patients with severe respiratory failure (PaO 2 /FIO 2 ratio ≥150) and the strict following of predictors of success for NIV such as SAPS II of 34 or lower and PaO 2 /FIO 2 ratio of 175 or lower after 1 h of NIV. Clinicians should be aware of pulmonary complications of influenza A H1N1 and strictly select the patients to undergo NIV. NIV could have an effective and safe role in reducing the high demand for critical care beds, particularly during the pandemic.