Massive pulmonary embolism (PE) is a type of complication related to the migration of deep venous thrombi clot to the lungs. Massive PE is associated with a high level of morbidity and mortality due to elevated pulmonary vascular resistance that can cause right ventricular failure, cardiogenic shock, and hypoxemia. This report aims to explain to the readers the efficacy of applying inhaled nitric oxide (iNO) to patients with a massive PE. It also aims to evaluate iNO's pulmonary vasodilator efficacy for acute PE.

Background: Bilevel positive airway pressure (BiPAP) is a form of non-invasive ventilation (NIV) that is used to help and facilitate breathing. Our objective is to evaluate the impact of BiPAP application time on the length of emergency room (ER) stay in pulmonary edema patients. Method: This is a retrospective cohort study that included patients who presented to the ER at King Abdullah Medical City (KAMC) from June 2019 to June 2021. The eligibility criteria for BiPAP application were congestive heart failure (CHF) and type 1 and type 2 respiratory failure, The data were collected from the Track Care system. We defined early BiPAP as BiPAP application time within one hour from admission, and late BiPAP more than one hour and we calculated the percentage of discharge within four hours in each group. Result: Out of 147 fulfilling study eligibility, 64% had CHF, 23% had type 2 respiratory failure and 13% had type 1 respiratory failure. For patients discharged within four hours, 85% were in the early BiPAP and 15% were in the late BiPAP groups (p = 0.001 as compared to the late discharge group). Discharge within four hours was observed with the following percentages in the study subgroups: CHF early BiPAP (84%), late BiPAP (16%) (p = 0.004), type 1 respiratory failure early BiPAP (79%), late BiPAP (21%) (p = 0.71) and type 2 respiratory failure early BiPAP (94%), late BiPAP (6%) (p = 0.89). Conclusion: Our results show that there is a significant outcome in early BiPAP application in decreasing the length of ER stay only in patients with pulmonary edema.

Background: HFNC is a respiratory mask that covers the nose like an oxygen mask, with the addition of nasal prongs to deliver extra oxygen. At 12 hours, a ROX score above or equal to 4.88 predicts a decreased probability of progressing to mechanical ventilation. Objective: The aim of this study was to evaluate using a high-flow nasal cannula as a potential predictor of delaying intubation. In doing this, the study also sought to verify whether the ROX index accurately predicts HFNC failure for COVID-19 patients treated in the intensive care unit (ICU). Method: Using retrospective observational analysis of prospectively collected data and the study population of patients in the ICUs at KAMC, the study collects and analyzes data using SPSS. Results: P values that are < 0.05 show that the mean differences are statistically significant, and this is seen on days 1-1, day 1-2, day2-1, day 2-2, day 3-1, day 3-2, day 4-2, day 10-1, and day 10-2. This suggests that ROX index can be used in intubation prediction with COVID-19 patients who have respiratory failure type I that received HFNC therapy.