Respiratory failure in tuberculosis: a modern perspective

Shneerson, John M.

doi:10.7861/clinmedicine.4-1-72

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…Various conditions, including TB, may result in ARF because of progression of underlying pulmonary infiltration or comorbidities [2], and high mortality in MTB may be the outcome of ARF itself or of other causes. Therefore, the clinical variables affecting the development of ARF and mortality were elucidated in patients with MTB.…”

Section: Discussionmentioning

confidence: 99%

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Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

Kim²,

Sy³

et al. 2008

Eur Respir J

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The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition.Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; ,18.5 kg?m The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (o3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB.A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

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Section: Discussionmentioning

confidence: 99%

“…The clinical implications of MTB are emphasised by the possibility of progression to acute respiratory failure (ARF) and high mortality [1][2][3][4]. While the mortality related to MTB is ,25-30% in adults, it is increased to 69% when patients with MTB require mechanical ventilation [4].…”

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confidence: 99%

Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

Kim²,

Sy³

et al. 2008

Eur Respir J

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“…Although the incidence of acute respiratory failure induced by pulmonary tuberculosis from a previous observational study was approximately 1.5%, mortality of the patients with pulmonary tuberculosis who developed acute respiratory failure and required mechanical ventilation ranged between 47% and 80% (4,5,(7)(8)(9)(10)(11)(12). The mortality rate of active pulmonary tuberculosis requiring mechanical ventilation (TBMV) was double the mortality rate of patients with severe bacterial pneumonia who developed acute respiratory failure (13). In addition, pulmonary tuberculosis complicated by acute respiratory failure requires several modalities, manpower, and interventions to treat and prevent further spreading of organisms, which may burden the limited resources of some countries (14,15).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review

Bhurayanontachai¹,

Maneenil²

2016

J. Thorac. Dis.

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Background: Pulmonary tuberculosis with acute respiratory failure is fatal and is a burden in the intensive care units and leads to mortality. This retrospective study identifies the factors influencing the development of pulmonary tuberculosis requiring mechanical ventilation (TBMV) and mortality in the hospitalized patients with pulmonary tuberculosis. Methods:The medical records of hospitalized adult patients with pulmonary tuberculosis were retrospectively reviewed. Demographic data, clinical presentations, radiographic findings, biochemical tests, and clinical outcomes were collected. Data were compared by Student's t-test and Chi-square test between groups. Select variables that were statistically significant with P values <0.1 were introduced into a forward, stepwise, logistic regression model. Odds ratios (ORs) and their 95% confidence intervals (CIs) identified the independent influencing factors in the development of TBMV and mortality.Results: Of 268 enrolled patients, 185 (69.0%) were male. The patients were equally divided between the TBMV and non-TBMV groups. The shorter duration of illness (OR, 0.99; 95% CI, 0.98-0.99), underlying disease of AIDS (OR, 14.55; 95% CI, 1.71-123.91), presentation of fever (OR, 2.11; 95% CI, 1.20-3.71) and dyspnea (OR, 3.51; 95% CI, 2.02-6.11), large amount of acid fast bacilli on sputum smear (OR, 3.76; 95% CI, 1.90-7.47), lower serum albumin level (OR, 0.39; 95% CI, 0.26-0.59), and delayed initiation of antituberculosis agents (OR, 1.06; 95% CI, 1.00-1.12) were independent factors to develop TBMV. Male gender (OR, 2.16; 95% CI, 1.01-4.61), consolidation pattern on chest X-ray (OR, 2.41; 95% CI, 1.17-4.98), and lower serum albumin (OR, 0.39; 95% CI, 0.21-0.71) were correlated to mortality. Conclusions:The incidence and mortality rate of TBMV patients were high. Acute tuberculous pneumonia, underlying disease of AIDS, amount of acid fast bacilli, and delayed administration of antituberculosis agents were independent risk factors to develop TBMV. Male gender, consolidation on chest X-ray, and low serum albumin were significantly related to mortality.

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“…In Japan, tuberculosis was one of the most contagious diseases before World War II; after that, the mortality of tuberculosis decreased rapidly over a 2-decade period [2]. During the time when no effective anti-tuberculosis drugs were available, surgical therapy, such as thoracoplasty, was the most effective therapy, and in Japan, 1 million patients with pulmonary tuberculosis underwent chest surgery [3,4]. Advanced pulmonary tuberculosis, due to delays in its diagnosis and treatment, continues to be a disease that causes a major health burden that can result in residual anatomic and cardiopulmonary changes [4][5][6][7], despite developments in anti-tuberculosis therapy [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…During the time when no effective anti-tuberculosis drugs were available, surgical therapy, such as thoracoplasty, was the most effective therapy, and in Japan, 1 million patients with pulmonary tuberculosis underwent chest surgery [3,4]. Advanced pulmonary tuberculosis, due to delays in its diagnosis and treatment, continues to be a disease that causes a major health burden that can result in residual anatomic and cardiopulmonary changes [4][5][6][7], despite developments in anti-tuberculosis therapy [8][9][10][11][12]. In Japan, the sequelae of pulmonary tuberculosis (TBsq) due to complicated TB and/or surgical therapy are related to the cardiopulmonary disorder that frequently occurs and still limits patients' activities of daily living because of exertional dyspnea.…”

Section: Introductionmentioning

confidence: 99%

Exertional dyspnea-related acidotic and sympathetic responses in patients with sequelae of pulmonary tuberculosis

et al. 2010

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The objective of this study was to investigate whether exertional dyspnea correlates with exercise responses, especially arterial blood pH and plasma norepinephrine (NE) changes, in patients with sequelae of tuberculosis (TBsq). Cardiopulmonary exercise testings were performed in 49 TBsq patients and 9 controls. Each group had a break point in the dyspnea, plasma lactate, and plasma NE changes during exercise, all of which occurred at a similar exercise point. In TBsq patients in both exercise phases before and after the dyspnea break point, the dyspnea-slope (DeltaBorg scale/Deltaminute ventilation) correlated with the pH-slope (DeltapH/Deltaoxygen uptake) (r = -0.616, p < 0.0001; r = -0.629, p < 0.0001, respectively, before and after the break point) and with the NE-slope (DeltaNE/Deltaoxygen uptake) (r = 0.443, p = 0.0012; r = 0.643, p < 0.0001, respectively, before and after the break point). In TBsq patients during exercise, increases in circulating NE levels and exertional acidosis were correlated with exertional dyspnea.

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Respiratory failure in tuberculosis: a modern perspective

Cited by 18 publications

References 20 publications

Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review

Exertional dyspnea-related acidotic and sympathetic responses in patients with sequelae of pulmonary tuberculosis

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