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Objective To investigate the risk factors for Type II respiratory failure associated with severe scoliosis in patients under 40 years of age. Methods Patients with severe scoliosis and pulmonary impairment treated in our hospital from January 2020 to December 2022 were recorded. We evaluated the spinal parameters in standing full spine X-rays, including the main thoracic curve, thoracic kyphosis, apical vertebrae, and distance between T1-T12. We also assessed the patient’s pulmonary function test (PFT), including forced vital capacity (FVC) and the percentage of measured FVC values to predicted values (FVC%). Results The study included 64 patients with severe and rigid scoliosis accompanied by severe pulmonary impairment. They were divided into two groups: Group 1 comprised 22 patients with Type II respiratory failure, and Group 2 comprised the remaining 42 patients without respiratory failure. The average age of onset for the two groups was 2.3 ± 2.9 years and 4.0 ± 4.5 years, respectively. The range of the apical vertebrae in Group 1 was from T6 to T11, and the range in Group 2 was the same. There was no significant difference in the main curve and kyphosis angle between the two groups. The average T1-T12 distances for the two groups were 130.3 ± 32.7 mm and 148.2 ± 37.6 mm, respectively. The PFT results indicated that all patients had severe pulmonary function impairment. Multivariate logistic regression analysis revealed that a T1-T12 distance of less than 100 mm was an independent risk factor for Type II respiratory failure. Conclusions If not treated properly, early onset scoliosis would have a severe impact on pulmonary function. The T1-T12 distance was a risk factor for Type II respiratory failure associated with severe scoliosis in patients under 40 years old.

Background Nasal Highflow (NHF) delivers a humidified and heated airflow via nasal prongs. Current data provide evidence for efficacy of NHF in patients with hypoxemic respiratory failure. Preliminary data suggest that NHF may decrease hypercapnia in hypercapnic respiratory failure. The aim of this study was to evaluate the mechanism of NHF mediated PCO 2 reduction in patients with chronic obstructive pulmonary disease (COPD). Methods In 36 hypercapnic COPD patients (PCO 2  > 45 mmHg), hypercapnia was evaluated by capillary gas sampling 1 h after NHF breathing under four conditions A to D with different flow rates and different degrees of leakage (A = 20 L/min, low leakage, two prongs, both inside; B = 40 L/min, low leakage, two prongs, both inside; C = 40 L/min, high leakage, two prongs, one outside and open; D = 40 L/min, high leakage, two prongs, one outside and closed). Under identical conditions, mean airway pressure was measured in the hypopharynx of 10 COPD patients. Results Hypercapnia significantly decreased in all patients. In patients with capillary PCO 2  > 55 mmHg ( n  = 26), PCO 2 additionally decreased significantly by increased leakage and/or flow rate in comparison to lower leakage/ flow rate conditions (A = 94.2 ± 8.2%; B = 93.5 ± 4.4%; C = 90.5 ± 7.2%; D = 86.8 ± 3.8%). The highest mean airway pressure was observed in patients breathing under condition B (2.3 ± 1.6 mbar; p  < 0.05). Conclusions This study demonstrates effective PCO 2 reduction with NHF therapy in stable hypercapnic COPD patients. This effect does not correlate with an increase in mean airway pressure but with increased leakage and airflow, indicating airway wash out and reduction of functional dead space as important mechanisms of NHF therapy. These results may be useful when considering NHF treatment in hypercapnic COPD patients. Trial registration Clinical Trials: NCT02504814; First posted July 22, 2015.

Objective To evaluate the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure. Methods Seventy-two patients with AECOPD and type II respiratory failure were randomly allocated to an HFNC oxygen therapy trial group or a non-invasive positive-pressure ventilator therapy (NIPPV) control group. Their arterial blood gas parameters and comfort, evaluated using a questionnaire, were compared before and after the therapeutic interventions. Results The PaCO2 and blood HCO 3 − concentration of both groups were significantly reduced by the treatments, whereas the pH, PaO2 and PaO2/FiO2 were increased. The PaCO2 of the experimental group was significantly lower than that of the control group following treatment. The PaO2 of the experimental group was significantly higher than that of the control group. The tracheal intubation rates of the two groups did not significantly differ. After treatment, all the indices of comfort were rated higher in the HFNC group than in the NIPPV group. Conclusions HFNC has a good therapeutic effect in patients with AECOPD and type II respiratory failure. It improves patient comfort and has clinical value.

Objective This study aims to summarize the risk factors of type II respiratory failure in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD), to guide clinical treatment in time, and consequently reduce the serious impact of COPD on human health. Methods Five databases were searched for relevant articles on risk factors of acute exacerbation of COPD combinate with type II respiratory failure. We calculated the standard mean difference (SMD), odds ratio (OR), and their 95% confidence interval (95% CI) utilizing a fixed‐effect model or a random‐effect model according to the level of heterogeneity. Results As of 14 May 2021, 13 articles were included in our meta‐analysis. The results showed that low albumin and uric acid levels were the risk factors for type II respiratory failure in acute exacerbation of COPD patients, and the differences were statistically significant (albumin: SMD = −2.03, 95% CI: −2.81, −1.26; uric acid: SMD = −1.28, 95% CI: −1.41, −1.15). Besides, 10 other systematic markers have been reported to be the risk factors for type II respiratory failure of patients with acute exacerbation of COPD, but only in single study. Conclusion The meta‐analysis results further confirm that low albumin and uric acid levels are risk factors for type II respiratory failure in acute exacerbation of COPD patients. Additionally, this analysis also summarizes many emerging inflammatory indicators, nutritional indicator, and cardiovascular system indicators to predict the progression of acute exacerbation of COPD to type II respiratory failure but only in single study.

Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy is well recognized in the management of hypoxemic respiratory failure; however, its role in acute hypercapnic respiratory failure remains less well defined and requires further investigation. It is important to detect more predictive factors for HFNC failure to guide early escalation of care. The evaluation of diaphragmatic dysfunction with the ultrasound (US) may provide an important first step. This study aimed to evaluate the value of bedside diaphragmatic ultrasound in predicting the outcome of HFNC in type II respiratory failure. We conducted a prospective study including 25 patients with type II respiratory failure who were admitted to the respiratory ICU at Cairo University and treated with HFNC between June and November 2022. They were divided into two groups according to HFNC outcome: the HFNC success group (11 patients) and the HFNC failure group (14 patients). Diaphragmatic ultrasound was performed in both groups prior to HFNC initiation to assess diaphragm excursion and thickening fraction. In the HFNC success group, follow-up diaphragmatic ultrasound was performed after liberation from HFNC. Results In the HFNC success group, the mean initial excursion was 1.70 ± 0.64 cm and the mean initial thickening fraction was 52.15 ± 22.20%, while in the HFNC failure group, the mean initial excursion was 1.83 ± 0.56 cm and the mean initial thickening fraction was 38.43 ± 16.13%. No statistically significant difference was found between the two groups. All patients with interstitial lung disease succeeded on HFNC therapy, while all patients with obesity hypoventilation syndrome failed on HFNC (p-value = 0.009 and p-value = 0.046 respectively). In the HFNC success group, statistically significant improvements were found between the initial and follow-up excursion (p-value = 0.008) and between the initial and follow - up thickening fraction (p-value = 0.021). Conclusion HFNC outcomes in type 2 respiratory failure are influenced by multiple factors, especially the diversity of underlying etiologies and disease processes. Diaphragmatic ultrasound parameters, including excursion and thickening fraction measured before initiation of high-flow nasal cannula (HFNC), were not sufficient on their own to predict the outcome of HFNC therapy in patients with type 2 respiratory failure. Following successful HFNC therapy, significant improvement was observed in diaphragmatic parameters, including excursion and thickening fraction.

Background: Hypothyroidism is a disease commonly observed in outpatient clinics but can occasionally cause severe cardiovascular and respiratory diseases requiring hospitalization. Case report: The patient reported herein suffered from heart failure, massive pericardial effusion, type II respiratory failure, and hypothyroidism. There was no related basic diseases of respiratory and cardiovascular system in the past. She failed to be weaned from invasive ventilation multiple times after routine treatment and was finally successfully weaned on day five of receiving the combination therapy of a high-dose methylprednisolone intravenous drip and levothyroxine oral administration. Conclusion: This case report indicates that hypothyroidism may be a cause of type II respiratory failure, heart failure, and massive pericardial effusion without cardiac tamponade and that a combination of levothyroxine and corticosteroids could effectively treat the disease. Clinical workers should consider the role of thyroid function in diagnosis, and the admission team should include this aspect in the monitoring scope. Moreover, the role of hormones in the treatment of patients with severe hypothyroidism should not be ignored, and timely treatment should be provided.

Acid α -glucosidase (GAA) is the sole lysosomal enzyme responsible for degrading glycogen into glucose monomers. Deficiency of GAA leads to progressive lysosomal glycogen accumulation and cellular dysfunction, resulting in Pompe disease (PD), an autosomal recessive disorder. This case report described a 41-year-old woman who presented with progressive dyspnea and decreased exercise tolerance. The preliminary examination in the outpatient clinic showed that the patient suffered from pulmonary hypertension (PH). After the patient was admitted to the hospital and further relevant auxiliary examinations were completed, and finally a diagnosis of late-onset Pompe disease (LOPD) was confirmed. Protein structure prediction suggested that the double mutation might disrupt the hydrogen bond network, hydrophobic core, and aromatic interactions of the GAA enzyme, potentially reducing the stability of the protein (ΔΔG = −2.55 kcal/mol). Although these computational insights provide a theoretical basis for the clinical phenotype, they require further validation. This is a rare case of PD complicated with PH in the absence of childhood symptoms, suggesting that specific missense mutations may contribute to late-onset and milder phenotypes. This case underscores that clinicians should strengthen clinical discrimination when diagnosing respiratory failure and PH. Understanding the characteristics of infantile-onset Pompe disease (IOPD)—relatively mild enzymatic activity impairment and late onset—helps in the clinical management of genetic metabolic.

Hypercarbic respiratory failure, occurring secondary to chronic lung disease, is a frequently encountered problem. These patients present a significant challenge to respiratory and critical care services, as many are unsuitable for mechanical ventilation and most have multiple comorbidities. Recently, noninvasive ventilation (NIV) has become established as the primary modality for respiratory support in this group of patients. Several factors limit patient compliance with NIV, not least comfort and tolerability. A recent innovation in adult critical care is the use of high-flow nasal oxygen (HFNO) devices. These systems are capable of delivering high gas flows via nasal cannulae, with the ability to blend air and oxygen to give a controlled FiO2. Few clinical studies have been conducted in adults, although several are planned. To date the majority of available evidence addresses the use of HFNO in hypoxemic respiratory failure. Here we present a case in which a HFNO system was used to successfully manage hypercarbic respiratory failure in a patient unable to tolerate conventional NIV.

Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.

To construct a risk prediction nomogram model for pulmonary infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type II respiratory failure. A retrospective analysis was conducted on clinical data of 361 patients with AECOPD complicated with type II respiratory failure. Restricted cubic spline analysis was used to analyze the nonlinear relationships between some continuous variables and the outcome. Single factor and multiple factor logistic regression analyses were used to determine independent influencing factors, the predictive model was constructed and the nomogram was drawn. ROC curve, calibration curve, and clinical decision curve were plotted to evaluate the predictive performance of the model. Age showed no significant nonlinear relationship with concurrent pulmonary infection (P for nonlinearity > 0.05), whereas length of hospital stay, APACHE II score, and duration of combined antibiotic use all showed significant nonlinear relationships with concurrent pulmonary infection (P for nonlinearity < 0.05). Age, diabetes, hospital stay > 15 days, APACHE II score > 15 points, antibiotics combination time > 14 days were independent risk factors for pulmonary infection, and albumin was an independent protective factor ( < 0.05). In the training and validation cohorts, the AUCs of the ROC curves were 0.917 and 0.884, respectively. The predicted results of the nomogram model showed a certain consistency with the actual observed results. The Hosmer-Lemeshow goodness of fit test showed χ values of 2.858 and 5.162, with -values of 0.943 and 0.740, respectively. The clinical decision curve results showed that the nomogram model exhibited a certain net benefit within the predictive risk threshold ranges of 0.05∼0.90 and 0.08∼0.79. The nomogram risk model constructed in this study may demonstrate a certain predictive performance in predicting pulmonary infection in patients with AECOPD complicated with type II respiratory failure, and may provide a reference for early clinical identification and intervention.