Tag Archives: respiratory failure

Transition from ICU to home care with long-term invasive ventilation using a single-limb BiPAP circuit

Mircea Stoian1, Nicolae Demenciuc2, Sergiu-Stefan Laszlo3, Anca Motataianu4, Dragoș-Florin Babă5, Adina Stoian6

1 Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2 Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3 Mures County Hospital, Targu Mures, Romania
4 Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5 Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
6 Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/jccm-2026-0004

Background: Patients with chronic respiratory failure caused by severe neuromuscular impairment often require long-term respiratory support. Invasive mechanical ventilation (IMV) via tracheostomy is usually provided in intensive care units (ICUs), but in carefully selected cases, it can be safely transitioned to home care. The use of a single-limb ventilator circuit (Single BiPAP circuit with Whisper Swivel II), intended initially for non-invasive ventilation (NIV), may represent a cost-effective and practical alternative for long-term home IMV.
Case presentation: We present a 50-year-old male with progressive neuromuscular disease and chronic respiratory failure, who required long-term IMV through a tracheostomy tube. After stabilization in the ICU, ventilation was maintained at home using a Single BiPAP circuit with Whisper Swivel II, combined with a mechanical insufflation-exsufflation (MIE) device for airway secretion clearance. The patient’s family received structured training in tracheostomy care, ventilator operation, and secretion management. Over 32-month period, the patient maintained stable respiratory function, experienced a marked reduction in infectious exacerbations, and preserved an acceptable quality of life.
Conclusion: In selected patients, long-term home IMV using a single-limb ventilator combined with an MIE device can be a safe, effective, and cost-efficient alternative to conventional ICU-based ventilation. Successful outcomes require structured patient and caregiver training, close follow-up, and coordinated multidisciplinary support.

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Nebulized tranexamic acid for hemoptysis in critically and non-critically ill patients:A retrospective analysis

Nancy Bethuel1, Chris Naum2, Cynthia Brown3

1 Indiana University, Purdue University Indianapolis, Indianapolis, Indiana, USA
2 Indiana University, Indianapolis, Indiana, USA
3 Indiana University School of Medicine, Indianapolis, Indiana, USA

DOI: 10.2478/jccm-2025-0031

Introduction: Hemoptysis is a commonly encountered diagnosis caused by blood originating from the respiratory tract. Current pharmacological guideline recommendations for treatment do not exist. Tranexamic acid is a synthetic anti-fibrinolytic used in the management of various bleeding complications. Tranexamic acid has gained popularity for the treatment of hemoptysis with limited side effect knowledge. Our aim is to describe the clinical characteristics of patients receiving nebulized tranexamic acid for hemoptysis and compare clinical outcomes to those of patients receiving supportive care.
Materials and Methods: This is a retrospective descriptive analysis performed in medical and ICU units at three tertiary hospitals. All patients were hospitalized with hemoptysis between January 1st, 2018 – December 31st, 2021. Demographic information, severity variables, and clinical outcomes were collected from medical records. For statistical analysis, we used t-test for continuous variables, chi-square or fishers’ exact test for categorical variables, and propensity analysis to adjust for disease severity and underlying medical conditions.
Results: 488 patients were identified; 96 received tranexamic acid. There were slightly more smokers in the no TXA group (p = 0.04) but otherwise the two groups were similar in terms of demographic characteristics. The average length of hospital and ICU stay, need for mechanical ventilation or bronchoscopy, and mortality were significantly higher in the tranexamic acid group (p<0.01). The propensity analysis showed higher odds of death with nebulized tranexamic acid use, OR 2.51 (1.56-4.02).
Conclusions: There appears to be an indication bias for tranexamic acid based on disease severity without an obvious improvement in clinical outcomes. Our analysis suggests that nebulized tranexamic acid for hemoptysis may be potentially harmful, and further larger prospective research is warranted.

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Repeated Bronchoscopy – Treatment of Severe Respiratory Failure in a Fire Victim

Ovidiu Rusalim Petris1, Cristina Bologa2, Victorita Sorodoc2, Catalina Lionte2

1 Nursing Department, 2nd Internal Medicine Clinic, “Sf. Spiridon” Clinical County Emergency Hospital, “Gr. T. Popa” University of Medicine, Iasi, Romania
2 Internal Medicine Department, 2nd Internal Medicine Clinic, “Sf. Spiridon” Clinical County Emergency Hospital, “Gr. T. Popa” University of Medicine, Iasi, Romania

DOI: 10.1515/jccm-2017-0024

A case of respiratory failure in a domestic fire victim presenting with 1-3-degree skin burns on 10% of the total body surface, is reported. Forty-eight hours after admission to hospital, the patient developed severe respiratory failure that did not respond to mechanical ventilation. Severe obstruction of the airway had resulted from secretions and deposits of soot-forming bronchial casts. The patient required repeated bronchoscopies to separate and remove the bronchial secretions and soot deposits. An emergency bronchial endoscopic exam was crucial in the patient’s survival and management. The patient was discharged from the hospital after twenty-four days.

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Acquired Tracheal Diverticulum as an Unexpected Cause of Endotracheal Tube Cuff Leak

René Agustin Flores-Franco*, Jesús Silva-Alcaraz

Departamento de Neumología y Medicina Interna, Hospital General Regional “Dr. Salvador Zubirán Anchondo”, Chihuahua, México

DOI: 10.1515/jccm-2015-0024

Introduction: Tracheal diverticulum has been associated with problems during endotracheal intubation but there are no reports concerning air leakage around an endotracheal tube (ETT).
Case report: The case of an elderly woman under mechanical ventilatory support because an exacerbation of chronic obstructive pulmonary disease (COPD) is reported. She presented with an inexplicably air leak around the endotracheal tube not attributed to structural defects. The intra-cuff pressure value was as high as 30 mmHg to prevent an air leakage. Bronchoscopy revealed a tracheal diverticulum at the site ofthe tube cuff that allowed air leakage around it. The problem was overcome by re-intubating the patient with a larger diameter tube and positioning its distal end above the diverticular opening.
Discussion: Endotracheal tube air leak is a frequently neglected problem. COPD and other inflammatory conditions are associated with changes in the elastic properties of the airways resulting in tracheomegaly or acquired tracheal diverticulum. Both entities have been linked to problems during intubation or ventilation of patients. However tracheal diverticulum has not been described previously as a cause of air leakage.
Conclusion: Acquired tracheal diverticulum should be recognized as a cause of air leakage in the intubated patient, especially if associated with a normal or elevated intracuff pressure.

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