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RESPIRATORY FAILURE and Flagyl

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RESPIRATORY FAILURE Symptoms and Causes

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include

  • Lung diseases such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, and pulmonary embolism
  • Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
  • Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
  • Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
  • Drug or alcohol overdose
  • Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes
What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?

Your health care provider will diagnose respiratory failure based on

  • Your medical history
  • A physical exam, which often includes
    • Listening to your lungs to check for abnormal sounds
    • Listening to your heart to check for arrhythmia
    • Looking for a bluish color on your skin, lips, and fingernails
  • Diagnostic tests, such as
    • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
    • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?

Treatment for respiratory failure depends on

  • Whether it is acute (short-term) or chronic (ongoing)
  • How severe it is
  • What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include

  • Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
  • Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
  • Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
  • Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
  • Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
  • Medicines for discomfort
  • Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

NIH: National Heart, Lung, and Blood Institute

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RESPIRATORY FAILURE Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Azithromycin Based Therapy for Induction of Remission in Active Pediatric Crohn's Disease
Condition: Crohn's Disease
Interventions: Drug: Azithromycin + Metronidazole;   Drug: Metronidazole
Outcome Measures: Response rate at 8 weeks defined as a drop in PCDAI (Pediatric Crohn's Disease Activity Index ) of at least 12.5 points (or remission without steroids, intention to treat principle);   Normalization of CRP ( CRP ≤0.5 mg/dL).;   Fecal calprotectin at 8 weeks .
2 Not yet recruiting Study to Determine the Equivalence of Three Products Containing Metronidazole Benzoate.
Condition: Bacterial Infections
Interventions: Drug: Metronidazole benzoate;   Drug: Flagyl 125 mg/5 ml oral suspension;   Drug: Flagyl 400 mg Tablets
Outcome Measures: Plasma concentration time profiles under the curve (AUC);   Maximum concentration (Cmax);   Time to maximum concentration (Tmax);   Elimination rate constant (Kel);   Terminal half life (t1/2);   Number of participants with Adverse Events
3 Recruiting Comparison Between Oral Clindamycin Vs Metronidazole for the Treatment of Abnormal Vaginal Flora in High Risk Pregnancies
Conditions: Abnormal Vaginal Flora;   Clindamycin Vs Metronidazole;   High Risk Pregnancies for Preterm Labor
Interventions: Drug: Clindamycin;   Drug: Metronidazole
Outcome Measures: To compare the efficacy between oral Clindamycin Vs Metronidazole in the eradication of abnormal vaginal flora;   The prevalence of adverse effects;   The prevalence of late abortions and preterm deliveries;   Assessing the correlation between Nugent score , physical examination and Ph indicators
4 Recruiting BASIC (Boric Acid, Alternate Solution for Intravaginal Colonization) Study
Condition: Bacterial Vaginosis
Interventions: Drug: Gelatin;   Drug: Boric acid;   Drug: Metronidazole
Outcome Measures: Effectiveness of treatment of intravaginal boric acid and metronidazole at 1 week and 30 days post-treatment will be measured as absence of symptoms or negative vaginal swab (Nugent score less than 7) if symptoms are present for BV.;   If during the 10 days of treatment of intravaginal boric acid and metronidazole the patient discontinues the treatment because of side effects or complained of intolerable side effects this will be considered a treatment failure for safety.
5 Recruiting Role of N-Acetylcysteine in Treatment of Bacterial Vaginosis
Condition: Bacterial Vaginosis
Interventions: Drug: N-Acetyl cysteine;   Drug: Metronidazole + N-Acetyl cysteine;   Drug: metronidazole
Outcome Measures: recovery of BV;   prevention of recurrence
6 Unknown  Increased Re-eradication Rate of Helicobacter Pylori by Adding N-acetylcystein or Metronidazole to the Triple Therapy
Condition: Bacterial Infection Due to Helicobacter Pylori (H. Pylori)
Interventions: Drug: 10RAC+acetylcystein;   Drug: 10RAC+metronidazole
Outcome Measures: Re-eradication rate;   Influence of Participant's CYP2C19 genotype on re-eradication rate
7 Unknown  Inflammation and Treatment of Bacterial Vaginosis Near Term
Condition: Bacterial Vaginosis
Interventions: Drug: Metronidazole;   Drug: Placebo
Outcome Measure: Levels of Interleukins 1 and 6 as well as Tumor Necrosis Factor Alpha
8 Recruiting Impact of Oral Antibiotic Treatment on C. Difficile
Conditions: C. Difficile;   Diarrhea;   Enterocolitis
Interventions: Drug: Fidaxomicin;   Drug: Metronidazole;   Drug: Vancomycin
Outcome Measures: Change in variation of the profile of C. difficile isolated from specific body sites of a patient with microbiology-proven CDAD;   Change in variation in the profile of C. difficile isolated from targeted surfaces in a hospital;   Extent and quantity of C. difficile shedding, colonization and environmental contamination in patients who received oral fidaxomicin vs. oral metronidazole or vancomycin;   Duration of diarrhea that were positive for CDAD
9 Unknown  Moxifloxacin Plus Metronidazole Versus Piperacillin/Tazobactam for the Treatment of Patients With Intra-abdominal Abscesses
Condition: Abscess, Intra-Abdominal
Intervention: Drug: Moxifloxacin/Metronidazole or Piperacillin/Tazobactam
Outcome Measures: Clinical success / failure rate at the Test-of-Cure visit;   Clinical + Bacteriological response at End-of-Treatment-visit;   Time to discharge from hospital;   Course of disease on the basis of clinical and laboratory parameters;   safety and tolerability of the study medication;   cost effectiveness of treatment regimes
10 Recruiting Comparison of the Eradications Rates of Sequential Therapy Versus Concomitant Therapy
Condition: Helicobacter Pylori Infection
Interventions: Drug: pantoprazole, amoxicillin, clarithromycin, metronidazole;   Drug: pantoprazole, amoxicillin, clarithromycin, metronidzole
Outcome Measure: Comparison of the eradications rates of sequential therapy versus concomitant therapy of treatment of Helicobacter pylori infection in Korea.
11 Recruiting Compare Ceftazidime-Avibactam + Metronidazole Versus Meropenem for Hospitalized Adults With Complicated Intra-Abdominal Infections
Condition: Complicated Intra-Abdominal Infection
Interventions: Drug: CAZ-AVI;   Drug: Metronidazole;   Drug: Meropenem
Outcome Measures: Clinical Cure as Measured by proportion of patients meeting cure criteria in the microbiological modified Intent-To-Treat analysis set.;   The proportion of patients with clinical cure in the microbiologically evaluable and extended microbiologically evaluable analysis set;   The proportion of patients with clinical cure in the microbiological modified intent-to-treat, microbiologically evaluable, and extended microbiologically evaluable analysis sets;   The proportion of patients with clinical cure in the clinically evaluable analysis set.;   The proportion of patients with a favorable per-patient microbiological response in the microbiological modified intent to treat, microbiologically evaluable, and extended microbiologically evaluable analysis sets;   The proportion of favorable per-pathogen microbiological response in the microbiological modified intent to treat, microbiologically evaluable, and extended microbiologically evaluable analysis sets;   The favorable per-pathogen microbiologic response by minimum inhibitory concentration (MIC) categories in the microbiological modified intent to treat, microbiologically evaluable, and extended microbiologically evaluable analysis sets;   Favorable per-patient clinical response & microbiological response for patients infected with ceftazidime-resistant pathogens in microbiological modified intent to treat, microbiologically evaluable & extended microbiologically evaluable analysis sets;   Proportion of patients with favorable per-pathogen microbiological response for patients infected with ceftazidime-resistant pathogens in microbiological modified ITT, microbiologically evaluable and extended microbiologically evaluable analysis sets;   The time to first defervescence in the clinically evaluable, microbiologically evaluable, and extended microbiologically evaluable analysis sets for patients who have fever at study entry;   The safety and tolerability by incidence and severity of adverse events and serious adverse events, vital signs, clinical laboratory tests, ECGs and physical exams.;   Pharmacokinetics: maximum concentration (Cmax), minimum concentration, area under the plasma concentration time curve at steady state, and terminal half-life
12 Recruiting Compare Ceftazidime-Avibactam + Metronidazole vs Meropenem for Hospitalized Adults With Complicated Intra-Abd Infections
Condition: Complicated Intra-abdominal Infection
Interventions: Drug: Ceftazidime-avibactam;   Drug: metronidazole;   Drug: Meropenem
Outcome Measures: The proportion of patients with clinical cure in the clinically evaluable analysis set;   The proportion of patients with clinical cure in the microbiologically evaluable, extended microbiologically evaluable and microbiological modified intent-to-treat analysis sets;   The proportion of patients with a favorable per-patient microbiological response in the microbiological modified intent to treat, microbiologically evaluable and extended microbiologically evaluable analysis sets;   The proportion of favorable per-pathogen microbiological response in the microbiological modified intent to treat, microbiologically evaluable and extended microbiologically evaluable analysis sets;   The favorable per-pathogen microbiologic response by minimum inhibitory concentration categories in the microbiological modified intent to treat, microbiologically evaluable and extended microbiologically evaluable analysis sets;   Favorable clinical response and favorable per-patient microbiological response for patients infected with ceftazidime-resistant pathogens in the microbiological modified intent to treat and (extended) microbiologically evaluable analysis sets;   The proportion of patients with a favorable per-pathogen microbiological response for patients infected with ceftazidime-resistant pathogens in the microbiological modified intent to treat and (extended) microbiologically evaluable analysis sets;   The time to first defervescence in the clinically evaluable, microbiologically evaluable and extended microbiologically evaluable analysis sets for patients who have fever at study entry;   Safety and tolerability by incidence and severity of adverse events and serious adverse events, exposure, mortality, reasons for discontinuations of study therapy, vital signs, laboratory tests, electrocardiogram parameters and physical exams
13 Unknown  Effects of the Variation in the Time of Systemic Administration of Metronidazole and Amoxicillin Associated to the Non-surgical Therapy of Chronic Periodontitis.
Conditions: Chronic Periodontitis;   Clinical and Microbiological Effects
Intervention: Drug: Administration of Metronidazole plus Amoxicillin
Outcome Measures: - Mean change in clinical attachment level (CAL);   - Mean change in probing pocket depths (PD)
14 Recruiting The Use of Erythritol Powder and Metronidazole Gel for the Non-surgical Treatment of Periodontitis
Condition: Periodontal Pocket
Interventions: Drug: metronidazole gel;   Procedure: ultrasonics;   Procedure: erythritol;   Drug: placebo
Outcome Measures: Probing pocket Depth change;   Bleeding on Probing change;   Clinical Attachment level change
15 Not yet recruiting Vaccine Plus Booster Shots in Men With Prostate Cancer Undergoing Treatment With Radical Prostatectomy
Conditions: Prostate Cancer;   Prostatic Neoplasms;   Neoplasms, Prostate
Interventions: Biological: PROSTVAC-V/TRICOM;   Biological: PROSTVAC-F/TRICOM
Outcome Measures: Changes from baseline to after surgery of CD4 and CD8 cell infiltrates;   Change in peripheral PSA-specific T cells;   Any intraprostatic Treg cell infiltration with CD4+FOX-P3 staining;   Any PSA changes secondary to vaccination;   Any MRI changes secondary to vaccination
16 Unknown  The Impact of Obesity on Nonsurgical Periodontal Therapy
Conditions: Periodontitis;   Periodontal Diseases;   Obesity
Interventions: Drug: Metronidazole;   Drug: Placebo;   Procedure: Scaling and root planning
Outcome Measures: Probing depth;   Attachment level
17 Recruiting Concomitant Therapy of H. Pylori
Condition: Gastritis, Gastric Ulcer, and Duodenal Ulcer
Intervention: Drug: amoxicillin, clarithromycin, metronidazole, rabeprazole
Outcome Measure: Evaluation of the efficacy of concomitant therapy for eradication of Helicobacter pylori
18 Recruiting Antibiotic Safety (SCAMP)
Condition: Complicated Intra Abdominal Infections
Interventions: Drug: ampicillin and metronidazole and gentamicin;   Drug: ampicillin and gentamicin and clindamycin;   Drug: gentamicin and Piperacillin- tazobactam;   Drug: standard of care antibiotics and metronidazole
Outcome Measures: Death;   Number of participants with therapeutic success at Day 30 and Day 90
19 Recruiting Enzalutamide in Combination With PSA-TRICOM in Patients With Non-Metastatic Castration Sensitive Prostate Cancer
Condition: Prostate Cancer
Interventions: Biological: PROSTVAC-F/TRICOM;   Biological: PROSTVAC-V/TRICOM;   Drug: Enzalutamide (Xtandi)
Outcome Measures: Decrease in tumor re-growth rate;   Immune response;   Determine impact on PSA
20 Recruiting Efficacy Study of Preconception Treatment of an Asymptomatic Bacterial Infection in an Infertility Population
Conditions: Vaginosis, Bacterial;   Infertility;   Miscarriage
Interventions: Drug: Metronidazole;   Drug: Placebo
Outcome Measures: Biochemical Pregnancy Rate (Positive Pregnancy Test);   Pregnancy Rate (Pregnancy Visible on Ultrasound);   Miscarriage Rate (Loss of a Clinically Recognized Pregnancy);   Infectious Morbidity (i.e. Chorioamnionitis, Neonatal Sepsis)