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Wang RH, Lu AL, Li HP, Ma ZH, Wu SB, Lu HJ, Wen WX, Huang Y, Wang LX, Yuan F. Prevalence, predictors, and outcomes of acute respiratory distress syndrome in severe stroke. Neurol Sci 2024; 45:2719-2728. [PMID: 38150131 DOI: 10.1007/s10072-023-07269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES Patients with severe stroke are at high risk of developing acute respiratory distress syndrome (ARDS), but this severe complication was often under-diagnosed and rarely explored in stroke patients. We aimed to investigate the prevalence, early predictors, and outcomes of ARDS in severe stroke. METHODS This prospective study included consecutive patients admitted to neurological intensive care unit (neuro-ICU) with severe stroke, including acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The incidence of ARDS was examined, and baseline characteristics and severity scores on admission were investigated as potential early predictors for ARDS. The in-hospital mortality, length of neuro-ICU stay, the total cost in neuro-ICU, and neurological functions at 90 days were explored. RESULTS Of 140 patients included, 35 (25.0%) developed ARDS. Over 90% of ARDS cases occurred within 1 week of admission. Procalcitonin (OR 1.310 95% CI 1.005-1.707, P = 0.046) and PaO2/FiO2 on admission (OR 0.986, 95% CI 0.979-0.993, P < 0.001) were independently associated with ARDS, and high brain natriuretic peptide (OR 0.994, 95% CI 0.989-0.998, P = 0.003) was a red flag biomarker warning that the respiratory symptoms may be caused by cardiac failure rather than ARDS. ARDS patients had longer stays and higher expenses in neuro-ICU. Among patients with ARDS, 25 (62.5%) were moderate or severe ARDS. All the patients with moderate to severe ARDS had an unfavorable outcome at 90 days. CONCLUSIONS ARDS is common in patients with severe stroke, with most cases occurring in the first week of admission. Procalcitonin and PaO2/FiO2 on admission are early predictors of ARDS. ARDS worsens both short-term and long-term outcomes. The conflict in respiratory support strategies between ARDS and severe stroke needs to be further studied.
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Affiliation(s)
- Rui-Hong Wang
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Ai-Li Lu
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui-Ping Li
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhao-Hui Ma
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shi-Biao Wu
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Ji Lu
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wan-Xin Wen
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Huang
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research On Emergency in TCM, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Xin Wang
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China.
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Research On Emergency in TCM, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, Guangdong, China.
| | - Fang Yuan
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China.
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, Guangdong, China.
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Ruiz LM, de Oliveira Braga KA, Nepomuceno NA, Correia AT, Ribeiro de Carvalho GH, Vilela VS, Dolhnikoff M, Pêgo-Fernandes PM. Effect of Hypertonic Saline Solution on the Ventilatory Mechanics of Lungs Donated After Brain Death. J Surg Res 2024; 298:109-118. [PMID: 38603941 DOI: 10.1016/j.jss.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Brain death (BD) compromises the viability of the lung for donation. Hypertonic saline solution (HSS) induces rapid intravascular volume expansion and immunomodulatory action. We investigated its role in ventilatory mechanics (VMs) and in the inflammatory activity of the lungs of rats subjected to BD. METHODS Wistar rats were divided into four groups: control, n = 10: intact rats subjected to extraction of the heart-lung block; BD, n = 8 (BD): rats treated with isotonic saline solution (4 mL/kg) immediately after BD; hypertonic saline 0 h, n = 9 (Hip.0'): rats treated with HSS (4 mL/kg) immediately after BD; and hypertonic saline 1 h, n = 9 (Hip.60'), rats treated with HSS (4 mL/kg) 60 min after BD. The hemodynamic characteristics, gas exchange, VMs, inflammatory mediators, and histopathological evaluation of the lung were evaluated over 240 min of BD. RESULTS In VMs, we observed increased airway resistance, tissue resistance, tissue elastance, and respiratory system compliance in the BD group (P < 0.037), while the treated groups showed no impairment over time (P > 0.05). In the histological analysis, the BD group showed a greater area of perivascular edema and a higher neutrophil count than the control group and the Hip.60' group (P < 0.05). CONCLUSIONS Treatment with HSS was effective in preventing changes in the elastic and resistive pulmonary components, keeping them at baseline levels. Late treatment reduced perivascular and neutrophilic edema in lung tissue.
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Affiliation(s)
- Liliane Moreira Ruiz
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
| | - Karina Andrighetti de Oliveira Braga
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Natalia Aparecida Nepomuceno
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aristides Tadeu Correia
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Vanessa Sana Vilela
- Doctoral Student, Laboratory of Thoracic Surgery Research, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Marisa Dolhnikoff
- Pathology Departament, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Laboratorio de Pesquisa em Cirurgia Toracica, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Díaz EA, Sáenz C, Torres D, Silva A, Segnini G. Successful management of pulmonary edema secondary to accidental electrocution in a young dog. BMC Vet Res 2024; 20:145. [PMID: 38641793 PMCID: PMC11027353 DOI: 10.1186/s12917-024-03982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/17/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Human records describe pulmonary edema as a life-threatening complication of electric shock. Successful management requires prompt recognition and intensive care. However, in companion animals, electrocutions are rarely reported, even though domestic environments are full of electrical devices and there is always the possibility of accidental injury. Therefore, it is important for veterinarians to know more about this condition in order to achieve successful patient outcomes. CASE PRESENTATION A 3-month-old male Labrador Retriever was presented with a history of transient loss of consciousness after chewing on a household electrical cord. On admission, the puppy showed an orthopneic position with moderate respiratory distress. Supplemental oxygen via nasal catheter was provided, but the patient showed marked worsening of respiratory status. Point-of-care ultrasound exams suggested neurogenic pulmonary edema due to electrical shock close to the central nervous system and increased B-lines without evidence of cardiac abnormalities. Mechanical ventilation of the patient was initiated using volume-controlled mode with a tidal volume of 9 to 15 ml/kg until reaching an end-tidal carbon dioxide ≤ 40 mm Hg, followed by a stepwise lung-recruitment maneuver in pressure-controlled mode with increases of the peak inspiratory pressure (15 to 20 cm H2O) and positive end-expiratory pressure (3 to 10 cm H2O) for 30 min, and return to volume-controlled mode with a tidal volume of 15 ml/kg until reaching a peripheral oxygen saturation ≥ 96%. Weaning from the ventilator was achieved in six hours, and the patient was discharged two days after admission without neurological or respiratory deficits. CONCLUSIONS We present a rather unusual case of a neurogenic pulmonary edema subsequent to accidental electrocution in a dog. Timely diagnosis by ultrasound and mechanical ventilation settings are described. Our case highlights that pulmonary edema should be considered a potentially life-threatening complication of electrical shock in small animal emergency and critical care medicine.
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Affiliation(s)
- Eduardo A Díaz
- Escuela de Medicina Veterinaria, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ, Diego de Robles s/n, 170901, Quito, Ecuador.
| | - Carolina Sáenz
- Instituto iBIOTROP, Hospital de Fauna Silvestre Tueri, Universidad San Francisco de Quito USFQ, Diego de Robles s/n, 170901, Quito, Ecuador
| | - Diana Torres
- Hospital Docente de Especialidades Veterinarias, Universidad San Francisco de Quito USFQ, Diego de Robles s/n, 170901, Quito, Ecuador
| | - Andrés Silva
- Hospital Docente de Especialidades Veterinarias, Universidad San Francisco de Quito USFQ, Diego de Robles s/n, 170901, Quito, Ecuador
| | - Gilberto Segnini
- Hospital Docente de Especialidades Veterinarias, Universidad San Francisco de Quito USFQ, Diego de Robles s/n, 170901, Quito, Ecuador
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Yeo HJ. Patient management for thoracic organ donor candidates: the lung transplantation team's view. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:18-22. [PMID: 38297997 PMCID: PMC11075818 DOI: 10.4285/kjt.23.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
Despite the increasing demand for lung transplants, donor lungs remain in short supply. Although organ donations have been steadily increasing in Korea, with the utilization rate for donor lungs increasing to 40% in recent years, many potential donor organs remain unused. To match the increasing number of patients on the lung transplant waitlist, it is essential to increase the donor procurement rate through optimal management. Improvements in donor lung management programs can lead to expansion of the donor pool and optimal posttransplant outcomes. This review focuses on basic protocols for the optimal management of donor lungs and summarizes coronavirus disease 2019-related considerations for donor lung evaluation.
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Affiliation(s)
- Hye Ju Yeo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Transplantation Research Center and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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5
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Hwang EH, Koo JH, Lee YH, Song JH, Lim YC. Neurogenic pulmonary edema and Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:3677-3684. [PMID: 37924360 DOI: 10.1007/s00701-023-05824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Neurogenic pulmonary edema (NPE) combined with Takotsubo cardiomyopathy (TCM) is a rare condition associated with aneurysmal subarachnoid hemorrhage (aSAH). Although several mechanisms have been proposed, the pathophysiology and management strategies are not yet fully established. We aimed to determine the radiological and clinical outcomes of patients with NPE and with TCM after aSAH to propose management strategies. METHODS We analyzed the data of 564 patients with aSAH recorded at a single medical center from February 2015 to July 2022. This study retrospectively investigated the incidence and demographics of SAH combined with both NPE and TCM and the clinical outcomes of the patients. Correlating factors, independently associated with NPE-TCM, were also investigated. RESULTS During the 7 years, 11 (2.0%) of 564 patients had NPE complicated with TCM after aSAH. Seven of 11 (63.6%) patients had poor-grade SAH (Hunt-Hess Grade 4 to 5). Three of 11 patients had a posterior circulation in the NPE-TCM group. The most prevalent treatment option was endovascular coil embolization, except for one case of clip. Long-term outcomes were favorable in 6 of 11 patients, and there was one case of mortality. Age, troponin I level, and alveolar-arterial oxygen gradient were correlating factors of NPE-TCM. CONCLUSION Although NPE-TCM represents a rare complication associated with aSAH, achieving active resolution of underlying neurological causes through early and appropriate treatment may contribute to a favorable prognosis. Considering the limited incidence of SAH complicated with NPE-TCM, a multi-center study may be needed.
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Affiliation(s)
- Eui-Hyun Hwang
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ja Ho Koo
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeon Hu Lee
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Hye Song
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
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Rojo MÁ, Goiria Z, Domingos S, Ibañez J, Ruiz LA. Dyspnoea after epileptic seizures: beyond aspiration pneumonia. Intern Emerg Med 2023; 18:2445-2447. [PMID: 37354292 DOI: 10.1007/s11739-023-03352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Miguel Ángel Rojo
- Internal Medicine Department, Hospital Universitario Cruces, Barakaldo, Spain.
| | - Ziortza Goiria
- Internal Medicine Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Sergio Domingos
- Medicine Department, University of Basque Country-UPV/EHU, Bilbao, Spain
| | - Jone Ibañez
- Medicine Department, University of Basque Country-UPV/EHU, Bilbao, Spain
| | - Luis Alberto Ruiz
- Pneumology Department, Hospital Universitario Cruces, Barakaldo, Spain
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Wieruszewski PM, Coleman PJ, Levine AR, Davison D, Smischney NJ, Kethireddy S, Guo Y, Hecht J, Mazzeffi MA, Chow JH. Trajectory of PaO 2/FiO 2 Ratio in Shock After Angiotensin II. J Intensive Care Med 2023; 38:939-948. [PMID: 37161301 DOI: 10.1177/08850666231174870] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION High-dose catecholamines can impair hypoxic pulmonary vasoconstriction and increase shunt fraction. We aimed to determine if Angiotensin II (Ang-2) is associated with improved PaO2/FiO2 and SpO2/FiO2 in patients in shock. METHODS Adult patients at four tertiary care centers and one community hospital in the United States who received Ang-2 from July 2018-September 2020 were included in this retrospective, observational cohort study. PaO2, SpO2, and FiO2 were measured at 13 timepoints during the 48-h before and after Ang-2 initiation. Piecewise linear mixed models of PaO2/FiO2 and SpO2/FiO2 were created to evaluate hourly changes in oxygenation after Ang-2 initiation. The difference in the proportion of patients with PaO2/FiO2 ≤ 300 mm Hg at the time of Ang-2 initiation and 48 h after was also examined. RESULTS The study included 254 patients. In the 48 h prior to Ang-2 initiation, oxygenation was significantly declining (hourly PaO2/FiO2 change -4.7 mm Hg/hr, 95% CI - 6.0 to -3.5, p < .001; hourly SpO2/FiO2 change -3.1/hr, 95% CI-3.7 to -2.4, p < .001). Ang-2 treatment was associated with significant improvements in PaO2/FiO2 and SpO2/FiO2 in the 48-h after initiation (hourly PaO2/FiO2 change +1.5 mm Hg/hr, 95% CI 0.5-2.5, p = .003; hourly SpO2/FiO2 change +0.9/hr, 95% CI 0.5-1.2, p < .001). The difference in the hourly change in oxygenation before and after Ang-2 initiation was also significant (pinteraction < 0.001 for both PaO2/FiO2 and SpO2/FiO2). This improvement was associated with significantly fewer patients having a PaO2/FiO2 ≤ 300 mm Hg at 48 h compared to baseline (mean difference -14.9%, 95% CI -25.3% to -4.6%, p = .011). Subgroup analysis found that patients with either a baseline PaO2/FiO2 ≤ 300 mm Hg or a norepinephrine-equivalent dose requirement >0.2 µg/kg/min had the greatest associations with oxygenation improvement. CONCLUSIONS Ang-2 is associated with improved PaO2/FiO2 and SpO2/FiO2. The mechanisms for this improvement are not entirely clear but may be due to catecholamine-sparing effect or may also be related to improved ventilation-perfusion matching, intrapulmonary shunt, or oxygen delivery.
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Affiliation(s)
- Patrick M Wieruszewski
- Department of Anesthesiology and Pharmacy, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Patrick J Coleman
- Department of Anesthesiology, Walter Reed National Military Medical Center, Baltimore, MD, USA
| | - Andrea R Levine
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Danielle Davison
- Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nathan J Smischney
- Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Shravan Kethireddy
- Department of Medicine, Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Yanglin Guo
- Department of Medicine, Division of Pulmonary & Critical Care, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jason Hecht
- Department of Pharmacy, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - Michael A Mazzeffi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Jonathan H Chow
- Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Leppert J, Ditz C, Souayah N, Behrens C, Tronnier VM, Küchler J. Limitations of prone positioning in patients with aneurysmal subarachnoid hemorrhage and concomitant respiratory failure. Clin Neurol Neurosurg 2023; 232:107878. [PMID: 37423091 DOI: 10.1016/j.clineuro.2023.107878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Prone positioning (PP) is an established treatment modality for respiratory failure. After aneurysmal subarachnoid hemorrhage (aSAH), PP is rarely performed considering the risk of intracranial hypertension. The aim of this study was to analyze the effects of PP on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and cerebral oxygenation following aSAH. PATIENTS AND METHODS Demographic and clinical data of aSAH patients admitted over a 6-year period and treated with PP due to respiratory insufficiency were retrospectively analyzed. ICP, CPP, brain tissue oxygenation (pBrO2), respiratory parameters and ventilator settings were analyzed before and during PP. RESULTS Thirty patients receiving invasive multimodal neuromonitoring were included. Overall, 97 PP sessions were performed. Mean arterial oxygenation and pBrO2 increased significantly during PP. We found a significant increase in median ICP compared to the baseline level in supine position. No significant changes in CPP were observed. Five PP sessions had to be terminated early due to medically refractory ICP-crisis. The affected patients were younger (p = 0.02) with significantly higher baseline ICP values (p = 0.009). Baseline ICP correlates significantly (p < 0.001) with ICP 1 h (R: 0.57) and 4 h (R: 0.55) after onset of PP. CONCLUSION PP in aSAH patients with respiratory insufficiency is an effective therapeutic option improving arterial and global cerebral oxygenation without compromising CPP. The significant increase in ICP was moderate in most sessions. However, as some patients experience intolerable ICP crises during PP, continuous ICP-Monitoring is considered mandatory. Patients with elevated baseline ICP and reduced intracranial compliance should not be considered for PP.
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Affiliation(s)
- Jan Leppert
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Claudia Ditz
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Noura Souayah
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Carianne Behrens
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Volker M Tronnier
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Küchler
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Giussani G, Falcicchio G, La Neve A, Costagliola G, Striano P, Scarabello A, Mostacci B, Beghi E. Sudden unexpected death in epilepsy: A critical view of the literature. Epilepsia Open 2023; 8:728-757. [PMID: 36896633 PMCID: PMC10472423 DOI: 10.1002/epi4.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death, occurring in benign circumstances, in an individual with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus in which postmortem examination does not reveal other causes of death. Lower diagnostic levels are assigned when cases met most or all of these criteria, but data suggested more than one possible cause of death. The incidence of SUDEP ranged from 0.09 to 2.4 per 1000 person-years. Differences can be attributed to the age of the study populations (with peaks in the 20-40-year age group) and the severity of the disease. Young age, disease severity (in particular, a history of generalized TCS), having symptomatic epilepsy, and the response to antiseizure medications (ASMs) are possible independent predictors of SUDEP. The pathophysiological mechanisms are not fully known due to the limited data available and because SUDEP is not always witnessed and has been electrophysiologically monitored only in a few cases with simultaneous assessment of respiratory, cardiac, and brain activity. The pathophysiological basis of SUDEP may vary according to different circumstances that make that particular seizure, in that specific moment and in that patient, a fatal event. The main hypothesized mechanisms, which could contribute to a cascade of events, are cardiac dysfunction (included potential effects of ASMs, genetically determined channelopathies, acquired heart diseases), respiratory dysfunction (included postictal arousal deficit for the respiratory mechanism, acquired respiratory diseases), neuromodulator dysfunction, postictal EEG depression and genetic factors.
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Affiliation(s)
- Giorgia Giussani
- Laboratory of Neurological Disorders, Mario Negri Institute for Pharmacological Research IRCCSMilanItaly
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of BariBariItaly
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of BariBariItaly
| | | | - Pasquale Striano
- IRCCS Istituto “Giannina Gaslini”GenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenovaItaly
| | - Anna Scarabello
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Mario Negri Institute for Pharmacological Research IRCCSMilanItaly
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Nastasovic T, Lazic I, Stosic M, Ilic R, Brzanov AG. Neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage - what is next? Neurosurg Rev 2023; 46:203. [PMID: 37587381 DOI: 10.1007/s10143-023-02115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Tijana Nastasovic
- Center for Anesthesiology and Resuscitation, Neurosurgery Clinic, Department of Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia.
- School of Medicine, Belgrade, Serbia.
| | - Igor Lazic
- Center for Anesthesiology and Resuscitation, Neurosurgery Clinic, Department of Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, Belgrade, Serbia
| | - Mila Stosic
- Center for Anesthesiology and Resuscitation, Neurosurgery Clinic, Department of Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia
| | - Rosanda Ilic
- School of Medicine, Belgrade, Serbia
- Neurosurgery Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Gavrilovska Brzanov
- Clinic for Anesthesia, Resuscitation and Intensive Care, University Clinical Center "Mother Teresa", Skopje, North Macedonia
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Seitz T, Bergmayr F, Kitzberger R, Holbik J, Grieb A, Hind J, Lucny F, Tyercha A, Neuhold S, Krenn C, Wenisch C, Zoufaly A, Kaniusas E, Széles JC. Randomized controlled study to evaluate the safety and clinical impact of percutaneous auricular vagus nerve stimulation in patients with severe COVID-19. Front Physiol 2023; 14:1223347. [PMID: 37614753 PMCID: PMC10442574 DOI: 10.3389/fphys.2023.1223347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction: A severe course of COVID-19 is characterized by a hyperinflammatory state resulting in acute respiratory distress syndrome or even multi-organ failure along a derailed sympatho-vagal balance. Methods: In this prospective, randomized study, we evaluate the hypothesis that percutaneous minimally invasive auricular vagus nerve stimulation (aVNS) is a safe procedure and might reduce the rate of clinical complications in patients with severe course of COVID-19. In our study, patients with SARS-CoV-2 infection admitted to the intensive care unit with moderate-to-severe acute respiratory distress syndrome, however without invasive ventilation yet, were included and following randomization assigned to a group receiving aVNS four times per 24 h for 3 h and a group receiving standard of care (SOC). Results: A total of 12 patients were included (six in the aVNS and six in the SOC group). No side effects in aVNS were reported, especially no significant pain at device placement or during stimulation at the stimulation site or significant headache or bleeding after or during device placement or lasting skin irritation. There was no significant difference in the aVNS and SOC groups between the length of stay in the intensive care unit and at the hospital, bradycardia, delirium, or 90-day mortality. In the SOC group, five of six patients required invasive mechanical ventilation during their stay at hospital and 60% of them venovenous extracorporeal membrane oxygenation, compared to three of six patients and 0% in the aVNS group (p = 0.545 and p = 0.061). Discussion: Vagus nerve stimulation in patients with severe COVID-19 is a safe and feasible method. Our data showed a trend to a reduction of progression to the need of invasive ventilation and venovenous extracorporeal membrane oxygenation which encourages further research with larger patient samples.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Franziska Bergmayr
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Kitzberger
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Felix Lucny
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Tyercha
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Claus Krenn
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
| | - József Constantin Széles
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
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12
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Guo L, Yang X, Yang B, Tang G, Li C. Prevalence, in-hospital mortality, and factors related to neurogenic pulmonary edema after spontaneous subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:169. [PMID: 37432487 PMCID: PMC10335949 DOI: 10.1007/s10143-023-02081-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
Neurogenic pulmonary edema (NPE) is a life-threatening and severe complication in patients with spontaneous subarachnoid hemorrhage (SAH). The prevalence of NPE varies significantly across studies due to differences in case definitions, study populations, and methodologies. Therefore, a precise estimation of the prevalence and risk factors related to NPE in patients with spontaneous SAH is important for clinical decision-makers, policy providers, and researchers. We conducted a systematic search of the PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane Library databases from their inception to January 2023. Thirteen studies were included in the meta-analysis, with a total of 3,429 SAH patients. The pooled global prevalence of NPE was estimated to be 13%. Out of the eight studies (n = 1095, 56%) that reported the number of in-hospital mortalities of NPE among patients with SAH, the pooled proportion of in-hospital deaths was 47%. Risk factors associated with NPE after spontaneous SAH included female gender, WFNS class, APACHE II score ≥ 20, IL-6 > 40 pg/mL, Hunt and Hess grade ≥ 3, elevated troponin I, elevated white blood cell count, and electrocardiographic abnormalities. Multiple studies showed a strong positive correlation between the WFNS class and NPE. In conclusion, NPE has a moderate prevalence but a high in-hospital mortality rate in patients with SAH. We identified multiple risk factors that can help identify high-risk groups of NPE in individuals with SAH. Early prediction of the onset of NPE is crucial for timely prevention and early intervention.
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Affiliation(s)
- Lei Guo
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xu Yang
- Department of Neurology, The Tradional Chinese Medicine Hospital of Leshan, Leshan, 614000, China
| | - Bo Yang
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Guo Tang
- Department of Emergency, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Chunling Li
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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13
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Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care 2023; 27:247. [PMID: 37353832 PMCID: PMC10290317 DOI: 10.1186/s13054-023-04532-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023] Open
Abstract
Acute brain injury (ABI) covers various clinical entities that may require invasive mechanical ventilation (MV) in the intensive care unit (ICU). The goal of MV, which is to protect the lung and the brain from further injury, may be difficult to achieve in the most severe forms of lung or brain injury. This narrative review aims to address the respiratory issues and ventilator management, specific to ABI patients in the ICU.
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Affiliation(s)
- S Frisvold
- Department of Anesthesia and Intensive Care, University Hospital of North Norway, Tromso, Norway
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - S Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
- Coordinated Research Center On Respiratory Failure, University of Milan, Milan, Italy
| | - S Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France
- INSERM, Centre d'étude Des Pathologies Respiratoires, U1100, Université de Tours, Tours, France
| | - D Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
- Coordinated Research Center On Respiratory Failure, University of Milan, Milan, Italy
| | - Claude Guérin
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008, Lyon, France.
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14
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Miszczenkow H, Krzych Ł. Insights into Hemodynamic Features of Survivors and the Deceased with Acute Brain Injury: A Step Forward Tailored Treatment. J Clin Med 2023; 12:4021. [PMID: 37373714 DOI: 10.3390/jcm12124021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pulmonary artery catheters are widely used for hemodynamical monitoring in critically ill patients. Acute brain injury is among the severe conditions treated in an intensive care unit. The advanced monitoring of hemodynamical parameters, fluid balance and adequate administered treatment based on those values are components of goal-directed therapy. METHODS A prospective observational study included adult patients who were hospitalized in the ICU due to acute bran injury, excluding brain oedema after cardiac arrest. Each patient had PAC inserted and hemodynamic data were collected during the first 3 days of the ICU stay every 6 h. Patients were divided into two groups based on the endpoint: the survivors and the deceased. RESULTS Length of stay in hospital differed between patiens. All patients, regardless of their outcome, had noradrenaline administered. The initial values of PAP differed between the groups (p = 0.05). There were positive correlations noticed between noradrenaline dose, CVP and fluid balance when compared to PCWP in a group of survivors and a positive correlation in the fluid balance when compared to PAP and PVRI. Lactate serum concentrations presented a correlation with the dose of noradrenaline in both groups. CONCLUSIONS Upon acute brain injury, values of PVRI and PAP increase. This is corelated with fluid load and worsened by an excessive fluid treatment in the case of an inconsiderate approach for stabilizing the patient hemodynamically. PAC may present limited advantages in terms of PAP and PVRI control during the treatment.
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Affiliation(s)
- Hanna Miszczenkow
- Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Łukasz Krzych
- Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
- Department of Cardiac Anesthesia and Intensive Care, Silesian Centre for Heart Diseases, Marii Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
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15
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Bromberger B, Brzezinski M, Kukreja J. Lung preservation: from perfusion to temperature. Curr Opin Organ Transplant 2023; 28:168-173. [PMID: 37053078 DOI: 10.1097/mot.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW This article will review the evidence behind elements of the lung preservation process that have remained relatively stable over the past decade as well as summarize recent developments in ex-vivo lung perfusion and new research challenging the standard temperature for static cold storage. RECENT FINDINGS Ex-vivo lung perfusion is becoming an increasingly well established means to facilitate greater travel distance and allow for continued reassessment of marginal donor lungs. Preliminary reports of the use of normothermic regional perfusion to allow utilization of lungs after DCD recovery exist, but further research is needed to determine its ability to improve upon the current method of DCD lung recovery. Also, research from the University of Toronto is re-assessing the optimal temperature for static cold storage; pilot studies suggest it is a feasible means to allow for storage of lungs overnight to allow for daytime transplantation, but ongoing research is awaited to determine if outcomes are superior to traditional static cold storage. SUMMARY It is crucial to understand the fundamental principles of organ preservation to ensure optimal lung function posttransplant. Recent advances in the past several years have the potential to challenge standards of the past decade and reshape how lung transplantation is performed.
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Affiliation(s)
| | | | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, California, USA
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16
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Cong Z, Yang C, Zeng Z, Wu C, Zhao F, Shen Z, Xiao H, Zhu X. α 1-adrenoceptor stimulation ameliorates lipopolysaccharide-induced lung injury by inhibiting alveolar macrophage inflammatory responses through NF-κB and ERK1/2 pathway in ARDS. Front Immunol 2023; 13:1090773. [PMID: 36685596 PMCID: PMC9853445 DOI: 10.3389/fimmu.2022.1090773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Catecholamines such as norepinephrine or epinephrine have been reported to participate in the development of acute respiratory distress syndrome (ARDS) by activating adrenergic receptors (ARs). But the role of α1-AR in this process has yet to be elucidated. Methods In this study, ARDS mouse model was induced by intratracheal instillation of lipopolysaccharide. After treatment with α1-AR agonist phenylephrine or antagonist prazosin, lung pathological injury, alveolar barrier disruption and inflammation, and haemodynamic changes were evaluated. Cytokine levels and cell viability of alveolar macrophages were measured in vitro. Nuclear factor κB (NF-κB), mitogen-activated protein kinase, and Akt signalling pathways were analysed by western blot. Results It showed that α1-AR activation alleviated lung injuries, including reduced histopathological damage, cytokine expression, and inflammatory cell infiltration, and improved alveolar capillary barrier integrity of ARDS mice without influencing cardiovascular haemodynamics. In vitro experiments suggested that α1-AR stimulation inhibited secretion of TNF-α, IL-6, CXCL2/MIP-2, and promoted IL-10 secretion, but did not affect cell viability. Moreover, α1-AR stimulation inhibited NF-κB and enhanced ERK1/2 activation without significantly influencing p38, JNK, or Akt activation. Discussion Our studies reveal that α1-AR stimulation could ameliorate lipopolysaccharide-induced lung injury by inhibiting NF-κB and promoting ERK1/2 to suppress excessive inflammatory responses of alveolar macrophages.
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Affiliation(s)
- Zhukai Cong
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China,Department of Anaesthesiology, Peking University Third Hospital, Beijing, China
| | - Cui Yang
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Zhaojin Zeng
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Changyi Wu
- Department of Anaesthesiology, Peking University Third Hospital, Beijing, China
| | - Feng Zhao
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Ziyuan Shen
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Han Xiao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China,National Health Commission (NHC) Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China,Key Laboratory of Cardiovascular Receptors Research, Beijing, China,*Correspondence: Xi Zhu, ; Han Xiao,
| | - Xi Zhu
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China,*Correspondence: Xi Zhu, ; Han Xiao,
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17
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Paulin MV, Snead EC. Case report: Hypoadrenocorticism crisis complicated by non-cardiogenic pulmonary edema in a dog. Front Vet Sci 2022; 9:1015739. [DOI: 10.3389/fvets.2022.1015739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
A 6-year-old castrated male Labradoodle was referred in uncompensated hypovolemic shock, with a 72-h history of lethargy, vomiting and diarrhea that had acutely worsened with subsequent development of profuse hemorrhagic diarrhea in the last 24 h after a visit to the groomer. In most respects this case was classic for a patient with a primary hypoadrenocortical crisis. After initial attempts to address hypovolemia and refractory hypotension, no clinical improvement was seen, and the respiratory rate had increased acutely to 80 bpm with crackles detected on thoracic auscultation and serosanguineous fluid began draining from the nose and mouth. An arterial blood gas sample while breathing room air revealed moderate hypoxemia (PaO2 59.9: RI 95–100 mmHg), an elevated alveolar-arterial (A-a) gradient at 54.7 (RI < 15 mmHg) and a PaO2:FiO2 ratio of 285 mmHg. Thoracic radiographs revealed severe bilateral alveolar lung pattern largely limited to the perihilar and caudodorsal lung fields. The radiographic findings, along with signs of ongoing hypovolemia, the lack of evidence of typical long-standing acquired cardiac disease, and the rapid resolution of the pulmonary edema without the need for diuretics or long-term cardiac medications supported non-cardiogenic pulmonary edema. The proposed cause of the non-cardiogenic pulmonary edema was speculated to be neurogenically mediated. Oxygen supplementation along with mineralocorticoid and glucocorticoid replacement therapy was sufficient for the management of the non-cardiogenic pulmonary edema in this case.
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18
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Yu WS, Son J. Donor Selection, Management, and Procurement for Lung Transplantation. J Chest Surg 2022; 55:277-282. [PMID: 35924533 PMCID: PMC9358168 DOI: 10.5090/jcs.22.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Lung transplantation is a life-saving procedure in patients with end-stage lung disease. However, it inherently depends on the availability of donor organs. The selection of suitable lungs for transplantation, management of donors to minimize further injury and improve organ function, and safe procurement remain critical for successful transplantation. In this review, we provide an update on the current understanding of donor selection, management, and lung procurement.
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Affiliation(s)
- Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - JeongA Son
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
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19
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Research Progress on the Mechanism of Right Heart-Related Pulmonary Edema. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8947780. [PMID: 35966729 PMCID: PMC9365571 DOI: 10.1155/2022/8947780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
Objective. To investigate the mechanisms underlying the development of right heart-associated PE. Background. Right heart-related pulmonary edema (PE) refers to PE resulting from impaired right heart function caused by primary or secondary factors, which is common in critically ill patients. Although the clinical manifestations of different types of right heart-related PE are similar, the pathophysiological changes and treatment methods are significantly different. According to the hemodynamic mechanism, right heart-related PE is primarily classified into two types. One is the increase of right heart flow, including extravascular compression, intravascular compression, cardiac compression, and cardiac decompression. The other type is the abnormal distribution of pulmonary circulation, including obstruction, resistance, pleural decompression, or negative pressure. With the development of hemodynamic monitoring, hemodynamic data not only help us understand the specific pathogenesis of right heart-related PE but also assist us in determining the direction of therapy and enabling individualized treatment. Summary. This article presents a review on right heart-associated PE, with a perspective of hemodynamic analysis, and emphasizes the importance of right heart function in the management of circulation. Understanding the mechanism of right heart-associated PE will not only aid in better monitoring right heart function but also help intensivists make a more accurate identification of various types of PE in the clinic.
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20
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Balko J, Havlin J, CasasMendez F, Zajacova A, Koblizek M, Svorcova M, Lischke R, Zamecnik J. Mapping of the lung megakaryocytes: A role in pathogenesis of idiopathic pulmonary arterial hypertension? Pathol Res Pract 2022; 237:154060. [DOI: 10.1016/j.prp.2022.154060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
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21
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Wu X, Guo Y, Zeng H, Chen G. DNase-1 Treatment Exerts Protective Effects in Neurogenic Pulmonary Edema via Regulating the Neutrophil Extracellular Traps after Subarachnoid Hemorrhage in Mice. J Clin Med 2022; 11:jcm11154349. [PMID: 35955969 PMCID: PMC9369252 DOI: 10.3390/jcm11154349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
It has been reported that neutrophil extracellular traps (NETs) involve inflammation, coagulation and cell death. Acute lung injury is also considered to be connected with NETs. Deoxyribonuclease I (DNase-1), a clinical medication for the respiratory system, has been reported to degrade cell-free DNA (cfDNA), which is the main component of NETs. Herein, we did research to clarify the therapeutic value of DNase-1 in NPE after SAH. In this model, we found that the treatment of DNase-1 remarkably decreased lung water, neutrophilic infiltration and inflammation. In addition, DNase-1 inhibited the NETs and proinflammatory subtype transition of the macrophages. Moreover, the depletion of neutrophil also verified the role of NETs in NPE. Our results suggest that DNase-1 has the potential to effectively relieve the NPE after SAH and to be a clinical drug for use after SAH.
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22
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Wang J, Zhang J, Ye Y, Xu Q, Li Y, Feng S, Xiong X, Jian Z, Gu L. Peripheral Organ Injury After Stroke. Front Immunol 2022; 13:901209. [PMID: 35720359 PMCID: PMC9200619 DOI: 10.3389/fimmu.2022.901209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
Stroke is a disease with high incidence, mortality and disability rates. It is also the main cause of adult disability in developed countries. Stroke is often caused by small emboli on the inner wall of the blood vessels supplying the brain, which can lead to arterial embolism, and can also be caused by cerebrovascular or thrombotic bleeding. With the exception of recombinant tissue plasminogen activator (rt-PA), which is a thrombolytic drug used to recanalize the occluded artery, most treatments have been demonstrated to be ineffective. Stroke can also induce peripheral organ damage. Most stroke patients have different degrees of injury to one or more organs, including the lung, heart, kidney, spleen, gastrointestinal tract and so on. In the acute phase of stroke, severe inflammation occurs in the brain, but there is strong immunosuppression in the peripheral organs, which greatly increases the risk of peripheral organ infection and aggravates organ damage. Nonneurological complications of stroke can affect treatment and prognosis, may cause serious short-term and long-term consequences and are associated with prolonged hospitalization and increased mortality. Many of these complications are preventable, and their adverse effects can be effectively mitigated by early detection and appropriate treatment with various medical measures. This article reviews the pathophysiological mechanism, clinical manifestations and treatment of peripheral organ injury after stroke.
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Affiliation(s)
- Jin Wang
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiehua Zhang
- Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yingze Ye
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingxue Xu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yina Li
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shi Feng
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoxing Xiong
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijuan Gu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
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23
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Arjuna A, Mazzeo AT, Tonetti T, Walia R, Mascia L. Management of the Potential Lung Donor. Thorac Surg Clin 2022; 32:143-151. [PMID: 35512933 DOI: 10.1016/j.thorsurg.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of donor management protocols has significantly improved recovery rates; however, the inherent instability of lungs after death results in low utilization rates of potential donor lungs. Donor lungs are susceptible to direct trauma, aspiration, neurogenic edema, ventilator-associated barotrauma, and ventilator-associated pneumonia. After irreversible brain injury and determination of futility of care, the goal of medical management of the donor shifts to maintaining hemodynamic stability and maximizing the likelihood of successful organ recovery.
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Affiliation(s)
- Ashwini Arjuna
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Campus, Phoenix, AZ, USA.
| | - Anna Teresa Mazzeo
- Department of Adult and Pediatric Pathology, University of Messina, Messina, Italy
| | - Tommaso Tonetti
- University of Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Medicine, Sant'Orsola Research Hospital - Bologna, Bologna, Italy. https://twitter.com/tomton87
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Campus, Phoenix, AZ, USA
| | - Luciana Mascia
- Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
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24
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Yang A, Liu B, Inoue T. Role of autonomic system imbalance in neurogenic pulmonary oedema. Eur J Neurosci 2022; 55:1645-1657. [PMID: 35277906 DOI: 10.1111/ejn.15648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 02/05/2023]
Abstract
Neurogenic pulmonary oedema (NPE) is a life-threatening complication that develops rapidly and dramatically after an injury to the central nervous system (CNS). The autonomic system imbalance produced by severe brain damage may play an important role in the development of NPE. Activation of the sympathetic nervous system and inhibition of the vagus nerve system are essential prerequisites for autonomic system imbalance. The more severe the damage, the more pronounced the phenomenon. Sympathetic hyperactivity is associated with increased release of catecholamines from peripheral sympathetic nerve endings, which can cause dramatic changes in haemodynamics and cause pulmonary oedema. On the other hand, the abnormal inflammatory response caused by vagus nerve inhibition may also play an important role in the pathogenesis of NPE. The perspective of autonomic system imbalance seems to perfectly integrate the existing pathogenesis of NPE and can explain the entire development progression of NPE.
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Affiliation(s)
- Aobing Yang
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Bin Liu
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Tsuyoshi Inoue
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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25
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Chacón-Aponte AA, Durán-Vargas ÉA, Arévalo-Carrillo JA, Lozada-Martínez ID, Bolaño-Romero MP, Moscote-Salazar LR, Grille P, Janjua T. Brain-lung interaction: a vicious cycle in traumatic brain injury. Acute Crit Care 2022; 37:35-44. [PMID: 35172526 PMCID: PMC8918716 DOI: 10.4266/acc.2021.01193] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the "blast injury" theory or "double hit" model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.
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Affiliation(s)
| | | | | | - Iván David Lozada-Martínez
- Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia
- Global Neurosurgery Committee, World Federation of Neurosurgical Societies, Cartagena, Colombia
- Medical and Surgical Research Center, Cartagena, Colombia
| | | | - Luis Rafael Moscote-Salazar
- Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia
- Medical and Surgical Research Center, Cartagena, Colombia
| | - Pedro Grille
- Department of Intensive Care, Hospital Maciel, Montevideo, Uruguay
| | - Tariq Janjua
- Department of Intensive Care, Regions Hospital, St. Paul, MN, USA
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26
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Lozada-Martínez ID, Rodríguez-Gutiérrez MM, Ospina-Rios J, Ortega-Sierra MG, González-Herazo MA, Ortiz-Roncallo LM, Martínez-Imbett R, Llamas-Nieves AE, Janjua T, Moscote-Salazar LR. Neurogenic pulmonary edema in subarachnoid hemorrhage: relevant clinical concepts. EGYPTIAN JOURNAL OF NEUROSURGERY 2021; 36:27. [PMID: 34988372 PMCID: PMC8590876 DOI: 10.1186/s41984-021-00124-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) continues to be a condition that carries high rates of morbidity, mortality, and disability around the world. One of its complications is neurogenic pulmonary edema (NPE), which is mainly caused by sympathetic hyperactivity. Due to the complexity of the pathophysiological process and the unspecificity of the clinical presentation, it is little known by general practitioners, medical students and other health care workers not directly related to the neurological part, making the management of this chaotic condition difficult. This review aims to present recent evidence on clinical concepts relevant to the identification and management of NPE secondary to SAH. MAIN BODY OF THE ABSTRACT NPE is defined as a syndrome of acute onset following significant central nervous system (CNS) injury. Its etiology has been proposed to stem from the release of catecholamines that produce cardiopulmonary dysfunction, with this syndrome being associated with spinal cord injury, cerebrovascular disorders, traumatic brain injury, status epilepticus, and meningitis. NPE has long been considered a rare event; but it may occur more frequently, mainly in patients with SAH. There are two clinical presentations of NPE: the early form develops in the first hours/minutes after injury, while the late form presents 12-24 h after neurological injury. Clinical manifestations consist of non-specific signs of respiratory distress: dyspnea, tachypnea, hypoxia, pink expectoration, crackles on auscultation, which usually resolve within 24-48 h in 50% of patients. Unfortunately, there are no tools to make the specific diagnosis, so the diagnosis is by exclusion. The therapeutic approach consists of two interventions: treatment of the underlying neurological injury to reduce intracranial pressure and control sympathetic hyperactivity related to the lung injury, and supportive treatment for pulmonary edema. SHORT CONCLUSION SAH is a severe condition that represents a risk to the life of the affected patient due to the possible complications that may develop. NPE is one of these complications, which due to the common manifestation of a respiratory syndrome, does not allow early and accurate diagnosis, being a diagnosis of exclusion. Therefore, in any case of CNS lesion with pulmonary involvement, NPE should be suspected immediately.
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Affiliation(s)
- Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
- Colombian Clinical Research Group in Neurocritical Care, School of Medicine, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care, Cartagena, Colombia
- Global Committee Neurosurgery, World Federation of Neurosurgical Societies, Cartagena, Colombia
| | | | - Jenny Ospina-Rios
- Department of Medicine, Fundación Universitaria Visión de Las Americas, Pereira, Colombia
| | | | | | | | | | | | - Tariq Janjua
- Department of Intensive Care, Regions Hospital, Saint Paul, MN USA
| | - Luis Rafael Moscote-Salazar
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
- Colombian Clinical Research Group in Neurocritical Care, School of Medicine, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care, Cartagena, Colombia
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27
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Ziaka M, Exadaktylos A. Brain-lung interactions and mechanical ventilation in patients with isolated brain injury. Crit Care 2021; 25:358. [PMID: 34645485 PMCID: PMC8512596 DOI: 10.1186/s13054-021-03778-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain–lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions—such as MV—may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.
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Affiliation(s)
- Mairi Ziaka
- Department of Internal Medicine, Thun General Hospital, Thun, Switzerland.
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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28
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Bayoumi Y, Sobhy N, Morsi A, El-Neshwey W, El-Seddawy N, Abdallah A. Clinical and histopathological studies on neurodegeneration and dysautonomia in buffalo calves during foot-and-mouth disease outbreaks in Egypt. Vet World 2021; 14:1622-1630. [PMID: 34316212 PMCID: PMC8304408 DOI: 10.14202/vetworld.2021.1622-1630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim Signs of dysautonomia were frequently observed in calves that died during foot-and-mouth disease (FMD) virus (FMDV) outbreaks in Egypt from 2015 to 2018. This study aimed to describe the clinical and histopathological features of the central nervous system in malignant cases of FMD and excluding possible concurrent bacterial, and bovine herpes virus 4 (BHV4) infections or both. Materials and Methods In this study, 335 FMDV-infected buffalo calves aged 1-22 months were clinically examined and followed until recovery or death. Of the 335 calves, 134 died (malignant group) and 201 recovered after exhibiting classic symptoms of FMD (recover group). The calves were subjected to clinical examination. For the malignant group, several laboratory trials were conducted to assess the possible cause/s of dysautonomia-related viral, bacterial, or concurrent infections. Koch's postulates and polymerase chain reaction were employed. Postmortem and histopathological examinations of nervous tissue were performed. Results In the malignant group, signs of dysautonomia were observed before death, including partial or complete gut dysfunction, loss of anal sphincter tone, rapid breathing sounds, fluctuating body temperature, and cardiac arrhythmias. In the malignant group, histopathological examination of the spinal cord, pons, medulla oblongata, hypothalamus, cerebellum, and cerebrum revealed demyelination, neuronal degeneration, and focal areas of malacia and gliosis. The nervous tissue and heart samples from malignant cases were positive for serotype O FMDV. Conclusion Findings revealed in this study support the existence of neurodegeneration induced by FMDV infection in buffalo calves.
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Affiliation(s)
- Yasmin Bayoumi
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Sobhy
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Abdelkarem Morsi
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Wafaa El-Neshwey
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Nora El-Seddawy
- Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Abdelmonem Abdallah
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
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29
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Rachfalska N, Putowski Z, Krzych ŁJ. Distant Organ Damage in Acute Brain Injury. Brain Sci 2020; 10:E1019. [PMID: 33371363 PMCID: PMC7767338 DOI: 10.3390/brainsci10121019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Acute brain injuries pose a great threat to global health, having significant impact on mortality and disability. Patients with acute brain injury may develop distant organ failure, even if no systemic diseases or infection is present. The severity of non-neurologic organs' dysfunction depends on the extremity of the insult to the brain. In this comprehensive review we sought to describe the organ-related consequences of acute brain injuries. The clinician should always be aware of the interplay between central nervous system and non-neurological organs, that is constantly present. Cerebral injury is not only a brain disease, but also affects the body as whole, and thus requires holistic therapeutical approach.
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Affiliation(s)
| | | | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (N.R.); (Z.P.)
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30
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Lo-Cao E, Hall S, Parsell R, Dandie G, Fahlström A. Neurogenic pulmonary edema. Am J Emerg Med 2020; 45:678.e3-678.e5. [PMID: 33308892 DOI: 10.1016/j.ajem.2020.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
AIM We report a case of neurogenic pulmonary edema in a patient who sustained a severe traumatic brain injury in a motorbike accident and review the current literature with regards to the management of neurogenic pulmonary edema (NPE). METHODS A 17 year old male was involved in a motorbike collision into a tree. Copious amounts of pink frothy sputum was noted on scene. Rapid sequence intubation was performed on scene and video laryngoscopy demonstrated profuse frothy secretions welling up from the larynx. RESULTS The patient underwent emergency external ventricular drain insertion for intracranial pressure (ICP) monitoring. Intracranial pressures remained refractorily high and a decompressive bifrontal craniectomy was performed on the subsequent day. He was tracheostomised on admission day 24 and discharged from ICU on day 34. DISCUSSION Neurogenic pulmonary edema is defined as acute respiratory distress triggered by severe sympathetic discharge from acute compromise in the central nervous system. Rapid intervention with intubation is often necessary to protect the airways and facilitate diagnostic evaluation. Reduction of ICP and supportive mechanical ventilation to improve oxygenation is necessary. Positive end-expiratory pressure should be carefully applied to balance recruitment of alveoli and minimisation of ICP. Although NPE is estimated to resolve within 72 h in more than half of patients, prognosis is generally poor due to the severity of the underlying brain injury, with estimated mortality rates of between 60 and 100%. CONCLUSION Neurogenic pulmonary edema is a potentially life-threatening complication of severe brain injury and should be recognised early to facilitate management.
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Affiliation(s)
- Edward Lo-Cao
- Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead 2145, New South Wales, Australia; The University of Sydney, Camperdown 2006, New South Wales, Australia.
| | - Samuel Hall
- Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead 2145, New South Wales, Australia
| | - Ruth Parsell
- Emergency Department, Nepean Hospital, Derby Street, Kingswood 2747, New South Wales, Australia; CareFlight Rapid Response Helicopter, Redbank Road, Northmead 2152, New South Wales, Australia
| | - Gordon Dandie
- Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead 2145, New South Wales, Australia
| | - Andreas Fahlström
- Department of Neurosurgery, Westmead Hospital, Hawkesbury Road, Westmead 2145, New South Wales, Australia; Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala 75185, Sweden
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31
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Komisarow JM, Chen F, Vavilala MS, Laskowitz D, James ML, Krishnamoorthy V. Epidemiology and Outcomes of Acute Respiratory Distress Syndrome Following Isolated Severe Traumatic Brain Injury. J Intensive Care Med 2020; 37:68-74. [PMID: 33191844 DOI: 10.1177/0885066620972001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with traumatic brain injury (TBI) are at risk for extra-cranial complications, such as the acute respiratory distress syndrome (ARDS). We conducted an analysis of risk factors, mortality, and healthcare utilization associated with ARDS following isolated severe TBI. The National Trauma Data Bank (NTDB) dataset files from 2007-2014 were used to identify adult patients who suffered isolated [other body region-specific Abbreviated Injury Scale (AIS) < 3] severe TBI [admission total Glasgow Coma Scale (GCS) from 3 to 8 and head region-specific AIS >3]. In-hospital mortality was compared between patients who developed ARDS and those who did not. Utilization of healthcare resources (ICU length of stay, hospital length of stay, duration of mechanical ventilation, and frequency of tracheostomy and gastrostomy tube placement) was also examined. This retrospective cohort study included 38,213 patients with an overall ARDS occurrence of 7.5%. Younger age, admission tachycardia, pre-existing vascular and respiratory diseases, and pneumonia were associated with the development of ARDS. Compared to patients without ARDS, patients that developed ARDS experienced increased in-hospital mortality (OR 1.13, 95% CI 1.01-1.26), length of stay (p = <0.001), duration of mechanical ventilation (p = < 0.001), and placement of tracheostomy (OR 2.70, 95% CI 2.34-3.13) and gastrostomy (OR 2.42, 95% CI 2.06-2.84). After isolated severe TBI, ARDS is associated with increased mortality and healthcare utilization. Future studies should focus on both prevention and management strategies specific to TBI-associated ARDS.
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Affiliation(s)
| | - Fangyu Chen
- School of Medicine, 12277Duke University, Durham, NC, USA
| | - Monica S Vavilala
- Department of Anesthesiology, 7284University of Washington, Seattle, WA, USA
| | | | - Michael L James
- Department of Neurology, 12277Duke University, Durham, NC, USA.,Department of Anesthesiology, 12277Duke University, Durham, NC, USA
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32
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Towner JE, Rahmani R, Zammit CG, Khan IR, Paul DA, Bhalla T, Roberts DE. Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:575. [PMID: 32972406 PMCID: PMC7512211 DOI: 10.1186/s13054-020-03269-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Objective Mechanical ventilation (MV) has a complex interplay with the pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH). We aim to provide a review of the physiology of MV in patients with aSAH, give recommendations based on a systematic review of the literature, and highlight areas that still need investigation. Data sources PubMed was queried for publications with the Medical Subject Headings (MeSH) terms “mechanical ventilation” and “aneurysmal subarachnoid hemorrhage” published between January 1, 1990, and March 1, 2020. Bibliographies of returned articles were reviewed for additional publications of interest. Study selection Study inclusion criteria included English language manuscripts with the study population being aSAH patients and the exposure being MV. Eligible studies included randomized controlled trials, observational trials, retrospective trials, case-control studies, case reports, or physiologic studies. Topics and articles excluded included review articles, pediatric populations, non-aneurysmal etiologies of subarachnoid hemorrhage, mycotic and traumatic subarachnoid hemorrhage, and articles regarding tracheostomies. Data extraction Articles were reviewed by one team member, and interpretation was verified by a second team member. Data synthesis Thirty-one articles met the inclusion criteria for this review. Conclusions We make recommendations on oxygenation, hypercapnia, PEEP, APRV, ARDS, and intracranial pressure monitoring.
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Affiliation(s)
- James E Towner
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Redi Rahmani
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Christopher G Zammit
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,TriHealth Critical Care, 10506 Montgomery Road, Suite 301, Cincinnatir, OH, 45242, USA
| | - Imad R Khan
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - David A Paul
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Tarun Bhalla
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 670, Rochester, NY, 14642, USA.,Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Debra E Roberts
- Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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33
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Zhao J, Xuan NX, Cui W, Tian BP. Neurogenic pulmonary edema following acute stroke: The progress and perspective. Biomed Pharmacother 2020; 130:110478. [PMID: 32739737 DOI: 10.1016/j.biopha.2020.110478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Neurogenic pulmonary edema (NPE) following acute stroke is an acute respiratory distress syndrome (ARDS) with clinical characteristics that include acute onset, apparent pulmonary interstitial fluid infiltration and rapid resolution. The pathological process of NPE centers on sympathetic stimulation and fulminant release of catecholamines, which cause contraction of resistance vessels. Elevated systemic resistance forces fluid into pulmonary circulation, while pulmonary circulation overload induces pulmonary capillary pressure that elevates, and in turn damages the alveolar capillary barrier. Damage to the alveolar capillary barrier leads to pulmonary ventilation disorder, blood perfusion disorder and oxygenation disorder. Eventually, NPE will cause post-stroke patients' prognosis to further deteriorate. At present, we lack specific biological diagnostic indicators and a meticulously unified diagnostic criterion, and this results in a situation in which many patients are not recognized quickly and/or diagnosed accurately. There are no drugs that are effective against NPE. Therefore, understanding how to diagnose NPE early by identifying the risk factors and how to apply appropriate treatment to avoid a deteriorating prognosis are important scientific goals. We will elaborate the progress of NPE after acute stroke in terms of its pathophysiological mechanisms, etiology, epidemiology, clinical diagnosis and early prediction, comprehensive treatment strategies, and novel drug development. We also propose our own thinking and prospects regarding NPE.
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Affiliation(s)
- Jie Zhao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Nan-Xia Xuan
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Wei Cui
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Bao-Ping Tian
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
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34
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Kaniusas E, Szeles JC, Kampusch S, Alfageme-Lopez N, Yucuma-Conde D, Li X, Mayol J, Neumayer C, Papa M, Panetsos F. Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome. Front Physiol 2020; 11:890. [PMID: 32848845 PMCID: PMC7399203 DOI: 10.3389/fphys.2020.00890] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Covid-19 is an infectious disease caused by an invasion of the alveolar epithelial cells by coronavirus 19. The most severe outcome of the disease is the Acute Respiratory Distress Syndrome (ARDS) combined with hypoxemia and cardiovascular damage. ARDS and co-morbidities are associated with inflammatory cytokine storms, sympathetic hyperactivity, and respiratory dysfunction. Hypothesis: In the present paper, we present and justify a novel potential treatment for Covid19-originated ARDS and associated co-morbidities, based on the non-invasive stimulation of the auricular branch of the vagus nerve. Methods: Auricular vagus nerve stimulation activates the parasympathetic system including anti-inflammatory pathways (the cholinergic anti-inflammatory pathway and the hypothalamic pituitary adrenal axis) while regulating the abnormal sympatho-vagal balance and improving respiratory control. Results: Along the paper (1) we expose the role of the parasympathetic system and the vagus nerve in the control of inflammatory processes (2) we formulate our physiological and methodological hypotheses (3) we provide a large body of clinical and preclinical data that support the favorable effects of auricular vagus nerve stimulation in inflammation, sympatho-vagal balance as well as in respiratory and cardiac ailments, and (4) we list the (few) possible collateral effects of the treatment. Finally, we discuss auricular vagus nerve stimulation protective potential, especially in the elderly and co-morbid population with already reduced parasympathetic response. Conclusions: Auricular vagus nerve stimulation is a safe clinical procedure and it could be either an effective treatment for ARDS originated by Covid-19 and similar viruses or a supplementary treatment to actual ARDS therapeutic approaches.
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Affiliation(s)
- Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Jozsef C. Szeles
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Nuria Alfageme-Lopez
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
| | - Daniela Yucuma-Conde
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Xie Li
- The Pediatric Department, Women and Children's Hospital of Hunan, Changsha, China
| | - Julio Mayol
- San Carlos Clinical Hospital, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Christoph Neumayer
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michele Papa
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fivos Panetsos
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
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35
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Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy-A Comparison with the Open Approach. J Clin Med 2020; 9:jcm9061896. [PMID: 32560416 PMCID: PMC7355913 DOI: 10.3390/jcm9061896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022] Open
Abstract
Patients undergoing esophageal cancer surgery are at high risk of developing severe pulmonary complications. Beneficial effects of minimally invasive esophagectomy had been discussed recently, but the incidence of perioperative respiratory impairment remains unclear. This is a retrospective single-center cohort study of patients, who underwent open (OE) or laparoscopically assisted, hybrid minimally invasive abdomino-thoracic esophagectomy (LAE) for cancer regarding respiratory impairment (PaO2/FiO2 ratio (P/FR) < 300 mmHg) and pneumonia. No differences were observed in the cumulative incidence of reduced P/FR between OE and LAE patients. Of note, until postoperative day (POD) 2, P/FR did not differ among both groups. Thereafter, the rate of patients with respiratory impairment was higher after OE on POD 3, 5, and 10 (p ≤ 0.05) and tended being higher on POD 7 and 9 (p ≤ 0.1). Although the duration of LAE procedure was slightly longer (total: p = 0.07, thoracic part: p = 0.004), the duration of surgery (Spearman's rank correlation coefficient (rsp) = -0.267, p = 0.006), especially of laparotomy (rsp = -0.242, p = 0.01) correlated inversely with respiratory impairment on POD 3 after OE. Pneumonia occurred on POD 5 (1-25) and 8.5 (3-14) after OE and LAE, respectively, with the highest incidence after OE (p = 0.01). In conclusion, respiratory impairment and pulmonary complications occur frequently after esophagectomy. Although early respiratory impairment is independent of the surgical approach, postoperative pneumonia rate is reduced after LAE.
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A Randomized Controlled Trial of Naloxone for Optimization of Hypoxemia in Lung Donors After Brain Death. Transplantation 2020; 103:1433-1438. [PMID: 30399122 DOI: 10.1097/tp.0000000000002511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persistent hypoxemia is the principal reason lungs from otherwise eligible brain dead (BD) organ donors are not transplanted. Experimental models and retrospective studies have suggested that naloxone attenuates neurogenic pulmonary edema and reverses hypoxemia after brain death. We undertook a multisite, randomized, placebo-controlled trial to evaluate whether naloxone is able to improve oxygenation in BD donors with hypoxemia. METHODS BD organ donors at 4 organ procurement organizations were randomized in a blinded manner to naloxone 8 mg or saline placebo if lung were being considered for allocation but exhibited hypoxemia (partial pressure of oxygen in arterial blood to fraction of inspired oxygen ratio [PFR] below 300 mm Hg). The primary outcome was change in PFR from baseline to final arterial blood gas. Secondary outcomes included early improvement in PFR and proportion of lungs transplanted. RESULTS A total of 199 lung-eligible BD donors were randomized to naloxone (n = 98) or placebo (n = 101). Groups were comparable at baseline. Both groups exhibited similar improvements in oxygenation (median improvement in PFR of 81 with naloxone versus 80 with saline, P = 0.68), with 37 (39%) versus 38 (40%) exhibiting reversal of hypoxemia. There was no difference in the rate of lungs transplanted (19% in both groups, P = 0.97) although it was significantly higher in those with reversal of hypoxemia (32/69 versus 2/111, P < 0.001). CONCLUSIONS Naloxone does not improve oxygenation more than placebo in hypoxemic organ donors. However, reversal of hypoxemia was a powerful predictor of lung utilization regardless of drug therapy. Further organ procurement organization-led research is needed to assess optimal interventions to improve oxygenation in BD donors with hypoxemia.
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Takagi Y, Imamura T, Endo S, Hayashi K, Akiyama S, Ikuta Y, Kawaguchi T, Sumita T, Katori T, Hashino M, Saito S, Odagiri T, Oba K, Kuroda M, Kageyama T. Neurogenic pulmonary edema following febrile status epilepticus in a 22-month-old infant with multiple respiratory virus co-detection: a case report. BMC Infect Dis 2020; 20:388. [PMID: 32487032 PMCID: PMC7266127 DOI: 10.1186/s12879-020-05115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 05/24/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Neurogenic pulmonary edema is a rare but serious complication of febrile status epilepticus in children. Comprehensive screening for viral pathogens is seldomly performed in the work-up of febrile children. CASE PRESENTATION A 22-month-old girl presented with her first episode of febrile status epilepticus, after which she developed acute pulmonary edema and respiratory failure. After the termination of seizure activity, the patient was intubated and managed on mechanical ventilation in the emergency room. The resolution of respiratory failure, as well as the neurological recovery, was achieved 9 h after admission, and the patient was discharged 6 days after admission without any complications. Molecular biological diagnostic methods identified the presence of human coronavirus HKU1, influenza C virus, and human parainfluenza virus 2 from the patient's nasopharyngeal specimens. CONCLUSIONS Neurogenic pulmonary edema following febrile status epilepticus was suspected to be the etiology of our patient's acute pulmonary edema and respiratory failure. Timely seizure termination and rapid airway and respiratory intervention resulted in favorable outcomes of the patient. Molecular biological diagnostic methods identified three respiratory viruses; however, their relevance and association with clinical symptoms remain speculative.
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Affiliation(s)
- Yoshie Takagi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
- Department of Emergency Medicine and Critical Care, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Takeaki Imamura
- Department of Emergency Medicine and Critical Care, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
- Department of Virology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, 980-8575, Japan
| | - Shota Endo
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Kenta Hayashi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Satoka Akiyama
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Yoji Ikuta
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Takahiro Kawaguchi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Tomoko Sumita
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Tatsuo Katori
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Masanori Hashino
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan
| | - Shinji Saito
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan
| | - Tsutomu Kageyama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan.
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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Gulsuna B, Turkmen T, Borcek AO, Celtikci E. Fluorescein-guided excision of a pediatric intraparenchymal schwannoma presenting with seizure and neurogenic pulmonary edema. Childs Nerv Syst 2020; 36:1075-1078. [PMID: 31786630 DOI: 10.1007/s00381-019-04438-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
Intraparenchymal schwannomas of the brain are very rare, accounting for < 1% of intracranial schwannomas. We present a case of an 11-year-old boy with a left frontotemporal lobe schwannoma presented with seizure and neurogenic pulmonary edema. To our knowledge, this is the first case of intracerebral schwannoma with neurogenic pulmonary edema published to date and is the first case of an intracerebral schwannoma operated with fluorescein guidance.
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Affiliation(s)
- Beste Gulsuna
- Department of Neurosurgery, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Tolga Turkmen
- Department of Neurosurgery, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Alp Ozgun Borcek
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey.
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Abstract
Although acute respiratory distress syndrome is the most common cause of noncardiogenic pulmonary edema, NPs also should be familiar with several other less common causes, including transfusion-related acute lung injury, neurogenic pulmonary edema, preeclampsia/eclampsia, opioid overdose, high-altitude pulmonary edema, and pulmonary embolism. This article addresses the pathophysiology, clinical presentation, diagnostics, treatment, and nursing considerations associated with each uncommon cause of noncardiogenic pulmonary edema.
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Packer RA, McGrath S. Onscreen-guided resection of extra-axial and intra-axial forebrain masses through registration of a variable-suction tissue resection device with a neuronavigation system. Vet Surg 2020; 49:676-684. [PMID: 32220078 DOI: 10.1111/vsu.13414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 01/10/2020] [Accepted: 03/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe a novel surgical technique in which neuronavigation is used to guide a tissue resection device during excision of forebrain masses in locations difficult to visualize optically. STUDY DESIGN Short case series. ANIMALS Six dogs and one cat with forebrain masses (five neoplastic, two nonneoplastic) undergoing excision with a novel tissue resection device and veterinary neuronavigation system. METHODS The animals and resection instrument were coregistered to the neuronavigation system. Surgery was guided by real-time onscreen visualization of the resection instrument position relative to the preoperative MR images. Surgical outcome was evaluated by calculating residual tumor volume according to postoperative MRI. RESULTS The technique was technically simple and led to the collection of diagnostic tissue samples in all cases. Postoperative MRI was available in six cases, two with gross-total resection, three with near-total resection, and one with subtotal resection. CONCLUSION Neuronavigation-guided resection of intra-axial and extra-axial brain masses with the resection device resulted in gross-total or near-total resection in five of six animals with tumors otherwise difficult to visualize. Risk of brain shift limited absolute reliance on navigation images. CLINICAL SIGNIFICANCE Real-time neuronavigation assistance is a feasible method for guidance and successful resection of brain masses that are poorly visualized because of intra-axial or deep location, tumor appearance, or hemorrhage.
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Affiliation(s)
- Rebecca A Packer
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Stephanie McGrath
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Zhuo Y, Shan F, Yang S, Zhan Y, Shi Y, Zhang Z. Advances in differential diagnosis of pulmonary ground glass opacity on high resolution computed tomography and histopathology. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jrid.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dang H, Li J, Liu C, Xu F. Chromogranin A provides additional prognostic information in children with severe hand, foot, and mouth disease: A prospective observational study. Int J Infect Dis 2020; 93:367-374. [PMID: 32109626 DOI: 10.1016/j.ijid.2020.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Severe hand, foot, and mouth disease (HFMD) is associated with high mortality in children, and persistent sympathetic activation is a common presentation. The aim of this study was to prospectively investigate serum chromogranin A (CHGA) levels and their prognostic role in this condition. METHODS Serum CHGA, creatine kinase myocardial band (CK-MB), serum D-dimer, norepinephrine, blood glucose, lactate, and C-reactive protein levels, white blood cell (WBC) counts, usage of vasopressors, pediatric risk of mortality Ⅲ (PRISM-Ⅲ) scores, and viral etiology were measured upon pediatric intensive care unit (PICU) admission. The correlation between clinical outcomes and the indicators listed above were analyzed, and the ability of CHGA as a biomarker to predict mortality was evaluated. RESULTS Serum CHGA levels were higher in the non-survivors group than in the survivors group (median (interquartile range): 434.8 (374.3-502.4) vs 183.3 (131.9-246.9) μg/l; p < 0.001) and were correlated with norepinephrine (r = 0.37. p < 0.001), blood glucose (r = 0.32, p = 0.001), lactate (r = 0.25, p = 0.009), WBC (r = 0.20, p = 0.039), and PRISM-Ⅲ scores (r = 0.748, p < 0.0001). Patients suffering neurogenic pulmonary edema, those infected with enterovirus A71, and those requiring more vasopressors had higher serum CHGA levels (median (interquartile range): 385 (239.9-488.8) vs 161 (115.6-222.9), 340.6 (190.6-436.0) vs 150.5 (112.1-210.0), 395.6 (209.1-487.0) vs 167.7 (110.5-240.5) μg/l, respectively; p < 0.0001). The CHGA level upon PICU admission in severe HFMD could be an independent risk factor for mortality (adjusted odds ratio 2.459, 95% confidence interval 1.054-5.906, p = 0.038) with high specificity (87.5%) and sensitivity (82.6%) (cut-off value at 339.6 μg/l). CONCLUSIONS The CHGA level in severe HFMD was found to be associated with cardiopulmonary failure. If measured upon PICU admission, CHGA may provide additional prognostic information in this disease.
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Affiliation(s)
- Hongxing Dang
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Jing Li
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Chengjun Liu
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Feng Xu
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
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Correia CDJ, Coutinho E Silva RDS, Soares RGF, Armstrong R, Ricardo-da-Silva FY, Sannomiya P, Breithaupt-Faloppa AC, Moreira LFP. Hypertonic saline reduces cell infiltration into the lungs after brain death in rats. Pulm Pharmacol Ther 2020; 61:101901. [PMID: 32044433 DOI: 10.1016/j.pupt.2020.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lung transplantation is a treatment method for end stage lung disease, but the availability of donor lungs remains a major constraint. Brain death (BD) induces hemodynamic instability with microcirculatory hypoperfusion and increased inflammation, leading to pulmonary dysfunction. Hypertonic saline solution (HSS) is a volume expander possessing immunomodulatory effects. This study evaluated the influence of HSS on pulmonary dysfunction and inflammation in a rat model of BD. METHODS BD was induced by inflation of an intracranial balloon catheter. Rats were divided into [1]: Sham, without BD [2]; NS, NaCl treatment (0.9%, 4 mL/kg, i.v.) immediately after BD [3]; HSS1, HSS treatment (NaCl 7.5%, 4 mL/kg, i.v.) immediately after BD; and [4] HSS60, HSS treatment 60 min post BD. All groups were analyzed after 360 min. RESULTS Animals subjected to BD exhibited increased exhaled O2 and decreased CO2.The number of leukocytes in the lungs was significantly increased in the NS group (p = 0.002) and the HSS treatment was able to reduce it (HSS1, p = 0.018 and HSS60 = 0.030). In parallel, HSS-treated rats showed reduced levels of ICAM-1 expression, which was increased in the NS compared to Sham group. Lung edema was found increased in the NS group animals compared to Sham and no effect of the HSS treatment was observed. There were no differences among the groups in terms of TNF-α, VEGF, and CINC-1 lung concentrations. CONCLUSIONS HSS is capable of reducing inflammatory cell infiltration into the lung after BD induction, which is associated with the reduction of ICAM-1 expression in organ vessels.
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Affiliation(s)
- Cristiano de Jesus Correia
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Raphael Dos Santos Coutinho E Silva
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafaela Garcia Ferreira Soares
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Armstrong
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Yamamoto Ricardo-da-Silva
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulina Sannomiya
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Breithaupt-Faloppa
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Felipe P Moreira
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Tsuchiya N, Griffin L, Yamashiro T, Gibo S, Okane T, Yasutani T, Murayama S. Imaging findings of pulmonary edema: Part 2. Infrequent or unusual pulmonary edema with definitive imaging findings. Acta Radiol 2020; 61:195-203. [PMID: 31237773 DOI: 10.1177/0284185119856880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsay Griffin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Shinji Gibo
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | - Tsuyoshi Okane
- Department of Radiology, Urasoe General Hospital, Okinawa, Japan
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Reichert M, Schistek M, Uhle F, Koch C, Bodner J, Hecker M, Hörbelt R, Grau V, Padberg W, Weigand MA, Hecker A. Ivor Lewis esophagectomy patients are particularly vulnerable to respiratory impairment - a comparison to major lung resection. Sci Rep 2019; 9:11856. [PMID: 31413282 PMCID: PMC6694108 DOI: 10.1038/s41598-019-48234-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
Pulmonary complications and a poor clinical outcome are common in response to transthoracic esophagectomy, but their etiology is not well understood. Clinical observation suggests that patients undergoing pulmonary resection, a surgical intervention with similarities to the thoracic part of esophagectomy, fare much better, but this has not been investigated in detail. A retrospective single-center analysis of 181 consecutive patients after right-sided thoracotomy for either Ivor Lewis esophagectomy (n = 83) or major pulmonary resection (n = 98) was performed. An oxygenation index <300 mm Hg was used to indicate respiratory impairment. When starting surgery, respiratory impairment was seen more frequently in patients undergoing major pulmonary resection compared to esophagectomy patients (p = 0.009). On postoperative days one to ten, however, esophagectomy caused higher rates of respiratory impairment (p < 0.05) resulting in a higher cumulative incidence of postoperative respiratory impairment for patients after esophagectomy (p < 0.001). Accordingly, esophagectomy patients were characterized by longer ventilation times (p < 0.0001), intensive care unit and total postoperative hospital stays (both p < 0.0001). In conclusion, the postoperative clinical course including respiratory impairment after Ivor Lewis esophagectomy is significantly worse than that after major pulmonary resection. A detailed investigation of the underlying causes is required to improve the outcome of esophagectomy.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany.
| | - Magdalena Schistek
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany.,Department of Thoracic Surgery, München Klinik Bogenhausen, Englschalkinger Strasse 77, D-81925, Munich, Germany
| | - Matthias Hecker
- Department of Pulmonary and Critical Care Medicine, University of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen, Klinikstrasse 33, D-35392, Giessen, Germany
| | - Rüdiger Hörbelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany
| | - Veronika Grau
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany.,Laboratory of Experimental Surgery, German Centre for Lung Research (DZL), Justus-Liebig-University Giessen, Feulgenstrasse 10-12, D-35392, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, D-35392, Giessen, Germany
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47
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Bölter C, Gabriel P, Appelt P, Salameh A, Schierle K, Rassler B. Effects of Adrenergic Agonists and Antagonists on Cardiopulmonary Function During Normobaric Hypoxia in Rat. Front Physiol 2019; 10:860. [PMID: 31333500 PMCID: PMC6624647 DOI: 10.3389/fphys.2019.00860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Pulmonary edema (PE) is an issue widely noted in acute exposure to hypoxia as seen in high altitude climbers, yet the etiology of this is not defined. Previous studies in rats showed that both hypoxia and strong sympathetic activation may induce PE. As acute exposure to hypoxia is accompanied by sympathetic activation, we assume that this may impair pulmonary circulation and contribute to the development of hypoxic PE. The aim of the present study was to investigate the effects of adrenergic agonists and antagonists as models for overstimulation and suppression, respectively, of sympathetic activity on cardiovascular function and formation of PE in hypoxic rats. Norepinephrine or adrenergic blockers were infused to rats exposed to normobaric hypoxia with 10% O2 over time intervals up to 24 h. Normoxic and hypoxic controls received 0.9% NaCl infusion. We evaluated hemodynamic function and lung histology. A significant decrease of left ventricular systolic function was observed after 6 h of hypoxia. This effect was less pronounced with α-adrenergic blockade but was more severe with combined α-plus β-adrenergic blockade. Norepinephrine delayed the onset of hypoxic left ventricular depression but did not reduce its degree. Significant PE developed after 16 h of hypoxia. It regressed under α- but not with β-adrenergic blockade, and was aggravated by combining hypoxia with norepinephrine. Almost half of the animals exposed to hypoxia over 16–24 h suffered cardiorespiratory arrest during the experiment and presented with signs of acute right ventricular failure. They had significantly elevated serum catecholamine concentrations and significantly stronger PE than the others. Notably, most of them had received norepinephrine or combined adrenergic blockade. Mild changes in serum catecholamine concentrations indicated that hypoxic sympathoadrenergic activation was only weak. Hence, it was not sufficient to prevent left ventricular depression. However, the results show that α-adrenergic mechanisms contribute to the formation of hypoxic PE. Adrenergic blockade but also sympathetic overactivity may induce pulmonary congestion, PE and acute right ventricular failure indicating that a fine balance of sympathetic activation under hypoxic conditions is crucial. This has important implications for climbers to high altitude as well as for patients suffering from hypoxia.
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Affiliation(s)
- Christian Bölter
- Carl-Ludwig-Institute for Physiology, University of Leipzig, Leipzig, Germany
| | - Philipp Gabriel
- Carl-Ludwig-Institute for Physiology, University of Leipzig, Leipzig, Germany
| | - Peter Appelt
- Carl-Ludwig-Institute for Physiology, University of Leipzig, Leipzig, Germany
| | - Aida Salameh
- Department of Pediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Katrin Schierle
- Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - Beate Rassler
- Carl-Ludwig-Institute for Physiology, University of Leipzig, Leipzig, Germany
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48
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Wen MD, Jiang Y, Huang J, Al-Hawwas M, Dan QQ, Yang RA, Yuan B, Zhao XM, Jiang L, Zhong MM, Xiong LL, Zhang YH. A Novel Role of VEGFC in Cerebral Ischemia With Lung Injury. Front Neurosci 2019; 13:479. [PMID: 31191213 PMCID: PMC6540825 DOI: 10.3389/fnins.2019.00479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
Cerebral ischemia (CI) is a severe brain injury resulting in a variety of motor impairments combined with secondary injury in remote organs, especially the lung. This condition occurs due to insufficient blood supply to the brain during infancy. However, it has a molecular linkage that needs to be thoroughly covered. Here, we report on the role of vascular endothelial growth factor C (VEGFC) in lung injury induced by CI. The middle cerebral artery occlusion (MCAO) was depended to establish the animal model of CI. Rats were used and brain ischemia was confirmed through TTC staining. Serum was used for protein chip analysis to study the proteomic interaction. Immunohistochemistry analyses were used to quantify and locate the VEGFC in the lung and brain. The role of VEGFC was detected by siVEGFC technology in SY5Y, HUCEV, and A549 cell lines, under normal and oxygen glucose deprivation (OGD) conditions in vitro. As a result, the TTC staining demonstrated that the model of brain ischemia was successfully established, and MPO experiments reported that lung damage was induced in MCAO rats. VEGFC levels were up-regulated in serum. On the other hand, immunohistochemistry showed that VEGFC increased significantly in the cytoplasm of neurons, the endothelium of small trachea and the lung cells of CI animals. On a functional level, siVEGFC effectively inhibited the proliferation of SY5Y cells and decreased the viability of HUVEC cells in normal cell lines. But under OGD conditions, siVEGFC decreased the growth of HUVEC and increased the viability of A549 cells, while no effect was noticed on SYSY cells. Therefore, we confirmed the different role of VEGFC played in neurons and lung cells in cerebral ischemia-reperfusion injury. These findings may contribute to the understanding the molecular linkage of brain ischemia and lung injury, which therefore provides a new idea for the therapeutic approach to cerebral ischemia-reperfusion.
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Affiliation(s)
- Mu-Dong Wen
- Department of Respiration, The First People's Hospital of Yunnan Province, Kunming, China
| | - Ya Jiang
- Laboratory Zoology Department, Institute of Neuroscience, Kunming Medical University, Kunming, China
| | - Jin Huang
- Laboratory Zoology Department, Institute of Neuroscience, Kunming Medical University, Kunming, China
| | - Mohammed Al-Hawwas
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Qi-Qin Dan
- Institute of Neurological Disease, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rui-An Yang
- Department of Respiration, The First People's Hospital of Yunnan Province, Kunming, China
| | - Bing Yuan
- Department of Respiration, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xiao-Ming Zhao
- Institute of Neurological Disease, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Jiang
- Institute of Neurological Disease, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Mei Zhong
- Department of Respiration, The First People's Hospital of Yunnan Province, Kunming, China
| | - Liu-Lin Xiong
- Department of Anesthesiology, National Traditional Chinese Medicine Clinical Research Base and Western Medicine Translational Medicine Research Center, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Yun-Hui Zhang
- Department of Respiration, The First People's Hospital of Yunnan Province, Kunming, China
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Suleiman S, Klassen S, Katz I, Balakirski G, Krabbe J, von Stillfried S, Kintsler S, Braunschweig T, Babendreyer A, Spillner J, Kalverkamp S, Schröder T, Moeller M, Coburn M, Uhlig S, Martin C, Rieg AD. Argon reduces the pulmonary vascular tone in rats and humans by GABA-receptor activation. Sci Rep 2019; 9:1902. [PMID: 30760775 PMCID: PMC6374423 DOI: 10.1038/s41598-018-38267-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022] Open
Abstract
Argon exerts neuroprotection. Thus, it might improve patients' neurological outcome after cerebral disorders or cardiopulmonary resuscitation. However, limited data are available concerning its effect on pulmonary vessel and airways. We used rat isolated perfused lungs (IPL) and precision-cut lung slices (PCLS) of rats and humans to assess this topic. IPL: Airway and perfusion parameters, oedema formation and the pulmonary capillary pressure (Pcap) were measured and the precapillary and postcapillary resistance (Rpost) was calculated. In IPLs and PCLS, the pulmonary vessel tone was enhanced with ET-1 or remained unchanged. IPLs were ventilated and PCLS were gassed with argon-mixture or room-air. IPL: Argon reduced the ET-1-induced increase of Pcap, Rpost and oedema formation (p < 0.05). PCLS (rat): Argon relaxed naïve pulmonary arteries (PAs) (p < 0.05). PCLS (rat/human): Argon attenuated the ET-1-induced contraction in PAs (p < 0.05). Inhibition of GABAB-receptors abolished argon-induced relaxation (p < 0.05) in naïve or ET-1-pre-contracted PAs; whereas inhibition of GABAA-receptors only affected ET-1-pre-contracted PAs (p < 0.01). GABAA/B-receptor agonists attenuated ET-1-induced contraction in PAs and baclofen (GABAB-agonist) even in pulmonary veins (p < 0.001). PLCS (rat): Argon did not affect the airways. Finally, argon decreases the pulmonary vessel tone by activation of GABA-receptors. Hence, argon might be applicable in patients with pulmonary hypertension and right ventricular failure.
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Affiliation(s)
- Said Suleiman
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Sergej Klassen
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Ira Katz
- Medical Research & Development, Air Liquide Santé Internationale, Centre de Recherche Paris-Saclay, 78354, Jouy-en-Josas, France
| | - Galina Balakirski
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Julia Krabbe
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | | | - Svetlana Kintsler
- Institute of Pathology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Aaron Babendreyer
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Jan Spillner
- Department of Cardiac and Thoracic Surgery, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Sebastian Kalverkamp
- Department of Cardiac and Thoracic Surgery, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Thomas Schröder
- Department of Surgery, Luisenhospital Aachen, 52064, Aachen, Germany
| | - Manfred Moeller
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Christian Martin
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Annette D Rieg
- Department of Anaesthesiology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany.
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50
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Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive Care Med 2019; 45:343-353. [PMID: 30741327 PMCID: PMC7095373 DOI: 10.1007/s00134-019-05551-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To provide a practical overview of the management of the potential organ donor in the intensive care unit. METHODS Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted. RESULTS AND CONCLUSIONS Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.
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