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Barbas CSV. Thoracic Computed Tomography to Assess ARDS and COVID-19 Lungs. Front Physiol 2022; 13:829534. [PMID: 35586712 PMCID: PMC9108486 DOI: 10.3389/fphys.2022.829534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
This review was designed to discuss the role of thoracic-computed tomography (CT) in the evaluation and treatment of patients with ARDS and COVID-19 lung disease. Non-aerated lungs characterize the ARDS lungs, compared to normal lungs in the lowermost lung regions, compressive atelectasis. Heterogenous ARDS lungs have a tomographic vertical gradient characterized by progressively more aerated lung tissues from the gravity-dependent to gravity-independent lungs levels. The application of positive pressure ventilation to these heterogeneous ARDS lungs provides some areas of high shear stress, others of tidal hyperdistension or tidal recruitment that increases the chances of appearance and perpetuation of ventilator-induced lung injury. Other than helping to the correct diagnosis of ARDS, thoracic-computed tomography can help to the adjustments of PEEP, ideal tidal volume, and a better choice of patient position during invasive mechanical ventilation. Thoracic tomography can also help detect possible intra-thoracic complications and in the follow-up of the ARDS patients’ evolution during their hospital stay. In COVID-19 patients, thoracic-computed tomography was the most sensitive imaging technique for diagnosing pulmonary involvement. The most common finding is diffuse pulmonary infiltrates, ranging from ground-glass opacities to parenchymal consolidations, especially in the lower portions of the lungs’ periphery. Tomographic lung volume loss was associated with an increased risk for oxygenation support and patient intubation and the use of invasive mechanical ventilation. Pulmonary dual-energy angio-tomography in COVID-19 patients showed a significant number of pulmonary ischemic areas even in the absence of visible pulmonary arterial thrombosis, which may reflect micro-thrombosis associated with COVID-19 pneumonia. A greater thoracic tomography severity score in ARDS was independently related to poor outcomes.
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Affiliation(s)
- Carmen Silvia Valente Barbas
- Associate Professor of Pneumology, University of São Paulo Medical School, Medical Staff Adult ICU Albert Einstein Hospital, São Paulo, Brazil
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Pinzon D, Baumgarten D, Galetke W. [39-Year-Old Woman with Severe COVID-19 Pneumonia: Successful Weaning after Septic Shock and Forefoot Amputation after Microvascular Complications]. Pneumologie 2021; 75:526-530. [PMID: 33873215 DOI: 10.1055/a-1362-4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We present the case of a slightly obese 39-year-old patient with a severe course of COVID-19 pneumonia. The patient was referred from a hospital to regular care with suspected COVID-19 pneumonia. The initial clinical symptoms consisted of dysuria and fever. A bilateral infiltrate was seen in the chest x-ray. In the CT thorax, advanced COVID-19 typical changes were found on both sides. The COVID-19 infection was confirmed by a positive SARS-CoV-2 PCR from the nasopharynx smear. In the case of progressive ARDS with respiratory exhaustion, the patient was intubated and invasively ventilated. When a bacterial superinfection was suspected, we initiated empirical antibiotic therapy. In addition, a therapy with dexamethasone was applied. Therapy with ASA and weight-adapted semi-therapeutic low molecular weight heparin was also carried out. During the intensive care treatment the patient developed a fulminant septic shock with consecutive severe thrombocytopenia. A dilated tracheotomy was performed. The weaning progress was hampered by recurrent septic attacks. Necrosis in the area of the right foot was identified as the cause of the septic relapses. As there was no alternative focus, surgical rehabilitation with partial amputation was carried out. The patient then remained infection-free and could be weaned from the respirator.
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Affiliation(s)
- D Pinzon
- Vamed Klinik Hagen-Ambrock, Klinik für Pneumologie, Hagen Ambrock
| | - D Baumgarten
- Vamed Klinik Hagen-Ambrock, Klinik für Pneumologie, Hagen Ambrock
| | - W Galetke
- Vamed Klinik Hagen-Ambrock, Klinik für Pneumologie, Hagen Ambrock
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Zhao K, Bai SJ, Wang ZT, Zhang YH, Liu C, Song HG, Wang HB, Li X, You WL. Association of high-resolution computed tomography score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome. J Int Med Res 2021; 48:300060520912966. [PMID: 32520632 PMCID: PMC7288822 DOI: 10.1177/0300060520912966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study was performed to explore the association of the high-resolution computed tomography (HRCT) score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome (ARDS). Method In total, 197 patients treated for ARDS from October 2004 to December 2015 were retrospectively analyzed. Univariate analysis and multifactor regression analysis were used to determine the relationship of the HRCT score with ventilator weaning and 28-day mortality. Curve-fitting analysis and threshold analysis were further used to explore the association of the HRCT score with ventilator weaning and 28-day mortality. Results The multifactor regression analysis showed that the HRCT score was significantly associated with a lower rate of ventilator weaning and a higher risk of 28-day mortality in patients with ARDS. HRCT scores of 257.0 and 243.2 were the thresholds for ventilator weaning and 28-day mortality, respectively. When the HRCT score was below the threshold, every 1-point increase in the HRCT score was associated with a 4.6% decrease in the ventilator weaning rate and a 4.6% increase in the 28-day mortality rate. Conclusion The HRCT score was associated with ventilator weaning and 28-day mortality with a threshold of 257.0 and 243.2 points, respectively.
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Affiliation(s)
- Kun Zhao
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Shu-juan Bai
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Zhi-tao Wang
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Yu-he Zhang
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Chao Liu
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Hai-gang Song
- Anesthesia Department, Sianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Hai-bo Wang
- Neurosurgical ICU, Xianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Xin Li
- Neurosurgical ICU, Xianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
| | - Wen-laing You
- Neurosurgical ICU, Xianyang Hospital of Yan'an University, Xianyang, Shaanxi Province, China
- Wen-liang You, Neurosurgical ICU, Xianyang Hospital of Yan'an University, No. 38 Wenlin Road, Xianyang, Shaanxi Province 712000, China.
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Barbas CSV, Ísola AM, Farias AMDC, Cavalcanti AB, Gama AMC, Duarte ACM, Vianna A, Serpa A, Bravim BDA, Pinheiro BDV, Mazza BF, de Carvalho CRR, Toufen C, David CMN, Taniguchi C, Mazza DDDS, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FRBG, Silva GS, de Matos GFJ, Emmerich JC, Valiatti JLDS, Teles JMM, Victorino JA, Ferreira JC, Prodomo LPDV, Hajjar LA, Martins LC, Malbouisson LMS, Vargas MADO, Reis MAS, Amato MBP, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MCP, Assunção MSC, Damasceno MPCD, Youssef NCM, Teixeira PJZ, Caruso P, Duarte PAD, Messeder O, Eid RC, Rodrigues RG, de Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, Amado VM. Brazilian recommendations of mechanical ventilation 2013. Part I. Rev Bras Ter Intensiva 2015; 26:89-121. [PMID: 25028944 PMCID: PMC4103936 DOI: 10.5935/0103-507x.20140017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Indexed: 12/19/2022] Open
Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
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Affiliation(s)
- Carmen Sílvia Valente Barbas
- Corresponding author: Carmen Silvia Valente Barbas, Disicplina de
Pneumologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, Zip code - 05403-900 - São Paulo
(SP), Brazil. E-mail:
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Holms CA, Otsuki DA, Kahvegian M, Massoco CO, Fantoni DT, Gutierrez PS, Junior JOCA. Effect of hypertonic saline treatment on the inflammatory response after hydrochloric acid-induced lung injury in pigs. Clinics (Sao Paulo) 2015; 70:577-83. [PMID: 26247671 PMCID: PMC4518820 DOI: 10.6061/clinics/2015(08)08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Hypertonic saline has been proposed to modulate the inflammatory cascade in certain experimental conditions, including pulmonary inflammation caused by inhaled gastric contents. The present study aimed to assess the potential anti-inflammatory effects of administering a single intravenous dose of 7.5% hypertonic saline in an experimental model of acute lung injury induced by hydrochloric acid. METHODS Thirty-two pigs were anesthetized and randomly allocated into the following four groups: Sham, which received anesthesia and were observed; HS, which received intravenous 7.5% hypertonic saline solution (4 ml/kg); acute lung injury, which were subjected to acute lung injury with intratracheal hydrochloric acid; and acute lung injury + hypertonic saline, which were subjected to acute lung injury with hydrochloric acid and treated with hypertonic saline. Hemodynamic and ventilatory parameters were recorded over four hours. Subsequently, bronchoalveolar lavage samples were collected at the end of the observation period to measure cytokine levels using an oxidative burst analysis, and lung tissue was collected for a histological analysis. RESULTS Hydrochloric acid instillation caused marked changes in respiratory mechanics as well as blood gas and lung parenchyma parameters. Despite the absence of a significant difference between the acute lung injury and acute lung injury + hypertonic saline groups, the acute lung injury animals presented higher neutrophil and tumor necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-8 levels in the bronchoalveolar lavage analysis. The histopathological analysis revealed pulmonary edema, congestion and alveolar collapse in both groups; however, the differences between groups were not significant. Despite the lower cytokine and neutrophil levels observed in the acute lung injury + hypertonic saline group, significant differences were not observed among the treated and non-treated groups. CONCLUSIONS Hypertonic saline infusion after intratracheal hydrochloric acid instillation does not have an effect on inflammatory biomarkers or respiratory gas exchange.
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Affiliation(s)
- Carla Augusto Holms
- Faculdade de Medicina da Universidade de São Paulo, Laboratory of Anesthesiology (LIM-08), São Paulo/SP, Brazil
| | - Denise Aya Otsuki
- Faculdade de Medicina da Universidade de São Paulo, Laboratory of Anesthesiology (LIM-08), São Paulo/SP, Brazil
- *Corresponding author: E-mail:
| | - Marcia Kahvegian
- Faculdade de Medicina da Universidade de São Paulo, Laboratory of Anesthesiology (LIM-08), São Paulo/SP, Brazil
| | | | | | - Paulo Sampaio Gutierrez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Laboratory of Pathology, São Paulo/SP, Brazil
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Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill
patients are evolving, as much evidence indicates that ventilation may have positive
effects on patient survival and the quality of the care provided in intensive care
units in Brazil. For those reasons, the Brazilian Association of Intensive Care
Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and
the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e
Tisiologia - SBPT), represented by the Mechanical Ventilation Committee
and the Commission of Intensive Therapy, respectively, decided to review the
literature and draft recommendations for mechanical ventilation with the goal of
creating a document for bedside guidance as to the best practices on mechanical
ventilation available to their members. The document was based on the available
evidence regarding 29 subtopics selected as the most relevant for the subject of
interest. The project was developed in several stages, during which the selected
topics were distributed among experts recommended by both societies with recent
publications on the subject of interest and/or significant teaching and research
activity in the field of mechanical ventilation in Brazil. The experts were divided
into pairs that were charged with performing a thorough review of the international
literature on each topic. All the experts met at the Forum on Mechanical Ventilation,
which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to
collaboratively draft the final text corresponding to each sub-topic, which was
presented to, appraised, discussed and approved in a plenary session that included
all 58 participants and aimed to create the final document.
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Ventilatory Strategy Used for Management of Acute Respiratory Failure Due to Novel Influenza A(H1N1) Infection. NONINVASIVE VENTILATION IN HIGH-RISK INFECTIONS AND MASS CASUALTY EVENTS 2014. [PMCID: PMC7120036 DOI: 10.1007/978-3-7091-1496-4_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The first cases of the novel influenza A(H1N1) virus were reported in April 2009, especially in Mexico and the United States [1, 2]. The disease spread rapidly, becoming a pandemic by June 2009. On August 21, 2009, a total of 177 reported cases of novel influenza 182.166 A(H1N1) infection, of which 1,799 were fatal [2]. It has been observed in animal studies that the novel influenza virus A has a high replication rate in lung tissue, with a great capacity to invade the lower respiratory tract in humans, causing especially acute fulminant respiratory failure.
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Camargo PCLB, Pato EZS, Campos SV, Afonso JE, Carraro RM, Costa AN, Teixeira RHOB, Samano MN, Pego-Fernandes PM. Pediatric lung transplantation: 10 years of experience. Clinics (Sao Paulo) 2014; 69 Suppl 1:51-4. [PMID: 24860860 PMCID: PMC3884157 DOI: 10.6061/clinics/2014(sup01)10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults.
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Affiliation(s)
- Priscila C L B Camargo
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Eduardo Z S Pato
- Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Silvia V Campos
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Jose E Afonso
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Rafael M Carraro
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Andre N Costa
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Ricardo H O B Teixeira
- Heart Institute (Incor), Pulmonology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | - Marcos N Samano
- Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
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Cárdenes N, Cáceres E, Romagnoli M, Rojas M. Mesenchymal stem cells: a promising therapy for the acute respiratory distress syndrome. Respiration 2013; 85:267-78. [PMID: 23428562 DOI: 10.1159/000347072] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a pulmonary syndrome with growing prevalence and high mortality and morbidity that increase with age. There is no current therapy able to restore pulmonary function in ARDS patients. Preclinical models of ARDS have demonstrated that intratracheal or systemic administration of mesenchymal stem cells (MSCs) protects the lung against injury. The mechanisms responsible for the protective effects are multiple, including the secretion of multiple paracrine factors capable of modulating the immune response and restoring epithelial and endothelial integrity. Recent studies have demonstrated that MSCs can also control oxidative stress, transfer functional mitochondria to the damaged cells, and control bacterial infection by secretion of antibacterial peptides. These characteristics make MSCs promising candidates for ARDS therapy.
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Affiliation(s)
- Nayra Cárdenes
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
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