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Chiang E, Kessler DO, Liebman M, Rabiner JE. Diaphragmatic Ultrasound in Children With Asthma Exacerbations. Pediatr Emerg Care 2024; 40:603-606. [PMID: 38776424 DOI: 10.1097/pec.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Asthma is a leading cause of pediatric emergency department visits, yet few tools exist to objectively measure asthma severity. Diaphragmatic ultrasound (DUS) is a novel method of assessing respiratory distress; however, data are lacking for children.Our primary aim was to determine if diaphragmatic excursion (DE), diaphragmatic thickening (DT), or diaphragmatic thickening fraction (TF) correlated with asthma severity as determined by the Pediatric Respiratory Assessment Measure (PRAM) score. Secondarily, we examined if these parameters correlated with need for respiratory support and evaluated interrater reliability. METHODS We conducted a prospective study of children 5-18 years presenting to a pediatric emergency department with an asthma exacerbation. Diaphragmatic ultrasound was performed by a trained pediatric emergency medicine sonologist in subcostal (DE) and midaxillary (DT). Thickening fraction was calculated from DT values as previously described in literature. To evaluate interrater reliability, a subset of subjects had DUS performed by a second sonologist. RESULTS We enrolled 47 subjects for a total of 51 encounters. The mean age was 9.1 ± 3.7 years. Twenty-five (49%) had mild, 24 (47%) had moderate, and 2 (4%) had severe asthma. There was a significant difference in midaxillary DT and TF between children with mild and moderate asthma ( P = 0.02; mean difference, 0.2 mm; 95% confidence interval [CI], 0.03-0.4 and P = 0.02; mean difference, 0.11 mm; 95% CI, 0.02-0.2, respectively). No difference was found in subcostal DE ( P = 0.43; mean difference, 1.4 mm; 95% CI, -2.1 to 4.8). No association was found between use of positive pressure and DUS parameters. Fourteen encounters had 2 sonologists perform DUS, with strong interrater reliability found for midaxillary DT (Pearson correlation, 0.56) and poor association for subcostal DE (Pearson correlation, 0.18). CONCLUSIONS In this pilot study, we conclude that DUS may be helpful in assessing severity of asthma. The midaxillary view assessment for DT and TF had the best correlation with asthma severity and the best interrater reliability. Future studies may benefit from focusing on the midaxillary view for DT and TF.
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Affiliation(s)
- Elaine Chiang
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Bozkurt S, Bozkurt S. Evaluation of Potential Effects of Increased Outdoor Temperatures Due to Global Warming on Cerebral Blood Flow Rate and Respiratory Function in Chronic Obstructive Disease and Anemia. GLOBAL CHALLENGES (HOBOKEN, NJ) 2023; 7:2300120. [PMID: 37829676 PMCID: PMC10566812 DOI: 10.1002/gch2.202300120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/19/2023] [Indexed: 10/14/2023]
Abstract
Global warming due to increased outdoor carbon dioxide (CO2) levels may cause several health problems such as headaches, cognitive impairment, or kidney dysfunction. It is predicted that further increases in CO2 levels will increase the morbidity and mortality of patients affected by a variety of diseases. For instance, patients with Chronic Obstructive Pulmonary Disease (COPD) may suffer cognitive impairments or intracranial bleeding due to an increased cerebral blood flow rate. Predicting the harmful effects of global warming on human health will help to take measures for potential problems. Therefore, the quantification of physiological parameters is an essential step to investigate the effects of global warming on human health. In this study, the effects of increased outdoor temperatures due to climate change on cerebral blood flow rate and respiratory function in healthy subjects and COPD patients with anemia and respiratory acidosis are evaluated utilizing numerical simulations. The numerical model simulates cardiac function and blood circulation in systemic, pulmonary and cerebral circulations, cerebral autoregulatory functions, respiratory function, alveolar gas exchange, oxygen (O2) and CO2 contents, and hemoglobin levels in the blood. The simulation results show that although the cardiovascular function is not significantly altered, the respiratory function and cerebral blood flow rates are altered remarkably.
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Affiliation(s)
- Surhan Bozkurt
- Department of Electrical and Electronics Engineering Dogus University Esenkent Dudullu OSB m. NATO Yolu c. Umraniye Istanbul 34775 Turkey
| | - Selim Bozkurt
- School of Engineering Ulster University 2-24 York Street Belfast BT15 1AP UK
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Gupta R, Bandyopadhyay T, Yadav B, Guleria M, Maria A. Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: A prospective cohort study. Pediatr Pulmonol 2023; 58:2889-2898. [PMID: 37530492 DOI: 10.1002/ppul.26608] [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: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic accuracy of sonographic assessment of diaphragmatic dimensions and excursions in predicting Continuous Positive Airway Pressure (CPAP) failure in preterm neonates with respiratory distress. METHODS Prospective cohort study among preterm neonates less than 34 weeks of gestation who were hemodynamically stable and either admitted with respiratory distress or who developed respiratory distress shortly after admission to the NICU and having Silverman-Anderson Score (SAS) ≥ 3/10 were included. We performed sonographic assessment of diaphragmatic dimensions and excursions before and one hour ±30 minutes after application of CPAP. 'CPAP failure' was defined as combined outcome of the need of surfactant and/or upgradation of respiratory support within first 72 hours after a trial of CPAP. Clinical parameters and diaphragmatic measurements were compared between CPAP failure and success groups. RESULTS Of 62 participants, 20 (32%) failed CPAP. On binomial logistic regression (after adjustment for gestational age and birth weight), initial SAS, higher diaphragmatic excursion (both left and right, before and after CPAP application), lower left hemidiaphragm diaphragmatic thickness fraction (DTF) (before CPAP application) and lower right DTF (after CPAP application) were independent predictors of CPAP failure. However, the receiver-operating characteristics curves showed that excursions of right and left hemi-diaphragm both before and after CPAP application, had highest accuracies in predicting CPAP failure (AUC 0.84, 0.80 and 0.86, 0.78, respectively; p < .001). CONCLUSION Diaphragmatic excursion can be a useful parameter to predict the failure of CPAP in preterm neonates with respiratory distress.
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Affiliation(s)
- Rashi Gupta
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | | | - Bharti Yadav
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Munish Guleria
- Department of Radiodiagnosis, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
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Suttapanit K, Wongkrasunt S, Savatmongkorngul S, Supatanakij P. Ultrasonographic evaluation of the diaphragm in critically ill patients to predict invasive mechanical ventilation. J Intensive Care 2023; 11:40. [PMID: 37726832 PMCID: PMC10507830 DOI: 10.1186/s40560-023-00690-3] [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: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Diaphragm dysfunction is common in critically ill patients and associated with poorer outcomes. The function of the diaphragm can be evaluated at the bedside by measuring diaphragmatic excursion using ultrasonography. In this study, we investigated the ability of right-sided diaphragmatic excursion (RDE) to predict the need for invasive mechanical ventilation (IMV). METHODS Critically ill patients aged 18 years and older who presented to our emergency department between May 20, 2021 and May 19, 2022 and underwent measurement of RDE within 10 min of arrival were enrolled in this prospective study. The ability of RDE to predict the need for IMV was assessed by multivariable logistic regression and analysis of the area under the receiver-operating characteristic curve (AUROC). RESULTS A total of 314 patients were enrolled in the study; 113 (35.9%) of these patients required IMV. An increase of RDE value per each 0.1 cm was identified to be an independent predictor of IMV (adjusted odds ratio 0.08, 95% confidence interval [CI] 0.04-0.17, p < 0.001; AUROC 0.850, 95% CI 0.807-0.894). The RDE cutoff value was 1.2 cm (sensitivity 82.3%, 95% CI 74.0-88.8; specificity 78.1%, 95% CI 71.7-83.6). Time on a ventilator was significantly longer when the RDE was ≤ 1.2 cm (13 days [interquartile range 5, 27] versus 5 days [interquartile range 3, 8], p = 0.006). CONCLUSIONS In this study, RDE had a good ability to predict the need for IMV in critically ill patients. The optimal RDE cutoff value was 1.2 cm. Its benefit in patient management requires further investigation.
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Affiliation(s)
- Karn Suttapanit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Supawit Wongkrasunt
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Sorravit Savatmongkorngul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Praphaphorn Supatanakij
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
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Lippi L, de Sire A, D’Abrosca F, Polla B, Marotta N, Castello LM, Ammendolia A, Molinari C, Invernizzi M. Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:889218. [PMID: 35615094 PMCID: PMC9124783 DOI: 10.3389/fmed.2022.889218] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 01/23/2023] Open
Abstract
Mechanical ventilation (MV) is currently considered a life-saving intervention. However, growing evidence highlighted that prolonged MV significantly affects functional outcomes and length of stay. In this scenario, controversies are still open about the optimal rehabilitation strategies for improving MV duration in ICU patients. In addition, the efficacy of physiotherapy interventions in critical ill patients without positive history of chronic respiratory conditions is still debated. Therefore, this systematic review of randomized controlled trials (RCTs) with meta-analysis aimed at characterizing the efficacy of a comprehensive physiotherapy intervention in critically ill patients. PubMed, Scopus, and Web of Science databases were systematically searched up to October 22, 2021 to identify RCTs assessing acute patients mechanical ventilated in ICU setting undergoing a rehabilitative intervention. The primary outcomes were MV duration, extubation, and weaning time. The secondary outcomes were weaning successful rate, respiratory function, ICU discharge rate and length of stay. Out of 2503 records, 12 studies were included in the present work. The meta-analysis performed in 6 RCTs showed a significant improvement in terms of MV duration (overall effect size: −3.23 days; 95% CI = −5.79, −0.67, p = 0.01; Z = 2.47) in patients treated with a comprehensive physiotherapy intervention including early mobilization, positioning, airway clearance techniques, lung expansion and respiratory muscle training. The quality assessment underlined 9 studies (75%) of good quality and 3 studies of fair quality according to the PEDro scale. In conclusion, our results provided previously unavailable data about the role of comprehensive physiotherapy intervention in improving MV duration in critical ill patients without chronic respiratory conditions. Further studies are needed to better characterize the optimal combination of rehabilitation strategies enhancing the improvements in critical ill patients without chronic respiratory disorders.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Francesco D’Abrosca
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Biagio Polla
- Cardiopulmonary Rehabilitation Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Unit of Internal Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Claudio Molinari
- Laboratory of Physiology, Department for Sustainable Development and Ecological Transition, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- *Correspondence: Marco Invernizzi,
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
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Jia Y, Zhang Q. Research Progress on Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:587-597. [PMID: 35065813 DOI: 10.1016/j.ultrasmedbio.2021.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease of the respiratory system, and its prevalence and mortality remain high. COPD results in continuous impairment of lung function, which severely affects the patient's work and life. In severe cases, there will be acute respiratory failure, which endangers the lives of patients, and respiratory muscle dysfunction is one of the main reasons for this result. As the diaphragm is the most important inspiratory muscle, its dysfunction has a great impact on the deterioration of respiratory function in COPD patients. With the development of ultrasound, more and more studies have found that diaphragm ultrasound can play an important role in the diagnosis and treatment of COPD patients. The main purpose of this article is to review the research progress on diaphragm ultrasound in COPD and briefly introduce diaphragmatic ultrasound examination methods.
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Affiliation(s)
- Yuhao Jia
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Qunxia Zhang
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Rodrigues SDO, da Cunha CMC, Soares GMV, Silva PL, Silva AR, Gonçalves-de-Albuquerque CF. Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease. Pharmaceuticals (Basel) 2021; 14:979. [PMID: 34681202 PMCID: PMC8539950 DOI: 10.3390/ph14100979] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). CS exposure causes an imbalance favoring pro- over antioxidants (oxidative stress), leading to transcription factor activation and increased expression of inflammatory mediators and proteases. Different cell types, including macrophages, epithelial cells, neutrophils, and T lymphocytes, contribute to COPD pathophysiology. Alteration in cell functions results in the generation of an oxidative and inflammatory microenvironment, which contributes to disease progression. Current treatments include inhaled corticosteroids and bronchodilator therapy. However, these therapies do not effectively halt disease progression. Due to the complexity of its pathophysiology, and the risk of exacerbating symptoms with existing therapies, other specific and effective treatment options are required. Therapies directly or indirectly targeting the oxidative imbalance may be promising alternatives. This review briefly discusses COPD pathophysiology, and provides an update on the development and clinical testing of novel COPD treatments.
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Affiliation(s)
- Sarah de Oliveira Rodrigues
- Laboratório de Imunofarmacologia, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040-900, Brazil;
- Laboratório de Imunofarmacologia, Departamento de Bioquímica, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20211-010, Brazil; (C.M.C.d.C.); (G.M.V.S.)
- Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Rio de Janeiro 24020-140, Brazil
| | - Carolina Medina Coeli da Cunha
- Laboratório de Imunofarmacologia, Departamento de Bioquímica, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20211-010, Brazil; (C.M.C.d.C.); (G.M.V.S.)
| | - Giovanna Martins Valladão Soares
- Laboratório de Imunofarmacologia, Departamento de Bioquímica, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20211-010, Brazil; (C.M.C.d.C.); (G.M.V.S.)
| | - Pedro Leme Silva
- Laboratório de Investigação Pulmonar, Carlos Chagas Filho, Instituto de Biofísica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil;
| | - Adriana Ribeiro Silva
- Laboratório de Imunofarmacologia, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040-900, Brazil;
- Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Rio de Janeiro 24020-140, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Cassiano Felippe Gonçalves-de-Albuquerque
- Laboratório de Imunofarmacologia, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040-900, Brazil;
- Laboratório de Imunofarmacologia, Departamento de Bioquímica, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20211-010, Brazil; (C.M.C.d.C.); (G.M.V.S.)
- Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Rio de Janeiro 24020-140, Brazil
- Programa de Pós-Graduação em Biologia Molecular e Celular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20210-010, Brazil
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Beghé B, Cerri S, Fabbri LM, Marchioni A. COPD, Pulmonary Fibrosis and ILAs in Aging Smokers: The Paradox of Striking Different Responses to the Major Risk Factors. Int J Mol Sci 2021; 22:ijms22179292. [PMID: 34502194 PMCID: PMC8430914 DOI: 10.3390/ijms22179292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/19/2023] Open
Abstract
Aging and smoking are associated with the progressive development of three main pulmonary diseases: chronic obstructive pulmonary disease (COPD), interstitial lung abnormalities (ILAs), and idiopathic pulmonary fibrosis (IPF). All three manifest mainly after the age of 60 years, but with different natural histories and prevalence: COPD prevalence increases with age to >40%, ILA prevalence is 8%, and IPF, a rare disease, is 0.0005–0.002%. While COPD and ILAs may be associated with gradual progression and mortality, the natural history of IPF remains obscure, with a worse prognosis and life expectancy of 2–5 years from diagnosis. Acute exacerbations are significant events in both COPD and IPF, with a much worse prognosis in IPF. This perspective discusses the paradox of the striking pathological and pathophysiologic responses on the background of the same main risk factors, aging and smoking, suggesting two distinct pathophysiologic processes for COPD and ILAs on one side and IPF on the other side. Pathologically, COPD is characterized by small airways fibrosis and remodeling, with the destruction of the lung parenchyma. By contrast, IPF almost exclusively affects the lung parenchyma and interstitium. ILAs are a heterogenous group of diseases, a minority of which present with the alveolar and interstitial abnormalities of interstitial lung disease.
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Affiliation(s)
- Bianca Beghé
- Respiratory Diseases Unit, University Hospital of Modena, 41124 Modena, Italy; (S.C.); (A.M.)
- Correspondence:
| | - Stefania Cerri
- Respiratory Diseases Unit, University Hospital of Modena, 41124 Modena, Italy; (S.C.); (A.M.)
| | - Leonardo M. Fabbri
- Department of Translational Medicine and Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Alessandro Marchioni
- Respiratory Diseases Unit, University Hospital of Modena, 41124 Modena, Italy; (S.C.); (A.M.)
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Chen Y, Yuan Y, Zhang H, Li F, Zhou X. Accuracy of the dynamic signal analysis approach in respiratory mechanics during noninvasive pressure support ventilation: a bench study. J Int Med Res 2021; 49:300060521992184. [PMID: 33626940 PMCID: PMC7925949 DOI: 10.1177/0300060521992184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of respiratory mechanics using dynamic signal analysis during noninvasive pressure support ventilation (PSV). METHODS A Respironics V60 ventilator was connected to an active lung simulator to model normal, restrictive, obstructive, and mixed obstructive and restrictive profiles. The PSV was adjusted to maintain tidal volumes (VT) that achieved 5.0, 7.0, and 10.0 mL/kg body weight, and the positive end-expiration pressure (PEEP) was set to 5 cmH2O. Ventilator performance was evaluated by measuring the flow, airway pressure, and volume. The system compliance (Crs) and airway resistance (inspiratory and expiratory resistance, Rinsp and Rexp, respectively) were calculated. RESULTS Under active breathing conditions, the Crs was overestimated in the normal and restrictive models, and it decreased with an increasing pressure support (PS) level. The Rinsp calculated error was approximately 10% at 10.0 mL/kg of VT, and similar results were obtained for the calculated Rexp at 7.0 mL/kg of VT. CONCLUSION Using dynamic signal analysis, appropriate tidal volume was beneficial for Rrs, especially for estimating Rexp during assisted ventilation. The Crs measurement was also relatively accurate in obstructive conditions.
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Affiliation(s)
- Yuqing Chen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yueyang Yuan
- School of Mechanical and Electrical Engineering, Hu Nan City University, Yi Yang, China
| | - Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Zhou
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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11
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Kumar A, Kogel U, Talikka M, Merg C, Guedj E, Xiang Y, Kondylis A, Titz B, Ivanov NV, Hoeng J, Peitsch M, Allen J, Gupta A, Skowronek A, Lee KM. A 7-month inhalation toxicology study in C57BL/6 mice demonstrates reduced pulmonary inflammation and emphysematous changes following smoking cessation or switching to e-vapor products. TOXICOLOGY RESEARCH AND APPLICATION 2021. [DOI: 10.1177/2397847321995875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cigarette smoking causes serious diseases, including lung cancer, atherosclerotic coronary artery disease, peripheral vascular disease, chronic bronchitis, and emphysema. While cessation remains the most effective approach to minimize smoking-related disease, alternative non-combustible tobacco-derived nicotine-containing products may reduce disease risks among those unable or unwilling to quit. E-vapor aerosols typically contain significantly lower levels of smoke-related harmful and potentially harmful constituents; however, health risks of long-term inhalation exposures are unknown. We designed a 7-month inhalation study in C57BL/6 mice to evaluate long-term respiratory toxicity of e-vapor aerosols compared to cigarette smoke and to assess the impact of smoking cessation (Cessation group) or switching to an e-vapor product (Switching group) after 3 months of exposure to 3R4F cigarette smoke (CS). There were no significant changes in in-life observations (body weights, clinical signs) in e-vapor groups compared to the Sham Control. The 3R4F CS group showed reduced respiratory function during exposure and had lower body weight and showed transient signs of distress post-exposure. Following 7 months of exposure, e-vapor aerosols resulted in no or minimal increase in pulmonary inflammation, while exposure to 3R4F CS led to impairment of lung function and caused marked lung inflammation and emphysematous changes. Biological changes observed in the Switching group were similar to the Cessation group. 3R4F CS exposure dysregulated the lung and nasal tissue transcriptome, while these molecular effects were substantially lower in the e-vapor group. Results from this study demonstrate that in comparison with 3R4F CS, e-vapor aerosols induce substantially lower biological responses including pulmonary inflammation and emphysematous changes, and that complete switching from CS to e-vapor products significantly reduces biological changes associated with CS in C57BL/6 mice.
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Affiliation(s)
| | - Ulrike Kogel
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Marja Talikka
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Celine Merg
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Emmanuel Guedj
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Yang Xiang
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | | | - Bjoern Titz
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | | | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Manuel Peitsch
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
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Tonelli R, Marchioni A, Tabbì L, Fantini R, Busani S, Castaniere I, Andrisani D, Gozzi F, Bruzzi G, Manicardi L, Demurtas J, Andreani A, Cappiello GF, Samarelli AV, Clini E. Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario. J Clin Med 2021; 10:975. [PMID: 33801368 PMCID: PMC7958611 DOI: 10.3390/jcm10050975] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 01/08/2023] Open
Abstract
The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual's excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type.
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Affiliation(s)
- Roberto Tonelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Luca Tabbì
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Riccardo Fantini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Stefano Busani
- Intensive Care Unit, University Hospital of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Ivana Castaniere
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Dario Andrisani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
| | - Filippo Gozzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Giulia Bruzzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Linda Manicardi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41124 Modena, Italy;
- Primary Care Department USL Toscana Sud Est-Grosseto, 58100 Grosseto, Italy
| | - Alessandro Andreani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Gaia Francesca Cappiello
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Anna Valeria Samarelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
| | - Enrico Clini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, 41124 Modena, Italy; (L.T.); (R.F.); (I.C.); (D.A.); (F.G.); (G.B.); (L.M.); (A.A.); (G.F.C.); (A.V.S.); (E.C.)
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Corradi F, Vetrugno L, Orso D, Bove T, Schreiber A, Boero E, Santori G, Isirdi A, Barbieri G, Forfori F. Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study. Respir Physiol Neurobiol 2020; 284:103585. [PMID: 33197604 PMCID: PMC7664482 DOI: 10.1016/j.resp.2020.103585] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute. METHODS We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP. RESULTS Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [β: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [β: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [β: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %). CONCLUSIONS In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Department of Anesthesiology. Ente Ospedaliero Ospedali Galliera, Genova, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Annia Schreiber
- Interdepartmental Division of Critical Care, University of Toronto, Unity Health Toronto (St Michael's Hospital) and the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Enrico Boero
- Dipartimento di Scienze Chirurgiche, Università Degli Studi di Torino, Turin, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Isirdi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
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14
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Kocyigit H, Gunalp M, Genc S, Oguz AB, Koca A, Polat O. Diaphragm dysfunction detected with ultrasound to predict noninvasive mechanical ventilation failure: A prospective cohort study. Am J Emerg Med 2020; 45:202-207. [PMID: 33046306 DOI: 10.1016/j.ajem.2020.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to examine the use of point-of-care ultrasonography (POCUS) in detecting diaphragmatic dysfunction (DD) and evaluate its ability to predict noninvasive mechanical ventilation (NIV) failure in patients presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS In this prospective cohort study, the diaphragm was examined using POCUS in patients with AECOPD. DD was defined as a diaphragm thickening fraction of less than 20% during spontaneous breathing. NIV failure was the primary outcome of the study, and duration of hospital stay and in-hospital mortality were the secondary outcomes. Specificity, sensitivity, positive predictive value, and negative predictive value were estimated for predicting NIV failure in DD and evaluating the diagnostic performance of POCUS. RESULTS 60 patients were enrolled the study. NIV failure was found in 11 (73.3%) of 15 patients with DD and in 2 (4.4%) of 45 patients without DD. In predicting NIV failure, DD had a sensitivity of 84.6% (95% confidence interval [CI]:54.6-98.1), specificity of 91.5% (95% CI:79.6-97.6), positive predictive value of 73.3% (95% CI:51.2-87.8), and negative predictive value of 95.6% (95% CI:85.7-98.7). The duration of hospital stay was not different between groups (p = .065). No in-hospital mortality was seen in patients without DD. CONCLUSIONS DD has high sensitivity and specificity in predicting NIV failure in patients admitted to the emergency department with AECOPD. DD can be assessed by an experienced clinician noninvasively using POCUS in emergency departments.
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Affiliation(s)
- Huseyin Kocyigit
- Diyarbakir Selahaddin Eyyubi State Hospital, Department of Emergency Medicine, Diyarbakir, Turkey
| | - Muge Gunalp
- Ankara University, School of Medicine, Department of Emergency Medicine, Ankara, Turkey
| | - Sinan Genc
- Ankara University, School of Medicine, Department of Emergency Medicine, Ankara, Turkey
| | - Ahmet Burak Oguz
- Ankara University, School of Medicine, Department of Emergency Medicine, Ankara, Turkey.
| | - Ayca Koca
- Ankara University, School of Medicine, Department of Emergency Medicine, Ankara, Turkey
| | - Onur Polat
- Ankara University, School of Medicine, Department of Emergency Medicine, Ankara, Turkey
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