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Hassan M, Griffiths S, Probyn B, Sadaka AS, Touman AA, Trevelyan G, Breen D, Daneshvar C. Thoracic ultrasound in guiding management of respiratory disease. Expert Rev Respir Med 2024; 18:611-630. [PMID: 39096207 DOI: 10.1080/17476348.2024.2387785] [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: 03/10/2024] [Revised: 05/06/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION The use of ultrasound in respiratory disease has evolved substantially over the past two decades. From a test done to confirm the safe site of pleural fluid drainage, thoracic ultrasound has become a point-of-care test that guides the management of patients on respiratory wards, in clinics and endoscopy. AREAS COVERED This review overviews the process of ultrasound examination in the chest. It then delves into specific disease areas (pleural disease, lung disease, diaphragm disease, and invasive procedures) to highlight how thoracic ultrasound is being used to refine management. The review concludes with discussion on the training curricula and assessment tools for competency in thoracic ultrasound. Being a scoping review, literature searches were conducted on PubMed using relevant search terms. EXPERT OPINION In addition to its current uses, there are many avenues where thoracic ultrasound will soon be beneficial. Recent studies show promising roles in areas such as patient-tailored guidance of pleurodesis and non-invasively predicting lung re-expansion after pleural fluid drainage. In addition, auxiliary tools such as contrast-enhanced ultrasound and elastography are proving useful in identifying the etiology and directing the successful sampling of pleural and lung lesions. Studies are also exploring the utility of sonographic biomarkers such as echogenicity and septations to predict outcomes in pleural disease.
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sally Griffiths
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Ben Probyn
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Ahmed S Sadaka
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Gareth Trevelyan
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Cyrus Daneshvar
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Plymouth Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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Palleschi A, Mattioni G, LoMauro A, Privitera E, Musso V, Morlacchi L, Vergari M, Velardo D, Grasselli G. Diaphragm and Lung Transplantation. Transpl Int 2024; 37:12897. [PMID: 38979122 PMCID: PMC11228173 DOI: 10.3389/ti.2024.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024]
Abstract
Mutual interactions between the diaphragm and lung transplantation (LTx) are known to exist. Before LTx, many factors can exert notable impact on the diaphragmatic function, such as the underlying respiratory disease, the comorbidities, and the chronic treatments of the patient. In the post-LTx setting, even the surgical procedure itself can cause a stressful trauma to the diaphragm, potentially leading to morphological and functional alterations. Conversely, the diaphragm can significantly influence various aspects of the LTx process, ranging from graft-to-chest cavity size matching to the long-term postoperative respiratory performance of the recipient. Despite this, there are still no standard criteria for evaluating, defining, and managing diaphragmatic dysfunction in the context of LTx to date. This deficiency hampers the accurate assessment of those factors which affect the diaphragm and its reciprocal influence on LTx outcomes. The objective of this narrative review is to delve into the complex role the diaphragm plays in the different stages of LTx and into the modifications of this muscle following surgery.
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Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanni Mattioni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- School of Thoracic Surgery, University of Milan, Milan, Italy
| | - Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Emilia Privitera
- Department of Healthcare Professions, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Musso
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Morlacchi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Pneumology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vergari
- Neuropathophysiology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Velardo
- Neuromuscular and Rare Diseases Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergencies, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Ralf E, Heine A, Obst A, Koerner K, Hustig-Kittler V, Boesche M, Elhadad M, Stubbe B, Westhoff M. Acute COPD exacerbation treatment with noninvasive ventilation. Sci Rep 2023; 13:6586. [PMID: 37085585 PMCID: PMC10121675 DOI: 10.1038/s41598-023-33871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/20/2023] [Indexed: 04/23/2023] Open
Abstract
The establishment of a guideline for long-term noninvasive ventilation treatment (LTH-NIV) of acute hypercapnic exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring acute ventilation has proven elusive. Most studies thus far have shown no mortality benefit of long-term noninvasive ventilation treatment. Using retrospective analysis of the data of our patients (n = 143) recruited from 2012 to 2019, we aimed to compare patients discharged with and without long-term noninvasive ventilation. The follow-up results showed no significant difference (p = 0.233) between the groups [LTH-NIV (n = 83); non-NIV (n = 60)] regarding readmission due to clinical worsening. However, the first- and second-year survival rates were 82% and 72%, respectively, in the LTH-NIV group and significantly different (p = 0.023) from 67 and 55% in the non-NIV group. The statistical models showed a significant mortality risk for the non-NIV group, with a hazard ratio (HR) of 2.82 (1.31; 6.03). To the best of our knowledge, this is the first study to demonstrate the mortality benefit of long-term NIV therapy for patients with AECOPD under real-world conditions.
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Affiliation(s)
- Ewert Ralf
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Alexander Heine
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Anne Obst
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Karoline Koerner
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Veit Hustig-Kittler
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Michael Boesche
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Mohamed Elhadad
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany
| | - Beate Stubbe
- Division of Pneumology, Department of Internal Medicine B, University Hospital Greifswald, F.-Sauerbruchstrasse, 17489, Greifswald, Germany.
| | - Michael Westhoff
- Center for Pneumology and Thoracic Surgery, Lung Clinic Hemer, Hemer, Germany
- Witten/Herdecke University, Witten, Germany
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Hatipoğlu U, Aboussouan LS. Chronic hypercapnic respiratory failure and non-invasive ventilation in people with chronic obstructive pulmonary disease. BMJ MEDICINE 2022; 1:e000146. [PMID: 36936555 PMCID: PMC9978688 DOI: 10.1136/bmjmed-2022-000146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) should no longer be seen as a condition for which little can be done. Novel pharmacotherapeutic interventions, surgical and procedural advances, and respiratory assist devices have provided numerous ways to help patients with COPD and treatable traits. For nearly 30 years, non-invasive ventilation, the application of positive pressure through a mask interface placed outside of the airway, has been the cornerstone for treatment of acute hypercapnic respiratory failure due to COPD exacerbation. Clinical trials indicate that this intervention could benefit patients with COPD and chronic hypercapnic respiratory failure in a stable state. This narrative review aims to provide the necessary background for internists to consider this therapeutic option for their COPD patients. We discuss the mechanism of action and implementation, and provide a glimpse into the future of this promising intervention.
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Affiliation(s)
- Umur Hatipoğlu
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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