1
|
Taivans I, Grima L, Jurka N, Zvaigzne L, Gordjušina V, Strazda G. FOT Technique Applied for Monitoring of COVID-19 Pneumonia Reveals Small Airways Involvement. Diagnostics (Basel) 2024; 14:1160. [PMID: 38893686 PMCID: PMC11171776 DOI: 10.3390/diagnostics14111160] [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: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The fact that some SARS-CoV-2 pneumonia patients benefit from changing body position, and some from continuous positive airways pressure (CPAP), indicates the functional character of hypoxia. We hypothesize that such effects could be explained by the closure of small airways. To prove the hypothesis, we evaluated the patency of small airways in 30 oxygen-dependent, spontaneously breathing patients with SARS-CoV-2 pneumonia during their hospital stay using the FOT method and then compared the results with data obtained three months later. During the acute period, total resistance (R5) and peripheral resistance (R5-20) rose above the upper limit of normal (ULN) in 28% and 50% of all patients, respectively. Reactance indices X5, AX and Fres exceeded ULN in 55%, 68% and 66% of cases. Significant correlations were observed between PaO2/FiO2, the time spent in the hospital and R5, X5, AX and Fres. After 3 months, 18 patients were re-examined. During the hospital stay, 11 of them had risen above the upper limit of normal (ULN), for both resistance (R5-20) and reactance (X5, AX) values. Three months later, ULN for R5-20 was exceeded in only four individuals, but ULN for X5 and AX was exceeded in five individuals. Lung function examination revealed a combined restrictive/obstructive ventilatory failure and reduced CO transfer factor. We interpret these changes as lung tissue remodeling due to the process of fibrosis. We conclude that during acute period of SARS-CoV-2 pneumonia, dilated pulmonary blood vessels and parenchymal oedema induce functional closure of small airways, which in turn induce atelectasis with pulmonary right-to-left shunting, followed by the resulting hypoxemia.
Collapse
Affiliation(s)
- Immanuels Taivans
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Laura Grima
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Normunds Jurka
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | | | - Valentina Gordjušina
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Gunta Strazda
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| |
Collapse
|
2
|
Oliveira JGM, Campos RP, Azevedo BLPA, de Alegria SG, Litrento PF, Mafort TT, Lopes AJ. Ventilation dynamics using a portable device coupled to the six-minute walk test in people with long-COVID syndrome: a preliminary study. BMC Res Notes 2023; 16:99. [PMID: 37291610 DOI: 10.1186/s13104-023-06374-3] [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: 11/15/2022] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS). RESULTS Sixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4-20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386-478) m, which corresponds to a value of 83% (78-97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO2peak) was 19 (14-37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (rs=-0.499, P = 0.039) and VO2peak (rs=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems.
Collapse
Affiliation(s)
- Jéssica Gabriela Messias Oliveira
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Renan Pereira Campos
- Post-Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro, 21032-060, Brazil
| | - Beatriz Luiza Pinheiro Alves Azevedo
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Samantha Gomes de Alegria
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil
| | - Patrícia Frascari Litrento
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Thiago Thomaz Mafort
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil
| | - Agnaldo José Lopes
- Department of Pulmonology, Universidade do Estado do Rio de Janeiro (UERJ), Policlínica Piquet Carneiro, Avenida Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.
- Post-Graduation Programme in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro, 21032-060, Brazil.
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, 20551-030, Brazil.
| |
Collapse
|
3
|
Bridi GDP, Tanni SE, Baldi BG. Current Understanding of Post-COVID Pulmonary Fibrosis: Where Are We? Arch Bronconeumol 2023; 59:69-70. [PMID: 36041958 PMCID: PMC9395235 DOI: 10.1016/j.arbres.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Guilherme das Posses Bridi
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Suzana Erico Tanni
- Pulmonology Division of Internal Medicine of Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Bruno Guedes Baldi
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital do Coração, São Paulo, Brazil.
| |
Collapse
|
4
|
Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology 2022; 306:e221806. [PMID: 36040336 PMCID: PMC9462591 DOI: 10.1148/radiol.221806] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.
Collapse
|
5
|
Nunes Duarte-Neto1 A, Dolhnikoff1 M. What remains in the pulmonary tissue after acute COVID-19? J Bras Pneumol 2022; 48:e20220209. [PMID: 35830059 PMCID: PMC9262435 DOI: 10.36416/1806-3756/e20220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Amaro Nunes Duarte-Neto1
- 1. Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Marisa Dolhnikoff1
- 1. Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| |
Collapse
|