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Roeder F, Röpke T, Steinmetz LK, Kolb M, Maus UA, Smith BJ, Knudsen L. Exploring alveolar recruitability using positive end-expiratory pressure in mice overexpressing TGF-β1: a structure-function analysis. Sci Rep 2024; 14:8080. [PMID: 38582767 PMCID: PMC10998853 DOI: 10.1038/s41598-024-58213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024] Open
Abstract
Pre-injured lungs are prone to injury progression in response to mechanical ventilation. Heterogeneous ventilation due to (micro)atelectases imparts injurious strains on open alveoli (known as volutrauma). Hence, recruitment of (micro)atelectases by positive end-expiratory pressure (PEEP) is necessary to interrupt this vicious circle of injury but needs to be balanced against acinar overdistension. In this study, the lung-protective potential of alveolar recruitment was investigated and balanced against overdistension in pre-injured lungs. Mice, treated with empty vector (AdCl) or adenoviral active TGF-β1 (AdTGF-β1) were subjected to lung mechanical measurements during descending PEEP ventilation from 12 to 0 cmH2O. At each PEEP level, recruitability tests consisting of two recruitment maneuvers followed by repetitive forced oscillation perturbations to determine tissue elastance (H) and damping (G) were performed. Finally, lungs were fixed by vascular perfusion at end-expiratory airway opening pressures (Pao) of 20, 10, 5 and 2 cmH2O after a recruitment maneuver, and processed for design-based stereology to quantify derecruitment and distension. H and G were significantly elevated in AdTGF-β1 compared to AdCl across PEEP levels. H was minimized at PEEP = 5-8 cmH2O and increased at lower and higher PEEP in both groups. These findings correlated with increasing septal wall folding (= derecruitment) and reduced density of alveolar number and surface area (= distension), respectively. In AdTGF-β1 exposed mice, 27% of alveoli remained derecruited at Pao = 20 cmH2O. A further decrease in Pao down to 2 cmH2O showed derecruitment of an additional 1.1 million alveoli (48%), which was linked with an increase in alveolar size heterogeneity at Pao = 2-5 cmH2O. In AdCl, decreased Pao resulted in septal folding with virtually no alveolar collapse. In essence, in healthy mice alveoli do not derecruit at low PEEP ventilation. The potential of alveolar recruitability in AdTGF-β1 exposed mice is high. H is optimized at PEEP 5-8 cmH2O. Lower PEEP folds and larger PEEP stretches septa which results in higher H and is more pronounced in AdTGF-β1 than in AdCl. The increased alveolar size heterogeneity at Pao = 5 cmH2O argues for the use of PEEP = 8 cmH2O for lung protective mechanical ventilation in this animal model.
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Affiliation(s)
- Franziska Roeder
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Tina Röpke
- Department of Experimental Pneumology, Hannover Medical School, Hannover, Germany
| | | | - Martin Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Ulrich A Maus
- Department of Experimental Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Disease (DZL), Hannover, Germany
| | - Bradford J Smith
- Department of Bioengineering, College of Engineering Design and Computing, University of Colorado Denver|Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatric Pulmonary and Sleep Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lars Knudsen
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Disease (DZL), Hannover, Germany.
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Pokhrel N, Neupane A, Thapa N, Yadav RK, Hamal PK, Malla P. Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury. J Nepal Health Res Counc 2024; 21:680-683. [PMID: 38616602 DOI: 10.33314/jnhrc.v21i4.5068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. METHODS Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. RESULTS Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. CONCLUSIONS The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.
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Affiliation(s)
- Nabin Pokhrel
- National Academy of Medical Science, Kathmandu, Nepal
| | | | - Nabin Thapa
- Karnali Academy of Health Science, Karnali, Nepal
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Li Q, Wen D, Chen Y, Yang L, Li J, Luo S. Early respiratory interventional therapy combined with antifungal agent for endobronchial cryptococcosis: A case report and literature review. Medicine (Baltimore) 2024; 103:e37455. [PMID: 38518007 PMCID: PMC10956943 DOI: 10.1097/md.0000000000037455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/24/2024] Open
Abstract
RATIONALE Cryptococcosis presenting as endobronchial obstruction and lung collapse is an extremely rare occurrence. While these patients were treated with antifungal agents, unfortunately, half of them showed a suboptimal response. PATIENT CONCERNS A 45-year-old immunocompetent male was admitted to the hospital due to a cough, yellow phlegm, and dyspnea persisting for 5 months. Chest computer tomography revealed a mass in the right main bronchus accompanied by right lower lobe atelectasis. DIAGNOSES Endobronchial cryptococcosis presenting as endobronchial obstruction and lung collapse. INTERVENTIONS Early rigid bronchoscopic therapy was performed to resect endobronchial obstruction, which combined with antifungal agent. OUTCOMES The patient recovered well with completely clinical and radiologic resolution at 1 year follow-up. LESSONS This case provides a good example of successful utilization of the early respiratory interventional therapy combined with antifungal agent in obstructive endobronchial cryptococcosis.
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Affiliation(s)
- Qinglan Li
- Department of Pulmonary and Critical Care Medicine, Heyuan People’s Hospital, Heyuan, Guangdong, China
| | - Daxiong Wen
- Department of Pathology, Heyuan People’s Hospital, Heyuan, Guangdong, China
| | - Yong Chen
- Department of Pulmonary and Critical Care Medicine, Heyuan People’s Hospital, Heyuan, Guangdong, China
| | - Longfeng Yang
- Department of Pulmonary and Critical Care Medicine, Heyuan People’s Hospital, Heyuan, Guangdong, China
| | - Jing Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Shaohua Luo
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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Shchomak Z, Oliveira L, Saianda A, Bandeira T. Endobronchial lesion in a premature neonate. BMJ Case Rep 2024; 17:e259839. [PMID: 38508601 PMCID: PMC10952865 DOI: 10.1136/bcr-2024-259839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Endobronchial and endotracheal tumours are rare in the paediatric population, especially in neonates. The common presentation is respiratory distress with persistent lung collapse or hyperinflation. Treatment usually involves endoscopic or surgical lobar resection. This case presents a preterm neonate who developed acute respiratory distress with persistent right upper lobe atelectasis. A flexible bronchoscopy showed a pediculate violaceous endobronchial lesion in the right main bronchus. Endoscopic resection was not possible due to the patient's low weight and the decision was made to support the patient with continuous positive airway pressure (CPAP) at home, while monitoring her closely. Remarkably, the lesion spontaneously resolved, and CPAP support was discontinued successfully. The case emphasises the importance of early bronchoscopy, continuous monitoring and the possibility of using CPAP support until conditions are reunited for an eventual resection. This unique case also demonstrates the potential for spontaneous resolution in some cases.
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Affiliation(s)
- Zakhar Shchomak
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Lia Oliveira
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Saianda
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Teresa Bandeira
- Pediatrics Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Sudy R, Dereu D, Lin N, Pichon I, Petak F, Habre W, Albu G. Respiratory effects of pressure support ventilation in spontaneously breathing patients under anaesthesia: Randomised controlled trial. Acta Anaesthesiol Scand 2024; 68:311-320. [PMID: 37923301 DOI: 10.1111/aas.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Lung volume loss is a major risk factor for postoperative respiratory complications after general anaesthesia and mechanical ventilation. We hypothesise that spontaneous breathing without pressure support may enhance the risk for atelectasis development. Therefore, we aimed at characterising whether pressure support prevents changes in lung function in patients breathing spontaneously through laryngeal mask airway. METHODS In this randomised controlled trial, adult female patients scheduled for elective gynaecological surgery in lithotomy position were randomly assigned to the continuous spontaneous breathing group (CSB, n = 20) or to the pressure support ventilation group (PSV, n = 20) in a tertiary university hospital. Lung function measurements were carried out before anaesthesia and 1 h postoperatively by a researcher blinded to the group allocation. Lung clearance index calculated from end-expiratory lung volume turnovers as primary outcome variable was assessed by the multiple-breath nitrogen washout technique (MBW). Respiratory mechanics were measured by forced oscillations to assess parameters reflecting the small airway function and respiratory tissue stiffness. RESULTS MBW was successfully completed in 18 patients in both CSB and PSV groups. The decrease in end-expiratory lung volume was more pronounced in the CSB than that in the PSV group (16.6 ± 6.6 [95% CI] % vs. 7.6 ± 11.1%, p = .0259), with no significant difference in the relative changes of the lung clearance index (-0.035 ± 7.1% vs. -0.18 ± 6.6%, p = .963). The postoperative changes in small airway function and respiratory tissue stiffness were significantly lower in the PSV than in the CSB group (p < .05 for both). CONCLUSIONS These results suggest that pressure support ventilation protects against postoperative lung-volume loss without affecting ventilation inhomogeneity in spontaneously breathing patients with increased risk for atelectasis development. TRIAL REGISTRATION NCT02986269.
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Affiliation(s)
- Roberta Sudy
- Unit for Anaesthesiological Investigations, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Domitille Dereu
- Unit for Obstetrics and Gynaecology Anaesthesia, University Hospitals of Geneva, Geneva, Switzerland
| | - Na Lin
- Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Isabelle Pichon
- Unit for Anaesthesiological Investigations, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Ferenc Petak
- Department of Medical Physics and Informatics, University of Szeged, Geneva, Hungary
| | - Walid Habre
- Unit for Anaesthesiological Investigations, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Gergely Albu
- Unit for Anaesthesiological Investigations, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
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Acosta CM, Poliotto S, Abrego D, Bradley D, de Esteban S, Mir F, Ricci L, Natal M, Wallin M, Hallbäck M, Sipmann FS, Tusman G. Effect of an Individualized Lung Protective Ventilation on Lung Strain and Stress in Children Undergoing Laparoscopy: An Observational Cohort Study. Anesthesiology 2024; 140:430-441. [PMID: 38064715 DOI: 10.1097/aln.0000000000004856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Exaggerated lung strain and stress could damage lungs in anesthetized children. The authors hypothesized that the association of capnoperitoneum and lung collapse in anesthetized children increases lung strain-stress. Their primary aim was to describe the impact of capnoperitoneum on lung strain-stress and the effects of an individualized protective ventilation during laparoscopic surgery in children. METHODS The authors performed an observational cohort study in healthy children aged 3 to 7 yr scheduled for laparoscopic surgery in a community hospital. All received standard protective ventilation with 5 cm H2O of positive end-expiratory pressure (PEEP). Children were evaluated before capnoperitoneum, during capnoperitoneum before and after lung recruitment and optimized PEEP (PEEP adjusted to get end-expiratory transpulmonary pressure of 0), and after capnoperitoneum with optimized PEEP. The presence of lung collapse was evaluated by lung ultrasound, positive Air-Test (oxygen saturation measured by pulse oximetry 96% or less breathing 21% O2 for 5 min), and negative end-expiratory transpulmonary pressure. Lung strain was calculated as tidal volume/end-expiratory lung volume measured by capnodynamics, and lung stress as the end-inspiratory transpulmonary pressure. RESULTS The authors studied 20 children. Before capnoperitoneum, mean lung strain was 0.20 ± 0.07 (95% CI, 0.17 to 0.23), and stress was 5.68 ± 2.83 (95% CI, 4.44 to 6.92) cm H2O. During capnoperitoneum, 18 patients presented lung collapse and strain (0.29 ± 0.13; 95% CI, 0.23 to 0.35; P < 0.001) and stress (5.92 ± 3.18; 95% CI, 4.53 to 7.31 cm H2O; P = 0.374) increased compared to before capnoperitoneum. During capnoperitoneum and optimized PEEP, children presenting lung collapse were recruited and optimized PEEP was 8.3 ± 2.2 (95% CI, 7.3 to 9.3) cm H2O. Strain returned to values before capnoperitoneum (0.20 ± 0.07; 95% CI, 0.17 to 0.22; P = 0.318), but lung stress increased (7.29 ± 2.67; 95% CI, 6.12 to 8.46 cm H2O; P = 0.020). After capnoperitoneum, strain decreased (0.18 ± 0.04; 95% CI, 0.16 to 0.20; P = 0.090), but stress remained higher (7.25 ± 3.01; 95% CI, 5.92 to 8.57 cm H2O; P = 0.024) compared to before capnoperitoneum. CONCLUSIONS Capnoperitoneum increased lung strain in healthy children undergoing laparoscopy. Lung recruitment and optimized PEEP during capnoperitoneum decreased lung strain but slightly increased lung stress. This little rise in pulmonary stress was maintained within safe, lung-protective, and clinically acceptable limits. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Cecilia M Acosta
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Sergio Poliotto
- Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Diego Abrego
- Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Dolores Bradley
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Santiago de Esteban
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Francisco Mir
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Lila Ricci
- Department of Mathematics, Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Argentina
| | - Marcela Natal
- Department of Mathematics, Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Argentina
| | - Mats Wallin
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; Getinge Critical Care AB, Solna, Sweden
| | | | - Fernando Suarez Sipmann
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; CIBERES (Network Biomedical Research Center), Madrid, Spain; Department of Critical Care, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, Madrid, Spain
| | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Huang R, Wang N, Lin X, Xia Y, Papadimos TJ, Wang Q, Xia F. Facilitating Lung Collapse for Thoracoscopic Surgery Utilizing Endobronchial Airway Occlusion Preceded by Pleurotomy and One-minute Suspension of Two-lung Ventilation. J Cardiothorac Vasc Anesth 2024; 38:475-481. [PMID: 38042744 DOI: 10.1053/j.jvca.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES To assess when and whether clamping the double-lumen endobronchial tube (DLT) limb of the non-ventilated lung is more conducive to a rapid and effective lung deflation than simply allowing the open limb of the DLT to communicate with the atmosphere. DESIGN This was a single-center, single-blind, randomized, controlled trial. SETTING The trial was performed in a single institutional setting. PARTICIPANTS The participants were 60 patients undergoing elective video-assisted thoracoscopic surgery. INTERVENTIONS Patients were randomized to the open-clamp airway technique (OCAT group) or control group. Patients in the control group had one-lung ventilation initiated upon being placed in the lateral decubitus position. The OCAT group had two-lung ventilation maintained until the pleural cavity was opened with the introduction of a planned thoracoscopic access port to allow the operated lung to fall away from the chest wall. Thereafter, ventilation was suspended (temporarily ceased) for 1 minute before the DLT lumen of the isolated lung was clamped. The primary outcome of the trial was the time to complete lung collapse scored as determined from video clips taken during surgery. The secondary outcomes were (1) lung collapse score at 30 minutes after pleural incision, (2) surgeon satisfaction with surgery, and (3) intraoperative hypoxemia. MEASUREMENTS AND MAIN RESULTS The median time to reach complete lung collapse in the OCAT group was 10 minutes (odds ratio 10.0, 95% CI 6.3-13.7), which was much shorter than that of the control group (25 minutes [odds ratio 25.0, 95% CI 13.6-36.4]). The difference in complete lung collapse at 30 minutes between the 2 groups was significant (p < 0.001). The surgeon's satisfaction with surgery was higher in the OCAT group than in the control group (8.5 ± 0.2 vs 6.8 ± 0.2; p < 0.001). There was no difference regarding intraoperative hypoxemia. CONCLUSIONS Suspending ventilation of both DLT limbs for 1 minute after pleural cavity opening and then clamping the DLT lumen of the isolated lung resulted in a more rapid deflation of the surgical lung. This open-clamp airway technique is an effective technique for rapid surgical lung collapse during thoracoscopic surgery.
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Affiliation(s)
- Rong Huang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Neng Wang
- Wenzhou Medical University, Zhejiang, China
| | - Xiaoming Lin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yun Xia
- Department of Anesthesiology, the Ohio State University Wexner Medical Centre, Columbus, OH
| | - Thomas J Papadimos
- Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Quanguang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Fangfang Xia
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
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Busana M, Rau A, Lazzari S, Gattarello S, Cressoni M, Biggemann L, Harnisch LO, Giosa L, Vogt A, Saager L, Lotz J, Meller B, Meissner K, Gattinoni L, Moerer O. Causes of Hypoxemia in COVID-19 Acute Respiratory Distress Syndrome: A Combined Multiple Inert Gas Elimination Technique and Dual-energy Computed Tomography Study. Anesthesiology 2024; 140:251-260. [PMID: 37656772 DOI: 10.1097/aln.0000000000004757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND Despite the fervent scientific effort, a state-of-the art assessment of the different causes of hypoxemia (shunt, ventilation-perfusion mismatch, and diffusion limitation) in COVID-19 acute respiratory distress syndrome (ARDS) is currently lacking. In this study, the authors hypothesized a multifactorial genesis of hypoxemia and aimed to measure the relative contribution of each of the different mechanism and their relationship with the distribution of tissue and blood within the lung. METHODS In this cross-sectional study, the authors prospectively enrolled 10 patients with COVID-19 ARDS who had been intubated for less than 7 days. The multiple inert gas elimination technique (MIGET) and a dual-energy computed tomography (DECT) were performed and quantitatively analyzed for both tissue and blood volume. Variables related to the respiratory mechanics and invasive hemodynamics (PiCCO [Getinge, Sweden]) were also recorded. RESULTS The sample (51 ± 15 yr; Pao2/Fio2, 172 ± 86 mmHg) had a mortality of 50%. The MIGET showed a shunt of 25 ± 16% and a dead space of 53 ± 11%. Ventilation and perfusion were mismatched (LogSD, Q, 0.86 ± 0.33). Unexpectedly, evidence of diffusion limitation or postpulmonary shunting was also found. In the well aerated regions, the blood volume was in excess compared to the tissue, while the opposite happened in the atelectasis. Shunt was proportional to the blood volume of the atelectasis (R2 = 0.70, P = 0.003). V˙A/Q˙T mismatch was correlated with the blood volume of the poorly aerated tissue (R2 = 0.54, P = 0.016). The overperfusion coefficient was related to Pao2/Fio2 (R2 = 0.66, P = 0.002), excess tissue mass (R2 = 0.84, P < 0.001), and Etco2/Paco2 (R2 = 0.63, P = 0.004). CONCLUSIONS These data support the hypothesis of a highly multifactorial genesis of hypoxemia. Moreover, recent evidence from post-mortem studies (i.e., opening of intrapulmonary bronchopulmonary anastomosis) may explain the findings regarding the postpulmonary shunting. The hyperperfusion might be related to the disease severity. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Mattia Busana
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Stefano Lazzari
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany; and Institute for Treatment and Research San Raffaele Scientific Institute, Department of Anesthesia and Intensive Care, Milan, Italy
| | - Simone Gattarello
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany; and Institute for Treatment and Research San Raffaele Scientific Institute, Department of Anesthesia and Intensive Care, Milan, Italy
| | - Massimo Cressoni
- Unit of Radiology, Institute for Treatment and Research Policlinico San Donato, Milan, Italy
| | - Lorenz Biggemann
- Institute for Diagnostic and Interventional Radiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Lars-Olav Harnisch
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Lorenzo Giosa
- Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Andreas Vogt
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leif Saager
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany; and Outcomes Research Consortium, Cleveland, Ohio
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Birgit Meller
- Clinic of Nuclear Medicine, University Medical Center of Göttingen, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Center of Göttingen, Göttingen, Germany
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Kim JH, Kim M, Oh M, Lee SK, Kwon YS. Effect of sugammadex on postoperative complications in patients with severe burn who underwent surgery: a retrospective study. Sci Rep 2024; 14:525. [PMID: 38177213 PMCID: PMC10767056 DOI: 10.1038/s41598-024-51171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024] Open
Abstract
This retrospective study investigated the association of sugammadex with postoperative pulmonary complication risk between 2013 and 2021 in patients with severe burn of five hospitals. Postoperative pulmonary complications included atelectasis, pulmonary edema, pulmonary effusion, pneumothorax, pneumonia, pulmonary thromboembolism, respiratory failure and acute respiratory distress. To identify whether sugammadex reduced the risk of postoperative pulmonary complication in patients with severe burn who underwent surgery, Kaplan-Meier curve were used to check the difference of incidence according to surgical cases and time-varying Cox hazard regression were used to calculate the hazard ratio. The study included 1213 patients with severe burn who underwent 2259 surgeries. Postoperative pulmonary complications were occurred in 313 (25.8%) patients. Among 2259 surgeries, sugammadex was used in 649 (28.7%) surgeries. Cumulative postoperative pulmonary complication were 268 (16.6%) cases in surgeries without sugammadex, and 45 (6.9%) cases in surgeries with sugammadex, respectively (P < 0.005). The postoperative pulmonary complications risk was reduced significantly in patients who use sugammadex than those who did not use sugammadex. (Adjusted hazard ratio, 0.61; 95% confidence interval, 0.42-0.89; P = 0.011). In conclusion, sugammadex reduced risk of postoperative pulmonary complications compared with nonuse of sugammadex in patients with severe burn who underwent surgery.
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Affiliation(s)
- Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea
- Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Minguan Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Minho Oh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea
| | - Soo-Kyung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea
| | - Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, South Korea.
- Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
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10
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Chowdhary T, Bracken J, Morgan L, Schultz A, Robinson P. The SPEC score-A quantifiable CT scoring system for primary ciliary dyskinesia. Pediatr Pulmonol 2024; 59:72-80. [PMID: 37842974 DOI: 10.1002/ppul.26709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Structural lung changes seen on computed tomography (CT) scans in persons with primary ciliary dyskinesia (pwPCD) are currently described using cystic fibrosis (CF) derived scoring systems. Recent work has shown structural changes and frequencies that are unique to PCD, indicating the need for a unique PCD-derived scoring system. METHODS Chest CT scans from 30 pwPCD, were described for structural changes including bronchiectasis, bronchial wall thickening, mucous plugging, atelectasis, air trapping, and interlobar septal thickening and, additionally, changes previously described as being frequent in pwPCD including extensive tree-in-bud pattern of mucous plugging, bronchoceles or nodules, thickening of interlobar and interlobular septa and whole lobe atelectasis. Based on these findings a novel and unique scoring system, the Specific PCD Evaluation by CT (SPEC) score was constructed. Scans were then re-scored using the SPEC score and results compared to corresponding measurements of lung function to assess structure-function correlation. RESULTS Total SPEC scores ranged from 0 to 60 (max possible score 90). There was a strong negative correlation between the SPEC score (SPEC) and forced vital capacity (FVC), forced expiratory volume over 1 s (FEV1 ) and FEV1 /FVC ratio (-r = .784, -.865, -.872 respectively). CONCLUSIONS Using PCD-derived data we describe the construct of a PCD-specific score for assessing lung structural damage on CT scans, the SPEC score. A strong correlation between the SPEC score and PFT variables was identified. The SPEC score holds the potential for describing longitudinal changes in CT scans and assessing the efficacy of interventive therapies in patients with PCD.
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Affiliation(s)
- Tarika Chowdhary
- Departments of Respiratory and Sleep Medicine and Medical Imaging, Royal Children's Hospital, Parkville, Australia
| | - Jennifer Bracken
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Hospital, Sydney, Australia
- Respiratory Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, Australia
| | - Andre Schultz
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
- Wal-Yan Centre for Respiratory Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Phil Robinson
- Departments of Respiratory and Sleep Medicine and Medical Imaging, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Respiratory Research Group, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, Australia
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11
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Cano PA, Mora LC, Enríquez I, Reis MS, Martínez E, Barturen F. One-lung ventilation with a bronchial blocker in thoracic patients. BMC Anesthesiol 2023; 23:398. [PMID: 38057754 PMCID: PMC10698967 DOI: 10.1186/s12871-023-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Lung isolation is a technique used in a multitude of surgeries to ensure single-lung ventilation with collapse of the contralateral lung, as to achieve improved access and visualization of relevant anatomical structures. Despite being accepted and having favorable outcomes, bronchial blockers (BBs) are not to this day the main device of choice among anaesthesiologists. METHODS In this retrospective and descriptive study, we analyzed the safety and efficacy of a BB in all types of thoracic surgeries in our centre between 2015 and 2022, excluding patients with massive hemoptysis or empyema, or who had undergone a prior pneumonectomy. RESULTS One hundred and thirty-four patients were intervened due to lung cancer (67.9%), respiratory disease (23.9%), and non-respiratory disease (8.2%) undergoing lung surgeries (65.7%), pleural and mediastinal surgeries (29.9%), chest wall surgeries (3.0%) and other surgeries (1.5%). In most cases, lung collapse was considered excellent (63.9%) or good (33.1%) with only 4 cases (3.0%) of poor lung collapse. More than 90% of patients did not present intraoperative or immediate postoperative complications. No statistically significant differences were found between lung collapse and the demographic, clinical or BB-related variables (p > 0.05). However, we found a significatively higher proportion of excellent lung collapses in VATS surgeries and lateral decubitus positioning, as well as a significatively less proportion of poor lung collapses (p < 0.05). Moreover, there was a significantly higher proportion of excellent lung collapses when the BB was placed in the left bronchus (p < 0.05). CONCLUSIONS With these results, in our experience BBs constitute an effective alternative, capable of achieving pulmonary collapse in all kinds of thoracic procedures with satisfactory safety rates due to their minimal complications.
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Affiliation(s)
- Paulo Andrés Cano
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain.
| | - Luis Carlos Mora
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain
| | - Irene Enríquez
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain
| | - Matías Santiago Reis
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain
| | - Eva Martínez
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain
| | - Fernando Barturen
- Department of Anaesthesiology and Resuscitation, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Islas Baleares, 07120, Spain
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12
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Cai W, Gu W, Ni H, Zhao L, Zhong S, Wang W. Effects of laryngeal mask ventilation on postoperative atelectasis in children undergoing day surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:362. [PMID: 37932735 PMCID: PMC10626763 DOI: 10.1186/s12871-023-02327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. METHODS Children aged 3-7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators. RESULTS The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05). CONCLUSION Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management. TRIAL REGISTRATION The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).
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Affiliation(s)
- Weiwei Cai
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Wei Gu
- Department of Statistics, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Huanhuan Ni
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Longde Zhao
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Shan Zhong
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China.
| | - Wei Wang
- Department of Anesthesiology, Children's Hospital of Fudan University, ShangHai, 201102, China.
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13
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Freidkin L, Heching M, Rosengarten D, Pertzov B, Gershman E, Izhakian S, Amor SM, Kramer MR. Bronchoscopy for management and identification of etiology of right middle lobe syndrome: Analysis of 66 cases. Thorac Cancer 2023; 14:3226-3231. [PMID: 37704575 PMCID: PMC10643790 DOI: 10.1111/1759-7714.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Right middle lobe (RML) syndrome is a recurrent or chronic obstruction of the RML causing atelectasis of the right middle lobe due to mechanical and nonmechanical etiologies. The consequences of untreated RML syndrome range from chronic cough to post-obstructive pneumonia and bronchiectasis. We report here our bronchoscopy experience in patients with RML syndrome. METHODS We conducted a retrospective study of adult patients who underwent bronchoscopy for RML syndrome at Rabin Medical Center from 2008 through 2022. Demographic data and medical history, bronchoscopy findings and procedures, and follow-up results were collected. RESULTS A total of 66 patients (57.6% male, mean age 63 ± 13 years) underwent bronchoscopy for RML syndrome during the study period. Bronchoscopy revealed a mechanical etiology in 49 (74.2%) cases, including endobronchial mass (21, 31.8%) and external compression (7, 10.6%). Malignancy was identified in 20 (30.3%) cases. In 62 patients (93.9%), the bronchoscopy resulted in partial or complete reopening of the RML bronchus. The therapeutic bronchoscopic procedures were balloon dilatation (19), laser ablation (17), mechanical debridement (12), endobronchial stent insertion (11), and cryoablation (6). CONCLUSIONS Malignancy was identified as the etiology of RML syndrome in approximately 25% of cases, suggesting bronchoscopy should be performed in every case of RML atelectasis. To our knowledge, this is the first reported series of endobronchial stenting of the RML bronchus in the context of RML syndrome.
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Affiliation(s)
- Lev Freidkin
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Moshe Heching
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dror Rosengarten
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Barak Pertzov
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Evgeni Gershman
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shimon Izhakian
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Shai M. Amor
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Mordechai Reuven Kramer
- Pulmonary DivisionRabin Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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14
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Fonseca LMC, Reboredo MM, Lucinda LMF, Fazza TF, Bergamini BC, Botelho MP, Lopes GM, Ferreira JDN, Carvalho EV, Pinheiro BV. Effects of atelectatic areas on the surrounding lung tissue during mechanical ventilation in an experimental model of acute lung injury induced by lipopolysaccharide. Crit Care Sci 2023; 35:386-393. [PMID: 38265320 PMCID: PMC10802780 DOI: 10.5935/2965-2774.20230190-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To assess the effect of atelectasis during mechanical ventilation on the periatelectatic and normal lung regions in a model of atelectasis in rats with acute lung injury induced by lipopolysaccharide. METHODS Twenty-four rats were randomized into the following four groups, each with 6 animals: the Saline-Control Group, Lipopolysaccharide Control Group, Saline-Atelectasis Group, and Lipopolysaccharide Atelectasis Group. Acute lung injury was induced by intraperitoneal injection of lipopolysaccharide. After 24 hours, atelectasis was induced by bronchial blocking. The animals underwent mechanical ventilation for two hours with protective parameters, and respiratory mechanics were monitored during this period. Thereafter, histologic analyses of two regions of interest, periatelectatic areas and the normally-aerated lung contralateral to the atelectatic areas, were performed. RESULTS The lung injury score was significantly higher in the Lipopolysaccharide Control Group (0.41 ± 0.13) than in the Saline Control Group (0.15 ± 0.51), p < 0.05. Periatelectatic regions showed higher lung injury scores than normally-aerated regions in both the Saline-Atelectasis (0.44 ± 0.06 x 0.27 ± 0.74 p < 0.05) and Lipopolysaccharide Atelectasis (0.56 ± 0.09 x 0.35 ± 0.04 p < 0.05) Groups. The lung injury score in the periatelectatic regions was higher in the Lipopolysaccharide Atelectasis Group (0.56 ± 0.09) than in the periatelectatic region of the Saline-Atelectasis Group (0.44 ± 0.06), p < 0.05. CONCLUSION Atelectasis may cause injury to the surrounding tissue after a period of mechanical ventilation with protective parameters. Its effect was more significant in previously injured lungs.
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Affiliation(s)
- Lídia Maria Carneiro Fonseca
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
| | - Maycon Moura Reboredo
- Center of Reproductive Biology, Universidade Federal de Juiz de
Fora - Juiz de Fora (MG), Brazil
| | | | - Thaís Fernanda Fazza
- Center of Reproductive Biology, Universidade Federal de Juiz de
Fora - Juiz de Fora (MG), Brazil
| | - Bruno Curty Bergamini
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
| | - Mateus Pinto Botelho
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
| | - Gabriele Moura Lopes
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
| | | | - Erich Vidal Carvalho
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, Hospital
Universitário, Universidade Federal de Juiz de Fora - Juiz de Fora (MG),
Brazil
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15
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Frassanito L, Grieco DL, Zanfini BA, Catarci S, Rosà T, Settanni D, Fedele C, Scambia G, Draisci G, Antonelli M. Effect of a pre-emptive 2-hour session of high-flow nasal oxygen on postoperative oxygenation after major gynaecologic surgery: a randomised clinical trial. Br J Anaesth 2023; 131:775-785. [PMID: 37543437 DOI: 10.1016/j.bja.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND We aimed at determining whether a 2-h session of high-flow nasal oxygen (HFNO) immediately after extubation improves oxygen exchange after major gynaecological surgery in the Trendelenburg position in adult female patients. METHODS In this single-centre, open-label, randomised trial, patients who underwent major gynaecological surgery were randomised to HFNO or conventional oxygen treatment with a Venturi mask. The primary outcome was the Pao2/FiO2 ratio after 2 h of treatment. Secondary outcomes included lung ultrasound score, diaphragm thickening fraction, dyspnoea, ventilatory frequency, Paco2, the percentage of patients with impaired gas exchange (Pao2/FiO2 ≤40 kPa) after 2 h of treatment, and postoperative pulmonary complications at 30 days. RESULTS A total of 83 patients were included (42 in the HFNO group and 41 in the conventional treatment group). After 2 h of treatment, median (inter-quartile range) Pao2/FiO2 was 52.9 (47.9-65.2) kPa in the HFNO group and 45.7 (36.4 -55.9) kPa in the conventional treatment group (mean difference 8.7 kPa [95% CI: 3.4 to 13.9], P=0.003). The lung ultrasound score was lower in the HFNO group than in the conventional treatment group (9 [6-10] vs 12 [10-14], P<0.001), mostly because of the difference of the score in dorsal areas (7 [6-8] vs 10 [9-10], P<0.001). The percentage of patients with impaired gas exchange was lower in the HFNO group than in the conventional treatment group (5% vs 37%, P<0.001). All other secondary outcomes were not different between groups. CONCLUSIONS In patients who underwent major gynaecological surgery, a pre-emptive 2-h session of HFNO after extubation improved postoperative oxygen exchange and reduced atelectasis compared with a conventional oxygen treatment strategy. CLINICAL TRIAL REGISTRATION NCT04566419.
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Affiliation(s)
- Luciano Frassanito
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico L Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Bruno A Zanfini
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Catarci
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Rosà
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Donatella Settanni
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy; Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy; Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Draisci
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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16
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Yan Y, Zhang X, Yao Y. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore) 2023; 102:e34668. [PMID: 37773789 PMCID: PMC10545020 DOI: 10.1097/md.0000000000034668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/19/2023] [Indexed: 10/01/2023] Open
Abstract
Postoperative pulmonary complications (PPCs) are among the most common complications after cardiovascular surgery. This study aimed to explore the real incidence of and risk factors for PPC in patients with acute type A aortic dissection (ATAAD) who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR + FET). In total, 305 ATAAD patients undergoing TAR + FET from January 2021 to August 2022 in a single-center were divided into PPCs or non-PPCs group. The incidence of PPCs was calculated, risk factors of PPCs were analyzed, and postoperative outcomes were compared between these 2 groups. The incidence of any PPC was 29.2%. And the incidence of respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, acute respiratory distress syndrome, aspiration pneumonitis, pulmonary edema and bronchospasm was 23.0%, 12.5%, 10.5%, 1.0%, 0.7%, 1.0%, 0%, 0.7%, 0%, respectively. The logistic regression analysis revealed that the history of diabetes, history of renal dysfunction, preoperative SpO2 <90%, cardiopulmonary bypass duration, fresh frozen plasma volume and platelet concentrates volume were independent risk factors for PPCs. Among 2 groups, postoperative ventilation duration, postoperative length of stay in intensive care unit and hospital were (73.5 ± 79.0 vs 24.8 ± 35.2 hours; P < .001), (228.3 ± 151.2 vs 95.2 ± 72.0 hours; P < .001) and (17.9 ± 8.8 vs 11.5 ± 6.2 days; P < .001). There was no difference between 2 groups of in-hospital mortality rate. Additionally, other short-term outcomes were also significantly poorer in patients with PPCs. PPCs are common in ATAAD patients undergoing TAR + FET, and could be multifactorial. PPCs occurrence are associated with poor patient outcomes postoperatively and worth further investigation.
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Affiliation(s)
- Yan Yan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Anesthesiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xuebing Zhang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Anesthesiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Yuntai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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17
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Su X, Wang HJ, Li B, Zhou MF, Duan YC, Jiang KY, Wang AQ, Wang R, Cao YS. [Characteristics of SPECT/CT-derived pulmonary perfusion imaging in chronic pulmonary vascular stenosis with different etiologies]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:970-976. [PMID: 37709714 DOI: 10.3760/cma.j.cn112148-20230611-00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Objective: To explore the characteristics of pulmonary blood flow perfusion imaging of single photo emission computer tomography/computer tomography (SPECT/CT) in chronic pulmonary vascular Stenosis (CPVS) caused by different etiological factors. Methods: This is a retropective study. Present study screened 50 consecutive cases diagnosed with chronic pulmonary vascular stenosis from January 2019 to January 2020 in the department of cardiology of Gansu Provincial Hospital and underwent SPECT/CT pulmonary blood flow perfusion examination. Thirteen patients were excluded because of pulmonary vascular lesions with a disease course of less than 3 months and poor image quality. According to the etiology, patients were divided into fibrosing mediastinitis (FM) group, Takyasu's arteritis (PTA) group, and chronic thromboembolic pulmonary hypertension/chronic thromboembolic pulmonary disease (CTEPH/CTED) group. The severity of pulmonary blood flow perfusion was evaluated in accordance with the Begic scoring principle in the three groups. The overall Begic score, lung lobe scores among three groups were compared. CT signs of lung SPECT/CT, such as enlargement of hilar lymph node, atelectasis, bronchial stenosis, were also analyzed in three groups. Results: A total of 37 patients with chronic pulmonary vascular stenosis were finally enrolled (18 in the FM group, 5 in the PTA group, and 14 in the CTEPH/CTED group). The total Begic score of pulmonary perfusions was similar among the three groups (F=0.657,P>0.05). There was a statistically significant difference in the left upper lobe Begic score among the three groups (H=4.081, P<0.05). The left upper lobe Begic score was higher in the FM group than in the PTA group (3.44±2.50 vs. 1.60±0.55, P<0.05). As compared to other two groups, patients in FM group were featured with CT signs of higher percent of hilar enlargement (FM group vs. PTA group: 16/18 vs. 1/5, P=0.008; FM group vs. CTEPH/CTED group: 16/18 vs. 3/14, P=0.000 2), enlargement of the pulmonary hilum lymph nodes (FM group vs. PTA group: 14/18 vs. 1/5, P=0.033; FM group vs. CTEPH/CTED group: 14/18 vs. 2/14, P=0.001), and calcification of mediastinal soft tissue (FM group vs. PTA group: 11/18 to 0/5, P=0.037; FM group vs. CTEPH/CTED group: 11/18 vs. 1/14, P=0.003). The proportion of CT signs of bronchial stenosis (9/18 vs. 0/14, P=0.002) and atelectasis (9/18 vs. 1/14, P=0.002) was also higher in the FM group than in the CTEPH/CTED group. In case of abnormal pulmonary blood flow perfusion, the diagnostic accuracy of CT signs hilar enlargement, hilar lymph node enlargement, mediastinal soft tissue calcification, bronchial stenosis, and atelectasis for the diagnosis of FM were 81.1%, 83.8%, 78.4%, 75.7%, and 73.0%, respectively. Conclusion: There is no significant difference in the Begic score of SPECT/CT pulmonary blood flow perfusion imagines among the three groups of patients. Impaired pulmonary blood flow perfusion combined with typical CT signs is useful for identifying patients with FM.
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Affiliation(s)
- X Su
- Department of Nuclear Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
| | - H J Wang
- Department of Nuclear Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
| | - B Li
- Department of Cardiology, Pulmonary Vascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, China
| | - M F Zhou
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China
| | - Y C Duan
- Department of Cardiology, Xianyang Central Hospital, Xianyang 712000, China
| | - K Y Jiang
- Department of Cardiology, Pulmonary Vascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, China
| | - A Q Wang
- Department of Cardiology, Pulmonary Vascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, China
| | - R Wang
- Department of Nuclear Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Y S Cao
- Department of Cardiology, Pulmonary Vascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, China
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18
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Vardhan A, Singh D, Tripathi S, Kumar M, Singhai A. Congenital myopathy presenting as recurrent pneumonia with lung collapse and pulmonary artery hypertension. BMJ Case Rep 2023; 16:e255502. [PMID: 37739444 PMCID: PMC10533661 DOI: 10.1136/bcr-2023-255502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
A boy presented with cough, breathlessness for 1 month, fever for 1 week with similar previous episodes without hospitalisation. He had generalised muscle wasting, acute chronic malnutrition and required immediate ventilation. Provisional diagnosis of recurrent pneumonia with failure to thrive was made. As serial chest X-rays showed recurrent lung collapse, congenital lung anomalies were ruled out. 2D-echocardiography showed pulmonary arterial hypertension. Workup for congenital immunodeficiency and cystic fibrosis was negative. There was no improvement in muscle mass despite total parenteral nutrition. He was noticed to have myopathic facies. History was reviewed when the mother reported reduced fetal movements in this pregnancy. The patient had low voice amplitude. Creatine kinase levels were normal. Muscle biopsy followed by whole exome sequencing identified frameshift duplication NM_020451.3(SELENON):c.249_250dupGG (p.Asp84Glyfs*17), thus, confirming diagnosis of SEPN1-related congenital myopathy (CM) with fibre-type disproportion. Respiratory system involvement was distracter, emphasising consideration of CM while evaluating persistent lung collapse with muscle wasting.
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Affiliation(s)
- Anand Vardhan
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Devina Singh
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Shalini Tripathi
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Mala Kumar
- Pediatrics, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Atin Singhai
- Pathology, King George Medical College, Lucknow, Uttar Pradesh, India
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19
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Liu Y, Liang P, Liang K, Chang Q. Automatic and efficient pneumothorax segmentation from CT images using EFA-Net with feature alignment function. Sci Rep 2023; 13:15291. [PMID: 37714871 PMCID: PMC10504271 DOI: 10.1038/s41598-023-42388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023] Open
Abstract
Pneumothorax is a condition involving a collapsed lung, which requires accurate segmentation of computed tomography (CT) images for effective clinical decision-making. Numerous convolutional neural network-based methods for medical image segmentation have been proposed, but they often struggle to balance model complexity with performance. To address this, we introduce the Efficient Feature Alignment Network (EFA-Net), a novel medical image segmentation network designed specifically for pneumothorax CT segmentation. EFA-Net uses EfficientNet as an encoder to extract features and a Feature Alignment (FA) module as a decoder to align features in both the spatial and channel dimensions. This design allows EFA-Net to achieve superior segmentation performance with reduced model complexity. In our dataset, our method outperforms various state-of-the-art methods in terms of accuracy and efficiency, achieving a Dice coefficient of 90.03%, an Intersection over Union (IOU) of 81.80%, and a sensitivity of 88.94%. Notably, EFA-Net has significantly lower FLOPs (1.549G) and parameters (0.432M), offering better robustness and facilitating easier deployment. Future work will explore the integration of downstream applications to enhance EFA-Net's utility for clinicians and patients in real-world diagnostic scenarios. The source code of EFA-Net is available at: https://github.com/tianjiamutangchun/EFA-Net .
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Affiliation(s)
- Yinghao Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 200237, China
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Pengchen Liang
- School of Microelectronics, Shanghai University, Shanghai, 201800, China
| | - Kaiyi Liang
- Department of Radiology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Key Laboratory of Shanghai Municipal Health Commission for Smart Image, Shanghai, 201800, China.
| | - Qing Chang
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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20
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Li YL, Hang LH. Recommendations and considerations for speeding the collapse of the non-ventilated lung during single-lung ventilation in thoracoscopic surgery: a literature review. Minerva Anestesiol 2023; 89:792-803. [PMID: 37307029 DOI: 10.23736/s0375-9393.23.17272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video-assisted thoracoscopic thoracic surgery has the advantages of less physical damage, less postoperative pain, and a rapid recovery. Therefore, it is widely used in the clinic. The quality of nonventilated lung collapse is the key point of thoracoscopic surgery. Poor lung collapse on the operative side damages surgical exposure and prolongs the process of surgery. Therefore, it is important to achieve good lung collapse as soon as possible after opening the pleura. Over the past two decades, there have been reports of advances in research on the physiological mechanism of lung collapse and several kinds of techniques for speeding up lung collapse. This review will inform the advances of each technique, make recommendations for reasonable implementation and discuss their controversies and considerations.
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Affiliation(s)
- Yu-Lin Li
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China
| | - Li-Hua Hang
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China -
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21
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Kumar N, Mitchell J, Siemens A, Deiparine S, Saddawi-Konefka D, Hussain N, Iyer MH, Essandoh M, Sawyer TR, Hao D. Left-Sided Double-Lumen Tube vs EZ-Blocker for One-Lung Ventilation in Thoracic Surgery: A Systematic Review and Meta-Analysis. Semin Cardiothorac Vasc Anesth 2023; 27:171-180. [PMID: 37347963 DOI: 10.1177/10892532231184781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background. The EZ-Blocker is the newest generation of bronchial blocker and offers a potential alternative to left-sided double lumen tubes for lung isolation and one-lung ventilation during thoracic surgery. Methods. Databases were searched for randomized controlled trials comparing left-sided double lumen tube to the EZ-Blocker for one-lung ventilation during thoracic surgery. The time for placement, incidence of intraoperative displacement, and surgeons' rating of lung collapse quality were designated as coprimary outcomes. The safety profiles of the two devices, including the incidence of airway trauma and post-extubation discomfort were also examined. Results. Six randomized controlled trials (495 patients) were analyzed. Compared to the EZ-Blocker, the left-sided double lumen tube was faster to place by a weighted mean difference of [95% CI] of -61.24 seconds [-102.48, -20.00] (P = .004) and was much less likely to become displaced during lung isolation with an odds ratio [95% CI] of .56 [.34, .91] (P = .02). The left-sided double lumen tube and the EZ-Blocker provided similar surgeon-rated quality of lung isolation. Although the left-sided double lumen tube caused a greater degree of post-extubation sore throat, there was a similar incidence of carinal trauma and post-extubation hoarseness compared to the EZ-Blocker. Conclusion. Our analysis suggests that the left-sided double lumen tube can be placed more quickly and is less prone to intraoperative displacement compared to the EZ-Blocker; the quality of lung collapse is similar. Thus, evidence appears to support the continued utilization of the left-sided double lumen tube for routine thoracic surgery requiring one-lung ventilation.
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Affiliation(s)
- Nicolas Kumar
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Justin Mitchell
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew Siemens
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Selina Deiparine
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel Saddawi-Konefka
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tamara R Sawyer
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - David Hao
- Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
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22
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Bai YX, Han JJ, Liu J, Li X, Xu ZZ, Lv Y, Liu KX, Wu QP. Sugammadex Reduced the Incidence of Postoperative Pulmonary Complications in Susceptible Patients Identified by ARISCAT Risk Index: Systematic Review and Meta-analysis. Adv Ther 2023; 40:3784-3803. [PMID: 37351811 DOI: 10.1007/s12325-023-02535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION The efficacy of sugammadex on postoperative pulmonary complications (PPCs) in susceptible patients, compared with neostigmine, remains indeterminate. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Group Investigators proposed a risk index for the early identification of susceptible patients, with excellent externally validated discrimination ability. Meta-analytical techniques were applied to evaluate the efficacy of sugammadex on PPCs in patients with ARISCAT-defined risk factors. METHODS The study is registered on PROSPERO, number CRD42021261156. We searched PubMed, Scopus, Embase, Cochrane library, GreyNet, and OpenGrey for eligible randomized controlled trials (RCTs) without restricting the language or year of publication. RESULTS Twelve RCTs consisting of 1182 patients susceptible to PPCs were included. A robust reduction was observed on the incidence of PPCs in susceptible patients who received sugammadex [RR 0.66; 95% CI (0.54, 0.80), p < 0.01], with a low level of between-study heterogeneity (I2 = 45.98%; H2 = 1.85). Similar protective effects were also proved in avoiding residual neuromuscular block (NMB) [RR 0.25; 95% CI (0.11, 0.56); p < 0.01], atelectasis [RR 0.74; 95% CI (0.59, 0.95); p = 0.02], pneumonia [RR 0.49; 95% CI (0.28, 0.88); p = 0.02], and respiratory failure [RR 0.61; 95% CI (0.39, 0.96); p = 0.03]. No difference was observed regarding adverse events [RR 0.85; 95% CI (0.72, 1.01); p = 0.06]. CONCLUSION Low to moderate quality of evidence demonstrated the edge of sugammadex over neostigmine for NMB reversal in reducing the likelihood of PPCs and residual NMB in patients with ARISCAT-defined risk factors. Clinicians may reassess the type of reversal agent when treating patients susceptible to PPCs.
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Affiliation(s)
- Yun-Xiao Bai
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing-Jing Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jie Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xia Li
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhen-Zhen Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Lv
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qing-Ping Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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23
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Nakanishi T, Sento Y, Kamimura Y, Nakamura R, Hashimoto H, Okuda K, Nakanishi R, Sobue K. Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial. J Clin Anesth 2023; 88:111136. [PMID: 37137259 DOI: 10.1016/j.jclinane.2023.111136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVE The combined use of the ProSeal laryngeal mask airway and a bronchial blocker may reduce postoperative hoarseness and sore throat. We aimed to test the feasibility and efficacy of this combination technique in thoracoscopic surgery. DESIGN A single-center, patient-assessor blinded, randomized controlled trial. SETTING Nagoya City University Hospital (between November 2020 and April 2022). PATIENTS A total of 100 adult patients undergoing lobectomy or segmentectomy by video- or robotic-assisted thoracoscopic surgery. INTERVENTIONS Patients were randomly assigned to either group using a combination of the ProSeal laryngeal mask airway and a bronchial blocker (pLMA+BB group) or a double-lumen endobronchial tube (DLT group). MEASUREMENTS The primary outcome was the hoarseness incidence on 1-3 postoperative days. Secondary outcomes included sore throat, intraoperative complications (hypoxemia, hypercapnia, surgical interruption, malposition of devices, unintended lung expansion, and ventilatory difficulty), lung collapse, device placement-related outcomes, and coughing during emergence. MAIN RESULTS A total of 100 patients underwent randomization (51 to the pLMA+BB group and 49 to the DLT group). After drop outs, a total of 49 patients in each group were analyzed per-protocol. The incidences of hoarseness in the pLMA+BB and DLT groups were 42.9% and 53.1% (difference, -10.2%; 95% confidence interval, -30.1% to 10.3%; p = 0.419), 18.4% vs. 32.7%, and 20.4% vs. 24.5% on postoperative day 1, 2, and 3, respectively. The incidences of sore throat in the pLMA+BB and DLT groups were 16.3% vs. 34.7% (difference, -18.4%; 95% confidence interval, -35.9% to -0.9%; p = 0.063) on postoperative day 1. In the pLMA+BB group, more intraoperative complications and less coughing during emergence were observed compared to the DLT group. Lung collapse and placement-related outcomes were comparable between the groups. CONCLUSIONS The combination of ProSeal laryngeal mask airway and bronchial blocker did not significantly reduce hoarseness compared to the double-lumen endobronchial tube.
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Affiliation(s)
- Toshiyuki Nakanishi
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryuji Nakamura
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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Jeong JH, Kim J, Choi CM, Ji W. Clinical Outcomes of Bronchoscopic Cryotherapy for Central Airway Obstruction in Adults: An 11-Years' Experience of a Single Center. J Korean Med Sci 2023; 38:e244. [PMID: 37582494 PMCID: PMC10427217 DOI: 10.3346/jkms.2023.38.e244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/12/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Although bronchoscopic cryotherapy (BC) is a pragmatic modality for recanalization of central airway obstruction (CAO), the risk of complications, such as bleeding, remains a concern. This study aimed to present the clinical outcomes of BC and evaluate the factors associated with its complications. METHODS In this retrospective study, we reviewed the medical records of patients who underwent BC for CAO at the Asan Medical Center, South Korea. Most sessions were conducted via flexible bronchoscopy under moderate sedation. A multivariate logistic regression analysis was used to identify the factors associated with the success rate and complications. RESULTS BC was performed in 262 sessions in 208 patients between January 2009 and December 2020. The most common cause of cryotherapy was recanalization of the endobronchial tumor related CAO (233/262, 88.9%). More than partial re-establishment of airway patency was achieved in 211 of 233 (90.6%) sessions. The success rate did not differ significantly in the multivariate logistic regression analysis. The most common complication was intrabronchial bleeding (78/233, 35.5%); however, severe bleeding occurred only in one case (0.4%). Univariate and multivariate logistic regression analyses revealed that diabetes mellitus (odds ratio [OR] = 2.820, P = 0.011), respiratory failure before BC (OR = 3.546, P = 0.028), and presence of distal airway atelectasis (OR = 0.417, P = 0.021) were independently associated with moderate to severe intrabronchial bleeding, while the histologic type of tumor was not related to bleeding. BC for CAO caused by blood clot or foreign body was successful in most cases, and there were no complications. CONCLUSION BC is an efficient and relatively safe intervention for patients with CAO. Our findings suggest that diabetes, respiratory failure before BC, and the absence of distal airway atelectasis may be risk factors of moderate to severe intrabronchial bleeding.
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Affiliation(s)
- Jong Hwan Jeong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jiwon Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Maranini B, Guzzinati I, Casoni GL, Ballotta M, Lo Monaco A, Govoni M. Case Report: Middle lobe syndrome: a rare presentation in eosinophilic granulomatosis with polyangiitis. Front Immunol 2023; 14:1222431. [PMID: 37638004 PMCID: PMC10448582 DOI: 10.3389/fimmu.2023.1222431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by necrotizing inflammation of small- and medium-sized blood vessels and the presence of circulating ANCA. Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic ANCA-associated vasculitis, characterized by peripheral eosinophilia, neuropathy, palpable purpuras or petechiae, renal and cardiac involvement, sinusitis, asthma, and transient pulmonary infiltrates. Middle lobe syndrome (MLS) is defined as recurrent or chronic atelectasis of the right middle lobe of the lung, and it is a potential complication of asthma. Case presentation Herein, we describe a case of MLS in a 51-year-old woman, never-smoker, affected by EGPA, presenting exclusively with leukocytosis and elevated concentrations of acute-phase proteins, without any respiratory symptom, cough, or hemoptysis. Chest computed tomography (CT) imaging documented complete atelectasis of the middle lobe, together with complete obstruction of lobar bronchial branch origin. Fiberoptic bronchoscopy (FOB) revealed complete stenosis of the middle lobar bronchus origin, thus confirming the diagnosis of MLS, along with distal left main bronchus stenosis. Bronchoalveolar lavage (BAL) did not detect any infection. Bronchial biopsies included plasma cells, neutrophil infiltrates, only isolated eosinophils, and no granulomas, providing the hypothesis of vasculitic acute involvement less likely. First-line agents directed towards optimizing pulmonary function (mucolytics, bronchodilators, and antibiotic course) were therefore employed. However, the patient did not respond to conservative treatment; hence, endoscopic management of airway obstruction was performed, with chest CT documenting resolution of middle lobe atelectasis. Conclusion To the best of our knowledge, this is the first detailed description of MLS in EGPA completely resolved through FOB. Identification of MLS in EGPA appears essential as prognosis, longitudinal management, and treatment options may differ from other pulmonary involvement in AAV patients.
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Affiliation(s)
- Beatrice Maranini
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Maria Ballotta
- Section of Anatomic Pathology, Azienda Ospedaliera Rovigo, Rovigo, Italy
| | - Andrea Lo Monaco
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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26
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Qi K, Lin G, Liu H, Zhang X, Huang W, Chen Z, Li J. Safety and feasibility of preferential manual bronchoplasty in 2-3 cm single-port video-assisted thoracoscopic lobectomy. Thorac Cancer 2023; 14:2484-2492. [PMID: 37442784 PMCID: PMC10447174 DOI: 10.1111/1759-7714.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This retrospective study aimed to compare preferential manual bronchoplasty (PMB) and mechanical stapler closure (MSC) of the bronchial stump after 2-3 cm single-port (SP) video-assisted thoracoscopic surgery (VATS) lobectomy in patients with pathological T1 (pT1) stage lung cancer. METHODS Between January 2019 and March 2022, patients with pulmonary neoplasms who underwent 2-3 cm SP VATS lobectomy were retrospectively screened. After propensity-matched analysis, we compared perioperative outcomes and analyzed the safety and feasibility of PMB and MSC of the bronchial stump while performing VATS lobectomy. RESULTS In this study, 280 and 832 patients were enrolled in the PMB and MSC groups, respectively. Propensity score matching produced 280 pairs. The operation time was shorter in the PMB group, whereas the average number of lymph nodes dissected was higher in the PMB group. The conversion rate was significantly lower in the PMB group. The following were similar between the PMB and MSC groups, respectively: average blood loss volume, postoperative hospital stay, and chest tube removal time. Postoperatively, the incidence of atelectasis was significantly higher in the MSC group. As per subgroup analyses, PMB was associated with a shorter operation time in left and right upper lobectomies. Particularly in left upper lobectomy, PMB had more lymph node dissections and less conversion to open and postoperative atelectasis. CONCLUSIONS In comparison with MSC of the bronchial stump, PMB showed better safety and feasibility in 2-3 cm SP VATS left and right superior lobectomies in patients with pT1 stage lung cancer.
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Affiliation(s)
- Kang Qi
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Gang Lin
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Haibo Liu
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Xining Zhang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Weiming Huang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Zhimao Chen
- Department of Precision Medicine in OncologyErasmus Medical Center Cancer InstituteRotterdamNetherlands
| | - Jian Li
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
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27
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Elders BBLJ, Kersten CM, Hermelijn SM, Wielopolski PA, Tiddens HAWM, Schnater JM, Ciet P. Congenital lung abnormalities on magnetic resonance imaging: the CLAM study. Eur Radiol 2023; 33:4767-4779. [PMID: 36826502 PMCID: PMC10290040 DOI: 10.1007/s00330-023-09458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Follow-up of congenital lung abnormalities (CLA) is currently done with chest computer tomography (CT). Major disadvantages of CT are exposure to ionizing radiation and need for contrast enhancement to visualise vascularisation. Chest magnetic resonance imaging (MRI) could be a safe alternative to image CLA without using contrast agents. The objective of this cohort study was to develop a non-contrast MRI protocol for the follow-up of paediatric CLA patients, and to compare findings on MRI to postnatal CT in school age CLA patients. METHODS Twenty-one CLA patients, 4 after surgical resection and 17 unoperated (mean age 12.8 (range 9.4-15.9) years), underwent spirometry and chest MRI. MRI was compared to postnatal CT on appearance and size of the lesion, and lesion associated abnormalities, such as hyperinflation and atelectasis. RESULTS By comparing school-age chest MRI to postnatal CT, radiological appearance and diagnostic interpretation of the type of lesion changed in 7 (41%) of the 17 unoperated patients. In unoperated patients, the relative size of the lesion in relation to the total lung volume remained stable (0.9% (range - 6.2 to + 6.7%), p = 0.3) and the relative size of lesion-associated parenchymal abnormalities decreased (- 2.2% (range - 0.8 to + 2.8%), p = 0.005). CONCLUSION Non-contrast-enhanced chest MRI was able to identify all CLA-related lung abnormalities. Changes in radiological appearance between MRI and CT were related to CLA changes, patients' growth, and differences between imaging modalities. Further validation is needed for MRI to be introduced as a safe imaging method for the follow-up of paediatric CLA patients. KEY POINTS • Non-contrast-enhanced chest MRI is able to identify anatomical lung changes related to congenital lung abnormalities, including vascularisation. • At long-term follow-up, the average size of congenital lung abnormalities in relation to normal lung volume remains stable. • At long-term follow-up, the average size of congenital lung abnormalities associated parenchymal abnormalities such as atelectasis in relation to normal lung volume decreases.
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Affiliation(s)
- Bernadette B L J Elders
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Casper M Kersten
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sergei M Hermelijn
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Radiology Department, University of Cagliari, Cagliari, Italy.
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He X, Chang Z, Yan H, Weng Y. Pulmonary aspergillus infection with abnormal imaging successfully treated with omalizumab: A case report. Medicine (Baltimore) 2023; 102:e33845. [PMID: 37327273 PMCID: PMC10270481 DOI: 10.1097/md.0000000000033845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/04/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pulmonary aspergillosis is a pulmonary infectious disease that is clinically difficult to diagnose and treat. When the lower respiratory tract is invaded by Aspergillus, the clinical manifestations and imaging features vary among patients with different immune states. The use of antifungal drugs and glucocorticoids are important, but some patients do not respond satisfactorily to treatment. CASE PRESENTATION A 59-year-old female had a long history of asthma and poor symptom control, with long-term use of long-acting inhaled glucocorticoids combined with a long-acting β2 receptor agonists (ICS + LABA) (salmeterol fluticasone inhalation powder). The ground glass shadow, tree-in-bud sign, and bronchiectasis in the middle lobe of the right lung and the lower lobe of both lungs were first detected by chest CT over 5 years ago. Atelectasis in the middle lobe of the right lung was detected over 3 years ago. Over 2 years ago, the patient was hospitalized and a repeat chest CT showed persistent atelectasis in the middle lobe of the right lung, and more lesions in bilateral lower lungs than before. Aspergillus fumigatus was detected in alveolar lavage fluid and sputum pathogenic culture, which confirmed the diagnosis of pulmonary aspergillosis. After treatment with voriconazole and amphotericin B, the middle lobe of the right lung partially reopened, but the lesions in bilateral lower lungs persisted. After 21 weeks of treatment, the antifungal drugs were stopped because the patient refused to use oral/intravenous glucocorticoids, and omalizumab was finally chosen for treatment. After 1 month of treatment, the patient's clinical symptoms began to ease. After 1 year of treatment, imaging reexamination of lung showed that the lesions were completely cleared, accompanied by significant improvement in nutritional status and airway function. CONCLUSIONS We reported the case of a patient with pulmonary Aspergillus infection who was treated with omalizumab and showed significant improvement in clinical symptoms and imaging abnormalities, which provides a new option for patients with pulmonary Aspergillus infection who show unsatisfactory response with first-line drugs.
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Affiliation(s)
- Xing He
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, China
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenzhen Chang
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, China
| | - Haiying Yan
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, China
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Weng
- School of Mathematics, Sichuan University, Chengdu, Sichuan, China
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田 小, 张 光, 王 崇, 谷 瑞, 李 媛, 李 沁, 罗 健, 罗 征. [Clinical characteristics of plastic bronchitis and risk factors for recurrence in children]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:626-632. [PMID: 37382133 PMCID: PMC10321426 DOI: 10.7499/j.issn.1008-8830.2211122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/23/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB. METHODS This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed. RESULTS A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05). CONCLUSIONS Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.
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Abstract
Background A significant increase in cardiac surgery has been observed globally, with prolonged length of stay (LOS) still prevalent due to post-operative complications. Physiotherapy pre and post cardiac surgery is known to reduce these complications and LOS, however cases referred for physiotherapy is unknown. Objective The study aimed to describe the profile and pre- and post-operative referrals to physiotherapy of patients admitted to the cardiothoracic unit at a selected hospital in Tanzania over a four-year period. Method Descriptive, retrospective design. A data extraction sheet was used to capture demographic, cardiac disease, ICU and hospital LOS, post-operative complications and physiotherapy referral data of all patients ≥18 years of age. Results 105 cardiac surgeries were performed. Patients' mean age was 30.6 years (SD=10.48) and 54.3% (n=57/105) were female. Cardiac surgeries performed declined from 48.6% (n=51/105) in 2010 to 10.5% (n=11/105) in 2013. Cardiac arrest (33%, n=7/21), pneumonia (19%, n=4/21) and lung collapse (4.8%, n=1/21) were the notable documented post-operative complications. ICU mortality was highest (72,7%, n=8/11). Only 1% (n=1/105) of cases were referred pre-operatively versus 77.7% (n=80/103) post-operatively for physiotherapy. Conclusion Cardiac surgeries were reduced annually but the post-operative complications need to be reduced. Pre-operative physiotherapy referral may reduce pneumonia and lung collapse following cardiac surgery.
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Affiliation(s)
- Abdallah R Makalla
- The Department of Rehabilitation Medicine Muhimbili National Hospital P.O.Box 65000, Dar Es Salaam, Tanzania
| | - Farhana Karachi
- Department of Physiotherapy, University of the Western Cape, Private Bag X17 Bellville 7535
| | - Joliana S Phillips
- Department of Physiotherapy, University of the Western Cape, Private Bag X17 Bellville 7535
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Gutowski JN, Donovan DJ, Firnberg MT, Constantinescu A, Kennedy TM. A Rare Complication of Anomalous Left Coronary Artery From the Pulmonary Artery Identified by Point-of-Care Ultrasound. Pediatr Emerg Care 2023; 39:201-203. [PMID: 36173337 DOI: 10.1097/pec.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Point-of-care ultrasound is a valuable tool in the evaluation of undifferentiated respiratory distress in children. This case report describes a 9-month-old male infant who presented with 4 months of progressively worsening cough and was found to be tachypneic in the emergency department. Chest radiography revealed complete opacification of the left hemithorax with cardiomegaly. Point-of-care ultrasound demonstrated atelectasis of the entire left lung and severe dilation of the left ventricle with poor function. Electrocardiogram and echocardiogram findings were consistent with a diagnosis of anomalous left coronary artery from the pulmonary artery. The patient underwent successful cardiac surgery to improve myocardial perfusion. Bronchoscopy visualized the etiology of his atelectasis, pulsatile compression of the left mainstem bronchus by the dilated heart. Focused cardiac and lung ultrasound techniques, as well as pertinent sonographic findings, are reviewed.
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Affiliation(s)
| | | | - Maytal T Firnberg
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine
| | - Andrei Constantinescu
- Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Thomas M Kennedy
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine
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Tank H, Kennedy G, Pollock R, Hodkinson P, Sheppard-Hickey RA, Woolford J, Green NDC, Stevenson A. Cabin Pressure Altitude Effect on Acceleration Atelectasis After Agile Flight Breathing 60% Oxygen. Aerosp Med Hum Perform 2023; 94:3-10. [PMID: 36757237 DOI: 10.3357/amhp.6123.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION: A flight trial was conducted to determine whether breathing 60% oxygen during high performance flight maneuvers using contemporary pilot flight equipment induces atelectasis and to explore whether cabin altitude had any influence on the extent of atelectasis identified.METHODS: On 2 separate days, 14 male aircrew flew as passengers at High [14,500-18,000 ft (4420-5486 m)] and Low [4000-6000 ft (1219-1829 m)] cabin pressure altitude in a Hawk T Mk1 aircraft breathing 60% oxygen. Sorties comprised 16 maneuvers at +5 Gz, each sustained for 30 s. Lung volumes (spirometry), basal lung volume (electrical impedance tomography, EIT), and peripheral oxygen saturation during transition from hyperoxia to hypoxia (pulmonary shunt fraction) were measured in the cockpit immediately before (Pre) and after (Post) flight.RESULTS: Forced inspiratory vital capacity (FIVC) was significantly lower Postflight after High (-0.24 L) and Low (-0.38 L) sorties, but recovered to Preflight values by the fourth repeat (FIVC4). EIT-derived measures of FIVC decreased after High (-3.3%) and Low (-4.4%) sorties but did not recover to baseline by FIVC4. FIVC reductions were attributable to decreased inspiratory capacity. Spo₂ was lower Postflight than Preflight in High and Low sorties.DISCUSSION: Breathing 60% oxygen during flight results in a 3.8-4.9% reduction in lung volume associated with a small decrease in blood oxygenation and an estimated pulmonary shunt of up to 5.7%. EIT measures suggest persisting airway closure despite repeated FIVC maneuvers. There was no meaningful influence of cabin pressure altitude. The operational consequence of the observed changes is likely to be small.Tank H, Kennedy G, Pollock R, Hodkinson P, Sheppard-Hickey R-A, Woolford J, Green NDC, Stevenson A. Cabin pressure altitude effect on acceleration atelectasis after agile flight breathing 60% oxygen. Aerosp Med Hum Perform. 2023; 94(1):3-10.
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Wu EB, Huang SC, Lu HI, Illias AM, Wang PM, Huang CJ, Shih TH, Chin JC, Wu SC. Use of rocuronium and sugammadex for video-assisted thoracoscopic surgery is associated with reduced duration of chest tube drainage: a propensity score-matched analysis. Br J Anaesth 2023; 130:e119-e127. [PMID: 36038393 DOI: 10.1016/j.bja.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We investigated the influence of different neuromuscular blocking agents and reversal agents during anaesthesia on early removal of chest tube drainage after video-assisted thoracoscopic surgery (VATS). METHODS This retrospective single-centre study included patients who underwent VATS after tracheal intubation under general anaesthesia. Patients received either cisatracurium and neostigmine (n=547) or rocuronium and sugammadex (n=151). Quantitative neuromuscular monitoring was used and one chest tube (size 24 Fr) was inserted. To reduce potential bias, 140 patients from each group were matched by propensity score for sex, age, body mass index and indication for VATS. Primary outcome was duration of chest tube drainage after surgery. RESULTS Use of rocuronium and sugammadex was associated with a shorter duration of chest tube drainage (2 [1-2] vs 2 [1-3] days; P=0.049) and a 63% reduction in delayed chest tube removal (odds ratio 0.37; 95% confidence interval [CI]: 0.20-0.67; P=0.005). This group also had a lower incidence of postoperative atelectasis (P=0.047) and consolidation (P=0.008). Each 1 h increase in the duration of anaesthesia was associated with a 1.57-fold increase in the delayed removal of the chest tube (95% CI: 1.25-1.96; P=0.005). CONCLUSIONS During general anaesthesia for VATS, compared with cisatracurium and neostigmine, use of rocuronium and sugammadex was associated with a significant decrease in the incidence of postoperative delayed removal of the chest tube, atelectasis, and pulmonary consolidation.
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Affiliation(s)
- En-Bo Wu
- Department of Anaesthesiology, Kaohsiung, Taiwan
| | | | - Hung-I Lu
- Department of Thoracic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Amina M Illias
- Department of Anaesthesiology, Linko Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Pei-Ming Wang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | - Jo-Chi Chin
- Department of Anaesthesiology, Park One International Hospital, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anaesthesiology, Kaohsiung, Taiwan.
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Morris K, Weston K, Davy A, Silva S, Goode V, Pereira K, Brysiewicz P, Bruce J, Clarke D. Identification of risk factors for postoperative pulmonary complications in general surgery patients in a low-middle income country. PLoS One 2022; 17:e0274749. [PMID: 36219615 PMCID: PMC9553039 DOI: 10.1371/journal.pone.0274749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are an important cause of perioperative morbidity and mortality. Although risk factors for PPCs have been identified in high-income countries, less is known about PPCs and their risk factors in low- and middle-income countries, such as South Africa. This study examined the incidence of PPCs and their associated risk factors among general surgery patients in a public hospital in the province of KwaZulu-Natal, South Africa to inform future quality improvement initiatives to decrease PPCs in this clinical population. METHODS A retrospective secondary analysis of adult patients with general surgery admissions from January 1, 2013 to December 31, 2017 was conducted using data from the health system's Hybrid Electronic Medical Registry. The sample was comprised of 5352 general surgery hospitalizations. PPCs included pneumonia, atelectasis, acute respiratory distress syndrome, pulmonary edema, pulmonary embolism, prolonged ventilation, hemothorax, pneumothorax, and other respiratory morbidity which encompassed empyema, aspiration, pleural effusion, bronchopleural fistula, and lower respiratory tract infection. Risk factors examined were age, tobacco use, number and type of pre-existing comorbidities, emergency surgery, and number and type of surgeries. Bivariate and multivariable logistic regression models were conducted to identify risk factors for developing a PPC. RESULTS The PPC rate was 7.8%. Of the 418 hospitalizations in which a patient developed a PPC, the most common type of PPC was pneumonia (52.4%) and the mortality rate related to the PPC was 11.7%. Significant risk factors for a PPC were increasing age, greater number of comorbidities, emergency surgery, greater number of general surgeries, and abdominal surgery. CONCLUSIONS PPCs are common in general surgery patients in low- and middle-income countries, with similar rates observed in high-income countries. These complications worsen patient outcomes and increase mortality. Quality improvement initiatives that employ resource-conscious methods are needed to reduce PPCs in low- and middle-income countries.
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Affiliation(s)
- Katelyn Morris
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Kylie Weston
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Alyssa Davy
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Susan Silva
- School of Nursing, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Victoria Goode
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Katherine Pereira
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Petra Brysiewicz
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - John Bruce
- Pietermaritzburg Metropolitan Trauma Service, Grey’s Hospital, Pietermaritzburg, South Africa
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Damian Clarke
- Pietermaritzburg Metropolitan Trauma Service, Grey’s Hospital, Pietermaritzburg, South Africa
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
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Chrysikos S, Papaioannou O, Karampitsakos T, Tavernaraki K, Thanou I, Filippousis P, Anyfanti M, Hillas G, Tzouvelekis A, Thanos L, Dimakou K. Diagnostic Accuracy of Multiple D-Dimer Cutoff Thresholds and Other Clinically Applicable Biomarkers for the Detection and Radiographic Evaluation of Pulmonary Embolism. Adv Respir Med 2022; 90:300-309. [PMID: 36004959 PMCID: PMC9717334 DOI: 10.3390/arm90040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
Abstract
Background: Diagnostic work-up of pulmonary embolism (PE) remains a challenge. Methods: We retrospectively studied all patients referred for computed tomography pulmonary angiography (CTPA) with suspicion of PE during a 12-month period (2018). The diagnostic accuracy of different D-dimer (Dd) cutoff thresholds for ruling out PE was evaluated. Furthermore, the association of Dd and red cell distribution width (RDW) with embolus location, CTPA findings, and patient outcome was recorded. Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). Patients with consolidation/atelectasis or intrapulmonary nodule(s)/mass on CTPA exhibited significantly greater median Dd values compared to patients without the aforementioned findings (2.34, (IQR 1.29−4.22) vs. 1.59, (IQR 0.81−2.96), and 2.39, (IQR 1.45−4.45) vs. 1.66, (IQR 0.84−3.12), p < 0.001, respectively). RDW was significantly greater in patients who died during hospitalization (p = 0.012). Conclusions: Age-adjusted Dd increased diagnostic accuracy of Dd testing without significantly decreasing the need for imaging. The proposed Dd value (0.74 mg/L) showed promise towards reducing considerably the need of CTPA. Multiple radiographic findings have been associated with increased Dd values in our study.
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Affiliation(s)
- Serafeim Chrysikos
- 5th Respiratory Medicine Department, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
- Correspondence:
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, 26504 Patras, Greece
| | | | - Kyriaki Tavernaraki
- Department of Medical Imaging and Interventional Radiology, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
| | - Ioanna Thanou
- Department of Medical Imaging and Interventional Radiology, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
| | - Petros Filippousis
- Department of Medical Imaging and Interventional Radiology, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
| | - Maria Anyfanti
- ICU, G Gennimatas, General Hospital, 11527 Athens, Greece
| | - Georgios Hillas
- 5th Respiratory Medicine Department, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, 26504 Patras, Greece
| | - Loukas Thanos
- Department of Medical Imaging and Interventional Radiology, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, “Sotiria” Chest Diseases Hospital, 11527 Athens, Greece
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Aujla S, Mohammed A, Khan N, Umapathy K. Multi-Level Classification of Lung Pathologies in Neonates using Recurrence Features. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1531-1535. [PMID: 36085782 DOI: 10.1109/embc48229.2022.9871011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The use of Lung Ultrasound (LUS) as a tool to diagnose and monitor lung diseases in neonates has increased in urban hospitals. LUS's main advantages compared to chest CT or X-rays is that it is less expensive, more accessible, and does not expose the patient to radiation. Performing LUS on neonates and diagnosing the LUS images require highly trained medical professional and clinicians. While availability of such specialists in general is not an issue in urban areas, there is lack of such personnel in rural and remote communities. Hence, an automated computer-aided screening approach as a first level diagnosis assistance in such scenarios might be of significant value. Many of the image morphologies used by clinicians in diagnosing the LUS have strong recurrence characteristics. Building upon this knowledge, in this paper, we propose a feature extraction method designed to quantify such recurrent features for classification of LUS images into 6 common neonatal lung conditions. These conditions were normal lung, chronic lung disease (CLD), transient tachypnea of the newborn (TTN), pneumothorax (PTX), respiratory distress syndrome (RDS), and consolidation (CON) that could be pneumonia or atelectasis. The proposed method extracts virtual scanlines from the LUS images and converts them into signals. Then using recurrence quantification analysis (RQA), features were extracted and fed to pattern classifiers. Using a simple linear classifier the proposed features can achieve a classification accuracy of 69.3% without clinical features and 77.6% with clinical features. Clinical Relevance- Development of an automated computer-aided screening tool for first level diagnosis assistance in neonatal LUS pathologies. Such a tool will be of significant value in rural and remote medical communities.
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Kanavitoon S, Raksamani K, Troy MP, Suphathamwit A, Thongcharoen P, Suksompong S, Oh SS. Lung ultrasound is non-inferior to bronchoscopy for confirmation of double-lumen endotracheal tube positioning: a randomized controlled noninferiority study. BMC Anesthesiol 2022; 22:168. [PMID: 35637457 PMCID: PMC9150310 DOI: 10.1186/s12871-022-01707-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Appropriate placement of left-sided double-lumen endotracheal tubes (LDLTs) is paramount for optimal visualization of the operative field during thoracic surgeries that require single lung ventilation. Appropriate placement of LDLTs is therefore confirmed with fiberoptic bronchoscopy (FOB) rather than clinical assessment alone. Recent studies have demonstrated lung ultrasound (US) is superior to clinical assessment alone for confirming placement of LDLT, but no large trials have compared US to the gold standard of FOB. This noninferiority trial was devised to compare lung US with FOB for LDLT positioning and achievement of lung collapse for operative exposure. METHODS This randomized, controlled, double-blind, noninferiority trial was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from October 2017 to July 2019. The study enrolled 200 ASA classification 1-3 patients that were scheduled for elective thoracic surgery requiring placement of LDLT. Study patients were randomized into either the FOB group or the lung US group after initial blind placement of LDLT. Five patients were excluded due to protocol deviation. In the FOB group (n = 98), fiberoptic bronchoscopy was used to confirm lung collapse due to proper positioning of the LDLT, and to adjust the tube if necessary. In the US group (n = 97), lung ultrasonography of four pre-specified zones (upper and lower posterior and mid-axillary) was used to assess lung collapse and guide adjustment of the tube if necessary. The primary outcome was presence of adequate lung collapse as determined by visual grading by the attending surgeon on scale from 1 to 4. Secondary outcomes included the time needed to adjust and confirm lung collapse, the time from finishing LDLT positioning to the grading of lung collapse, and intraoperative parameters such has hypotension or hypertension, hypoxia, and hypercarbia. The patient, attending anesthesiologist, and attending thoracic surgeon were all blinded to the intervention arm. RESULTS The primary outcome of lung collapse by visual grading was similar between the intervention and the control groups, with 89 patients (91.8%) in the US group compared to 83 patients (84.1%) in the FOB group (p = 0.18) experiencing adequate collapse. This met criteria for noninferiority per protocol analysis. The median time needed to confirm and adjust LDLT position in the US group was 3 min (IQR 2-5), which was significantly shorter than the median time needed to perform the task in the FOB group (6 min, IQR 4-10) (p = 0.002). CONCLUSIONS In selected patients undergoing thoracic surgery requiring LDLT, lung ultrasonography was noninferior to fiberoptic bronchoscopy in achieving adequate lung collapse and reaches the desired outcome in less time. TRIAL REGISTRATION This study was registered at clinicaltrials.gov, NCT03314519 , Principal investigator: Kasana Raksamani, Date of registration: 19/10/2017.
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Affiliation(s)
- Sawita Kanavitoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Kasana Raksamani
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Michael P Troy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Aphichat Suphathamwit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Punnarerk Thongcharoen
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirilak Suksompong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Scott S Oh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ji JY, Chung JH, Kim NS, Seo YH, Jung HS, Chun HR, Gong HY, Kim WJ, Ahn JM, Park YJ. Causes and Treatment of Hypoxia during Total Hip Arthroplasty in Elderly Patients: A Case Report. IJERPH 2021; 18:ijerph182412931. [PMID: 34948542 PMCID: PMC8700985 DOI: 10.3390/ijerph182412931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Intraoperative hypoxia occurs in approximately 6.8% of surgeries and requires appropriate management to avoid poor outcomes, such as increased mortality or extended hospitalization. Hypoxia can be caused by a variety of factors, including laryngospasm, inhalational anesthetics, and surgery for abdominal pathology or hip fractures. In particular, elderly patients are more vulnerable to hypoxia due to their existing lung diseases or respiratory muscle weakness. This study presents the cases of two elderly patients who developed hypoxia during total hip arthroplasty under general anesthesia. Positive end expiratory pressure, the recruitment maneuver, and increased fraction of inspired oxygen improved hypoxia only temporarily, and patients’ oxygen saturation level again dropped to 79–80%. We suspected that hypoxia was caused by atelectasis and, therefore, resumed spontaneous respiration. Thereafter, both the patients showed an improvement in hypoxia. Intraoperative hypoxia that is suspected to be caused by atelectasis can be improved by securing sufficient lung volume for respiration through increased muscle tone with spontaneous respiration.
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Affiliation(s)
- Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
- Correspondence: ; Tel.: +82-41-570-2823
| | - Jin Hun Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Hyung Yoon Gong
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Jae Min Ahn
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Yu Jun Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
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P1-40: Pig bronchus: A rare tracheobronchial anomaly causing lung collapse and recurrent pneumonia. Respirology 2021; 26 Suppl 3:87-8. [PMID: 34799896 DOI: 10.1111/resp.14150_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pollock RD, Gates SD, Radcliffe JJ, Stevenson AT. Indirect Measurements of Acceleration Atelectasis and the Role of Inspired Oxygen Concentrations. Aerosp Med Hum Perform 2021; 92:780-785. [PMID: 34641998 DOI: 10.3357/amhp.5859.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: A growing number of symptom reports suggestive of acceleration atelectasis in fast jet aircrew have raised the question as to whether traditional guidelines on inspired gas composition remain valid. The aim of this study was to assess the effects of inspired O₂ concentration on the development of acceleration atelectasis when wearing modern anti-G garments. METHODS: There were 14 nonaircrew subjects who completed 5 centrifuge exposures to +5 Gz lasting 90 s. During exposures subjects breathed a gas mixture containing 21, 35, 45, 60, or 75% O₂. To assess the extent of atelectasis post-Gz, forced inspiratory vital capacity (FIVC), regional FIVC (EITFIVC), shunt, respiratory resistance, reactance, and compliance and peripheral O₂ saturation during a hypoxic exposure were measured. RESULTS: Compared with baseline, FIVC was not statistically significantly altered. EITFIVC was 14.4% lower after the 75% O₂ exposure only with a greater symptom reporting with higher FIO₂ in some individuals. A significantly greater shunt (3>6%) followed the 60 and 75% O₂ exposures. O₂ concentration during Gz had no effect on respiratory resistance, reactance, compliance, or hypoxemia. DISCUSSION: There is evidence of mild acceleration atelectasis present when breathing 60% O₂, particularly in susceptible individuals, with 75% O₂ causing more obvious physiological compromise. An inspired oxygen concentration of <60% will prevent the majority of individuals from developing acceleration atelectasis. Pollock RD, Gates SD, Radcliffe JJ, Stevenson AT. Indirect measurements of acceleration atelectasis and the role of inspired oxygen concentrations. Aerosp Med Hum Perform. 2021; 92(10):780785.
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Hochhausen N, Kapell T, Dürbaum M, Follmann A, Rossaint R, Czaplik M. Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study. J Clin Monit Comput 2021; 36:1205-1212. [PMID: 34542735 PMCID: PMC9294009 DOI: 10.1007/s10877-021-00754-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). We examined whether the presence of obesity (ADP group) has an influence on pulmonary recovery compared to normal weight patients (NWP group). During the stay at PACU, measurements were taken every 15 min. GI Index, TIV, and ΔEELI were calculated for each time point. 107 patients were monitored and EIT-data of 16 patients were excluded for various reasons. EIT-data of 91 patients were analyzed off-line. Their length of stay averaged 80 min (25th and 75th quartile 52–112). The ADP group demonstrated a significantly higher GI Index at PACU arrival (p < 0.001). This finding disappeared during their stay at the PACU. Additionally, the ADP group showed a significant increase in ΔEELI between PACU arrival and discharge (p = 0.025). Furthermore, TIV showed a significantly lower value during the first 90 min of PACU stay as compared to the time period thereafter (p = 0.036). Our findings demonstrate that obesity has an influence on intraoperative atelectasis formation and de-recruitment during PACU stay. The application of EIT in spontaneously breathing PACU patients seems meaningful in monitoring pulmonary recovery.
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Affiliation(s)
- Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Torsten Kapell
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Martin Dürbaum
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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de Oliveira Vacchi C, Martha BA, Macagnan FE. Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systematic review and meta-analysis. Support Care Cancer 2021; 30:1079-1092. [PMID: 34417883 DOI: 10.1007/s00520-021-06467-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study is to systematically review the effect of inspiratory muscle training (IMT) associated or not with physical rehabilitation in the preoperative period of anatomical pulmonary resection. METHODS Search in the databases: MEDLINE, Cochrane CENTRAL, EMBASE, LILACS and PEDro up to November 2019. Randomized clinical trials (RCTs) were included in adults in the preoperative period of pulmonary resection. The selection of studies and data extraction was performed by two independent reviewers. The risk of bias assessed with RoB 2.0 and the quality of evidence with GRADE. PROSPERO CRD42018105859. RESULTS Six RCTs were included; patients who underwent IMT in the preoperative period showed a significant improvement in functional capacity assessed by the 6-min walk test (6WT) (MD 28,93 [IC 95% 0,28; 57,58], p = 0,04, I2 = 0%) and significantly reduced the length of hospital stay (MD -3,63 [IC 95% -4,96; -2,29], p = 0,00, I2 = 0%). There was no significant difference between groups regarding pulmonary function, in postoperative complications such as pneumonia (RR 0,56 [IC 95% 0,29; 1,10], p = 0,09, I2 = 0%), atelectasis (RR 0,81 [IC 95% 0,24; 2,69], p = 0,72, I2 = 0%), mechanical ventilation > 48 h (RR 0,43 [IC 95% 0,12; 1,58], p = 0,20, I2 = 0%), in mortality (RR 0,33 [IC 95% 0,04; 3,12], p = 0,33, I2 = 0%), and quality of life. CONCLUSION IMT associated with physical exercise in the preoperative period of pulmonary resection improves functional capacity and reduces the length of hospital stay in the postoperative period.
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Affiliation(s)
- Cindy de Oliveira Vacchi
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil.
| | - Bianca Andrade Martha
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Fabrício Edler Macagnan
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Amaru P, Delannoy B, Genty T, Desebbe O, Laverdure F, Rezaiguia-Delclaux S, Stéphan F. Effect of Recruitment Maneuvers and PEEP on Respiratory Failure After Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial. Respir Care 2021; 66:1306-1314. [PMID: 33975901 PMCID: PMC9994372 DOI: 10.4187/respcare.08607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obesity may increase the risk of respiratory failure after cardiothoracic surgery. A recruitment maneuver followed by PEEP might decrease the risk of respiratory failure in obese subjects. We hypothesized that the routine use after heart surgery of a recruitment maneuver followed by high or low PEEP level would decrease the frequency of respiratory failure in obese subjects. METHODS In a pragmatic, randomized controlled trial, we assigned obese subjects (ie, with body mass index [BMI] ≥ 30 kg/m2) in the immediate postoperative period of cardiothoracic surgery to either volume control ventilation with 5 cm H2O of PEEP (control group) or a recruitment maneuver followed by 5 or 10 cm H2O of PEEP in the intervention arms (RM5 and RM10 groups, respectively). The primary outcome was the proportion of subjects with postextubation respiratory failure, defined as the need for re-intubation, bi-level positive airway pressure, or high-flow nasal cannula within the first 48 h. RESULTS The study included 192 subjects: 65 in the control group (BMI 33.5 ± 3.2 kg/m2), 66 in the RM5 group (BMI 34.5 ± 3.2 kg/m2, and 61 in RM10 group (BMI 33.8 ± 4.8 kg/m2). Postextubation respiratory failure occurred in 14 subjects in the control group (21.5% [95% CI 13.3-35.3]), 21 subjects in the RM5 group (31.8% [95% CI 21.2-44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4-26.7]) (P = .07). The recruitment maneuver was stopped prematurely due to severe hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P = .28). There were no significant differences between the 3 groups for the frequencies of atelectasis, pneumonia, and death in the ICU. CONCLUSIONS The routine use after heart surgery of a recruitment maneuver followed by 5 or 10 cm H2O of PEEP did not decrease the frequency of respiratory failure in obese subjects. A recruitment maneuver followed by 5 cm H2O of PEEP is inappropriate.
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Affiliation(s)
- Priscilla Amaru
- Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - Thibaut Genty
- Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - Florent Laverdure
- Anesthesiology, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - François Stéphan
- Cardiothoracic ICU, Department of Anesthesiology and ICU, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
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Cózar Bernal F, Zúñiga Sánchez LG, Barrero García I. Reexpansion Pulmonary Edema: Myth or Reality? Arch Bronconeumol 2021; 57:492. [PMID: 35698957 DOI: 10.1016/j.arbr.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/12/2019] [Indexed: 06/15/2023]
Affiliation(s)
- Fernando Cózar Bernal
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | | | - Irene Barrero García
- Servicio de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Moreault O, Couture EJ, Provencher S, Somma J, Lohser J, Ugalde PA, Lemieux J, Lellouche F, Bussières JS. Double-lumen endotracheal tubes and bronchial blockers exhibit similar lung collapse physiology during lung isolation. Can J Anaesth 2021; 68:791-800. [PMID: 33594596 DOI: 10.1007/s12630-021-01938-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) are frequently used to allow one-lung ventilation (OLV) during video-assisted thoracic surgery (VATS). Recently, faster lung collapse has been documented with a BB than with a DL-ETT. The physiologic mechanisms behind this faster collapse remained unknown. We aimed to measure ambient air absorption (Vresorb) and intra-bronchial pressure (Pairway) into the non-ventilated lung during OLV using DL-ETT and BB. METHODS Patients undergoing VATS and OLV for lung resection were randomly assigned to have measurements made of Vresorb or Pairway within the non-ventilated lung using either a DL-ETT or BB. RESULTS Thirty-nine patients were included in the analyses. The mean (standard error of the mean [SEM]) Vresorb was similar in the DL-ETT and BB groups [504 (85) vs 630 (86) mL, respectively; mean difference, 126; 95% confidence interval [CI], -128 to 380; P = 0.31]. The mean (SEM) Pairway became progressively negative in the non-ventilated lung in both the DL-ETT and the BB groups reaching [-20 (5) and -31 (10) cmH2O, respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the time of the pleural opening. CONCLUSIONS During OLV before pleural opening, entrainment of ambient air into the non-ventilated lung occurs when the lumen of the lung isolation device is kept open. This phenomenon is prevented by occluding the lumen of the isolation device before pleural opening, resulting in a progressive build-up of negative pressure in the non-ventilated lung. Future clinical studies are needed to confirm these physiologic results and their impact on lung collapse and operative outcomes. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02919267); registered 28 September 2016.
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Affiliation(s)
- Olivier Moreault
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Steeve Provencher
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jacques Somma
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Jens Lohser
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Ugalde
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jérôme Lemieux
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - François Lellouche
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jean S Bussières
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada.
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
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Somma J, Couture ÉJ, Pelletier S, Provencher S, Moreault O, Lohser J, Ugalde PA, Vigneault L, Lemieux J, Somma A, Guay SE, Bussières JS. Non-ventilated lung deflation during one-lung ventilation with a double-lumen endotracheal tube: a randomized-controlled trial of occluding the non-ventilated endobronchial lumen before pleural opening. Can J Anaesth 2021; 68:801-811. [PMID: 33797018 DOI: 10.1007/s12630-021-01957-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Lung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surgery (VATS). METHODS Thirty patients undergoing VATS using DL-ETT to allow OLV were randomized to having the lumen of the operative lung either open (control group) or occluded (intervention group) to ambient air. The primary outcome was the time to lung collapse evaluated intraoperatively by the surgeons. The T50, an index of rate of deflation, was also determined from a probabilistic model derived from intraoperative video clips presented in random order to three observers. RESULTS The median [interquartile range] time to lung deflation occurred faster in the intervention group than in the control group (24 [20-37] min vs 54 [48-68] min, respectively; median difference, 30 min; 95% confidence interval [CI], 14 to 46; P < 0.001). The estimated T50 was 32.6 min in the intervention group compared with 62.3 min in the control group (difference, - 29.7 min; 95% CI, - 51.1 to - 8.4; P = 0.008). CONCLUSION Operative lung deflation during OLV with a DL-ETT is faster when the operative lumen remains closed before pleural opening thus preventing it from entraining ambient air during the closed chest phase of OLV. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03508050); registered 27 September 2017.
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Affiliation(s)
- Jacques Somma
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Étienne J Couture
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Sabrina Pelletier
- Department of Anesthesiology and Critical Care, Laval University, Quebec City, QC, Canada
| | - Steeve Provencher
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, QC, Canada
| | - Olivier Moreault
- Department of Anesthesiology and Critical Care, Laval University, Quebec City, QC, Canada
| | - Jens Lohser
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paula A Ugalde
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, QC, Canada
| | - Louise Vigneault
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Jérome Lemieux
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Antoine Somma
- Faculté des sciences et génie, Departement d'informatique et de génie logiciel, Laval University, Quebec City, QC, Canada
| | | | - Jean S Bussières
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
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Sunther M, Ruiz G, Audi N, Brugha R. Atypical cause of lobar collapse. BMJ Case Rep 2021; 14:e236952. [PMID: 33731398 PMCID: PMC7978063 DOI: 10.1136/bcr-2020-236952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Meera Sunther
- Paediatric Respiratory Medicine, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Gary Ruiz
- Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Nadia Audi
- Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Rossa Brugha
- Paediatric Respiratory Medicine, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Abstract
An 86-year-old woman was admitted for the investigation of atelectasis of the upper lobe of her right lung with a mass shadow in the hilum (Golden S sign). Chest computed tomography revealed swollen connective tissue around the right bronchus, and needle aspirate grew Bifidobacterium longum and Veillonella species. She was diagnosed with peribronchial connective tissue infection, and her condition improved with antibiotics. Although this sign is strongly suggestive of malignant disease, benign disease should be considered in the differential diagnosis. Pulmonary infection caused by Bifidobacterium longum is extremely rare; however, clinicians should consider it as a possible cause of pulmonary infections.
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Affiliation(s)
- Yasuo Takiguchi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, Japan
| | - Masaru Nagayosi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, Japan
| | - Yukiko Matsuura
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, Japan
| | - Yoko Akiba
- Department of Laboratory Medicine, Chiba Aoba Municipal Hospital, Japan
| | - Akira Naito
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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McClelland M, McClelland S. Case of a 21-year-old man with persistent lung collapse leading to a pericardectomy linked to vape use. Heart Lung 2020; 50:262-267. [PMID: 33373941 DOI: 10.1016/j.hrtlng.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
This case report describes multiple organ failure in a young man with illicit vape use which he did not initially disclose to his health care providers. His symptoms were not readily diagnosed until he experienced lung collapse and significant heart failure. Treatment plan recommendations varied among health care providers leading to increased anxiety for the patient and his family. It was ultimately determined that illicit vape use along with chronic substance abuse contributed to a respiratory virus causing pulmonary collapse. The pulmonary virus migrated to the patient's heart causing severe restrictive pericarditis ultimately requiring a pericardectomy. Assessment, interventions, and follow-up care occurred during the global Corona-19 pandemic of 2020.
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Affiliation(s)
- Molly McClelland
- College of Health Professions, #425, 4001W. McNichols Rd., Detroit, MI 48221, United States.
| | - Steven McClelland
- North Woodward Internal Medicine, NWIMA, Ste. 100, Clawson, MI 48017, United States.
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50
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Long TW, Lin JL, Dai JH. [Influencing factors for the clinical effect of bronchoalveolar lavage in children with Mycoplasma pneumoniae pneumonia and atelectasis]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22:984-989. [PMID: 32933631 PMCID: PMC7499439 DOI: 10.7499/j.issn.1008-8830.2003182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the influencing factors for the clinical effect of bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and atelectasis. METHODS A total of 75 children with MPP and atelectasis were divided into a good response group with 51 children and a poor response group with 24 children according to the clinical effect of BAL treatment. LASSO logistic regression analysis was used to investigate the factors influencing the clinical effect of BAL treatment. The receiver operating characteristic (ROC) curve and restricted cubic spline model analysis were used to evaluate the value of the course of the disease at the time of BAL treatment in predicting the clinical effect of BAL treatment. RESULTS Compared with the good response group, the poor response group had a significantly lower percentage of lymphocytes in bronchoalveolar lavage fluid, a significantly higher proportion of children with atelectasis of two or more lung lobes or stenosis of the bronchial cavity or opening caused by inflammation, and a significantly longer course of the disease at the time of BAL treatment and azithromycin treatment (P<0.05). The LASSO logistic regression analysis showed that a prolonged course of the disease at the time of BAL treatment (OR=1.23), atelectasis of two or more lung lobes (OR=11.99), and stenosis of the bronchial cavity or opening caused by inflammation (OR=5.31) were independent risk factors for poor clinical effect of BAL treatment (P<0.05). The ROC curve analysis showed that the course of disease of ≥11.5 days at the time of BAL treatment suggested a poor clinical effect of BAL treatment, with a sensitivity of 91.7% and a specificity of 54.9%. The restricted cubic spline model analysis showed that there was a non-linear dose-response relationship between the course of disease at the time of BAL treatment and the clinical effect of BAL treatment (P<0.05). CONCLUSIONS Early BAL treatment may have a good clinical effect in children with MPP and atelectasis. Atelectasis of two or more lung lobes and inflammation-induced stenosis of the bronchial cavity or opening shown under bronchoscope may indicate a poor clinical effect of BAL treatment.
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Affiliation(s)
- Ting-Wen Long
- Department of Respiratory Diseases, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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