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1.
Trials ; 25(1): 585, 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39232795

RESUMO

BACKGROUND: Postoperative hypoxemia and pulmonary complications remain a frequent event after on-pump cardiac surgery and mostly characterized by pulmonary atelectasis. Surfactant dysfunction or hyposecretion happens prior to atelectasis formation, and sigh represents the strongest stimulus for surfactant secretion. The role of sigh breaths added to conventional lung protective ventilation in reducing postoperative hypoxemia and pulmonary complications among cardiac surgery is unknown. METHODS: The perioperative sigh ventilation in cardiac surgery (E-SIGHT) trial is a single-center, two-arm, randomized controlled trial. In total, 192 patients scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB) and aortic cross-clamp will be randomized into one of the two treatment arms. In the experimental group, besides conventional lung protective ventilation, sigh volumes producing plateau pressures of 35 cmH2O (or 40 cmH2O for patients with body mass index > 35 kg/m2) delivered once every 6 min from intubation to extubation. In the control group, conventional lung protective ventilation without preplanned recruitment maneuvers is used. Lung protective ventilation (LPV) consists of low tidal volumes (6-8 mL/kg of predicted body weight) and positive end-expiratory pressure (PEEP) setting according to low PEEP/FiO2 table for acute respiratory distress syndrome (ARDS). The primary endpoint is time-weighted average SpO2/FiO2 ratio during the initial post-extubation hour. Main secondary endpoint is the severity of postoperative pulmonary complications (PPCs) computed by postoperative day 7. DISCUSSION: The E-SIGHT trial will be the first randomized controlled trial to evaluate the impact of perioperative sigh ventilation on the postoperative outcomes after on-pump cardiac surgery. The trial will introduce and assess a novel perioperative ventilation approach to mitigate the risk of postoperative hypoxemia and PPCs in patients undergoing cardiac surgery. Also provide the basis for a future larger trial aiming at verifying the impact of sigh ventilation on postoperative pulmonary complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT06248320. Registered on January 30, 2024. Last updated February 26, 2024.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Hipóxia , Respiração com Pressão Positiva , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Hipóxia/etiologia , Hipóxia/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Respiração com Pressão Positiva/métodos , Ponte Cardiopulmonar/efeitos adversos , Resultado do Tratamento , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/prevenção & controle , Fatores de Tempo , Assistência Perioperatória/métodos , Pessoa de Meia-Idade , Feminino , Masculino , Adulto , Pulmão/fisiopatologia , Pulmão/cirurgia , Idoso , Respiração Artificial/efeitos adversos , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Pneumopatias/diagnóstico
2.
Braz J Cardiovasc Surg ; 39(5): e20230403, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39241201

RESUMO

INTRODUCTION: With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS: We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS: From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION: Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Pneumopatias , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Pneumopatias/etiologia , Pneumopatias/cirurgia , Toracotomia/efeitos adversos , Toracotomia/métodos , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hérnia/etiologia , Adulto , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Complicações Pós-Operatórias/etiologia
3.
BMC Anesthesiol ; 24(1): 330, 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39289608

RESUMO

BACKGROUND: Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. METHODS: Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8-10% during the one lung ventilation (OLV) stage and 8-12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8-12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). RESULTS: Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C. CONCLUSIONS: In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).


Assuntos
Esofagectomia , Hidratação , Hemodinâmica , Complicações Pós-Operatórias , Humanos , Hidratação/métodos , Esofagectomia/métodos , Esofagectomia/efeitos adversos , Masculino , Feminino , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Idoso , Hemodinâmica/fisiologia , Pneumopatias/prevenção & controle , Pneumopatias/etiologia , Volume Sistólico/fisiologia , Tempo de Internação
5.
Zhonghua Jie He He Hu Xi Za Zhi ; 47(9): 815-826, 2024 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-39266479

RESUMO

Objective: To study the dynamic pathological characteristics of lung tissue in a Nano-ITO induced rat model of indium lung disease and to guide clinical and basic scientific research to further explore the mechanisms of pulmonary interstitial injury and pulmonary alveolar proteinosis (PAP). Methods: Dose-response (three divided doses) and time-course studies (six exposure periods) were performed to investigate the pulmonary toxicity induced by Nano-ITO. At the end of the experiment, cytokine levels and oxidative stress were analyzed in the bronchoalveolar lavage fluid. Rat lung tissues were also collected for staining with H&E, PAS, Masson's, Oil Red O, and Sirius Red. Ultrastructure of lung tissue cells was observed by transmission electron microscopy. Expression of IL-1ß, HO-1, SP-A was observed by immunohistochemistry, and the expression of α-SMA was observed by immunofluorescence. Results: Nano-ITO intratracheal instillation caused pulmonary toxicity by inducing acute inflammation at 3 days, granuloma (nodule) formation and collagen hyperplasia at 14 days, and alveolar proteinosis at 56 days post-exposure. Pathological features of lung tissue included typical alveolar exudates, cellular fibrous nodules, enlarged alveolar fat droplet fusion, cholesterol crystal granuloma and pulmonary alveolar proteinosis. The intra-alveolar eosinophilic material (multilamellated, lattice-shaped, and myelin-like structure) showed abnormal lamellar bodies (features of alveolar type Ⅱ epithelial cells) and abundant rough endoplasmic reticulum and mitochondria (features of fibroblasts) on transmission electron microscopy of the lung tissue from rats exposed to Nano-ITO on the 84th day. Cellular pathology revealed that a large amount of amorphous PAS stain-positive substances appear in BALF at 28 days post-exposure, and pink granular protein-like substances can be seen in alveolar macrophages. Conclusions: There are three characteristic developmental stages in Nano-ITO induced pulmonary injury in rats, acute inflammation, granuloma (nodule) formation and collagen proliferation, and pulmonary alveolar proteinosis, which provide a reference feature model for the pathogenesis of indium lung disease.


Assuntos
Modelos Animais de Doenças , Índio , Pulmão , Animais , Ratos , Índio/efeitos adversos , Índio/toxicidade , Masculino , Pulmão/patologia , Pulmão/metabolismo , Ratos Sprague-Dawley , Proteinose Alveolar Pulmonar/induzido quimicamente , Proteinose Alveolar Pulmonar/patologia , Titânio/efeitos adversos , Titânio/toxicidade , Pneumopatias/induzido quimicamente , Pneumopatias/patologia , Pneumopatias/etiologia , Líquido da Lavagem Broncoalveolar , Estresse Oxidativo
6.
BMC Pulm Med ; 24(1): 420, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39210309

RESUMO

BACKGROUND: Postoperative pulmonary complication (PPC) is a leading cause of mortality and poor outcomes in postoperative patients. No studies have enrolled intensive care unit (ICU) patients after noncardiac thoracic surgery, and effective prediction models for PPC have not been developed. This study aimed to explore the incidence and risk factors and construct prediction models for PPC in these patients. METHODS: This study retrospectively recruited patients admitted to the ICU after noncardiac thoracic surgery at West China Hospital, Sichuan University, from July 2019 to December 2022. The patients were randomly divided into a development cohort and a validation cohort at a 70% versus 30% ratio. The preoperative, intraoperative and postoperative variables during the ICU stay were compared. Univariate and multivariate logistic regression analyses were applied to identify candidate predictors, establish prediction models, and compare the accuracy of the models with that of reported risk models. RESULTS: A total of 475 ICU patients were enrolled after noncardiac thoracic surgery (median age, 58; 72% male). At least one PPC occurred in 171 patients (36.0%), and the most common PPC was pneumonia (153/475, 32.21%). PPC significantly increased the duration of mechanical ventilation (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (LOS) (p < 0.001), and rate of reintubation (p = 0.047) in ICU patients. Seven risk factors were identified, and then the prediction nomograms for PPC were constructed. At ICU admission, the area under the curve (AUC) was 0.766, with a sensitivity of 0.71 and specificity of 0.60; after extubation, the AUC was 0.841, with a sensitivity of 0.75 and specificity of 0.83. The models showed robust discrimination in both the development cohort and the validation cohort, and they were well calibrated and more accurate than reported risk models. CONCLUSIONS: ICU patients who underwent noncardiac thoracic surgery were at high risk of developing PPCs. Prediction nomograms were constructed and they were more accurate than reported risk models, with excellent sensitivity and specificity. Moreover, these findings could help assess individual PPC risk and enhance postoperative management of patients.


Assuntos
Unidades de Terapia Intensiva , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Idoso , China/epidemiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Medição de Risco/métodos , Respiração Artificial/estatística & dados numéricos , Incidência , Pneumopatias/etiologia , Pneumopatias/epidemiologia , Adulto
7.
Medicine (Baltimore) ; 103(34): e39260, 2024 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-39183417

RESUMO

Postoperative pulmonary complications (PPCs) are a significant concern following lung resection due to prolonged hospital stays and increased morbidity and mortality among patients. This study aims to develop and validate a risk prediction model for PPCs after lung resection using the random forest (RF) algorithm to enhance early detection and intervention. Data from 180 patients who underwent lung resections at the Third Affiliated Hospital of the Naval Medical University between September 2022 and February 2024 were retrospectively analyzed. The patients were randomly allocated into a training set and a test set in an 8:2 ratio. An RF model was constructed using Python, with feature importance ranked based on the mean Gini index. The predictive performance of the model was evaluated through analyses of the receiver operating characteristic curve, calibration curve, and decision curve. Among the 180 patients included, 47 (26.1%) developed PPCs. The top 5 predictive factors identified by the RF model were blood loss, maximal length of resection, number of lymph nodes removed, forced expiratory volume in the first second as a percentage of predicted value, and age. The receiver operating characteristic curve and calibration curve analyses demonstrated favorable discrimination and calibration capabilities of the model, while decision curve analysis indicated its clinical applicability. The RF algorithm is effective in predicting PPCs following lung resection and holds promise for clinical application.


Assuntos
Algoritmos , Pneumonectomia , Complicações Pós-Operatórias , Humanos , Feminino , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Pneumonectomia/efeitos adversos , Idoso , Medição de Risco/métodos , Curva ROC , Fatores de Risco , Adulto , Pneumopatias/etiologia , Pneumopatias/epidemiologia , Algoritmo Florestas Aleatórias
8.
Medicina (B Aires) ; 84(4): 635-640, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-39172562

RESUMO

INTRODUCTION: Shrinking lung syndrome (SLS) is a rare and less-known manifestation of systemic lupus erythematosus (SLE). The aim of this study is to describe the demographic, clinical, functional, imaging characteristics, and treatment received in a cohort of patients diagnosed with SLS. METHODS: Clinical records were reviewed retrospectively in a cohort of patient with SLE and SLS followedup prospectively between 2007 to 2023 in the Rheumatology and Neumonology Units. RESULTS: Eleven SLS patients (10.3%) of 107 SLE patients were diagnosed. They were 81.8% female and 18.2% male. Median age was 30 years old (RIQ = 25-75% [25.5-41.5]). Clinical symptoms were dyspnea (72%), pleuritic pain (36%), but 27.3% of patients were asymptomatic at diagnosis. Respiratory functional evaluation was, median FEV1 / FVC : 86% (RIQ = 82-90), median FVC: 61% (RIQ = 38.5-71), median DLCO: 65% (RIQ = 48-69) and median DLCO/VA: 95% (RIQ = 89-106). High-resolution computed tomography of thorax (HRCT) showed atelectasis (54.5%), diafragmatic elevation (27.3%), normal (27.3%) and pleural effusion (9%). Patients were treated with systemic corticosteroids (100%); in 72.7% of them, associated to other immunosupressives: methotrexate (36%), mycophenolate (27.3%), hydroxychloroquine (27.3%) and azatioprine (18.2%). CONCLUSION: SLS prevalence was 10.3%, higher than reported in other studies of SLE. Dyspnea was the most clinical symptom. Suspicion of moderate restriction were determined with mild deterioration of DLCO. Atelectasis was the most frequent HCRT sign. Immunosupressive treatment was prescribed in all patients with systemic corticosteroids associated to other drugs.


Introducción: El síndrome de pulmón encogido (SPE) es una manifestación rara y poco conocida del lupus eritematoso sistémico (LES). El objetivo es describir las características demográficas, manifestaciones clínicas, funcionales, imagenológicas y tratamiento recibido en una cohorte de pacientes diagnosticados con SPE. Métodos: Se examinaron las historias clínicas de una cohorte de pacientes con LES seguidos prospectivamente desde 2007 al 2023 por los Servicios de Reumatología y Neumotisiología. Resultados: De 107 pacientes diagnosticados con LES, se hallaron 11 pacientes con SPE (10.3%), 81.8% fueron mujeres y 18.2 % varones; edad (mediana): 30 años (RIQ 25-75% = 25.5-41.5). Presentaron disnea 72%, dolor pleurítico 36%, y asintomáticos 27.3% al momento del diagnóstico. Funcionalmente presentaron FEV1 / FVC = 86% mediana, (RIQ = 82-90), FVC mediana 61% (RIQ= 38.5-71), DLCO mediana: 65% (RIQ = 48­69) y DLCO/VA mediana: 95% (RIQ = 89-106). Se observó en la tomografía de tórax de alta resolución (TACAR) atelectasias (54.5%), elevación del diafragma (27.3%), normalidad (27.3%) y derrame pleural (9%). Recibieron tratamiento con corticoides sistémicos (100%), asociados a otros inmunosupresores en 72.7%: metotrexato (36%), micofenolato (27.3%), hidroxicloroquina (27.3%) y azatioprina (18.2%). Conclusión: La prevalencia de SPE fue 10.3%, más alta que lo reportado en otras series de casos de LES. La disnea fue el síntoma principal de consulta. Los pacientes presentaron funcionalmente sospecha de restricción moderada y leve caída de la DLCO. La atelectasia fue el signo más frecuente en la TACAR. El tratamiento inmunosupresor fue indicado en todos los pacientes con corticoides sistémicos asociados usualmente a otros inmunosupresores.


Assuntos
Lúpus Eritematoso Sistêmico , Humanos , Feminino , Masculino , Lúpus Eritematoso Sistêmico/complicações , Adulto , Estudos Retrospectivos , Síndrome , Pneumopatias/etiologia , Tomografia Computadorizada por Raios X , Pessoa de Meia-Idade , Testes de Função Respiratória , Dispneia/etiologia , Adulto Jovem
9.
BMC Anesthesiol ; 24(1): 282, 2024 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-39123102

RESUMO

BACKGROUND: This study compares the effect of positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in patients with obesity undergoing laparoscopic bariatric surgery (LBS) under general anesthesia with mechanical ventilation. METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Internet, Wanfang database, and Google Scholar for studies published up to July 29, 2023, without time or language restrictions. The search terms included "PEEP," "laparoscopic," and "bariatric surgery." Randomized controlled trials comparing different levels of PEEP or PEEP with zero-PEEP (ZEEP) in patients with obesity undergoing LBS were included. The primary outcome was a composite of PPCs, and the secondary outcomes were intraoperative oxygenation, respiratory compliance, and mean arterial pressure (MAP). A fixed-effect or random-effect model was selected for meta-analysis based on the heterogeneity of the included studies. RESULTS: Thirteen randomized controlled trials with a total of 708 participants were included for analysis. No statistically significant difference in PPCs was found between the PEEP and ZEEP groups (risk ratio = 0.27, 95% CI: 0.05-1.60; p = 0.15). However, high PEEP ≥ 10 cm H2O significantly decreased PPCs compared with low PEEP < 10 cm H2O (risk ratio = 0.20, 95% CI: 0.05-0.89; p = 0.03). The included studies showed no significant heterogeneity (I2 = 20% & 0%). Compared with ZEEP, PEEP significantly increased intraoperative oxygenation and respiratory compliance (WMD = 74.97 mm Hg, 95% CI: 41.74-108.21; p < 0.001 & WMD = 9.40 ml cm H2O- 1, 95% CI: 0.65-18.16; p = 0.04). High PEEP significantly improved intraoperative oxygenation and respiratory compliance during pneumoperitoneum compared with low PEEP (WMD = 66.81 mm Hg, 95% CI: 25.85-107.78; p = 0.001 & WMD = 8.03 ml cm H2O- 1, 95% CI: 4.70-11.36; p < 0.001). Importantly, PEEP did not impair hemodynamic status in LBS. CONCLUSIONS: In patients with obesity undergoing LBS, high PEEP ≥ 10 cm H2O could decrease PPCs compared with low PEEP < 10 cm H2O, while there was a similar incidence of PPCs between PEEP (8-10 cm H2O) and the ZEEP group. The application of PEEP in ventilation strategies increased intraoperative oxygenation and respiratory compliance without affecting intraoperative MAP. A PEEP of at least 10 cm H2O is recommended to reduce PPCs in patients with obesity undergoing LBS. REGISTRATION NUMBER: CRD42023391178 in PROSPERO.


Assuntos
Cirurgia Bariátrica , Laparoscopia , Respiração com Pressão Positiva , Complicações Pós-Operatórias , Humanos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Obesidade/cirurgia , Respiração com Pressão Positiva/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
10.
BMC Pediatr ; 24(1): 516, 2024 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-39127673

RESUMO

BACKGROUND: Pulmonary complications are common among children with sickle cell disease (SCD). However, there is little literature on associated lung function abnormalities in Uganda. We aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among children with SCD in a tertiary care hospital in Uganda. METHOD: A cross-sectional study was conducted among children aged 6 to 18 years at the SCD clinic (SCC) of Mulago National Super-Specialized Hospital between January 2020 and April 2021. Data on sociodemographic and clinical characteristics was collected using a standardized questionnaire. Laboratory investigations, including a complete blood count and serum lactate dehydrogenase (LDH), were done. Spirometry was performed following the ATS/ERS standards. Multivariable modified Poisson regression analysis was performed to determine factors associated with abnormal lung function. RESULTS: A total of 332 participants were enrolled. The mean age was 11.7 ± 3.4 years, and 184 (55.4%) were female. Overall, 126 (37.9%) participants had abnormal lung function: 67/126 (53.2%) restrictive, 57/126 (45.2%) obstructive, and 2/126 (1.6%) mixed-ventilatory patterns. Factors associated with abnormal lung function were; serum LDH level > 600UL (aIRR: 1.89 95% CI: 1.2 - 7.4, p = 0.049), a history of acute chest syndrome (aIRR: 1.55, 95% CI: 1.06-2.25, p = 0.024), wasting (aIRR: 1.33, 95%CI: 1.02 - 1.72, p = 0.032), and use of charcoal for household cooking (aIRR: 1.49, 95% CI: 1.03-2.15, p = 0.035). CONCLUSION: More than one-third of children with SCD in Uganda have lung function abnormalities. Strategies to improve nutrition, reduce exposure to charcoal smoke, and monitoring serum LDH levels may be important in preventing or managing abnormal lung function in this population. The identification of reversible and irreversible airway obstruction in children with sickle cell disease also highlights the need for targeted interventions to address these specific patterns of abnormal lung function.


Assuntos
Anemia Falciforme , Humanos , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Uganda/epidemiologia , Criança , Feminino , Masculino , Estudos Transversais , Adolescente , Prevalência , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Fatores de Risco , Testes de Função Respiratória , Espirometria
11.
Rheumatol Int ; 44(10): 1975-1986, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39167172

RESUMO

OBJECTIVES: This cross-sectional study aimed to determine the prevalence, manifestation, and risk factors of pulmonary involvement in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to evaluate the efficacy of various diagnostic tools in screening for pulmonary involvement. METHODS: Untreated, newly diagnosed patients with RA and PsA underwent an extensive multimodal diagnostic approach including clinical and laboratory assessment, pulmonary function tests, and chest radiography. RESULTS: We recruited 50 arthritis patients (26 RA, 24 PsA) and 26 control subjects. Respiratory symptoms were found in 36.0 % of arthritis patients and 11.5 % of controls (p = 0.031). Pathologically reduced breathing width (< 3.0 cm) was significantly more common in arthritis patients (64.0 %) than in controls (23.1 %) (p < 0.001). Pulmonary function test results did not differ significantly between groups. Chest radiography revealed pulmonary involvement in 37.0 % of arthritis patients, higher in RA (50.0 %) than in PsA (22.7 %). Notably, only 35.3 % of arthritis patients with radiographic pulmonary involvement were symptomatic, with 64.7 % being asymptomatic. Radiographic pulmonary involvement was associated with advanced age (p = 0.002) and increased rheumatoid factor levels (p = 0.024). CONCLUSION: Our research underscores the significant prevalence of largely asymptomatic pulmonary involvement in newly diagnosed RA and PsA patients. These findings highlight the importance of an early, multidisciplinary screening approach, particularly for high-risk individuals. Further large-scale studies are needed to develop comprehensive screening protocols to improve early detection and treatment of pulmonary involvement in arthritis.


Assuntos
Artrite Psoriásica , Artrite Reumatoide , Testes de Função Respiratória , Humanos , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/diagnóstico por imagem , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/diagnóstico , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Transversais , Adulto , Prevalência , Fatores de Risco , Idoso , Pneumopatias/diagnóstico por imagem , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Estudos de Casos e Controles
12.
Lupus ; 33(11): 1242-1247, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39134064

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multi organ involvement. One of the most common manifestations is pulmonary disease with a reported prevalence between 5%-90%. PURPOSE: Given this wide range of prevalence, there is a need to more closely define types of pulmonary disease in SLE and associated risk factors. RESEARCH DESIGN: We sought to characterize the presentation of pulmonary manifestations in an established SLE cohort using electronic health record data. STUDY SAMPLE: All patients were >18 years of age and had confirmed SLE by a rheumatologist using SLICC or 2019 ACR/EULAR classification criteria. 220 patients with imaging were included in this study; average age was 42.5 years, 86.7% identified as female, 60.5% identified as white, 37.3% as Black, and 1.82% as Asian. ANALYSIS: Generalized estimating equations were utilized to analyze the data, accounting for its repeated measured nature. RESULTS: We found an association between smoking (present/prior smoker) and radiologist reported disease on computerized tomography (CT) scan, as well as an association between smoking (present/prior smoker), older age, and male sex with having pulmonary disease identified on chest X-ray. The most common findings on CT and X-ray were increased lung density (24%, 12%) and atelectasis (18%, 10%). The most common disease found on CT was pleural effusion (24%) and mediastinal/axillary lymphadenopathy (16%). CONCLUSION: While our study is limited by the retrospective nature, our results show that certain factors, namely smoking, older age, or male sex should prompt clinicians to have a higher suspicion for lung disease in SLE patients.


Assuntos
Pneumopatias , Lúpus Eritematoso Sistêmico , Tomografia Computadorizada por Raios X , Humanos , Lúpus Eritematoso Sistêmico/complicações , Feminino , Masculino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Pneumopatias/etiologia , Pneumopatias/epidemiologia , Pneumopatias/diagnóstico por imagem , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Prevalência , Pulmão/diagnóstico por imagem , Pulmão/patologia
13.
Turk J Pediatr ; 66(3): 323-331, 2024 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-39024603

RESUMO

BACKGROUND: Pulmonary Langerhans cell histiocytosis (pLCH) is a rare disease, mostly a component of multisystemic LCH. We aimed to investigate the clinical features and treatment results in children with pLCH. METHODS: We retrospectively reviewed the clinical, radiological, and treatment data of 37 patients with pLCH, diagnosed from 1974 to 2022. RESULTS: 10% (n=37) of 367 patients with LCH had lung involvement. The median age was 1.8 years (range: 0.4 & 17.7) with a male-to-female ratio of 2.3. At admission 29.7% (n=11) presented with respiratory symptoms. Imaging showed a spectrum from nodular opacities to multiple cysts. All but one patient had multisystem disease. Twenty-nine received vinblastine-containing therapy. Ten-year event-free (EFS) and overall survival (OS) rates were 47.8% and 63.3%, respectively. In children younger and older than two years of age, the 10-year EFS was 53.3% vs. 40.2% and the 10-year OS was 58.7% vs. 68.8%, respectively. In children with and without risk organ involvement, 10-year EFS was 51.9% vs. 46.3% and 10-year OS was 51.9% vs. 73.7%. CONCLUSIONS: Lung and multisystem involvement are significant concerns in LCH, highlighting the need for careful management to reduce morbidity and mortality.


Assuntos
Histiocitose de Células de Langerhans , Pneumopatias , Humanos , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/tratamento farmacológico , Histiocitose de Células de Langerhans/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Pré-Escolar , Lactente , Criança , Adolescente , Pneumopatias/etiologia , Pneumopatias/tratamento farmacológico , Pneumopatias/diagnóstico , Taxa de Sobrevida/tendências
14.
BMJ Paediatr Open ; 8(1)2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39019541

RESUMO

INTRODUCTION: Lung-protective ventilation strategies (LPVS) for one-lung ventilation (OLV) in paediatric patients pose greater challenges than in adults. Optimising LPVS for paediatric OLV to mitigate postoperative pulmonary complications (PPCs) has emerged as a current research focal point. However, there remains a divergence of opinions concerning the individualised setting and application of positive end-expiratory pressure (PEEP). Lung dynamic compliance (Cdyn) can serve as a reflection of the lung's physiological state in children during OLV and is a readily obtainable parameter. This study protocol is formulated to assess the effectiveness of Cdyn-guided PEEP titration on PPCs during paediatric OLV. METHODS AND ANALYSIS: This study constitutes a single-centre, prospective, double-blind, randomised controlled trial. The trial aims to recruit 60 paediatric patients scheduled for video-assisted thoracoscopic surgery. These eligible patients will be randomly assigned to either the Cdyn-guided PEEP group or the conventional PEEP group during general anaesthesia for OLV. The primary outcome will involve assessing the incidence of PPCs at 7 days after surgery. Secondary outcomes will encompass the evaluation of the modified lung ultrasound score following surgery, as well as monitoring the oxygenation index, driving pressure and Cdyn during mechanical ventilation. Data collection will be performed by investigators who are kept blinded to the interventions. ETHICS AND DISSEMINATION: The Clinical Trial Ethics Committee at Shenzhen Children's Hospital has conferred ethical approvals for this trial (approval number: 2022076). Results from this trial will be disseminated in peer-reviewed journals and presented at professional symposiums. TRAIL REGISTRATION NUMBER: NCT05386901.


Assuntos
Respiração com Pressão Positiva , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida , Humanos , Respiração com Pressão Positiva/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Método Duplo-Cego , Estudos Prospectivos , Criança , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complacência Pulmonar , Ventilação Monopulmonar/métodos , Ventilação Monopulmonar/efeitos adversos , Feminino , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Pré-Escolar , Pneumopatias/prevenção & controle , Pneumopatias/etiologia
15.
Clin Chest Med ; 45(3): 749-760, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39069335

RESUMO

Sickle cell lung disease presents a challenging care paradigm involving acute and chronic lower airway disease, sleep-disordered breathing, pulmonary vascular disease, and modification by environmental factors. Understanding the presentation, pathophysiology, and diagnostic approaches is essential for accurate identification and management. While significant progress has been made, there remains a need for research to develop effective treatments and interventions to decrease disease burden in these children. Additionally, the long-term impact of interventions on cardiopulmonary outcomes is unknown. Collaborative efforts among health care providers, researchers, advocacy groups, and policy makers are crucial to improving the lives of children with SCD.


Assuntos
Anemia Falciforme , Pneumopatias , Humanos , Anemia Falciforme/terapia , Anemia Falciforme/fisiopatologia , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico , Anemia Falciforme/epidemiologia , Criança , Pneumopatias/diagnóstico , Pneumopatias/terapia , Pneumopatias/fisiopatologia , Pneumopatias/etiologia
16.
Front Immunol ; 15: 1394690, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38994372

RESUMO

Connective tissue represents the support matrix and the connection between tissues and organs. In its composition, collagen, the major structural protein, is the main component of the skin, bones, tendons and ligaments. Especially at the pediatric age, its damage in the context of pathologies such as systemic lupus erythematosus, scleroderma or dermatomyositis can have a significant negative impact on the development and optimal functioning of the body. The consequences can extend to various structures (e.g., joints, skin, eyes, lungs, heart, kidneys). Of these, we retain and reveal later in our manuscript, mainly the respiratory involvement. Manifested in various forms that can damage the chest wall, pleura, interstitium or vascularization, lung damage in pediatric systemic inflammatory diseases is underdeveloped in the literature compared to that described in adults. Under the threat of severe evolution, sometimes rapidly progressive and leading to death, it is necessary to increase the popularization of information aimed at physiopathological triggering and maintenance mechanisms, diagnostic means, and therapeutic directions among medical specialists. In addition, we emphasize the need for interdisciplinary collaboration, especially between pediatricians, rheumatologists, infectious disease specialists, pulmonologists, and immunologists. Through our narrative review we aimed to bring up to date, in a concise and easy to assimilate, general principles regarding the pulmonary impact of collagenoses using the most recent articles published in international libraries, duplicated by previous articles, of reference for the targeted pathologies.


Assuntos
Doenças do Colágeno , Humanos , Criança , Doenças do Colágeno/complicações , Pulmão/patologia , Pulmão/imunologia , Pneumopatias/etiologia , Morbidade
17.
Exp Clin Transplant ; 22(5): 373-380, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38970280

RESUMO

OBJECTIVES: We aimed to reveal the incidence of lateonset noninfectious pulmonary complications and bronchiolitis obliterans syndrome and risk factors involved in development. MATERIALS AND METHODS: In this cross-sectional study, we retrospectively investigated 745 patients who underwent allogeneic hematopoietic stem cell transplantation in our hospital between January 2000 and December 2020. We evaluated demographic characteristics, comorbidities, and hematopoietic stem cell transplantation characteristics to determine possible risk factors affecting development of lateonset noninfectious pulmonary complications and bronchiolitis obliterans syndrome. RESULTS: Of 745 patients, 8.9% (n = 66) had late-onset noninfectious pulmonary complications. Complications included 38 patients with bronchiolitis obliterans syndrome, 13 with venous thromboembolism, 8 with cryptogenic organizing pneumonia, 5 with pneumothorax, 4 with interstitial lung disease-restrictive graft-versus-host disease, 5 with bronchiectasis, 2 with pneumomediastinum, and 1 with pleural effusion. Patients with and without complications were not significantly differentin terms of smoking history, hematopoietic stem cell transplantation characteristics, and conditioning regimens. Patients with complications had higher busulfan and lower antithymocyte globulin use than those without complications (both P<.05). Patients with complications more commonly had hematopoietic stem cell transplantation from related donors and chronic graft-versus-host disease (P < .05). Patients with bronchiolitis obliterans syndrome had more frequent use of busulfan (P <.05) but less frequent use of total body irradiation (P <.05) and antithymocyte globulin (P <.05) than those without this syndrome. Rate of hematopoietic stem cell transplantation from a related donor (P < .05) and frequency of chronic graftversus-host disease (P < .001) were significantly higher in patients with bronchiolitis obliterans syndrome, presented with bronchiectasis (78.6%), air trapping (67.9%), bronchial wallthickening (53.6%), and mosaic attenuation (39.3%) in thorax computed tomography. Pretransplant spirometry did not predict bronchiolitis obliterans syndrome development. CONCLUSIONS: Determining risk factors for late-onset noninfectious pulmonary complications is needed to aid in prevention and follow-up.


Assuntos
Bronquiolite Obliterante , Transplante de Células-Tronco Hematopoéticas , Humanos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Estudos Retrospectivos , Masculino , Feminino , Fatores de Risco , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Fatores de Tempo , Incidência , Bronquiolite Obliterante/etiologia , Bronquiolite Obliterante/epidemiologia , Bronquiolite Obliterante/diagnóstico , Resultado do Tratamento , Adulto Jovem , Pneumopatias/etiologia , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Medição de Risco , Adolescente , Turquia/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/epidemiologia
18.
J Cardiothorac Surg ; 19(1): 425, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38978064

RESUMO

BACKGROUND: Postoperative pulmonary complications (PPCs) after one-lung ventilation (OLV) significantly impact patient prognosis and quality of life. OBJECTIVE: To study the impact of an optimal inspiratory flow rate on PPCs in thoracic surgery patients. METHODS: One hundred eight elective thoracic surgery patients were randomly assigned to 2 groups in this consort study (control group: n = 53 with a fixed inspiratory expiratory ratio of 1:2; and experimental group [flow rate optimization group]: n = 55). Measurements of Ppeak, Pplat, PETCO2, lung dynamic compliance (Cdyn), respiratory rate, and oxygen concentration were obtained at the following specific time points: immediately after intubation (T0); immediately after starting OLV (T1); 30 min after OLV (T2); and 10 min after 2-lung ventilation (T4). The PaO2:FiO2 ratio was measured using blood gas analysis 30 min after initiating one-lung breathing (T2) and immediately when OLV ended (T3). The lung ultrasound score (LUS) was assessed following anesthesia and resuscitation (T5). The occurrence of atelectasis was documented immediately after the surgery. PPCs occurrences were noted 3 days after surgery. RESULTS: The treatment group had a significantly lower total prevalence of PPCs compared to the control group (3.64% vs. 16.98%; P = 0.022). There were no notable variations in peak airway pressure, airway plateau pressure, dynamic lung compliance, PETCO2, respiratory rate, and oxygen concentration between the two groups during intubation (T0). Dynamic lung compliance and the oxygenation index were significantly increased at T1, T2, and T4 (P < 0.05), whereas the CRP level and number of inflammatory cells decreased dramatically (P < 0.05). CONCLUSION: Optimizing inspiratory flow rate and utilizing pressure control ventilation -volume guaranteed (PCV-VG) mode can decrease PPCs and enhance lung dynamic compliance in OLV patients.


Assuntos
Ventilação Monopulmonar , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Ventilação Monopulmonar/métodos , Idoso , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Pneumopatias/prevenção & controle , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Estudos Prospectivos
19.
J Atheroscler Thromb ; 31(9): 1249-1259, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39010219

RESUMO

Dyslipidemia is one of the most common diseases worldwide. As a component of metabolic syndrome, the prevalence and mechanism by which dyslipidemia promotes cardiovascular diseases has been well studied, although the relationship between pulmonary diseases is not well understood. Because the lung is a respiratory organ with a large surface area and is exposed to the environment outside the body, it continuously inhales various substances. As a result, pulmonary diseases have a vast diversity, including chronic inflammatory diseases, allergic diseases, cancers, and infectious diseases. Recently, growing evidence has suggested that dyslipidemia plays a role in the pathogenesis and prognosis of various pulmonary diseases. We herein review the current understanding of the relationship between dyslipidemia and pulmonary diseases, including chronic obstructive pulmonary diseases, asthma, and lung cancer, and infectious pulmonary diseases, including community-acquired pneumonia, tuberculosis, nontuberculous mycobacterial pulmonary disease, and COVID-19. In addition, we focus on recent evidence of the utility of statins, specifically 3-hydroxy-3-methylglutaryl-coA reductase inhibitors, in the prevention and treatment of the various pulmonary diseases described above.


Assuntos
COVID-19 , Dislipidemias , Inibidores de Hidroximetilglutaril-CoA Redutases , Pneumopatias , Humanos , Dislipidemias/complicações , Pneumopatias/etiologia , Pneumopatias/epidemiologia , COVID-19/complicações , COVID-19/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , SARS-CoV-2 , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia
20.
Respir Investig ; 62(5): 850-855, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39067258

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH)-specific therapies are generally ineffective in patients with pulmonary hypertension associated with lung disease (PH-LD). The aim of this preliminary study was to evaluate the potential efficacy of selexipag, titrated according to individual tolerance, in patients with PH-LD. METHODS: Consecutive patients diagnosed with PH-LD between October 2016 and March 2019, who received selexipag treatment, were retrospectively evaluated. Specific parameters, including changes in hemodynamic parameters, 6-min walk distance (6MWD), and partial pressure of atrial oxygen/fraction of inspiratory oxygen (PaO2/FiO2) were evaluated. Patients whose 6MWD improved ≥20 m were defined as responders. RESULTS: Eight patients with PH-LD were included, comprising four with chronic obstructive pulmonary disease (COPD), two with interstitial lung disease (ILD) related to rheumatoid arthritis, one with ILD related to systemic sclerosis, and one with pulmonary Langerhans cell histiocytosis. No statistically significant improvements in hemodynamic parameters and 6MWD were noted following selexipag treatment. However, four patients showed improvements in 6MWD ≥20 m at follow-up and were considered responders. They had a higher body mass index (BMI) and lower PaO2/FiO2 at baseline than non-responders (p = 0.02 and p = 0.04, respectively). No Grade 3 or 4 adverse events were observed. CONCLUSIONS: Selexipag was effective in half of the PH-LD cases, emphasizing higher BMI and lower PaO2/FiO2 as possible indicators for favorable response. Since selexipag starting at a low dose with subsequent titration may reduce the risk of early adverse events, it can be considered a treatment option for PH-LD. Further large-scale studies are warranted to confirm these findings.


Assuntos
Acetamidas , Hipertensão Pulmonar , Pirazinas , Humanos , Masculino , Feminino , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Idoso , Pirazinas/administração & dosagem , Pirazinas/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Acetamidas/administração & dosagem , Resultado do Tratamento , Pneumopatias/etiologia , Pneumopatias/tratamento farmacológico , Teste de Caminhada , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/complicações
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