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1.
Am J Forensic Med Pathol ; 41(4): e61-e63, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32969849

RESUMO

The autopsy findings for 3 cases of SARS-(CoV-2) pneumonia-related deaths are reported with pulmonary histology and immunohistochemistry findings. In 2 cases (cases 1 and 2), the time interval from presentation to death was approximately 1 week, whereas for case 3, the time interval from presentation to death was hours. Case 1 and case 2 presented with shortness of breath, cough, and flu-like symptoms. The decedent from case 3 died shortly after presenting to a local emergency room with high fever, chest and abdominal pain, and shortness of breath. All 3 cases had 1 or more comorbidities. The postmortem interval for cases 1 and 2 was 2 weeks as they died at sea and were stored on board within the respective cruise ships' refrigeration units, whereas case 3 was examined within 24 hours of death. The autopsies were conducted at the Miami-Dade County Medical Examiners Department under routine infectious precautions. Salient clinical history and autopsy findings are summarized. Microscopic examination revealed pneumonia with associated atypical endovascular cells.


Assuntos
Betacoronavirus , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Adulto , Autopsia , Cardiomegalia/complicações , Cardiomegalia/patologia , Círculo Arterial do Cérebro/patologia , Comorbidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/patologia , Infecções por Coronavirus/complicações , Complicações do Diabetes/patologia , Evolução Fatal , Feminino , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Obesidade/complicações , Obesidade/patologia , Pandemias , Pneumonia Viral/complicações , Edema Pulmonar/complicações , Edema Pulmonar/patologia , Uso de Tabaco/patologia
3.
Eur Heart J ; 40(45): 3721-3730, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609443

RESUMO

AIMS: Increases in extravascular lung water (EVLW) during exercise contribute to symptoms, morbidity, and mortality in patients with heart failure and preserved ejection fraction (HFpEF), but the mechanisms leading to pulmonary congestion during exercise are not well-understood. METHODS AND RESULTS: Compensated, ambulatory patients with HFpEF (n = 61) underwent invasive haemodynamic exercise testing using high-fidelity micromanometers with simultaneous lung ultrasound, echocardiography, and expired gas analysis at rest and during submaximal exercise. The presence or absence of EVLW was determined by lung ultrasound to evaluate for sonographic B-line artefacts. An increase in EVLW during exercise was observed in 33 patients (HFpEFLW+, 54%), while 28 (46%) did not develop EVLW (HFpEFLW-). Resting left ventricular function was similar in the groups, but right ventricular (RV) dysfunction was two-fold more common in HFpEFLW+ (64 vs. 31%), with lower RV systolic velocity and RV fractional area change. As compared to HFpEFLW-, the HFpEFLW+ group displayed higher pulmonary capillary wedge pressure (PCWP), higher pulmonary artery (PA) pressures, worse RV-PA coupling, and higher right atrial (RA) pressures during exercise, with increased haemoconcentration indicating greater loss of water from the vascular space. The development of lung congestion during exercise was significantly associated with elevations in PCWP and RA pressure as well as impairments in RV-PA coupling (area under the curve values 0.76-0.84). CONCLUSION: Over half of stable outpatients with HFpEF develop increases in interstitial lung water, even during submaximal exercise. The acute development of lung congestion is correlated with increases in pulmonary capillary hydrostatic pressure that favours fluid filtration, and systemic venous hypertension due to altered RV-PA coupling, which may interfere with fluid clearance. CLINICAL TRIAL REGISTRATION: NCT02885636.


Assuntos
Teste de Esforço/efeitos adversos , Exercício Físico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Pulmão/patologia , Edema Pulmonar/complicações , Idoso , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia/métodos , Feminino , Átrios do Coração/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Circulação Pulmonar , Edema Pulmonar/fisiopatologia , Pressão Propulsora Pulmonar/fisiologia , Volume Sistólico/fisiologia , Ultrassonografia/métodos , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Esquerda/fisiologia
4.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 318-326, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184121

RESUMO

Objetivos. Investigar si la radiografía de tórax en pacientes con insuficiencia cardiaca aguda (ICA) puede contribuir a establecer el pronóstico. Método. Se incluyeron pacientes consecutivos diagnosticados de ICA en urgencias. Se valoró: cardiomegalia radiológica (CR), derrame pleural (DP) y el patrón parenquimatoso pulmonar (PPP: redistribución vascular, edema intersticial, edema alveolar). Se recogieron variables del estado basal del paciente y del episodio. Las variables de resultado evaluadas fueron mortalidad intrahospitalaria y al año, ingreso prolongado (> 7 días) y evento combinado (reconsulta, rehospitalización o muerte) a 30 días postalta, para las cuales se calcularon las hazard ratio crudas y ajustadas para las tres variables radiológicas y su combinación entre ellas. Resultados. Se incluyeron 2.703 pacientes con una edad media de 81 (DE 19) años; el 54,5% eran mujeres. Se observó CR en 1.711 casos (76,8%), DP en 992 (36,7%) y todos los pacientes mostraron PPP (redistribución vascular el 61,9%, edema intersticial el 23,3% y edema alveolar el 14,9%). El análisis ajustado mostró que la CR no tuvo valor pronóstico; el DP incrementó un 23% (IC 95% 2-49%) los eventos combinados a los 30 días postalta; y el PPP edema alveolar aumentó un 89% (30-177%) la mortalidad intrahospitalaria y un 38% (14-67%) la mortalidad al año respecto al PPP redistribución vascular (referencia). El estudio de la combinación de estos tres hallazgos radiológicos mostró resultados similares y congruentes con los hallazgos del estudio individualizado. Conclusiones. La radiografía de tórax, además de ayudar a establecer el diagnóstico de ICA, puede contribuir a estimar el pronóstico de eventos adversos. Así, el DP se asocia a un incremento de eventos adversos postalta y el PPP edema alveolar a una mayor mortalidad


Objective. To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). Methods. Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient’s baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. Results. A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. Conclusions. A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Radiografia Torácica/métodos , Serviços Médicos de Emergência , Cardiomegalia/diagnóstico por imagem , Edema Pulmonar/complicações , Edema Pulmonar/diagnóstico por imagem , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem
6.
Curr Heart Fail Rep ; 16(4): 81-88, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31183779

RESUMO

PURPOSE OF REVIEW: To analyze whether the use of morphine, as initial treatment in acute cardiogenic pulmonary edema (ACPE), has an impact in clinical outcomes and mortality. A systematic review of the literature was performed, including all the studies comparing clinical outcomes in patients with ACPE who were treated or not with morphine. RECENT FINDINGS: Seven studies were selected, none of which were a randomized trial focused on answering the aim of this systematic review. The studies consisted of clinical trial secondary analysis assessing non-invasive ventilation in ACPE, one open non-randomized trial, two propensity score evaluations from large registries, and three clinical case reviews. Most of the studies showed unfavorable results with the use of morphine in terms of adverse events and mortality, and many of them were statistically significant. Finally, the ongoing MIdazolam versus MOrphine in acute cardiogenic pulmonary edema (MIMO) trial was specifically designed to compare the results of morphine use versus midazolam. The potential hemodynamic and sedative benefit of the use of morphine for vasodilatation and dyspnea amelioration may be opposed by an increase in mortality, ICU admission, and adverse events. Until there is a randomized clinical trial, the use of morphine for ACPE should be limited.


Assuntos
Derivados da Morfina/uso terapêutico , Edema Pulmonar/tratamento farmacológico , Doença Aguda , Insuficiência Cardíaca/mortalidade , Humanos , Derivados da Morfina/efeitos adversos , Edema Pulmonar/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Acta méd. costarric ; 61(2): 55-61, abr.-jun. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1001116

RESUMO

Resumen Objetivo: La ventilación mecánica no invasiva se considera la primera elección de ventilación en pacientes con insuficiencia respiratoria secundaria a enfermedad pulmonar obstructiva crónica reagudizada, edema agudo de pulmón y en inmunocomprometidos. Un aspecto clave de la ventilación mecánica no invasiva es la posibilidad de evitar la entubación endotraqueal y la ventilación mecánica invasiva con sus potenciales complicaciones, y por ende, lograr menor morbimortalidad y estancia hospitalaria. El objetivo principal fue establecer si los pacientes con patología respiratoria sometidos a ventilación mecánica no invasiva presentaron un beneficio estadísticamente significativo en la mortalidad. Como objetivos específicos se determinaron las patologías respiratorias más frecuentes, el tipo de insuficiencia respiratoria asociado a la terapia, la interface más utilizada, las complicaciones más frecuentes, y las patologías respiratorias sometidas a terapia que obtuvieron mayor beneficio en la morbimortalidad. Métodos: Se realizó un estudio prospectivo, observacional y de reporte de casos, de una población adulta de 18 - 85 años hospitalizada en el período comprendido entre el 1 de agosto y el 31 de noviembre de 2014. Se estudió 40 pacientes con patología respiratoria que cumplieron criterios para recibir tratamiento con ventilación mecánica no invasiva. Resultados: El servicio más frecuente donde se utilizó ventilación mecánica no invasiva fue la Unidad de Cuidados Intensivos. Se brindó terapia a más pacientes masculinos con edad promedio de 55 años. El tiempo promedio de terapia fue de 8,4 horas. Los diagnósticos más frecuentes fueron: neumonía, edema agudo de pulmón y edema pulmonar lesional. Para dichos diagnósticos la insuficiencia respiratoria hipoxémica fue la principal indicación. La "full fase" fue la interface más usada. Las complicaciones de úlceras por presión y neumonía fueron infrecuentes. No se encontró cambios gasométricos, de índice respiratorio, ni de gradiente alveolo - arterial durante la terapia. Los puntajes de APACHE-II y SOFA fueron bajos para la mayoría de los pacientes, y el 57,5 % de los pacientes terminó por deshabituarse, con una mortalidad observada del 12 %. Conclusión: Las indicaciones más frecuentes para ventilación mecánica no invasiva en este estudio fueron edema agudo de pulmón y neumonía en el paciente inmunocomprometido. Algunos pacientes con índices respiratorios menores de 150, no se planteó la entubación, pero esto no se reflejó en una mayor tasa de fracaso en la deshabituación, o mayor mortalidad. Debido a la diversidad en la aplicación de la terapia, se debe tratar de protocolizar su uso en el Hospital México, para buscar obtener mejores resultados.


Abstract Aim: The non invasive mechanical ventilation is considered the first choice of ventilation in patients with respiratory insufficiency secondary to exacerbated chronic pulmonary obstructive disease, acute pulmonary edema and immunocompromised patients. The clue of the non invasive mechanical ventilation is the possibility to avoid intubation and invasive mechanical ventilation with its complications, less morbidity and mortality, and less hospital stay. Besides, it is more comfortable, the patient can communicate, eat and drink, cough, avoid the need of profound sedation, and maintain the defense mechanisms of superior airway. The main objective was to establish if the patients who received non invasive ventilation had a benefit in mortality statistically significant. It was also evaluated which were the most frequent pulmonary diseases, the type of respiratory insufficiency associated with the therapy, the type of interface used, the most frequent complications, and which of the pulmonary diseases benefited most in morbidity and mortality with the use of this type of ventilation. Methods: We did a prospective, observational and case report study. Of a total population of 18 - 85 years hospitalized in a period between 1 of August and 31 of November of 2014, we studied a total of 40 patients who developed a respiratory disease who met the criteria to receive treatment with non invasive ventilation. Results: The department who used more non invasive ventilation was the Intensive Care Unit. There were more male patients, with an average age of 55 years. The average time of therapy was 8,4 hours. The most frequent diagnostics where pneumoniae, acute pulmonary edema, and acute respiratory distress syndrome. For these diseases the hipoxemic respiratory insufficiency was the principal indication. The fullface was the main interface used. The complications of pressure ulcers and pneumoniae where infrequent during therapy. There were none shocked patients under therapy and tachycardia was the main risk factor of dying without being statistically significant. We didn't find gasometric changes neither changes in the respiratory index or alveolar-arterial gradient during therapy. The majority of patients with pneumonia and acute pulmonary edema started the therapy with a respiratory index less than 150, but this didn`t relate with more time in therapy neither more mortality. The scores of APACHE-II and SOFA where low at the beginning of the therapy, the observed mortality was of 12%. Conclusion: The most frequent indications for non invasive ventilation obsesrved were acute pulmonary edema and pneumoniae in inmunocompromised patients. The elaboration of protocols to guide the correct use of this ventilations method is needed.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia/complicações , Edema Pulmonar/complicações , Respiração Artificial/estatística & dados numéricos , Costa Rica
8.
Semin Respir Crit Care Med ; 40(1): 31-39, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31060086

RESUMO

Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure caused by noncardiogenic pulmonary edema. Despite five decades of basic and clinical research, there is still no effective pharmacotherapy for this condition and the treatment remains primarily supportive. It is critical to study the molecular and physiologic mechanisms that cause ARDS to improve our understanding of this syndrome and reduce mortality. The goal of this review is to describe our current understanding of the pathogenesis and pathophysiology of ARDS. First, we will describe how pulmonary edema fluid accumulates in ARDS due to lung inflammation and increased alveolar endothelial and epithelial permeabilities. Next, we will review how pulmonary edema fluid is normally cleared in the uninjured lung, and describe how these pathways are disrupted in ARDS. Finally, we will explain how clinical trials and preclinical studies of novel therapeutic agents have further refined our understanding of this condition, highlighting, in particular, the study of mesenchymal stromal cells in the treatment of ARDS.


Assuntos
Edema Pulmonar/complicações , /fisiopatologia , Humanos , Células-Tronco Mesenquimais/citologia , Edema Pulmonar/fisiopatologia , /terapia
9.
BMC Anesthesiol ; 19(1): 63, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043172

RESUMO

BACKGROUND: The negative pressure pulmonary edema is rare clinical situation which caused mainly by upper airway obstruction. However except upper airway obstruction, there may be other pathophysiological disorders making patients more vulnerable to pulmonary edema. Based on these disorders, upper airway obstruction is the trigger to induce negative pressure pulmonary edema. CASE PRESENTATION: This case was a 5-year-old girl with tumor on saddle area, her hormones level were abnormal preoperatively, such as cortisol, adrenocorticotrophic hormone, free T4 and total T4. During the stage of induction, negative pressure pulmonary edema took place due to mild upper airway obstruction. And the instant chest Computer tomography proved diagnosis clue. After intensive care, most lung field of this girl recovered to normal within 48 h. CONCLUSION: The patient with abnormal hormone levels is vulnerable to pulmonary edema, mild upper airway obstruction triggered negative pressure pulmonary. Thus pre-operation hormones supplement is as important as keeping upper airway unobstructed.


Assuntos
Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/cirurgia , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Feminino , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico por imagem , Hipotireoidismo/cirurgia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/diagnóstico por imagem , Obesidade Pediátrica/cirurgia , Edema Pulmonar/complicações , Edema Pulmonar/etiologia
10.
High Alt Med Biol ; 20(2): 150-156, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31045443

RESUMO

Background: Acute mountain sickness (AMS) is a common disease that may have a pulmonary component, as suggested by interstitial pulmonary edema quantified by the B-line score (BLS) on ultrasound (US). This subclinical pulmonary edema has been shown to increase with ascent to high altitude and AMS severity, but has not been prospectively associated with AMS incidence in a large prospective study. Materials and Methods: This prospective observational study was part of a randomized controlled trial enrolling healthy adults over four weekends ascending White Mountain, California. Subjects were assessed by lung US and the Lake Louise Questionnaire at 4110 ft (1240 m), upon ascent to 12,500 ft (3810 m), and the next morning at 12,500 ft (3810 m). Results: Three hundred five USs in total were completed on 103 participants, with 73% total incidence of AMS. The mean (±standard deviation) BLS increased from baseline (1.15 ± 1.80) to high altitude (2.56 ± 2.86), a difference of 1.37 (±2.48) (p = 0.04). Overall BLS was found, on average, to be higher among those diagnosed with AMS than without (2.97 vs. 2.0, p = 0.04, 95% confidence interval [CI] -∞ to -0.04). The change in BLS (ΔBLS) from low altitude baseline was significantly associated with AMS (0.88 vs. 1.72, r2 = 0.023, 95% CI -∞ to -0.01, p = 0.048). Conclusions: Interstitial subclinical pulmonary edema by lung US was found to have a small but significant association with AMS.


Assuntos
Doença da Altitude/complicações , Edema Pulmonar/complicações , Edema Pulmonar/diagnóstico por imagem , Adulto , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Estudos Prospectivos , Amostragem , Ultrassonografia
11.
Chest ; 155(4): e113-e116, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30955582

RESUMO

CASE PRESENTATION: A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.


Assuntos
Dor no Peito/etiologia , Tosse/etiologia , Hemoptise/etnologia , Hipóxia/etiologia , Alvéolos Pulmonares/irrigação sanguínea , Edema Pulmonar/complicações , Convulsões/complicações , Biópsia , Dor no Peito/diagnóstico , Tosse/diagnóstico , Diagnóstico Diferencial , Feminino , Hemoptise/diagnóstico , Humanos , Hipóxia/diagnóstico , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 98(8): e14626, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813195

RESUMO

RATIONALE: Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH. PATIENT CONCERNS: A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia. DIAGNOSIS: Chest x-ray and computed tomography showed DAH. INTERVENTIONS: Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid. OUTCOMES: The patient was discharged uneventfully. LESSONS: Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.


Assuntos
Hemorragia/induzido quimicamente , Pneumopatias/induzido quimicamente , Edema Pulmonar/induzido quimicamente , Remifentanil/efeitos adversos , Sugammadex/efeitos adversos , Adulto , Analgésicos Opioides/efeitos adversos , Anestesia Geral/efeitos adversos , Hemoptise/etiologia , Humanos , Pulmão/patologia , Masculino , Edema Pulmonar/complicações , Tomografia Computadorizada por Raios X
16.
J Cell Physiol ; 234(8): 13942-13950, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30624762

RESUMO

BACKGROUND AIMS: Sepsis and related disorders, especially acute lung injury (ALI), are the most challenging life-threatening diseases in the hospital intensive care unit. Complex pathophysiology, unbalanced immune condition, and high rate of mortality complicate the treatment of sepsis. Recently, cell therapy has been introduced as a promising option to recover the sepsis symptoms. The aim of this study was to investigate the therapeutic potential of human unrestricted somatic stem cells (USSCs) isolated from human umbilical cord blood in the mouse model of ALI. USSCs significantly enhanced the survival rate of mice suffering from ALI and suppressed concentrations of proinflammatory mediators TNF-α, and interleukin (IL)-6, and the level of anti-inflammatory cytokine IL-10. ALI mice injected by USSCs showed notable reduction in lung and liver injury, pulmonary edema, and hepatic enzymes, compared with the control group. These results determined the in vivo immunomodulatory effect of USSCs for recovery of immune balance and reduction of tissue injury in the mouse model of ALI. Therefore, USSCs can be a suitable therapeutic approach to manage sepsis disease through the anti-inflammatory potential.


Assuntos
Lesão Pulmonar Aguda/complicações , Lesão Pulmonar Aguda/terapia , Células-Tronco Adultas/transplante , Sepse/complicações , Sepse/terapia , Transplante de Células-Tronco , Animais , Modelos Animais de Doenças , Humanos , Imunofenotipagem , Inflamação/patologia , Fígado/enzimologia , Fígado/patologia , Pulmão/patologia , Masculino , Camundongos Endogâmicos C57BL , Edema Pulmonar/complicações , Edema Pulmonar/terapia
17.
J Stroke Cerebrovasc Dis ; 28(1): 229-231, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30337209

RESUMO

Medullary hemorrhage is quite rare among brain stem hemorrhage cases, thus the clinical course remains unclear. In the medulla oblongata, respiratory centers are located and previous reports indicate that medullary lesions have possible relationship with acute respiratory distress syndrome. This kind of respiratory failure is commonly caused by neurogenic pulmonary edema (NPE), which is defined as noncardiac noninfectious acute respiratory distress syndrome with changes in intracranial condition including cerebrovascular events. However, to date, very few reports have described cases with medullary hemorrhage accompanied by NPE. We experienced 2 patients with medullary hemorrhages. A 65-year-old man presented with sudden onset of headache, whose head computed tomography showed right medullary hemorrhage. Another 76-year-old woman was transferred because of sudden limb weakness and diagnosed with left medullary hemorrhage. Digital subtraction angiography showed the presence of arteriovenous fistula in the medulla oblongata and drainer veins in the second case. Both cases were complicated by acute pulmonary edema in the early phase, suggesting the possible association of the medullary hemorrhage with NPE.


Assuntos
Hemorragia Cerebral/complicações , Bulbo , Edema Pulmonar/complicações , /complicações , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Bulbo/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , /diagnóstico por imagem
18.
Am J Transplant ; 19(5): 1464-1477, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30582269

RESUMO

Primary graft dysfunction (PGD) is a major limitation in short- and long-term lung transplant survival. Recent work has shown that mitochondrial damage-associated molecular patterns (mtDAMPs) can promote solid organ injury, but whether they contribute to PGD severity remains unclear. We quantitated circulating plasma mitochondrial DNA (mtDNA) in 62 patients, before lung transplantation and shortly after arrival to the intensive care unit. Although all recipients released mtDNA, high levels were associated with severe PGD development. In a mouse orthotopic lung transplant model of PGD, we detected airway cell-free damaged mitochondria and mtDNA in the peripheral circulation. Pharmacologic inhibition or genetic deletion of formylated peptide receptor 1 (FPR1), a chemotaxis sensor for N-formylated peptides released by damaged mitochondria, inhibited graft injury. An analysis of intragraft neutrophil-trafficking patterns reveals that FPR1 enhances neutrophil transepithelial migration and retention within airways but does not control extravasation. Using donor lungs that express a mitochondria-targeted reporter protein, we also show that FPR1-mediated neutrophil trafficking is coupled with the engulfment of damaged mitochondria, which in turn triggers reactive oxygen species (ROS)-induced pulmonary edema. Therefore, our data demonstrate an association between mtDAMP release and PGD development and suggest that neutrophil trafficking and effector responses to damaged mitochondria are drivers of graft damage.


Assuntos
Alarminas/metabolismo , Pneumopatias/imunologia , Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Mitocôndrias/metabolismo , Disfunção Primária do Enxerto , Idoso , Animais , Separação Celular , DNA Mitocondrial/sangue , Feminino , Citometria de Fluxo , Sobrevivência de Enxerto , Humanos , Pulmão/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Edema Pulmonar/complicações , Edema Pulmonar/imunologia , Espécies Reativas de Oxigênio/metabolismo , Receptores de Formil Peptídeo/metabolismo , Traumatismo por Reperfusão , Estudos Retrospectivos , Doadores de Tecidos
19.
Am J Emerg Med ; 37(4): 651-656, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30068489

RESUMO

AIMS: Evaluation of the efficacy of prehospital non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema (CPE). MATERIAL AND METHODS: Consecutive patients who were prehospitally treated by Emergency Physicians using NIV were prospectively included. A step-by-step approach escalating NIV-application from continuous positive airway pressure (CPAP) to continuous positive airway pressure supplemented by pressure support (CPAP-ASB) and finally bilevel inspiratory positive airway pressure (BIPAP) was used. Patients were divided into two groups according to the prehospital NIV-treatment-time (NIV-group 1: ≤15 min, NIV-group 2: >15 min). In addition, a historic control group undergoing standard care was created. Endpoints were heart rate, peripheral oxygen saturation, breathing rate, systolic blood pressure, and a dyspnea score. RESULTS: A total of 99 patients were analyzed (NIV-group 1: n = 41, NIV-group 2: n = 58). The control group consisted of 30 patients. The majority of NIV-patients (90%) received CPAP-ASB, while CPAP without ASB was conducted in 8% and BIPAP-ventilation in 2% of all cases. Technical application of NIV lasted 6.1 ±â€¯3.8 min. NIV-treatment-time was as follows: NIV-group 1: 13.1 ±â€¯3.2 min, NIV-group 2: 22.8 ±â€¯5.9 min. Differences between baseline- and hospital admission values of all endpoints showed significantly better improvement in NIV-groups compared to the control group (p < 0.001). The stabilizing effect of NIV in terms of vital parameters was comparable between both NIV-groups, independent of the duration of treatment (n.s.). CONCLUSION: Prehospital NIV-treatment should be performed in patients with COPD-exacerbation and CPE, even if the distance between emergency scene and hospital is short.


Assuntos
Serviços Médicos de Emergência/métodos , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/complicações , Edema Pulmonar/complicações , Insuficiência Respiratória/terapia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Alemanha , Hemodinâmica , Hospitais , Humanos , Masculino , Estudos Prospectivos , Insuficiência Respiratória/etiologia
20.
J Clin Monit Comput ; 33(3): 413-418, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29936563

RESUMO

Acute pulmonary oedema is a serious complication of preeclampsia. Early detection of pulmonary edema in preeclampsia would improve fluid management and would also allow earlier detection of severe cases. The aim of this work is to evaluate the ability of thoracic fluid content measured by electrical cardiometry for early detection of pulmonary edema in parturients with preeclampsia. A prospective observational study included a cohort of preeclamptic parturients. On admission, lung ultrasound score was calculated, and thoracic fluid content was recorded using electrical cardiometry ICON device. Area under receiver operating characteristic (AUROC) curve was calculated for lung ultrasound score, thoracic fluid content for detection of pulmonary edema. Spearman correlation coefficient was calculated for correlation between lung ultrasound score and thoracic fluid content. Sixty patients were included in the study; of them, 6 patients (10%) required diuretics for pulmonary edema. Patients with pulmonary edema had higher lung ultrasound score and thoracic fluid content compared to other patients. Good correlation was reported between Lung ultrasound score and thoracic fluid content (r = 0.82). Thoracic fluid content and lung ultrasound score showed excellent diagnostic properties for pulmonary edema {AUROC: 0.941 (0.849-0.986), best cut-off value: 40 k ohm-1}, and {AUROC: 0.961 (0.887-0.994), best cut-off value of 15.7}. In parturients with preeclampsia, both lung ultrasound score and thoracic fluid content showed excellent properties for detection pulmonary edema. The high negative predictive value of both tests makes them useful screening tests to rule out pulmonary edema. The excellent correlation between both measures suggests that electrical cardiometry could be a promising surrogate to ultrasound for assessment of extravascular lung water.


Assuntos
Pré-Eclâmpsia/fisiopatologia , Edema Pulmonar/complicações , Edema Pulmonar/diagnóstico por imagem , Ultrassonografia , Adulto , Área Sob a Curva , Água Extravascular Pulmonar , Feminino , Hemodinâmica , Humanos , Unidades de Terapia Intensiva , Pulmão/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Curva ROC , Resultado do Tratamento , Adulto Jovem
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