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3.
Turk J Pediatr ; 64(2): 400-407, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35611432

RESUMO

BACKGROUND: High Altitude Pulmonary Edema (HAPE) is a fatal form of severe high-altitude illness. It is a form of noncardiogenic, noninfectious pulmonary edema secondary to alveolar hypoxia. The exact incidence of HAPE in children is unknown; however, most literature reports an incidence between 0.5-15%. There are three proposed HAPE types including classic HAPE, reentry HAPE, and high-altitude resident pulmonary edema (HARPE). CASE: We present three pediatric patients who were diagnosed with re-entry high altitude pulmonary edema and did not have any underlying cardiac abnormalities. All patients reside in areas of high altitude with a history of travelling to places of lower altitude. They had respiratory infections prior to the manifestation of HAPE. CONCLUSIONS: These are the first reported cases of children with reentry HAPE in Saudi Arabia. Reentry HAPE can occur in otherwise healthy children. Rapid ascent to high altitude and recent respiratory infections are the most commonly reported triggers. Prognosis is very favorable with a very rapid response to oxygen therapy. Education about HAPE is mandatory for families and health care workers working in high altitude areas.


Assuntos
Doença da Altitude , Edema Pulmonar , Infecções Respiratórias , Altitude , Doença da Altitude/complicações , Doença da Altitude/diagnóstico , Criança , Humanos , Hipertensão Pulmonar , Hipóxia/complicações , Edema Pulmonar/etiologia , Infecções Respiratórias/complicações
5.
Can Respir J ; 2022: 9309611, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35607595

RESUMO

Background: There is no accurate radiological measurement to estimate the severity of pediatrics acute respiratory distress syndrome (PARDS). We validated the effectiveness of an adult radiographic assessment of lung edema (RALE) score in PARDS. Aim: To assess the severity and prognosis of PARDS based on a chest radiograph (CXR) RALE scoring method. Methods: Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria were used to diagnose PARDS. General demographics, pulmonary complications, and 28-day mortality of the patients were recorded. Subgroups were compared by prognosis (survive and death) and etiology (infection and noninfection). Two observers calculated RALE independently. Each quadrant of CXR was scored by consolidation scores 0 (none alveolar opacity), 1 (extent <25%), 2 (extent 25%-50%), 3 (50%-75%), and 4 (>75%) and density scores 1 (hazy), 2 (moderate), and 3 (dense). Quadrant score equals consolidation score times density score. Total score equals to the sum of four quadrants scores. The ROC curve and survival curve were established, and the optimal cutoff score for discrimination prognosis was set. Results: 116 PARDS (72 boys and 44 girls) and 463 CXRs were enrolled. The median age was 25 months (5 months, 60.8 months) and with a mortality of 37.9% (44/116). The agreement between two independent observers was excellent (ICC = 0.98, 95% CI: 0.97-0.99). Day 3 score was independently associated with better survival (p < 0.001). The area under the curve of ROC was 0.773 (95% CI: 0.709-0.838). The cutoff score was 21 (sensitivity 71.7%, specificity 76.5%), and the hazard ratio (HR) was 9.268 (95% CI: 1.257-68.320). The pulmonary complication showed an HR of 3.678 (95% CI: 1.174-11.521) for the discrimination. Conclusion: CXR RALE score can be used in PARDS for discriminating the prognosis and has a better agreement among radiologist and pediatrician. PARDS with pulmonary complications, day 3 score whether greater than 21 points, have a better predictive effectiveness.


Assuntos
Pediatria , Edema Pulmonar , Síndrome do Desconforto Respiratório , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prognóstico , Edema Pulmonar/etiologia , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Sons Respiratórios
8.
High Alt Med Biol ; 23(2): 119-124, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35384735

RESUMO

Kelly, Timothy D., Maxene Meier, Jason P. Weinman, Dunbar Ivy, John T. Brinton, and Deborah R. Liptzin. High-altitude pulmonary edema in Colorado children: a cross-sectional survey and retrospective review. High Alt Med Biol. 23:119-124, 2022. Introduction: Few studies of high-altitude pulmonary edema (HAPE) are specific to the pediatric population. The purpose of this investigation was to further characterize the radiographic patterns of pediatric HAPE, and to better understand ongoing risk following an initial pediatric HAPE episode. Methods: This study uses both a retrospective chart review and cross-sectional survey. Pediatric patients with HAPE at a single quaternary referral center in the Rocky Mountain Region were identified between the years 2013 and 2020. Patients were eligible if they presented with a clinical diagnosis of HAPE and had a viewable chest radiograph (CXR). Surveys were sent to eligible patients/families to gather additional information relating to family history, puberty, and HAPE recurrence. Results: Forty-two individuals met criteria for clinical diagnosis of HAPE with a viewable CXR. A majority of CXRs (24/42, 57.1%) demonstrated predominant right-sided involvement. Similarly, 24 CXRs (24/42, 57.1%) demonstrated predominant upper lobe involvement. Twenty-one (21/42, 50%) surveys were completed. A minority of individuals went on to experience at least one other HAPE episode (8/19, 42.1%). Conclusion: The most common radiographic pattern seen in pediatric HAPE is pulmonary edema that favors the right lung and upper lobes. After an initial HAPE presentation, some children will experience additional HAPE episodes.


Assuntos
Doença da Altitude , Edema Pulmonar , Altitude , Doença da Altitude/diagnóstico , Doença da Altitude/epidemiologia , Criança , Colorado/epidemiologia , Estudos Transversais , Humanos , Hipertensão Pulmonar , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Estudos Retrospectivos
9.
Trials ; 23(1): 252, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379296

RESUMO

BACKGROUND: In May 2018, the first patient was enrolled in the phase-IIb clinical trial "Safety and Preliminary Efficacy of Sequential Multiple Ascending Doses of Solnatide to Treat Pulmonary Permeability Edema in Patients with Moderate to Severe ARDS." With the onset of the COVID-19 pandemic in early 2020, the continuation and successful execution of this clinical study was in danger. Therefore, before the Data Safety Monitoring Board (DSMB) allowed proceeding with the study and enrollment of further COVID-19 ARDS patients into it, additional assessment on possible study bias was considered mandatory. METHODS: We conducted an ad hoc interim analysis of 16 patients (5 COVID-19- ARDS patients and 11 with ARDS from different causes) from the phase-IIB clinical trial. We assessed possible differences in clinical characteristics of the ARDS patients and the impact of the pandemic on study execution. RESULTS: COVID-19 patients seemed to be less sick at baseline, which also showed in higher survival rates over the 28-day observation period. Trial specific outcomes regarding pulmonary edema and ventilation parameters did not differ between the groups, nor did more general indicators of (pulmonary) sepsis like oxygenation ratio and required noradrenaline doses. CONCLUSION: The DSMB and the investigators did not find any evidence that patients suffering from ARDS due to SARS-CoV-2 may be at higher (or generally altered) risk when included in the trial, nor were there indications that those patients might influence the integrity of the study data altogether. For this reason, a continuation of the phase IIB clinical study activities can be justified. Researchers continuing clinical trials during the pandemic should always be aware that the exceptional circumstances may alter study results and therefore adaptations of the study design might be necessary.


Assuntos
COVID-19 , Edema Pulmonar , Síndrome do Desconforto Respiratório , COVID-19/complicações , Método Duplo-Cego , Edema , Estudos de Viabilidade , Humanos , Pandemias , Peptídeos Cíclicos , Permeabilidade , Edema Pulmonar/diagnóstico , Edema Pulmonar/tratamento farmacológico , Edema Pulmonar/etiologia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/tratamento farmacológico , SARS-CoV-2
10.
J Int Med Res ; 50(4): 3000605221093678, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35466750

RESUMO

Acute myocarditis is often secondary to an acute virus infection, which can be the first manifestation of upper respiratory tract symptoms, followed by chest tightness, shortness of breath, palpitations, chest pain and other non-specific symptoms. In severe cases, it can quickly progress to serious complications such as heart failure, shock and respiratory failure. Laboratory examinations can show an increase of myocardial injury markers, infection and inflammatory indicators. Cardiac ultrasound can detect the weakening of the myocardial contraction and valve regurgitation. On imaging, bilateral pulmonary oedema demonstrates symmetrical infiltration along the hilum of lung, called the "butterfly shadow". This current case report describes a patient with unilateral pulmonary oedema caused by myocarditis that was initially misdiagnosed and treated as pneumonia. The patient was subsequently treated with the application of extracorporeal membrane oxygenation and he made a full recovery. A review of this case highlights that when a patient's symptoms are not typical, a comprehensive examination and evaluation are required to avoid incorrect treatment.


Assuntos
Oxigenação por Membrana Extracorpórea , Miocardite , Edema Pulmonar , Choque , Dor no Peito , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Masculino , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia
12.
Arch Med Res ; 53(4): 399-406, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35370011

RESUMO

BACKGROUND: The Radiographic Assessment of Lung Edema (RALE) score has been used to estimate the extent of pulmonary damage in patients with acute respiratory distress syndrome and might be useful in patients with COVID-19. AIM OF THE STUDY: To examine factors associated with the need for mechanical ventilation in hospitalized patients with a clinical diagnosis of COVID-19, and to estimate the predictive value of the RALE score. METHODS: In a series of patients admitted between April 14 and August 28, 2020, with a clinical diagnosis of COVID-19, we assessed lung involvement on the chest radiograph using the RALE score. We examined factors associated with the need for mechanical ventilation in bivariate and multivariate analysis. The area under the receiver operating curve (AUC) indicated the predictive value of the RALE score for need for mechanical ventilation. RESULTS: Among 189 patients, 90 (48%) were judged to need mechanical ventilation, although only 60 were placed on a ventilator. The factors associated with the need for mechanical ventilation were a RALE score >6 points, age >50 years, and presence of chronic kidney disease. The AUC for the RALE score was 60.9% (95% CI 52.9-68.9), indicating it was an acceptable predictor of needing mechanical ventilation. CONCLUSIONS: A score for extent of pulmonary oedema on the plain chest radiograph was a useful predictor of the need for mechanical ventilation of hospitalized patients with COVID-19.


Assuntos
COVID-19 , Edema Pulmonar , COVID-19/complicações , COVID-19/terapia , Hospitais Gerais , Humanos , Pessoa de Meia-Idade , Prognóstico , Edema Pulmonar/etiologia , Respiração Artificial , Sons Respiratórios
13.
Clin Med (Lond) ; 22(2): 160-162, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35304375

RESUMO

A 44-year-old woman presented to the emergency department with sudden chest tightness and breathlessness, and a chest X-ray revealed unilateral pulmonary oedema (UPO). Colour Doppler echocardiography showed that the leaflet prolapsed with severe regurgitation, and the regurgitant jet tended to blow rightward within the left atrium. With the assistance of mechanical ventilation and venoarterial extracorporeal membrane oxygenation, the patient underwent mitral valve replacement. UPO is easily misdiagnosed, which leads to delays in treatment. Therefore, accurate diagnosis and immediate treatment are crucial.


Assuntos
Insuficiência da Valva Mitral , Edema Pulmonar , Doença Aguda , Adulto , Feminino , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/terapia
14.
BMJ Case Rep ; 15(2)2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35228236

RESUMO

Any insult to the central nervous system can lead to the rare occurrence of neurogenic pulmonary oedema (NPO). It is usually associated with significant neurological injury (eg, subarachnoid haemorrhage or traumatic brain injury) with a relatively rapid onset. As an exception to this observation, we report a middle-aged woman who developed NPO 72 hours after the onset of a subtle but evolving right middle cerebral artery infarction confirmed on CT. Aggressive use of diuretics and vasodilators, as is normally the case for cardiogenic pulmonary oedema, can compromise cerebral blood flow and the ischaemic penumbra. This case illustrates how the diagnostic and therapeutic challenges were successfully addressed with the aid of bedside ultrasonography and close haemodynamic monitoring to reverse the respiratory failure while protecting the brain.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Edema Pulmonar , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Feminino , Humanos , Infarto da Artéria Cerebral Média , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Acidente Vascular Cerebral/complicações
15.
J Hypertens ; 40(5): 1042-1049, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35249965

RESUMO

Flash pulmonary oedema is a life-threatening complication of renal artery stenosis. We report a very rare complication in a patient with bilateral atherosclerotic renal artery stenosis who underwent unilateral renal artery angioplasty because of recurrent flash pulmonary oedema. Shortly after the procedure, she developed extreme polyuria (over 201 in the first 48 h) with massive natriuresis (>1000 mmol urinary sodium excretion in the first 24 h). Most likely, the occurrence of this phenomenon is related to the fact that her contralateral kidney was atrophic and no longer functioning due to total renal artery occlusion. We provide an overview of the literature and discuss several mechanisms that may contribute to the occurrence of this exaggerated natriuretic response in patients with one-kidney renovascular hypertension who undergo renovascular revascularization. We recommend close monitoring of natriuresis in such patients and - if needed - administration of intravenous isotonic saline (0.9% NaCl) to prevent hypovolemia.


Assuntos
Angioplastia com Balão , Hipertensão Renovascular , Edema Pulmonar , Obstrução da Artéria Renal , Angioplastia/efeitos adversos , Angioplastia com Balão/efeitos adversos , Feminino , Humanos , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/terapia , Rim , Masculino , Natriurese , Edema Pulmonar/etiologia , Artéria Renal , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/cirurgia
17.
Anaesthesiol Intensive Ther ; 54(1): 91-93, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35266374

RESUMO

The impact of diuretics on the foetus is controversial, and thus they are not preferred during pregnancy [1]. Excessive fluid retention during late pregnancy can lead to acute pulmonary oedema (APO), which increases the foeto-maternal morbidity and mortality [2, 3]. Reported incidence is about 0.08%, which can become 1.5% in pre-eclampsia [2-4]. Although most commonly reported during late pregnancy and early puerperium, the occurrence of APO during labour is very rare [2, 3].


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Gravidez , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia
18.
Hawaii J Health Soc Welf ; 81(3): 71-76, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35261987

RESUMO

Causes of the extraordinarily high and increasing incidence of snorkeler drownings in Hawai'i have remained unexplained for years. Defining the mechanisms and factors predisposing to drowning while snorkeling is needed to provide recommendations to substantially mitigate the incidence of this form of preventable death. The mechanisms of drowning are described and insight into the predisposing factors are explored in this study. Methods included measuring snorkel airway resistance characteristics, case reports from the State of Hawai'i Medical Examiner's office, and collating information by survey, principally from rescued survivors. This study identified 2 modes of drowning while snorkeling that need further investigation: accidental or inadvertent aspiration, and hypoxia resulting from acute negative pressure pulmonary edema. The incidence of drowning from mechanisms of hypoxia due to rapid onset pulmonary edema is an important focus of the study and a number of potentially significant predisposing factors are presented that need further investigation but provide bases that may become part of updated policies and practices for snorkelers to substantially lower the risk of death. This report is meant for both medical and public health information purposes.


Assuntos
Afogamento , Edema Pulmonar , Afogamento/epidemiologia , Hawaii/epidemiologia , Humanos , Hipóxia , Incidência , Edema Pulmonar/epidemiologia , Edema Pulmonar/etiologia
19.
Am J Emerg Med ; 55: 11-15, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35245775

RESUMO

BACKGROUND: Dyspnea is a common Emergency Department (ED) complaint of which acute pulmonary edema (APE) is a potentially life-threatening etiology. Remote Dielectric Sensing (ReDS™) is a novel, non-invasive, radar based, rapid, point of care vest testing system used to objectively quantify lung fluid content and may be useful in the early diagnosis of APE. OBJECTIVE: To determine the accuracy of ReDS to detect pathologic lung fluid in ED undifferentiated dyspneic patients. METHODS: We performed a prospective convenience sample observation pilot study enrolling adult ED patients with a chief complaint of "shortness of breath." After informed consent, patients were fitted with the ReDS vest and a reading, blinded to the care team, was recorded. A gold standard diagnosis of pulmonary edema, determined by 2 physicians performing a chart review and blinded to ReDs data, was compared to the ReDS reading. RESULTS: Overall, 123 patients were included; 59% (n = 73) were male, mean (SD) age 57.2 (±12) years, 46.3% (n = 57) Hispanic, 34.1%(n = 42) African American, 13.0% (n = 16) Caucasian and 5.7% (n = 7) Asian. The gold standard diagnosis showed pulmonary edema in 38 (30.9%) patients, of which 30 were detected by ReDS. At an optimal cutoff (≥ 37%), ReDS had a Sn of 79.5% (CI 63.5% - 90.5%), Sp of 72.6% (CI 61.8% - 81.8%), a PPV of 57.4% and a NPV of 88.4%. CONCLUSIONS: ReDS is moderately sensitive and specific with an accuracy of 74.8% for pulmonary edema.


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Adulto , Dispneia/complicações , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia
20.
JAAPA ; 35(4): 29-33, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35276715

RESUMO

ABSTRACT: Acute respiratory distress syndrome (ARDS) is a severe, often fatal, lung condition frequently seen in patients in the ICU. ARDS is triggered by an inciting event such as pneumonia or sepsis, which is followed by an inappropriate host inflammatory response that results in pulmonary edema and impaired gas exchange, and may progress to fibrosis. With the increased spotlight and discussion focused on ARDS during the COVID-19 pandemic, healthcare providers must be able to identify and manage symptoms based on evidence-based research.


Assuntos
COVID-19 , Pneumonia , Edema Pulmonar , Síndrome do Desconforto Respiratório , Humanos , Pandemias , Pneumonia/diagnóstico , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia
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