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1.
Medicine (Baltimore) ; 100(3): e24356, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546070

RESUMO

ABSTRACT: To investigate the characteristics of pulmonary artery distensibility (PAD) in patients with acute pulmonary embolism (APE) and to assess the correlation of PAD with APE severity and right ventricular function. A total of 33 patients who underwent retrospective electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) with a definite diagnosis of APE were included in the study. According to APE severity, the patients were divided into severe (SPE) and non-severe (NSPE) groups. Data from a control group without APE matching the basic demographics of the APE patients were collected. Pulmonary artery distensibility (PAD) and right ventricular function parameters were compared among the 3 groups, their relationships were investigated, and receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the above parameters for the diagnosis of APE severity. The PAD values of the control, NSPE, and SPE groups were (7.877 ±â€Š2.637) × 10-3 mm/Hg, (6.050 ±â€Š2.011) × 10-3 mm/Hg, (4.321 ±â€Š1.717) × 10-3 mm/Hg, respectively (P < .01). There were statistically significant differences in right ventricular function parameters among the 3 groups (P < .05). The correlation analysis between PAD and right ventricular function parameters showed a weak negative correlation (r = -0.281--0.392). The area under the ROC curve of PAD was 0.743, the critical value was 4.200, and the sensitivity and specificity were 62.5% and 94.1%, respectively. The PAD obtained by retrospective ECG-gated CTPA could accurately evaluate APE severity and right ventricular function. As the severity of APE increases, PAD decreases, which is helpful to identify patients at high risk of APE.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Artéria Pulmonar/anormalidades , Embolia Pulmonar/fisiopatologia , Função Ventricular Direita/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/patologia , Curva ROC , Estudos Retrospectivos
4.
Swiss Med Wkly ; 151: w20420, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33516166

RESUMO

The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.


Assuntos
Lesão Renal Aguda/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Falência Hepática/fisiopatologia , Linfo-Histiocitose Hemofagocítica/fisiopatologia , Embolia Pulmonar/fisiopatologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Alanina Transaminase/sangue , /complicações , Creatinina/sangue , Progressão da Doença , Evolução Fatal , Insuficiência Cardíaca/etiologia , Humanos , Falência Hepática/sangue , Falência Hepática/etiologia , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Embolia Pulmonar/etiologia , /fisiopatologia , /terapia
5.
Respir Res ; 22(1): 27, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478514

RESUMO

BACKGROUND: Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity. METHODS: Α prospective case-control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal-Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test). RESULTS: Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 µm and 15.8 ± 1.9 µm vs. 11.5 ± 2.3 µm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001). CONCLUSION: The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.


Assuntos
Capilares/diagnóstico por imagem , Capilares/fisiologia , Hipertensão Pulmonar Primária Familiar/diagnóstico por imagem , Microcirculação/fisiologia , Angioscopia Microscópica/métodos , Embolia Pulmonar/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/fisiopatologia
8.
Emerg Med Clin North Am ; 38(4): 931-944, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981627

RESUMO

Emergency physicians must be prepared to rapidly diagnose and resuscitate patients with pulmonary embolism (PE). Certain aspects of PE resuscitation run counter to typical approaches. A specific understanding of the pathophysiology of PE is required to avoid cardiovascular collapse potentially associated with excessive intravenous fluids and positive pressure ventilation. Once PE is diagnosed, rapid risk stratification should be performed and treatment guided by patient risk class. Although anticoagulation remains the mainstay of PE treatment, emergency physicians also must understand the indications and contraindications for thrombolysis and should be aware of new therapies and models of care that may improve outcomes.


Assuntos
Embolia Pulmonar/terapia , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Estado Terminal , Ecocardiografia , Eletrocardiografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Hidratação , Humanos , Intubação Intratraqueal , Ácido Láctico/sangue , Trombólise Mecânica , Peptídeo Natriurético Encefálico/sangue , Óxido Nítrico/uso terapêutico , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Respiração com Pressão Positiva , Embolia Pulmonar/classificação , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Ressuscitação/métodos , Medição de Risco , Índice de Gravidade de Doença , Terapia Trombolítica , Troponina/sangue , Vasoconstritores/uso terapêutico
9.
Arterioscler Thromb Vasc Biol ; 40(11): 2586-2597, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32960072

RESUMO

The severe acute respiratory syndrome coronavirus-2 emerged as a serious human pathogen in late 2019, causing the disease coronavirus disease 2019 (COVID-19). The most common clinical presentation of severe COVID-19 is acute respiratory failure consistent with the acute respiratory distress syndrome. Airway, lung parenchymal, pulmonary vascular, and respiratory neuromuscular disorders all feature in COVID-19. This article reviews what is known about the effects of severe acute respiratory syndrome coronavirus-2 infection on different parts of the respiratory system, clues to understanding the underlying biology of respiratory disease, and highlights current and future translation and clinical research questions.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Pulmão/virologia , Pneumonia Viral/virologia , Respiração , Insuficiência Respiratória/virologia , Pesquisa Médica Translacional , Animais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Interações Hospedeiro-Patógeno , Humanos , Pulmão/fisiopatologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Embolia Pulmonar/virologia , Respiração Artificial , /fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Fatores de Risco , Tromboembolia Venosa/fisiopatologia , Tromboembolia Venosa/terapia , Tromboembolia Venosa/virologia
10.
Arch. bronconeumol. (Ed. impr.) ; 56(9): 578-585, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-198502

RESUMO

BACKGROUND AND OBJECTIVE: Ventilatory inefficiency (high V′E/V′CO2) and resting hypocapnia are common in pulmonary vascular disease and are associated with poor prognosis. Low resting PaCO2 suggests increased chemosensitivity or an altered PaCO2 set-point. We aimed to determine the relationships between exercise gas exchange variables reflecting the PaCO2 set-point, exercise capacity, hemodynamics and V′E/V′CO2. METHODS: Pulmonary arterial hypertension (n=34), chronic thromboembolic pulmonary hypertension (CTEPH, n = 19) and pulmonary veno-occlusive disease (PVOD, n = 6) patients underwent rest and peak exercise arterial blood gas measurements during cardiopulmonary exercise testing. Patients were grouped according to resting PaCO2: hypocapnic (PaCO2 ≤ 34 mmHg) or normocapnic (PaCO2 35-45 mmHg). The PaCO2 set-point was estimated by the maximal value of end-tidal PCO2 (maximal PETCO2) between the anaerobic threshold and respiratory compensation point.: Results The hypocapnic group (n=39) had lower resting cardiac index (3.1 ± 0.8 vs. 3.7 ± 0.7L/min/m2, p < 0.01), lower peak V′O2 (15.8 ± 3.5 vs. 20.7 ± 4.3 mL/kg/min, p < 0.01), and higher V′E/V′CO2 slope (60.6 ± 17.6 vs. 38.2 ± 8.0, p < 0.01). At peak exercise, hypocapic patients had lower PaO2, higher VD/VT and higher P(a-ET)CO2. Maximal PETCO2 (r = 0.59) and VD/VT (r = -0.59) were more related to cardiac index than PaO2 or PaCO2 at rest or peak exercise. Maximal PETCO2 was the strongest correlate of V′E/V′CO2 slope (r = -0.86), peak V′O2 (r = 0.64) and peak work rate (r = 0.49). CONCLUSIONS: Resting hypocapnia is associated with worse cardiac function, more ventilatory inefficiency and reduced exercise capacity. This could be explained by elevated chemosensitivity and lower PaCO2 set-point. Maximal PETCO2 may be a useful non-invasive marker of PaCO2 setpoint and disease severity even with submaximal effort


CONTEXTO GENERAL Y OBJETIVO: La ineficiencia ventilatoria (V'E/V'CO2 alta) y la hipocapnia en reposo son comunes en la enfermedad vascular pulmonar y se asocian con un mal pronóstico. La PaCO2 baja en reposo sugiere una mayor quimiosensibilidad o una alteración en el ajuste fisiológico de la PaCO2. Nuestro objetivo fue determinar las relaciones entre las variables de intercambio de gases que reflejan el ajuste de la PaCO2 durante el ejercicio, la capacidad de ejercicio, la hemodinámica y la V'E/V'CO2. MÉTODOS: Se realizaron mediciones de gases en sangre arterial durante las pruebas de ejercicio cardiopulmonar a pacientes con hipertensión arterial pulmonar (n = 34), hipertensión pulmonar tromboembólica crónica (HPTEC, n = 19) y enfermedad venooclusiva pulmonar (EVOP, n = 6). Los pacientes se agruparon de acuerdo con su PaCO2 en reposo: hipocapnia (PaCO2 ≤ 34 mmHg) o normocapnia (PaCO2 35-45 mmHg). El ajuste de la PaCO2 se estimó mediante el valor máximo de PCO2 exhalado (PETCO2 máximo) entre el umbral anaeróbico y el punto de compensación respiratoria. RESULTADOS: El grupo hipocápnico (n = 39) tenía un índice cardíaco en reposo más bajo (3,1 ± 0,8 vs. 3,7 ± 0,7L/min/m2, p < 0,01), un pico de V'O2 más bajo (15,8 ± 3,5 vs 20,7 ± 4,3 mL/kg/min, p < 0,01), y mayor pendiente de V'E/V'CO2 (60,6 ± 17,6 vs. 38,2 ± 8,0, p < 0,01). En el punto de ejercicio máximo, los pacientes hipocápnicos tenían una PaO2 más baja, un VD/VT más alto y una P(a-ET) CO2 más alta. La PETCO2 máxima (r = 0,59) y la VD/VT (r = -0,59) estaban más relacionadas con el índice cardíaco que la PaO2 o la PaCO2 en reposo o en el punto de máximo esfuerzo. La PETCO2 máxima fue la que mayor correlación tuvo con la pendiente V'E/V'CO2 (r = -0,86), la V'O2 máxima (r = 0.64) y la tasa de esfuerzo máximo (r = 0,49). CONCLUSIONES: La hipocapnia en reposo se asocia a una peor función cardíaca, una mayor ineficiencia ventilatoria y una capacidad disminuída de ejercicio. Esto podría explicarse por una quimiosensibilidad elevada y un ajuste fisiológico más bajo de la PaCO2. La PETCO2 máxima puede ser un marcador no invasivo útil del ajuste de PaCO2 y la gravedad de la enfermedad incluso con un esfuerzo submáximo


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Ventilação Pulmonar/fisiologia , Troca Gasosa Pulmonar/fisiologia , Hipertensão Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Pneumopatia Veno-Oclusiva/fisiopatologia , Índice de Gravidade de Doença , Estudos Retrospectivos , Espirometria , Prognóstico
13.
Clin Appl Thromb Hemost ; 26: 1076029620948137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795186

RESUMO

The SARS-CoV-2 virus caused a global pandemic within weeks, causing hundreds of thousands of people infected. Many patients with severe COVID-19 present with coagulation abnormalities, including increase D-dimers and fibrinogen. This coagulopathy is associated with an increased risk of death. Furthermore, a substantial proportion of patients with severe COVID-19 develop sometimes unrecognized, venous, and arterial thromboembolic complications. A better understanding of COVID-19 pathophysiology, in particular hemostatic disorders, will help to choose appropriate treatment strategies. A rigorous thrombotic risk assessment and the implementation of a suitable anticoagulation strategy are required. We review here the characteristics of COVID-19 coagulation laboratory findings in affected patients, the incidence of thromboembolic events and their specificities, and potential therapeutic interventions.


Assuntos
Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/fisiopatologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Trombose Venosa/tratamento farmacológico , Trombose Venosa/fisiopatologia
15.
Rev. chil. cardiol ; 39(2): 133-146, ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138526

RESUMO

INTRODUCCIÓN: El tromboembolismo pulmonar (TEP) es una causa frecuente de morbimortalidad cardiovascular y la trombolisis local asistida por ultrasonido (TLUS) constituye una alternativa de tratamiento validada para pacientes de riesgo intermedio. No existen reportes del uso de esta tecnología en el ámbito nacional. MÉTODOS: Análisis descriptivo, prospectivo, sobre una serie de pacientes con TEP agudo, de riesgo intermedio, tratados en forma percutánea con trombolisis local asistida por catéter de ultrasonido terapéutico (EKOSonic®). Se analiza la eficacia y seguridad del procedimiento mediante variables clínicas, hemodinámicas y radiológicas, así como desenlaces intra hospitalarios. Se reporta, además, el seguimiento a 30 días. RESULTADOS: Entre Junio de 2019 y Marzo de 2020, 4 pacientes con TEP de riesgo intermedio fueron tratados con esta técnica. El score PESI (Pulmonary Embolism severity Index) promedio era de 79,5 + 6,1. Dos pacientes requirieron la instalación de 2 catéteres para efectuar terapia bilateral. Se observó una reducción promedio en la presión sistólica de arteria pulmonar de 29% y en 3 de los 4 enfermos se logró revertir la dilatación ventricular derecha presente al ingreso. La carga trombótica se redujo en un 20% medido por score CTOI. No hubo complicaciones intraoperatorias ni intrahospitalarias asociadas a la intervención. CONCLUSIONES: En esta serie inicial, el uso de la trombolisis local con catéter de ultrasonido en pacientes con TEP de riesgo intermedio fue segura y efectiva. Los resultados perioperatorios y a 30 días fueron comparables a los descritos en experiencias internacionales; sin embargo, aún se requieren de estudios con mayor número de pacientes para confirmar los beneficios de esta técnica en nuestro medio.


BACKGROUND: Pulmonary thromboembolism (PE) is a common cause of cardiovascular morbidity and mortality and local ultrasound-assisted thrombolysis (USAT) is a validated alternative treatment for intermediate-risk patients. There are no reports on the use of this technology in our country. METHODS: Prospective series of patients with acute, intermediate-risk PE treated percutaneously with therapeutic ultrasound catheter-assisted local thrombolysis (EKOSonic®). The efficacy and safety of the procedure were analyzed using clinical, hemodynamic, and radiological variables, as well as intra-hospital outcomes. The 30-day follow-up is also reported. RESULTS: between June 2019 and March 2020, a total of 4 patients with intermediate-risk PE were treated with this technique. The average PESI score was 79.5 + 6.1. Two out of 4 patients required the use of 2 catheters for bilateral therapy. The average reduction in systolic pressure of the pulmonary artery was 29% and 3 patients reversed the right ventricular dilation present at admission. The thrombotic burden was reduced by 20% according to the Computed Tomography Obstruction Index (CTOI). There were no intraoperative or in hospital complications associated with the intervention. CONCLUSION: In this initial series, the use of local thrombolysis with an ultrasound catheter in patients with intermediate-risk PE was safe and effective. The perioperative and 30-day outcomes were similar to those previously reported in international series. However, larger randomized trials are needed to confirm this potential benefit.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Embolia Pulmonar/terapia , Terapia por Ultrassom , Cateteres , Trombólise Mecânica , Artéria Pulmonar , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/diagnóstico por imagem , Segurança , Índice de Gravidade de Doença , Doença Aguda , Estudos Prospectivos , Seguimentos , Função Ventricular , Resultado do Tratamento , Ultrassonografia de Intervenção , Hemodinâmica , Tempo de Internação
16.
J Comput Assist Tomogr ; 44(4): 578-585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649425

RESUMO

OBJECTIVE: The objective of this study was to assess the correlation between dual-energy computed tomography quantitative parameters and hemodynamics in patients with chronic thromboembolic pulmonary hypertension. METHODS: Dual-energy computed tomography of 52 chronic thromboembolic pulmonary hypertension patients were evaluated retrospectively. The mean lung perfused blood volume (lung PBV) and the mean pulmonary artery (PA) enhancement measured at pulmonary parenchymal phase were compared with the hemodynamics by Spearman rank correlation coefficient (rs) and receiver operating characteristic analysis. RESULTS: Lung PBV was correlated with mean pulmonary arterial pressure (rs = 0.47, P < 0.001). Pulmonary artery enhancement was correlated with cardiac index (rs = -0.49, P < 0.001) and pulmonary vascular resistance (rs = 0.48, P < 0.001). The areas under the curves were 0.86 for lung PBV to predict mean pulmonary arterial pressure of >50 mm Hg and 0.86 for PA enhancement to predict pulmonary vascular resistance of >1000 dyne·s/cm. CONCLUSIONS: Lung PBV and PA enhancement could be indicators of hemodynamics.


Assuntos
Hipertensão Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Volume Sanguíneo , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/fisiopatologia , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
17.
Am J Cardiol ; 128: 54-59, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650924

RESUMO

To conduct a systematic review and meta-analysis evaluating the safety and effectiveness of inferior vena cava filter (IVCF) placement in the setting of massive and submassive pulmonary embolism (PE), Pubmed and Cochrane Library were queried to identify all clinical studies evaluating IVCF placement in patients with massive and submassive PE from database establishment to December 2019. The rate of recurrent PE, PE-related mortality, adverse events, IVCF type, additional treatment intervention, DVT status, and follow-up length were retrieved. Recurrent PE, mortality, and complication rates were pooled. Meta-analysis was performed to compare mortality rates between groups with and without IVCF placement. Subgroup analysis was performed based on whether catheter-directed therapy was used for PE intervention. Fifteen observational studies with a total of 232 patients who received IVCF for submassive or massive PE were included. The pooled overall recurrent symptomatic PE and mortality rates were 1.4% and 5.5%, respectively. A lower mortality rate among patients with IVCF was observed than those without (6.8% vs 26.3%; odds ratio [OR] 0.275 [95% confidence interval] 0.090 to 0.839], I2 = 30.6%, p = 0.023). Patients who received concurrent catheter-directed therapy demonstrated a lower recurrent PE (0% vs 2.8%) and mortality rate (3.4% vs 7.8%) than those who did not. The cumulative IVCF-related complication rate was 0.63%. In conclusion, based on a limited amount of low-quality evidence, IVCF placement is associated with low recurrent PE and PE-related mortality rates among patients with massive and submassive PE, suggestive of a potential clinical benefit in this scenario. Prospectively designed studies are warranted to confirm these findings.


Assuntos
Embolia Pulmonar/terapia , Filtros de Veia Cava , Anticoagulantes/uso terapêutico , Humanos , Hipotensão/fisiopatologia , Trombólise Mecânica , Mortalidade , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Recidiva , Índice de Gravidade de Doença , Trombectomia , Terapia Trombolítica , Disfunção Ventricular Direita/fisiopatologia
18.
Paediatr Respir Rev ; 35: 20-24, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32653469

RESUMO

Since the initial description in 2019, the novel coronavirus SARS-Cov-2 infection (COVID-19) pandemic has swept the globe. The most severe form of the disease presents with fever and shortness of breath, which rapidly deteriorates to respiratory failure and acute lung injury (ALI). COVID-19 also presents with a severe coagulopathy with a high rate of venous thromboembiolism. In addition, autopsy studies have revealed co-localized thrombosis and inflammation, which is the signature of thromboinflammation, within the pulmonary capillary vasculature. While the majority of published data is on adult patients, there are parallels to pediatric patients. In our experience as a COVID-19 epicenter, children and young adults do develop both the coagulopathy and the ALI of COVID-19. This review will discuss COVID-19 ALI from a hematological perspective with discussion of the distinct aspects of coagulation that are apparent in COVID-19. Current and potential interventions targeting the multiple thromboinflammatory mechanisms will be discussed.


Assuntos
Lesão Pulmonar Aguda/sangue , Infecções por Coronavirus/sangue , Inflamação/sangue , Pneumonia Viral/sangue , Trombose/sangue , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/imunologia , Lesão Pulmonar Aguda/fisiopatologia , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/imunologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Capilares/imunologia , Capilares/fisiopatologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Endotélio Vascular/imunologia , Endotélio Vascular/fisiopatologia , Inibidores do Fator Xa/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Inflamação/imunologia , Inflamação/fisiopatologia , Pandemias , Ativação Plaquetária , Inibidores da Agregação de Plaquetas/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/sangue , Embolia Pulmonar/imunologia , Embolia Pulmonar/fisiopatologia , Trombina/imunologia , Trombina/metabolismo , Trombose/tratamento farmacológico , Trombose/imunologia , Trombose/fisiopatologia
19.
Expert Rev Med Devices ; 17(8): 739-749, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32700589

RESUMO

INTRODUCTION: Studies performed in the past decade suggested that evolving reperfusion strategies may improve early outcomes of patients with acute pulmonary embolism (PE) and hemodynamic decompensation. In this regard, catheter-directed treatment (CDT) options are receiving increasing attention. AREAS COVERED: A broad spectrum of CDT options exists for the treatment of patients with acute PE. Procedures include catheter-directed local thrombolysis with or without ultrasound assistance, catheter-directed mechanical or suction embolectomy, and combined pharmaco-mechanical approaches. We present here an overview of the available CDT techniques, focusing on the EkoSonic® endovascular system. EXPERT COMMENTARY: CDT, particularly local ultrasound accelerated thrombolysis, continues to evolve. Its increasing popularity is the result of accumulating promising results, which suggest a relief of right ventricular (RV) pressure overload and improvement of RV function. These favorable effects on surrogate endpoints were accompanied by a low rate of procedure-related adverse events, notably intracranial hemorrhage. Although the overall risk of serious bleeding appears to be low in CDT, the lack of direct comparisons with other reperfusion options does not allow definitive conclusions. Prospective controlled trials with robust clinical outcomes are urgently needed to establish the postulated benefits of CDT in selected patients with acute PE.


Assuntos
Cateteres , Procedimentos Endovasculares , Embolia Pulmonar/cirurgia , Reperfusão , Doença Aguda , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Terapia Trombolítica , Resultado do Tratamento
20.
J Card Surg ; 35(7): 1638-1639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557777

RESUMO

Pulmonary embolism can be associated with paradox embolism requiring immediate surgical therapy regardless of hemodynamic status. Here we present images illustrating a giant transit thrombus as a concomitant finding in a patient with pulmonary artery embolism.


Assuntos
Embolectomia/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombose/patologia , Trombose/cirurgia , Ecocardiografia Transesofagiana , Forame Oval/patologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Embolia Pulmonar/patologia , Embolia Pulmonar/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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