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2.
ASAIO J ; 67(4): 392-394, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33769994

RESUMO

A subset of patients with coronavirus disease 2019 (COVID-19) develop profound respiratory failure and are treated via invasive mechanical ventilation (IMV). Of these, a smaller subset has severe gas exchange abnormalities that are refractory to maximal levels of IMV support. Extracorporeal membrane oxygenation (ECMO) has been used successfully in these circumstances. However, using ECMO only after failure of IMV exposes patients to the risks of ventilator-induced lung injury. We report a successful outcome using ECMO in the setting of COVID-19 in the absence of IMV failure in an awake, nonintubated patient. This approach may be beneficial for selected patients with COVID-19.


Assuntos
/terapia , Oxigenação por Membrana Extracorpórea , Lesão Pulmonar/etiologia , Respiração Artificial , Insuficiência Respiratória/terapia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
J Appl Physiol (1985) ; 130(4): 1143-1151, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33600286

RESUMO

Many patients who suffer from pulmonary diseases cannot inflate their lungs normally, as they need mechanical ventilation (MV) to assist them. The stress associated with MV can damage the delicate epithelium in small airways and alveoli, which can cause complications resulting in ventilation-induced lung injuries (VILIs) in many cases, especially in patients with acute respiratory distress syndrome (ARDS). Therefore, efforts were directed to develop safe modes for MV. In our work, we propose a different approach to decrease injuries of epithelial cells (EpCs) upon MV. We alter EpCs' cytoskeletal structure to increase their survival rate during airway reopening conditions associated with MV. We tested two anti-inflammatory drugs dexamethasone (DEX) and transdehydroandrosterone (DHEA) to alter the cytoskeleton. Cultured rat L2 alveolar EpCs were exposed to airway reopening conditions using a parallel-plate perfusion chamber. Cells were exposed to a single bubble propagation to simulate stresses associated with mechanical ventilation in both control and study groups. Cellular injury and cytoskeleton reorganization were assessed via fluorescence microscopy, whereas cell topography was studied via atomic force microscopy (AFM). Our results indicate that culturing cells in media, DEX solution, or DHEA solution did not lead to cell death (static cultures). Bubble flows caused significant cell injury. Preexposure to DEX or DHEA decreased cell death significantly. The AFM verified alteration of cell mechanics due to actin fiber depolymerization. These results suggest potential beneficial effects of DEX and DHEA for ARDS treatment for patients with COVID-19. They are also critical for VILIs and applicable to future clinical studies.NEW & NOTEWORTHY Preexposure of cultured cells to either dexamethasone or transdehydroandrosterone significantly decreases cellular injuries associated with mechanical ventilation due to their ability to alter the cell mechanics. This is an alternative protective method against VILIs instead of common methods that rely on modification of mechanical ventilator modes.


Assuntos
Androsterona/uso terapêutico , Dexametasona/uso terapêutico , Lesão Pulmonar/tratamento farmacológico , Respiração Artificial/efeitos adversos , Animais , /tratamento farmacológico , Morte Celular/efeitos dos fármacos , Células Cultivadas , Citoesqueleto/efeitos dos fármacos , Células Epiteliais/efeitos dos fármacos , Lesão Pulmonar/etiologia , Ratos
4.
Respir Res ; 22(1): 32, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514373

RESUMO

BACKGROUND: Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. METHODS: We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. RESULTS: Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. CONCLUSION: Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.


Assuntos
/patologia , Lesão Pulmonar/patologia , Pulmão/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Autopsia , Demografia , Progressão da Doença , Feminino , Humanos , Infarto/epidemiologia , Infarto/patologia , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Alvéolos Pulmonares/patologia , Trombose/etiologia , Trombose/patologia , Adulto Jovem
5.
Am J Case Rep ; 22: e927954, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33500377

RESUMO

BACKGROUND Invasive mechanical ventilation can cause pulmonary barotrauma due to elevated transpulmonary pressure and alveolar rupture. A significant proportion of COVID-19 patients with acute respiratory distress syndrome (ARDS) will require mechanical ventilation. We present 2 interesting cases that demonstrate the possibility of COVID-19-associated ARDS manifesting with pulmonary barotrauma at acceptable ventilatory pressures. CASE REPORT The first patient was a 71-year-old man who was intubated and placed on mechanical ventilation due to hypoxemic respiratory failure from SARS-CoV-2 infection. His partial pressure of O2 to fraction of inspired oxygen ratio (PaO2/FiO2) was 156. He developed subcutaneous emphysema (SE) and pneumomediastinum on day 5 of mechanical ventilation at ventilatory settings of positive end-expiratory pressure (PEEP) ≤15 cmH2O, plateau pressure (Pplat) ≤25 cmH2O and pulmonary inspiratory pressure (PIP) ≤30 cmH2O. He was managed with 'blow-hole' incisions, with subsequent clinical resolution of subcutaneous emphysema. The second patient was a 58-year-old woman who was also mechanically ventilated due to hypoxemic respiratory failure from COVID-19, with PaO2/FiO2 of 81. She developed extensive SE with pneumomediastinum and pneumothorax while on mechanical ventilation settings PEEP 13 cmH2O and PIP 28 cmH2O, Pplat 18 cmH2O, and FiO2 90%. SE was managed with blow-hole incisions and pneumothorax with chest tube. CONCLUSIONS Clinicians should be aware of pulmonary barotrauma as a possible complication of COVID-19 pulmonary disease, even at low ventilatory pressures.


Assuntos
Barotrauma/etiologia , Lesão Pulmonar/etiologia , Respiração Artificial/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Enfisema Mediastínico/etiologia , Pessoa de Meia-Idade , /virologia , Enfisema Subcutâneo/etiologia
6.
Am J Surg ; 221(1): 211-215, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32854902

RESUMO

BACKGROUND: Pulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion. METHODS: We identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality. RESULTS: Among 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16-33%], respiratory failure 40% [95%CI: 31-50%], and intubation 46% [95%CI: 33-61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications. CONCLUSIONS: There is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.


Assuntos
Contusões/classificação , Contusões/etiologia , Lesão Pulmonar/classificação , Lesão Pulmonar/etiologia , Fraturas das Costelas/complicações , Idoso , Feminino , Humanos , Lesão Pulmonar/complicações , Lesão Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
8.
Pediatrics ; 147(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33380433

RESUMO

Electronic cigarette or vaping product use-associated lung injury (EVALI) is a disease process that has become prevalent in the United States.1 The Centers for Disease Control and Prevention reported there have been almost 2700 cases of this condition in the United States as of January 14, 2020, with >50% of these patients aged ≤24.2 We present a 13-year-old boy with a history of functional abdominal pain who presented with recurrent episodes of nausea, emesis, periodic fevers, and severe episodic abdominal pain after a 12-month history of significant electronic cigarette use. On admission, he had severe abdominal pain and appeared anxious. A computed tomography scan of the abdomen was unremarkable, but a computed tomography scan of the chest demonstrated both multifocal ground-glass and crazy-paving pulmonary opacities bilaterally, with scattered septal thickening and dependent bibasilar opacities associated with volume loss. Inflammatory markers were significantly elevated, and cell counts were remarkable for leukocytosis and neutrophilia. The patient was ultimately diagnosed with EVALI and treated with intravenous methylprednisolone, resulting in improvement. This is an example of a case of EVALI in an adolescent, in which the presenting symptoms are largely gastrointestinal. It is important to keep EVALI in the differential diagnosis of patients who exhibit gastrointestinal symptoms, have markers of increased systemic inflammation, and endorse a history of vaping or are in the age range of electronic cigarette users. Although obtaining an accurate history of vaping can be challenging in the pediatric population, it is especially critical to do so.


Assuntos
Dor Abdominal/etiologia , Lesão Pulmonar/diagnóstico , Vaping/efeitos adversos , Adolescente , Humanos , Lesão Pulmonar/etiologia , Masculino , Vaping/fisiopatologia
9.
Nicotine Tob Res ; 22(Suppl 1): S96-S99, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320257

RESUMO

Implications In this commentary, we describe the evidence-based approach used to identify the primary cause of EVALI and to curb the 2019 outbreak. We also discuss future research opportunities and public health practice considerations to prevent a resurgence of EVALI.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Lesão Pulmonar/etiologia , Vaping/efeitos adversos , Vaping/epidemiologia , Surtos de Doenças , Humanos , Lesão Pulmonar/patologia , Estados Unidos/epidemiologia
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(5): 623-628, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33210491

RESUMO

Radiation-induced lung injury (RILI), including acute radiation pneumonitis and chronic radiation-induced pulmonary fibrosis (RIPF), is a side effect of radiotherapy for lung cancer and esophageal cancer. Pulmonary macrophages, as a kind of natural immune cells maintaining lung homeostasis, play a key role in the whole pathological process of RILI. In the early stage of RILI, classically activated M1 macrophages secrete proinflammatory cytokines to induce inflammation and produce massive reactive oxygen species (ROS) through ROS-induced cascade to further impair lung tissue. In the later stage of RILI, alternatively activated M2 macrophages secrete profibrotic cytokines to promote the development of RIPF. The roles of macrophage in the pathogenesis of RILI and the related potential clinical applications are summarized in this review.


Assuntos
Lesão Pulmonar , Pulmão , Macrófagos , Lesões por Radiação , Radioterapia , Humanos , Pulmão/efeitos da radiação , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Macrófagos/metabolismo , Pneumonite por Radiação/etiologia , Radioterapia/efeitos adversos
11.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(10): 1465-1471, 2020 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-33118515

RESUMO

OBJECTIVE: To elucidate the pathogenic role of leukotriene B4 (LTB4) in pulmonary hyper-permeability and inflammation induced by lung-protective mechanical ventilation (LPMV) in rabbits. METHODS: Thirty-two healthy Japanese white rabbits were randomized into 4 groups for treatment with vehicle or bestatin (a leukotriene A4 hydrolase inhibitor that inhibits LTB4 production) administered intragastrically at the daily dose of 8 mg/kg for 5 days, followed by sham operation (group S and group BS, respectively, in which the rabbits were anesthetized only) or LPMV (group PM and group BPM, respectively, in which the rabbits received ventilation with 50% oxygen at a tidal volume of 8 mL/kg for 5 h). The concentrations of LTB4 and cyclic adenosine monophosphate (cAMP) in the lung tissues were analyzed by ELISA. cAMP content, protein kinase A (PKA) protein expression and the Rap1-GTP protein to total Rap1 protein ratio were determined to assess the activities of cAMP/PKA and Rap1 signaling pathways. The lung injury was evaluated by assessing lung permeability index, lung wet/dry weight ratio, polymorphonuclear leukocyte (PMN) count in bronchoalveolar lavage fluid (BALF), pulmonary myeloperoxidase (MPO) activity and lung histological scores. RESULTS: None of the examined parameters differed significantly between group S and group BS. All the parameters with the exception of lung histological score increased significantly in group PM and group BPM as compared to those in group S (P < 0.05). Compared with those in PM group, the rabbits in group BPM showed significantly reduced LTB4 production in the lungs (P < 0.05), up-regulated cAMP/ PKA and Rap1 signaling pathway activities (P < 0.05), and alleviated lung hyper-permeability and inflammation (P < 0.05). CONCLUSIONS: LPMV can induce LTB4 overproduction to down-regulate cAMP/PKA and Rap1 signaling pathways in the lungs of rabbits, which results in lung hyper-permeability and inflammation. Bestatin can inhibit LTB4 production in the lungs to protect against LPMV-induced lung hyper-permeability and inflammation.


Assuntos
Lesão Pulmonar , Animais , Líquido da Lavagem Broncoalveolar , Leucotrieno B4 , Pulmão , Lesão Pulmonar/etiologia , Lesão Pulmonar/prevenção & controle , Neutrófilos , Coelhos , Respiração Artificial/efeitos adversos
12.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 214-217, 2020 08 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32991116

RESUMO

Introduction: Electrical burns account for 3 to 4% of all burns. The most common sites of impact are the cardiovascular system, muscle tissue, neurological and skin. The commitment of the respiratory system is uncommon, with few cases reported in the literature. Case: 26-year-old male patient who enters after high-voltage electrical injury. He presented skin and respiratory distress engagement with requirement of mechanical respiratory assistance, deep sedation and neuromuscular blockade. Conclusion: There are few reported cases in the literature of lung injury associated with electrical trauma. Recognizing the respiratory system as a possible site of impact by highlighting the importance of advanced life support is critical.


Assuntos
Queimaduras por Corrente Elétrica , Lesão Pulmonar , Adulto , Queimaduras por Corrente Elétrica/complicações , Humanos , Lesão Pulmonar/etiologia , Masculino
13.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32885626

RESUMO

'Tree-in-bud' (TIB) appearance in computed tomography (CT) chest is most commonly a manifestation of infection. We here describe an unusual cause of TIB during the COVID-19 pandemic. A young male patient who had a history of fever, cough, and respiratory distress presented in the emergency department. As these symptoms matched with coronavirus infection, the COVID-19 test was done, which was found negative. He was then moved to the intensive care unit where he developed severe acute respiratory distress syndrome and was put on mechanical ventilation. Further workup did not reveal any source of infection, as all his cultures were negative, but his CT chest showed a tree-in-bud appearance. After obtaining a detailed history from his friends, the patient was found a chronic abuser of inhaled cocaine and treated with intravenous steroids. Subsequently, he was weaned from the ventilator and discharged from the intensive care unit after becoming asymptomatic.


Assuntos
Fumar Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Infecções por Coronavirus/diagnóstico , Lesão Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , /diagnóstico por imagem , Adulto , Betacoronavirus , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/terapia , Masculino , Metilprednisolona/uso terapêutico , Pandemias , Respiração Artificial , /terapia , Tomografia Computadorizada por Raios X
14.
Anesthesiology ; 133(5): 1029-1045, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902561

RESUMO

BACKGROUND: In the Protective Ventilation in Cardiac Surgery (PROVECS) randomized, controlled trial, an open-lung ventilation strategy did not improve postoperative respiratory outcomes after on-pump cardiac surgery. In this prespecified subanalysis, the authors aimed to assess the regional distribution of ventilation and plasma biomarkers of lung epithelial and endothelial injury produced by that strategy. METHODS: Perioperative open-lung ventilation consisted of recruitment maneuvers, positive end-expiratory pressure (PEEP) = 8 cm H2O, and low-tidal volume ventilation including during cardiopulmonary bypass. Control ventilation strategy was a low-PEEP (2 cm H2O) low-tidal volume approach. Electrical impedance tomography was used serially throughout the perioperative period (n = 56) to compute the dorsal fraction of ventilation (defined as the ratio of dorsal tidal impedance variation to global tidal impedance variation). Lung injury was assessed serially using biomarkers of epithelial (soluble form of the receptor for advanced glycation end-products, sRAGE) and endothelial (angiopoietin-2) lung injury (n = 30). RESULTS: Eighty-six patients (age = 64 ± 12 yr; EuroSCORE II = 1.65 ± 1.57%) undergoing elective on-pump cardiac surgery were studied. Induction of general anesthesia was associated with ventral redistribution of tidal volumes and higher dorsal fraction of ventilation in the open-lung than the control strategy (0.38 ± 0.07 vs. 0.30 ± 0.10; P = 0.004). No effect of the open-lung strategy on the dorsal fraction of ventilation was noted at the end of surgery after median sternotomy closure (open-lung = 0.37 ± 0.09 vs. control = 0.34 ± 0.11; P = 0.743) or in extubated patients at postoperative day 2 (open-lung = 0.63 ± 0.18 vs. control = 0.59 ± 0.11; P > 0.999). Open-lung ventilation was associated with increased intraoperative plasma sRAGE (7,677 ± 3,097 pg/ml vs. 6,125 ± 1,400 pg/ml; P = 0.037) and had no effect on angiopoietin-2 (P > 0.999). CONCLUSIONS: In cardiac surgery patients, open-lung ventilation provided larger dorsal lung ventilation early during surgery without a maintained benefit as compared with controls at the end of surgery and postoperative day 2 and was associated with higher intraoperative plasma concentration of sRAGE suggesting lung overdistension.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Lesão Pulmonar/prevenção & controle , Assistência Perioperatória/métodos , Respiração com Pressão Positiva/métodos , Volume de Ventilação Pulmonar/fisiologia , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Respiração com Pressão Positiva/efeitos adversos , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Volume de Ventilação Pulmonar/efeitos dos fármacos
15.
Chin J Traumatol ; 23(5): 249-257, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32917472

RESUMO

PURPOSE: Blast lung injury (BLI) is the most common damage resulted from explosion-derived shock wave in military, terrorism and industrial accidents. However, the molecular mechanisms underlying BLI induced by shock wave are still unclear. METHODS: In this study, a goat BLI model was established by a fuel air explosive power. The key genes involved in were identified. The goats of the experimental group were fixed on the edge of the explosion cloud, while the goats of the control group were 3 km far away from the explosive environment. After successful modeling for 24 h, all the goats were sacrificed and the lung tissue was harvested for histopathological observation and RNA sequencing. Gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) analysis were performed to identify the main enriched biological functions of differentially expressed genes (DEGs). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to verify the consistency of gene expression. RESULTS: Of the sampled goat lungs, 895 genes were identified to be significantly differentially expressed, and they were involved in 52 significantly enriched GO categories. KEGG analysis revealed that DEGs were highly enriched in 26 pathways, such as cytokine-cytokine receptor interaction, antifolate resistance, arachidonic acid metabolism, amoebiasis and bile secretion, JAK-STAT, and IL-17 signaling pathway. Furthermore, 15 key DEGs involved in the biological processes of BLI were confirmed by qRT-PCR, and the results were consistent with RNA sequencing. CONCLUSION: Gene expression profiling provide a better understanding of the molecular mechanisms of BLI, which will help to set strategy for treating lung injury and preventing secondary lung injury induced by shock wave.


Assuntos
Traumatismos por Explosões/genética , Perfilação da Expressão Gênica/métodos , Ondas de Choque de Alta Energia/efeitos adversos , Lesão Pulmonar/genética , Transcriptoma , Animais , Traumatismos por Explosões/etiologia , Modelos Animais de Doenças , Cabras , Lesão Pulmonar/etiologia , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de RNA
16.
Euro Surveill ; 25(36)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32914744

RESUMO

In March 2020, we observed an outbreak of COVID-19 among a relatively homogenous group of 199 young (median age 21 years; 87% men) Swiss recruits. By comparing physical endurance before and in median 45 days after the outbreak, we found a significant decrease in predicted maximal aerobic capacity in COVID-19 convalescent but not in asymptomatically infected and SARS-CoV-2 naive recruits. This finding might be indicative of lung injury after apparently mild COVID-19 in young adults.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Exercício Físico/fisiologia , Lesão Pulmonar/etiologia , Consumo de Oxigênio , Resistência Física/fisiologia , Pneumonia Viral/diagnóstico , Ventilação Pulmonar/fisiologia , Adulto , Infecções Assintomáticas , Betacoronavirus , Convalescença , Coronavirus/genética , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Militares , Pandemias , Resistência Física/imunologia , Aptidão Física , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Suíça/epidemiologia , Adulto Jovem
17.
Medicine (Baltimore) ; 99(33): e21685, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872040

RESUMO

Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.Lung contusions were found in all of the patients (mean LCS: 22, range: 5-47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86-15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Lesão Pulmonar/diagnóstico por imagem , Fraturas das Costelas/diagnóstico por imagem , Esterno/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Criança , Feminino , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Fraturas das Costelas/etiologia , Esterno/lesões , Fatores de Tempo , Adulto Jovem
18.
Crit Care ; 24(1): 494, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778136

RESUMO

Deterioration of lung function during the first week of COVID-19 has been observed when patients remain with insufficient respiratory support. Patient self-inflicted lung injury (P-SILI) is theorized as the responsible, but there is not robust experimental and clinical data to support it. Given the limited understanding of P-SILI, we describe the physiological basis of P-SILI and we show experimental data to comprehend the role of regional strain and heterogeneity in lung injury due to increased work of breathing.In addition, we discuss the current approach to respiratory support for COVID-19 under this point of view.


Assuntos
Infecções por Coronavirus/fisiopatologia , Progressão da Doença , Lesão Pulmonar/fisiopatologia , Pneumonia Viral/fisiopatologia , Trabalho Respiratório/fisiologia , Infecções por Coronavirus/terapia , Cuidados Críticos , Humanos , Lesão Pulmonar/etiologia , Pandemias , Pneumonia Viral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial
19.
Ecotoxicol Environ Saf ; 204: 110948, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32739672

RESUMO

Exposure to arsenic is epidemiologically associated with increased lung disease. In detailing the mechanism by which arsenic exposure leads to disease, studies have emphasized that metabolic reprogramming and immune dysfunction are related to arsenic-induced lung injury. However, the association between the mechanisms listed above is not well understood. Thus, the current study aimed to investigate the interaction of energy metabolism and macrophage polarization, by which arsenic exposure adversely induced lung injury in both in vitro and human studies. First, we confirmed a shift to glycolytic metabolism resulting from mitochondrial dysfunction. This shift was accompanied by an increase in the levels of phosphorylated PDHE1α (S293) and PDK1 and a concomitant marked increase in several key markers of the HIF-1α signaling pathway (HIF-1α, p-PKM2, GLUT1 and HK-2). In addition, utilizing an in vitro model in which lung epithelial cells are cultured with macrophages, we determined that arsenic treatment polarizes macrophages towards the M2 phenotype through lactate. In the human study, the serum lactate and TGF-ß levels were higher in arsenic-exposed subjects than that in reference subjects (t= 4.50, 6.24, both p < 0.05), while FVC and FEV1 were both lower (t= 5.47, 7.59, both p < 0.05). Pearson correlation analyses showed a significant negative correlation between the serum TGF-ß and lactate levels and the lung function parameters (pcorrelation<0.05). In mediation analyses, lactate and TGF-ß significantly mediated 24.3% and 9.0%, respectively, of the association between arsenic and FVC (pmediation<0.05), while lactate and TGF-ß significantly mediated 22.2% and 12.5%, respectively, of the association between arsenic and FEV1 (pmediation<0.05). Together, the results of the in vitro and human studies indicated that there is complex communication between metabolic reprogramming and immune dysfunction, resulting in exacerbated effects in a feedback loop with increased arsenic-induced lung damage.


Assuntos
Arsênico/toxicidade , Metabolismo Energético/efeitos dos fármacos , Lesão Pulmonar/metabolismo , Macrófagos/efeitos dos fármacos , Adulto , Células Epiteliais , Feminino , Humanos , Lesão Pulmonar/etiologia , Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Células THP-1
20.
Ann Am Thorac Soc ; 17(8): 918-921, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32735170

RESUMO

Amid efforts to care for the large number of patients with coronavirus disease (COVID-19), there has been considerable speculation about whether the lung injury seen in these patients is different than acute respiratory distress syndrome from other causes. One idea that has garnered considerable attention, particularly on social media and in free open-access medicine, is the notion that lung injury due to COVID-19 is more similar to high-altitude pulmonary edema (HAPE). Drawing on this concept, it has also been proposed that treatments typically employed in the management of HAPE and other forms of acute altitude illness-pulmonary vasodilators and acetazolamide-should be considered for COVID-19. Despite some similarities in clinical features between the two entities, such as hypoxemia, radiographic opacities, and altered lung compliance, the pathophysiological mechanisms of HAPE and lung injury due to COVID-19 are fundamentally different, and the entities cannot be viewed as equivalent. Although of high utility in the management of HAPE and acute mountain sickness, systemically delivered pulmonary vasodilators and acetazolamide should not be used in the treatment of COVID-19, as they carry the risk of multiple adverse consequences, including worsened ventilation-perfusion matching, impaired carbon dioxide transport, systemic hypotension, and increased work of breathing.


Assuntos
Doença da Altitude , Infecções por Coronavirus , Hipertensão Pulmonar , Pandemias , Pneumonia Viral , Acetazolamida/farmacologia , Doença da Altitude/fisiopatologia , Doença da Altitude/terapia , Betacoronavirus/isolamento & purificação , Inibidores da Anidrase Carbônica/farmacologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Lesão Pulmonar/terapia , Nifedipino/farmacologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , /fisiopatologia , Vasodilatadores/farmacologia
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