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1.
Sci Rep ; 12(1): 7094, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501363

RESUMO

Respiratory pathologies alter the structure of the lung and impact its mechanics. Mice are widely used in the study of lung pathologies, but there is a lack of fundamental mechanical measurements assessing the interdependent effect of varying inflation volumes and cycling frequency. In this study, the mechanical properties of five male C57BL/6J mice (29-33 weeks of age) lungs were evaluated ex vivo using our custom-designed electromechanical, continuous measure ventilation apparatus. We comprehensively quantify and analyze the effect of loading volumes (0.3, 0.5, 0.7, 0.9 ml) and breathing rates (5, 10, 20 breaths per minute) on pulmonary inflation and deflation mechanical properties. We report means of static compliance between 5.4-16.1 µl/cmH2O, deflation compliance of 5.3-22.2 µl/cmH2O, percent relaxation of 21.7-39.1%, hysteresis of 1.11-7.6 ml•cmH2O, and energy loss of 39-58% for the range of four volumes and three rates tested, along with additional measures. We conclude that inflation volume was found to significantly affect hysteresis, static compliance, starting compliance, top compliance, deflation compliance, and percent relaxation, and cycling rate was found to affect only hysteresis, energy loss, percent relaxation, static compliance and deflation compliance.


Assuntos
Insuflação , Pulmão , Animais , Complacência Pulmonar , Medidas de Volume Pulmonar , Masculino , Camundongos , Camundongos Endogâmicos C57BL
2.
Libyan J Med ; 17(1): 2059893, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35379081

RESUMO

The validity of the GLI-2021 norms for SLVs in healthy Algerian adults has not been assessed. To ascertain how well do the GLI-2021 norms fit to contemporary SLVs data in Algerian adults. This was a cross-sectional study involving 481 (n = 242 females) healthy non-smoking adults recruited from the Algiers general population. All participants underwent a clinical examination and a plethysmography. Z-scores for slow vital capacity (SVC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), expiratory reserve volume (ERV), inspiratory capacity (IC), and RV/TLC were calculated. The mean difference between the determined and the predicted values (∆value) of SLVs were calculated. The GLI-2021 norms would be considered as reflective of contemporary Algerian SLVs if the total sample mean z-scores were in the normal range (ie; -0.5 to +0.5). The participants' means ± SDs of age and height were 46.4 ± 16.4 years and 166 ± 10 cm, respectively. The determined SLVs were significantly different from those predicted (∆values means ± SDs were -170 ± 470 ml for IC, -100 ± 490 ml for SVC, 170 ± 400 ml for ERV, 240 ± 620 ml for TLC, 370 ± 340 ml for RV, 480 ± 480 ml for FRC, and 5.28 ± 4.38% for RV/TLC). The means ± SDs z-scores for IC, SVC, ERV, and TLC were in the normal range (-0.29 ± 0.88, -0.17 ± 0.94, 0.29 ± 0.77, and 0.35 ± 0.86, respectively), but those of RV, FRC, and RV/TLC were out of the normal range (0.74 ± 0.66, 0.75 ± 0.72, and 0.83 ± 0.75, respectively). In healthy Algerian adults, the GLI-2021 norms fit well to SVC, TLC, ERV, and IC, but they do not fit to FRC, RV, and RV/TLC.


Assuntos
Pulmão , Adulto , Argélia/epidemiologia , Estudos Transversais , Feminino , Humanos , Medidas de Volume Pulmonar/métodos , Volume Residual
3.
Respir Res ; 23(1): 105, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488261

RESUMO

BACKGROUND: Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS: Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS: Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS: Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.


Assuntos
COVID-19 , COVID-19/tratamento farmacológico , Humanos , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar/métodos , Estudos Retrospectivos , Esteroides/uso terapêutico
4.
Physiol Meas ; 43(3)2022 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-35322796

RESUMO

Objective. A linear relationship between impedance change (ΔZ) measured by thoracic electrical impedance tomography (EIT) and tidal volume (VT) has been demonstrated. This study evaluated the agreement between the displayed VT calculated by the EIT software (VTEIT) and spirometry (VTSPIRO) after an indirect two-point calibration.Approach.The EIT software was programmed to execute a bedside two-point calibration from the subject-specific, linear equation defining the relationship between ΔZand VTSPIROand displaying VTEITbreath-by-breath in 20 neutered male, juvenile pigs. After EIT calibration VTs of 8, 12, 16 and 20 ml kg-1were applied to the lungs. VTEITand VTSPIROwere recorded and analysed using Bland-Altman plot for multiple subject measurements. Volumetric capnography (VCap) and spirometry data were explored as components of variance using multiple regression.Main results.A mean relative difference (bias) of 0.7% with 95% confidence interval (CI) of -10.4% to 10.7% were found between VTEITand VTSPIROfor the analysed data set. The variance in VTEITcould not be explained by any of the measured VCap or spirometry variables.Significance.The narrow CI estimated in this study allows the conclusion that EIT and its software can be used to measure and accurately convert ΔZinto mililitre VT at the bedside after applying an indirect two-point calibration.


Assuntos
Tomografia , Animais , Calibragem , Impedância Elétrica , Medidas de Volume Pulmonar/métodos , Masculino , Suínos , Volume de Ventilação Pulmonar , Tomografia/métodos
5.
Respir Med ; 196: 106825, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35325741

RESUMO

BACKGROUND AND OBJECTIVE: Severe COPD patients can significantly benefit from bronchoscopic lung volume reduction (BLVR) treatments with coils or endobronchial valves. However, the potential impact of BLVR on survival is less understood. Therefore, our aim was to investigate the survival rate in patients who are evaluated for BLVR treatment and whether there is a difference in survival rate between patients who undergo BLVR treatment and patients who do not. METHODS: We included patients with COPD who visited our hospital for a consultation evaluating their eligibility for BLVR treatment and who performed pulmonary function tests during this visit. Furthermore, vital status was verified. RESULTS: In total 1471 patients were included (63% female, mean age 61 years). A total of 531 patients (35%) died during follow-up and the median survival time of the total population was 2694 days (95% confidence interval(CI) 2462-2926) which is approximately 7.4 years. The median survival time of patients who were treated with BLVR was significantly longer compared to patients who were not treated with BLVR (3133 days versus 2503 days, p < 0.001), and BLVR was found to be an independent predictor of survival when adjusting for other survival-influencing factors such as age, gender or severity of disease. CONCLUSIONS: Our results suggest that bronchoscopically reducing lung volume in patients with severe hyperinflation may lead to a survival benefit for a population with a severely reduced life expectancy.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Broncoscopia/métodos , Feminino , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Resultado do Tratamento
6.
Prenat Diagn ; 42(5): 628-635, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35262959

RESUMO

OBJECTIVES: To calculate 3D-segmented total lung volume (TLV) in fetuses with thoracic anomalies using deformable slice-to-volume registration (DSVR) with comparison to 2D-manual segmentation. To establish a normogram of TLV calculated by DSVR in healthy control fetuses. METHODS: A pilot study at a single regional fetal medicine referral centre included 16 magnetic resonance imaging (MRI) datasets of fetuses (22-32 weeks gestational age). Diagnosis was CDH (n = 6), CPAM (n = 2), and healthy controls (n = 8). Deformable slice-to-volume registration was used for reconstruction of 3D isotropic (0.85 mm) volumes of the fetal body followed by semi-automated lung segmentation. 3D TLV were compared to traditional 2D-based volumetry. Abnormal cases referenced to a normogram produced from 100 normal fetuses whose TLV was calculated by DSVR only. RESULTS: Deformable slice-to-volume registration-derived TLV values have high correlation with the 2D-based measurements but with a consistently lower volume; bias -1.44 cm3 [95% limits: -2.6 to -0.3] with improved resolution to exclude hilar structures even in cases of motion corruption or very low lung volumes. CONCLUSIONS: Deformable slice-to-volume registration for fetal lung MRI aids analysis of motion corrupted scans and does not suffer from the interpolation error inherent to 2D-segmentation. It increases information content of acquired data in terms of visualising organs in 3D space and quantification of volumes, which may improve counselling and surgical planning.


Assuntos
Feto , Imageamento por Ressonância Magnética , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Imageamento Tridimensional/métodos , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar/métodos , Imageamento por Ressonância Magnética/métodos , Projetos Piloto , Gravidez
7.
Respir Res ; 23(1): 60, 2022 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-35300687

RESUMO

BACKGROUND: PAP is an ultra-rare respiratory syndrome characterized by the accumulation of surfactant within the alveoli. Whole lung lavage (WLL) is the current standard of care of PAP, however it is not a standardized procedure and the total amount of fluid used to wash each lung is still debated. Considering ICU hospitalization associated risks, a "mini-WLL" with anticipated manual clapping and reduced total infusion volume and has been proposed in our center. The aim of the study is to retrospectively analyze the efficacy of mini-WLL compared to standard WLL at the Pavia center. METHODS: 13 autoimmune PAP patients eligible for WLL were included: 7 patients were admitted to mini-WLL (9 L total infusion volume for each lung) and 6 patients underwent standard WLL (14 L of infusion volume). Functional data (VC%, FVC%, TLC%, DLCO%) and alveolar-arterial gradient values (A-aO2) were collected at the baseline and 1, 3, 6, 12, 18 months after the procedure. RESULTS: A statistically significant improvement of VC% (p = 0.013, 95%CI 3.49-30.19), FVC% (p = 0.016, 95%CI 3.37-32.09), TLC% (p = 0.001, 95%CI 7.38-30.34) was observed in the mini-WLL group in comparison with the standard WLL group, while no significant difference in DLCO% and A-aO2 mean values were reported. CONCLUSION: Mini-WLL has demonstrated higher efficacy in ameliorating lung volumes, suggesting that a lower infusion volume is sufficient to remove the surfactant accumulation and possibly allows a reduced mechanical insult of the bronchi walls and the alveoli. However, no statistically significant differences were found in terms of DLCO% and Aa-O2.


Assuntos
Doenças Autoimunes/terapia , Autoimunidade , Lavagem Broncoalveolar/métodos , Proteinose Alveolar Pulmonar/terapia , Alvéolos Pulmonares/fisiopatologia , Surfactantes Pulmonares/metabolismo , Adulto , Doenças Autoimunes/imunologia , Doenças Autoimunes/metabolismo , Feminino , Seguimentos , Humanos , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/imunologia , Proteinose Alveolar Pulmonar/metabolismo , Estudos Retrospectivos
8.
J Bras Pneumol ; 48(1): e20210280, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35293484

RESUMO

OBJECTIVE: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. METHODS: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. RESULTS: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. CONCLUSIONS: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.


Assuntos
Dispneia , Pulmão , Humanos , Medidas de Volume Pulmonar , Complicações Pós-Operatórias , Período Pós-Operatório
9.
Rev. Méd. Inst. Mex. Seguro Soc ; 60(1): 59-66, 17-feb-2022. tab
Artigo em Espanhol | LILACS | ID: biblio-1361376

RESUMO

Introducción: los pacientes con SARS-CoV-2 presentan signos y síntomas que involucran principalmente el sistema respiratorio. Las secuelas son consecuencia de un deterioro de la calidad de vida, neumonía, fatiga, disnea y dolor articular. Objetivo: tener el sustento científico que permita evidenciar la importancia de la fisioterapia respiratoria y sus efectos sobre los pacientes adultos post-COVID-19 de fase aguda. Material y métodos: se hizo una revisión sistemática de la literatura en cuatro bases de datos (Scopus, Web of Science, PubMed y ScienceDirect). La búsqueda fue realizada en febrero de 2021 con un total de 1229 estudios. Finalmente, se incluyeron cinco estudios que cumplieron con los criterios de elegibilidad: dos ensayos clínicos, dos reportes de caso y un estudio transversal. La calidad metodológica de las publicaciones fue evaluada. Resultados: el entrenamiento de la musculatura respiratoria, las respiraciones dirigidas y el fortalecimiento general dan datos significativos en la mejora de la funcionalidad. La evidencia demuestra que hay efectos positivos de la fisioterapia respiratoria en pacientes adultos post-COVID-19, pues aumenta la resistencia al ejercicio, disminuye la fatiga, se reduce la disnea, mejora la funcionalidad y la calidad de vida. Conclusiones: es necesario que se desarrollen más ensayos clínicos aleatorizados y estudios de grupos de menor rango de edad y con enfoques individualizados.


Background: Patients with SARS-CoV-2 present signs and symptoms that primarily involve the respiratory system. The sequelae result in impaired quality of life, pneumonia, dyspnea, fatigue, and joint pain.


Assuntos
Humanos , Masculino , Feminino , Exercícios Respiratórios , Modalidades de Fisioterapia , COVID-19 , Medidas de Volume Pulmonar , Qualidade de Vida , Assistência ao Convalescente , SARS-CoV-2/efeitos dos fármacos , México
10.
Respir Res ; 23(1): 35, 2022 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-35183181

RESUMO

BACKGROUND: Lung inhomogeneity plays a pivotal role in the development of ventilator-induced lung injury (VILI), particularly in the context of pre-existing lung injury. The mechanisms that underlie this interaction are poorly understood. We aimed to elucidate the regional transcriptomic response to mechanical ventilation (MV), with or without pre-existing lung injury, and link this to the regional lung volume response to MV. METHODS: Adult female BALB/c mice were randomly assigned into one of four groups: Saline, MV, lipopolysaccharide (LPS) or LPS/MV. Lung volumes (tidal volume, Vt; end-expiratory volume, EEV) were measured at baseline or after 2 h of ventilation using four-dimensional computed tomography (4DCT). Regional lung tissue samples corresponding to specific imaging regions were analysed for the transcriptome response by RNA-Seq. Bioinformatics analyses were conducted and the regional expression of dysregulated gene clusters was then correlated with the lung volume response. RESULTS: MV in the absence of pre-existing lung injury was associated with regional variations in tidal stretch. The addition of LPS also caused regional increases in EEV. We identified 345, 141 and 184 region-specific differentially expressed genes in response to MV, LPS and LPS/MV, respectively. Amongst these candidate genes, up-regulation of genes related to immune responses were positively correlated with increased regional tidal stretch in the MV group, while dysregulation of genes associated with endothelial barrier related pathways were associated with increased regional EEV and Vt when MV was combined with LPS. Further protein-protein interaction analysis led to the identification of two protein clusters representing the PI3K/Akt and MEK/ERK signalling hubs which may explain the interaction between MV and LPS exposure. CONCLUSION: The biological pathways associated with lung volume inhomogeneity during MV, and MV in the presence of pre-existing inflammation, differed. MV related tidal stretch induced up-regulation of immune response genes, while LPS combined with MV disrupted PI3K/Akt and MEK/ERK signalling.


Assuntos
Lesão Pulmonar/genética , Medidas de Volume Pulmonar/métodos , Respiração Artificial/métodos , Volume de Ventilação Pulmonar/fisiologia , Transcriptoma/genética , Animais , Modelos Animais de Doenças , Feminino , Lesão Pulmonar/fisiopatologia , Lesão Pulmonar/terapia , Camundongos , Camundongos Endogâmicos BALB C , Transdução de Sinais
11.
PLoS One ; 17(2): e0263261, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35113939

RESUMO

PURPOSE: To evaluate the association between the coronavirus disease 2019 (COVID-19) and post-inflammatory emphysematous lung alterations on follow-up low-dose CT scans. METHODS: Consecutive patients with proven COVID-19 infection and a follow-up CT were retrospectively reviewed. The severity of pulmonary involvement was classified as mild, moderate and severe. Total lung volume, emphysema volume and the ratio of emphysema/-to-lung volume were quantified semi-automatically and compared inter-individually between initial and follow-up CT and to a control group of healthy, age- and sex-matched patients. Lung density was further assessed by drawing circular regions of interest (ROIs) into non-affected regions of the upper lobes. RESULTS: A total of 32 individuals (mean age: 64 ± 13 years, 12 females) with at least one follow-up CT (mean: 52 ± 66 days, range: 5-259) were included. In the overall cohort, total lung volume, emphysema volume and the ratio of lung-to-emphysema volume did not differ significantly between the initial and follow-up scans. In the subgroup of COVID-19 patients with > 30 days of follow-up, the emphysema volume was significantly larger as compared to the subgroup with a follow-up < 30 days (p = 0.045). Manually measured single ROIs generally yielded lower attenuation values prior to COVID-19 pneumonia, but the difference was not significant between groups (all p > 0.05). CONCLUSION: COVID-19 patients with a follow-up CT >30 days showed significant emphysematous lung alterations. These findings may help to explain the long-term effect of COVID-19 on pulmonary function and warrant validation by further studies.


Assuntos
COVID-19/complicações , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Doses de Radiação , SARS-CoV-2/genética , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/virologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/fisiopatologia , Estudos Retrospectivos
12.
Sci Rep ; 12(1): 2520, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-35169160

RESUMO

Non-invasive analysis using computed tomography (CT) data may be a promising candidate to evaluate neo-alveolarization in adult lungs following lung resection. This study evaluates and compares the validity of CT analysis with histologic morphometry for compensatory lung growth in a large animal model. We calculated the radiologic tissue volume and the radiologic lung weight from CT data taken at 1, 3, and 6 months post-surgery on 15 male beagle dogs that had a right thoractotomy, bilobectomy, or pneumonectomy (n = 5 in each group). Results were analyzed using one-way ANOVA and were subsequently compared to histologic findings of tissue samples at 6 months post-surgery using Pearson's correlation. An increase in radiologic tissue volume and radiologic lung weight was identified, which was positively correlated with histologic lung parenchymal amounts (correlation coefficient = 0.955 and 0.934, respectively, p < 0.001). Histology of lung specimens at 6 months post-surgery revealed an increase in the tissue amount in both Bilobectomy and Peumonectomy groups, which was consistent with compensatory lung growth. Radiologic tissue volume and radiologic lung weight reflected compensatory lung growth following lung resection. Radiologic assessment using CT data can be a promising clinical modality to evaluate postoperative lung growth.


Assuntos
Regeneração Hepática/fisiologia , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pneumonectomia/métodos , Toracotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Cães , Pulmão/fisiologia , Medidas de Volume Pulmonar/métodos , Masculino , Modelos Animais
14.
Eur Radiol ; 32(6): 4292-4303, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35029730

RESUMO

OBJECTIVES: To compare the lung CT volume (CTvol) and pulmonary function tests in an interstitial lung disease (ILD) population. Then to evaluate the CTvol loss between idiopathic pulmonary fibrosis (IPF) and non-IPF and explore a prognostic value of annual CTvol loss in IPF. METHODS: We conducted in an expert center a retrospective study between 2005 and 2018 on consecutive patients with ILD. CTvol was measured automatically using commercial software based on a deep learning algorithm. In the first group, Spearman correlation coefficients (r) between forced vital capacity (FVC), total lung capacity (TLC), and CTvol were calculated. In a second group, annual CTvol loss was calculated using linear regression analysis and compared with the Mann-Whitney test. In a last group of IPF patients, annual CTvol loss was calculated between baseline and 1-year CTs for investigating with the Youden index a prognostic value of major adverse event at 3 years. Univariate and log-rank tests were calculated. RESULTS: In total, 560 patients (4610 CTs) were analyzed. For 1171 CTs, CTvol was correlated with FVC (r: 0.86) and TLC (r: 0.84) (p < 0.0001). In 408 patients (3332 CT), median annual CTvol loss was 155.7 mL in IPF versus 50.7 mL in non-IPF (p < 0.0001) over 5.03 years. In 73 IPF patients, a relative annual CTvol loss of 7.9% was associated with major adverse events (log-rank, p < 0.0001) in univariate analysis (p < 0.001). CONCLUSIONS: Automated lung CT volume may be an alternative or a complementary biomarker to pulmonary function tests for the assessment of lung volume loss in ILD. KEY POINTS: • There is a good correlation between lung CT volume and forced vital capacity, as well as for with total lung capacity measurements (r of 0.86 and 0.84 respectively, p < 0.0001). • Median annual CT volume loss is significantly higher in patients with idiopathic pulmonary fibrosis than in patients with other fibrotic interstitial lung diseases (155.7 versus 50.7 mL, p < 0.0001). • In idiopathic pulmonary fibrosis, a relative annual CT volume loss higher than 9.4% is associated with a significantly reduced mean survival time at 2.0 years versus 2.8 years (log-rank, p < 0.0001).


Assuntos
Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Medidas de Volume Pulmonar , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital
15.
Trials ; 23(1): 63, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35057852

RESUMO

BACKGROUND: In acute respiratory distress syndrome (ARDS), response to positive end-expiratory pressure (PEEP) is variable according to different degrees of lung recruitability. The search for a tool to individualize PEEP based on patients' individual response is warranted. End-expiratory lung volume (EELV) assessment by nitrogen washing-washout aids bedside estimation of PEEP-induced alveolar recruitment and may therefore help titrate PEEP on patient's individual recruitability. We designed a randomized trial to test whether an individualized PEEP setting protocol driven by EELV measurement may improve a composite clinical outcome in patients with moderate-to-severe ARDS (IPERPEEP trial). METHODS: IPERPEEP is an open-label, multicenter, randomized trial that will be conducted in 10 intensive care units in Italy and will enroll 132 ARDS patients showing PaO2/FiO2 ratio ≤ 150 mmHg within 24 h from endotracheal intubation while on mechanical ventilation with PEEP 5 cmH2O. To standardize lung volumes at study initiation, all patients will undergo mechanical ventilation with tidal volume of 6 ml/kg of predicted body weight and PEEP set to obtain a plateau pressure within 28 and 30 cmH2O for 30 min (EXPRESS PEEP). Afterwards, a 5-step decremental PEEP trial will be conducted (EXPRESS PEEP to PEEP 5 cmH2O), and EELV will be measured at each step. Recruitment-to-inflation ratio will be calculated for each PEEP range from EELV difference. Patients will be then randomized to receive mechanical ventilation with PEEP set according to the optimal recruitment observed in the PEEP trial (IPERPEEP arm) trial or to achieve a plateau pressure of 28-30 cmH2O (control arm, EXPRESS strategy). In both groups, tidal volume size, use of prone positioning and neuromuscular blocking agents, and weaning from PEEP and from mechanical ventilation will be standardized. The primary endpoint of the study is a composite clinical outcome incorporating in-ICU mortality, 60-day ventilator-free days, and serum interleukin-6 concentration over the course of the initial 72 h of treatment. DISCUSSION: The IPERPEEP study is a randomized trial powered to elucidate whether an individualized PEEP setting protocol based on bedside assessment of lung recruitability can improve a composite clinical outcome during moderate-to-severe ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04012073 . Registered 9 July 2019.


Assuntos
Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório , Humanos , Pulmão , Medidas de Volume Pulmonar , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/terapia , Volume de Ventilação Pulmonar
16.
J Speech Lang Hear Res ; 65(2): 525-537, 2022 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-35050707

RESUMO

PURPOSE: The primary purpose of this study was to validate common respiratory calibration methods for estimating lung volume in children. METHOD: Respiratory kinematic data were collected via inductive plethysmography from 81 typically developing children and nine children with neuromotor disorders. Correction factors for the rib cage and abdomen were calculated using three different methods: (a) least squares method with both rib cage and abdomen corrections (LsqRC/AB), (b) least squares method with rib cage correction only (LsqRC), and (c) a standard 2:1 rib-cage-to-abdomen ratio (Banzett). Correction factors for the LsqRC/AB and LsqRC methods were calculated with and without the use of the speech-like breathing calibration task. Lung volume estimation errors were calculated by comparing the estimated lung volumes based on the correction factors and the actual lung volumes acquired from a spirometer, normalized to each participant's vital capacity. RESULTS: For typically developing children, the LsqRC/AB method resulted in significantly smaller lung volume estimation errors compared with other methods. Lung volume estimation errors decreased as age increased for each method. For the children with neuromotor disorders, the LsqRC/AB and LsqRC methods resulted in significantly smaller lung volume estimation errors than the Banzett method but were not significantly different from one another. There were no significant differences in lung volume estimation errors for the LsqRC/AB and LsqRC methods when the correction factors were calculated with and without the speech-like breathing calibration task. CONCLUSION: The LsqRC/AB method exclusively utilizing the rest breathing calibration task is the most accurate and efficient respiratory calibration method for use with children with and without neuromotor disorders at this time.


Assuntos
Pletismografia , Fala , Calibragem , Criança , Humanos , Medidas de Volume Pulmonar , Pletismografia/métodos , Respiração , Volume de Ventilação Pulmonar
17.
Rev Bras Ter Intensiva ; 33(4): 616-623, 2022.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35081246

RESUMO

Manual hyperinflation is used in neonatal and pediatric intensive care units to promote expiratory flow bias, but there is no consensus on the benefits of the technique. Thus, a review that presents supporting evidence is necessary. This study aims to review the literature on the manual hyperinflation maneuver in neonatal and pediatric intensive care units to analyze the evidence for this technique in terms of the forms of application (associated with other techniques or not), its safety, the performance of manual resuscitators and the influence of the physical therapist's experience, in addition to evaluating the methodological quality of the identified articles. A search was performed in the following databases: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL and SciELO. Two researchers independently selected the articles. Duplicate studies were assessed, evaluated by title and abstract and then read in full. The quality of the articles was analyzed using the PEDro scale. Six articles were included, two of which had high methodological quality. The main results provided information on the contribution of the positive end-expiratory pressure valve to increasing lung volumes and the use of chest compressions to optimize expiratory flow bias, the negative influence of operator experience on the increase in peak inspiratory flow, the performance of different manual resuscitators when used with the technique and the safety of application in terms of maintaining hemodynamic stability and increasing peripheral oxygen saturation. The available studies point to a positive effect of the manual hyperinflation maneuver in children who are admitted to intensive care units. Registration PROSPERO: CRD42018108056.


A hiperinsuflação manual é utilizada em unidades de terapia intensiva neonatal e pediátrica para promover um flow bias expiratório, porém não há consenso sobre os benefícios da técnica. Assim faz-se necessária uma revisão que apresente suas evidências. Este estudo objetiva revisar a literatura sobre a manobra de hiperinsuflação manual em unidades de terapia intensiva neonatal e pediátrica, para analisar as evidências dessa técnica em relação às formas de aplicação (associadas ou não a outras técnicas), sua segurança, o desempenho dos ressuscitadores manuais e a influência da experiência do fisioterapeuta, além de avaliar a qualidade metodológica dos artigos encontrados. Realizou-se uma busca nas bases de dados: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL e SciELO. Dois pesquisadores selecionaram os artigos de forma independente. Verificaram-se os estudos duplicados, avaliados por títulos, resumos e, então, leitura na íntegra. Analisou-se a qualidade dos artigos pela escala PEDro. Foram incluídos seis artigos, sendo dois com alta qualidade metodológica. Os principais resultados trouxeram informações sobre a contribuição da válvula de pressão positiva expiratória final no aumento dos volumes pulmonares e a utilização das compressões torácicas para otimizar o flow bias expiratório, a influência negativa da experiência do operador no aumento do pico de fluxo inspiratório, o desempenho de diferentes ressuscitadores manuais durante a realização da técnica e a segurança na aplicação, com manutenção da estabilidade hemodinâmica e aumento da saturação periférica de oxigênio. Os estudos disponíveis apontam para um efeito positivo da manobra de hiperinsuflação manual realizada em crianças internadas em unidades de terapia intensiva. Registro PROSPERO: CRD42018108056.


Assuntos
Respiração Artificial , Criança , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Medidas de Volume Pulmonar , Respiração com Pressão Positiva
18.
Respir Med ; 192: 106713, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35033964

RESUMO

BACKGROUND: Exercise ventilatory limitation conventionally defined by reduced breathing reserve (BR) may underestimate the effect of lung disease on exercise capacity in patients with mild to moderate obstructive lung diseases. OBJECTIVE: To investigate whether ventilatory limitation may be present despite a normal BR in Cystic Fibrosis (CF). METHODS: Twenty adult CF patients (age 16-58y) with a wide range of pulmonary obstruction severity completed a symptom-limited incremental exercise test on a cycle ergometer. Operating lung volumes were derived from inspiratory capacity (IC) measurement during exercise and exercise tidal flow volume loop analysis. RESULTS: six patients had a severe airway obstruction (FEV1<45% predicted) and conventional evidence of ventilatory limitation (low BR). Fourteen patients had mild to moderate-severe airway obstructive (FEV1 46-103% predicted), and a normal BR [12-62 L/min, BR% (17-40)]. However, dynamic respiratory mechanics demonstrated that even CF patients with mild to moderate-severe lung disease had clear evidence of ventilatory limitation during exercise. IC was decreased by (median) 580 ml (range 90-1180 ml) during exercise, indicating dynamic hyperinflation. Inspiratory reserve volume at peak exercise was 445 ml (241-1350 ml) indicating mechanical constraint on the respiratory system. The exercise tidal flow met or exceeded the expiratory boundary of the maximal flow volume loop over 72% of the expiratory volume (range 40-90%), indicating expiratory flow limitation. CONCLUSION: Reduced BR as a sole criterion underestimates ventilatory limitation during exercise in mild to moderate-severe CF patients. Assessment of dynamic respiratory mechanics during exercise revealed ventilatory limitation, present even in patients with mild obstruction.


Assuntos
Fibrose Cística , Adolescente , Adulto , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Exercício Físico , Teste de Esforço , Humanos , Capacidade Inspiratória , Medidas de Volume Pulmonar , Pessoa de Meia-Idade , Adulto Jovem
19.
Medicine (Baltimore) ; 101(4): e28727, 2022 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-35089245

RESUMO

ABSTRACT: Pursed-lip breathing (PLB) and forward trunk lean posture (FTLP) are commonly used to relieve dyspnea and improve ventilation in a rehabilitation program. However, their effect on chest wall volumes and movements in older adults without chronic obstructive pulmonary disease has never been investigated. This observational study aimed to identify the effect of combined PLB and FTLP on total and regional chest wall volumes, ventilatory pattern, and thoracoabdominal movement using in older adults. It was hypothesized that the combined PLB with FTLP would result in the highest chest wall volumes among the experimental tasks. Twenty older adults performed 2 breathing patterns of quiet breathing (QB) and PLB during a seated upright (UP) position and FTLP. An optoelectronic plethysmography system was used to capture the chest wall movements during the 4 experimental tasks. Tidal volume (VT) was separated into pulmonary ribcage, abdominal ribcage, and abdomen volume. The changes in anterior-posterior (AP) and medial-lateral (ML) chest wall diameters at 3 levels were measured and used to identify chest wall mechanics to improve chest wall volumes. The PLB significantly improved ventilation and chest wall volumes than the QB (P < .05). VT of pulmonary ribcage, VT of abdominal ribcage, and VT were significantly higher during the PLB + UP (P < .05) and during the PLB + FTLP (P < .01) as compared to those of QB performed in similar body positions. However, there was no significant in total and regional lung volumes between the PLB + UP and the PLB + FTLP. The AP diameter changes at the angle of Louis and xiphoid levels were greater during the PLB + UP than the QB + UP and the QB + FTLP (P < .01). The AP diameter changes at the umbilical level and the ML diameter changes at the xiphoid level were significantly larger during the PLB + FTLP than the QB + FTLP and the QB + UP (P < .05). The ML diameter changes at the umbilical level were significantly greater during the PLB + FTLP than the QB + UP (P < .05). However, no significant difference in the relative regional chest wall volumes and phase angle among the experimental tasks (P > .05). In conclusion, a combined PLB performed in an FTLP or UP sitting could be used as a strategy to improve chest wall volumes and ventilation in older adults.


Assuntos
Pletismografia/métodos , Postura , Respiração , Mecânica Respiratória , Parede Torácica/fisiologia , Capacidade Pulmonar Total/fisiologia , Idoso , Dispneia , Feminino , Humanos , Lábio , Medidas de Volume Pulmonar , Masculino , Músculos Respiratórios
20.
Eur Radiol ; 32(4): 2650-2660, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34716781

RESUMO

OBJECTIVES: In patients with IPF, this study aimed (i) to examine the relationship between serial change in CT parameters of lung volume and lung function, (ii) to identify the prognostic value of serial change in CT parameters of lung volume, and (iii) to define a threshold for serial change in CT markers of lung volume that optimally captures disease progression. METHODS: Serial CTs were analysed for progressive volume loss or fibrosis progression in 81 IPF patients (66 males, median age = 67 years) with concurrent forced vital capacity (FVC) (median follow-up 12 months, range 6-23 months). Serial CT measurements of volume loss comprised oblique fissure posterior retraction distance (OFPRD), aortosternal distance (ASD), lung height corrected for body habitus (LH), and automated CT-derived total lung volumes (ALV) (measured using commercially available software). Fibrosis progression was scored visually. Serial changes in CT markers and FVC were compared using regression analysis, and evaluated against mortality using Cox proportional hazards. RESULTS: There were 58 deaths (72%, median survival = 17 months). Annual % change in ALV was most significantly related to annual % change in FVC (R2 = 0.26, p < 0.0001). On multivariate analysis, annual % change in ASD predicted mortality (HR = 0.97, p < 0.001), whereas change in FVC did not. A 25% decline in annual % change in ASD best predicted mortality, superior to 10% decline in FVC and fibrosis progression. CONCLUSION: In IPF, serial decline in CT markers of lung volume and, specifically, annualised 25% reduction in aortosternal distance provides evidence of disease progression, not always identified by FVC trends or changes in fibrosis extent. KEY POINTS: • Serial decline in automated and surrogate markers of lung volume on CT corresponds to changes in FVC. • Annualised reductions in the distance between ascending aorta and posterior border of the sternum on CT predict mortality beyond annualised percentage change in FVC.


Assuntos
Fibrose Pulmonar Idiopática , Pré-Escolar , Progressão da Doença , Humanos , Lactente , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar , Masculino , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital
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