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1.
Medicine (Baltimore) ; 99(24): e20578, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541486

RESUMO

RATIONALE: Polydimethylsiloxane, commonly referred as silicone, is an inert liquid compound used in esthetic procedures due to its durability and thermal stability, yet the application of non-pure silicone generates risks. One of the complications is systemic embolism syndrome which is presents with fever, hypoxemia, and progression to respiratory failure, diffuse alveolar damage and alveolar hemorrhage, as well as neurological alterations in one-third of the cases. Management is strictly supportive. We present the case of acute pneumonitis with alveolar hemorrhage after silicone injection. PATIENT CONCERNS: 25-year-old transsexual man, who consulted 48 hours after liquid silicone injection in the buttocks and trochanteric area, with progressive dyspnea and chest tightness, with rapid progression to respiratory failure. DIAGNOSIS: Clinical diagnosis of silicone embolism was made. Chest x-ray and CT angiography showed diffuse alveolar infiltrates and pleural effusion without evidence of acute venous thromboembolism. Bronchoscopy plus bronchoalveolar lavage showed hemorrhagic fluid, 60% macrophages with hemosiderin in cytology and negative cultures. INTERVENTION: Sedation, relaxation, pronation, and protective ventilation were implemented until hemodynamic stabilization; as well as IV steroids and antibiotics. OUTCOMES: Clinical progress was slow towards improvement with resolution of radiological or physical abnormalities. Despite severity, the patient improved satisfactorily without late sequelae. LESSONS: Silicone injection can trigger phenomena similar to that seen in fat embolism causing inflammation and immune response activation that lead to alveolar hemorrhage, diffuse alveolar damage, and acute respiratory distress syndrome. We reported pulmonary complications related to the illegal use of injected silicone for esthetic procedures.


Assuntos
Embolia/induzido quimicamente , Pneumonia/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/etiologia , Procedimentos de Readequação Sexual/efeitos adversos , Silicones/efeitos adversos , Adulto , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pneumonia/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Pessoas Transgênero
2.
Crit Care ; 24(1): 198, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375845

RESUMO

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8-12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.


Assuntos
Lesão Pulmonar Aguda/diagnóstico por imagem , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/terapia , Lesão Pulmonar Aguda/epidemiologia , Lesão Pulmonar Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Creatina Quinase/sangue , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Radiografia , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/classificação , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Índice de Gravidade de Doença , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(19): e20207, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384516

RESUMO

RATIONALE: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. PATIENT CONCERNS: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. DIAGNOSIS: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral ground-glass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. INTERVENTIONS: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. OUTCOMES: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. LESSONS: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Idoso , Alanina/análogos & derivados , Alanina/uso terapêutico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Evolução Fatal , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem
4.
Nuklearmedizin ; 59(3): 276-280, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32259853

RESUMO

The current outbreak of coronavirus SARS-CoV-2 has reached multiple countries worldwide. While the number of newly diagnosed cases and fatalities is rising quickly, far-reaching measures were enacted to prevent further spread. Diagnosis relies on clinical presentation, exposure history, PCR using specimens from the respiratory tract together with computed tomography (CT) imaging. One of the hallmarks of a critical course of COVID-19 is the development of severe acute respiratory distress syndrome (ARDS). As management of COVID-19 can be considered a multi-disciplinary approach involving various medical specialties, we here review the first 18F-FDG-PET/CT scans of COVID-19 to discuss how Nuclear Medicine could contribute to management of this disease.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Fluordesoxiglucose F18/farmacologia , Medicina Nuclear/métodos , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Betacoronavirus , Surtos de Doenças , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Medicina Nuclear/tendências , Pandemias , Reação em Cadeia da Polimerase
5.
Mycoses ; 63(6): 528-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32339350

RESUMO

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Aspergilose Pulmonar/complicações , Síndrome do Desconforto Respiratório do Adulto/complicações , Idoso , Antifúngicos/uso terapêutico , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/virologia , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Alemanha , Hemorragia/etiologia , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Pneumopatias/etiologia , Masculino , Mananas/análise , Metapneumovirus/isolamento & purificação , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Pandemias , Infecções por Paramyxoviridae/etiologia , Pneumonia Viral/diagnóstico por imagem , Aspergilose Pulmonar/diagnóstico por imagem , Piridinas/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico , Voriconazol/uso terapêutico
6.
Int J Infect Dis ; 93: 192-197, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32112966

RESUMO

INTRODUCTION: Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. OBJECTIVE: We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). RESULTS: Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. CONCLUSIONS: Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Betacoronavirus/isolamento & purificação , China , Progressão da Doença , Humanos , Itália , Pulmão/patologia , Coronavírus da Síndrome Respiratória do Oriente Médio , Pandemias , Síndrome do Desconforto Respiratório do Adulto/virologia , Vírus da SARS
7.
Br J Anaesth ; 124(3): 345-353, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31952649

RESUMO

BACKGROUND: Bedside lung volume measurement could personalise ventilation and reduce driving pressure in patients with acute respiratory distress syndrome (ARDS). We investigated a modified gas-dilution method, the inspired sinewave technique (IST), to measure the effective lung volume (ELV) in pigs with uninjured lungs and in an ARDS model. METHODS: Anaesthetised mechanically ventilated pigs were studied before and after surfactant depletion by saline lavage. Changes in PEEP were used to change ELV. Paired measurements of absolute ELV were taken with IST (ELVIST) and compared with gold-standard measures (sulphur hexafluoride wash in/washout [ELVSF6] and computed tomography (CT) [ELVCT]). Measured volumes were used to calculate changes in ELV (ΔELV) between PEEP levels for each method (ΔELVIST, ΔELVSF6, and ΔELVCT). RESULTS: The coefficient of variation was <5% for repeated ELVIST measurements (n=13 pigs). There was a strong linear relationship between ELVIST and ELVSF6 in uninjured lungs (r2=0.97), and with both ELVSF6 and ELVCT in the ARDS model (r2=0.87 and 0.92, respectively). ELVIST had a mean bias of -12 to 13% (95% limits=±17 - 25%) compared with ELVSF6 and ELVCT. ΔELVIST was concordant with ΔELVSF6 and ΔELVCT in 98-100% of measurements, and had a mean bias of -73 to -77 ml (95% limits=±128 - 186 ml) compared with ΔELVSF6 and -1 ml (95% limits ±333 ml) compared with ΔELVCT. CONCLUSIONS: IST provides a repeatable measure of absolute ELV and shows minimal bias when tracking PEEP-induced changes in lung volume compared with CT in a saline-lavage model of ARDS.


Assuntos
Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Animais , Modelos Animais de Doenças , Medidas de Volume Pulmonar/métodos , Testes Imediatos , Reprodutibilidade dos Testes , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Solução Salina , Sus scrofa , Tomografia Computadorizada por Raios X
8.
Eur J Radiol ; 122: 108748, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31775082

RESUMO

PURPOSE: Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury that frequently shows fatal outcomes. As radiographic predictive factors, some reports have focused on the region of ill-aerated lung, but none have focused on well-aerated lung. Our objective was to evaluate the relationship between computed tomography (CT) volume of the well-aerated lung region and prognosis in patients with ARDS. METHOD: This retrospective observational study of a single intensive care unit (ICU) included patients with ARDS treated between April 2011 and May 2013. We identified 42 patients with ARDS for whom adequate helical CT scans were available. CT images were analyzed for 3-dimensional reconstruction, and lung region volumes were measured using automated volumetry methods. Lung regions were identified by CT attenuation in Hounsfield units (HU). RESULTS: Of the 42 patients, 35 (83.3 %) survived 28 days and 32 (76.2 %) survived to ICU discharge. CT lung volumetry was performed within 144.5 ±â€¯76.6 s, and inter-rater reliability of CT lung volumetry for lung regions below -500 HU (well-aerated lung region) were near-perfect. Well-aerated lung region showed a positive correlation with 28-day survival (P = 0.020), and lung volumes below -900 HU correlated positively with 28-day survival and ICU survival, respectively (P = 0.028, 0.017). Survival outcome was better for percentage of well-aerated lung region/predicted total lung capacity ≥40 % than for <40 % (P = 0.039). CONCLUSIONS: CT lung volumetry of the well-aerated lung region using an automated method allows fast, reliable quantitative CT analysis and potentially prediction of the clinical course in patients with ARDS.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Feminino , Humanos , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume de Ventilação Pulmonar/fisiologia , Capacidade Pulmonar Total
9.
Radiol Clin North Am ; 58(1): 119-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731896

RESUMO

There is a wide variety of causes of diffuse lung disease in the intensive care unit patient, of which adult respiratory distress syndrome is the commonest clinical consideration. Plain radiography, computed tomography, and ultrasound can be used synergistically to evaluate patients with diffuse lung disease and respiratory impairment. Imaging is not limited to characterization of the cause of diffuse lung disease but also aids in monitoring its evolution and in ventilator setting management.


Assuntos
Cuidados Críticos/métodos , Diagnóstico por Imagem/métodos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Pneumonia Associada à Ventilação Mecânica/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva , Pulmão/diagnóstico por imagem
12.
Respir Res ; 20(1): 218, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606045

RESUMO

BACKGROUND: Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis. METHODS: All individuals enrolled in the Registry of Critical Illness at Brigham and Women's Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient's CXR was assigned an opacification score of 0-4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score's association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively. RESULTS: A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05-1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07-1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04-1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02-1.07, p < 0.001). CONCLUSIONS: Higher values on a simple visual score of a patient's CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.


Assuntos
Estado Terminal , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tórax/diagnóstico por imagem , APACHE , Adulto , Idoso , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/terapia , Estudos Retrospectivos , Resultado do Tratamento
13.
Contrast Media Mol Imaging ; 2019: 1510507, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531003

RESUMO

In recent years, imaging has given a fundamental contribution to our understanding of the pathophysiology of acute lung diseases. Several methods have been developed based on computed tomography (CT), positron emission tomography (PET), and magnetic resonance (MR) imaging that allow regional, in vivo measurement of variables such as lung strain, alveolar size, metabolic activity of inflammatory cells, ventilation, and perfusion. Because several of these methods are noninvasive, they can be successfully translated from animal models to patients. The aim of this paper is to review the advances in knowledge that have been accrued with these imaging modalities on the pathophysiology of acute respiratory distress syndrome (ARDS), ventilator-induced lung injury (VILI), asthma and chronic obstructive pulmonary disease (COPD).


Assuntos
Pneumopatias/diagnóstico por imagem , Imagem Molecular/métodos , Doença Aguda , Animais , Asma/diagnóstico por imagem , Humanos , Pneumopatias/patologia , Pneumopatias/fisiopatologia , Imagem por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Lesão Pulmonar Induzida por Ventilação Mecânica/diagnóstico por imagem
14.
Crit Care Nurs Q ; 42(4): 349-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449145

RESUMO

Acute respiratory distress syndrome (ARDS) is a disease associated with both short- and long-term complications. Acute complications include refractory respiratory failure requiring prolonged dependence on mechanical ventilation and the subsequent need for tracheostomy and gastrostomy tubes, protracted immobilization, and lengthy stays in the intensive care unit resulting in delirium, critical illness myopathy, and polyneuropathy, as well as secondary nosocomial infections. Chronic adverse outcomes of ARDS include irreversible changes such as fibrosis, tracheal stenosis from prolonged tracheostomy tube placement, pulmonary function decline, cognitive impairment and memory loss, posttraumatic stress disorder, depression, anxiety, muscle weakness, ambulatory dysfunction, and an overall poor quality of life. The degree of disability in ARDS survivors is heterogeneous and can be evident even years after hospitalization. Although survival rates have improved over the past 4 decades, mortality remains significant with rates reported as high as 40%. Despite advancements in management, the causes of death in ARDS have remained relatively unchanged since the 1980s with sepsis/septic shock and multiorgan failure at the top of the list.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Disfunção Cognitiva/etiologia , Enfermagem de Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Choque Séptico/mortalidade
15.
Am J Med Sci ; 358(2): 159-163, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331453

RESUMO

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for perioperative complications. The frequency of complications depends on the severity of COPD, the type of anesthesia used, the surgical site, and other comorbidities. Patients undergoing upper abdominal surgery have significant changes in lung volumes, likely secondary to changes in diaphragm function and abdominal pain, and these changes increase the risk for complications, including acute respiratory failure, atelectasis, pneumonia and unplanned reintubation. We discuss a patient with COPD who did well for the first 3 days following an open incisional hernia repair. However, on the fourth day he noted significant dyspnea and radiographic studies revealed atelectasis. Over the next week the patient remained symptomatic and dependent on noninvasive ventilation; he eventually had a rapid response to corticosteroids. This case indicates that atelectasis can develop late following a surgical procedure and that multiple factors potentially influence development of this complication.


Assuntos
Herniorrafia , Complicações Pós-Operatórias/etiologia , Atelectasia Pulmonar/etiologia , Doença Pulmonar Obstrutiva Crônica/cirurgia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Idoso , Humanos , Masculino , Respiração com Pressão Positiva , Complicações Pós-Operatórias/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Testes de Função Respiratória , Fatores de Risco , Fatores de Tempo , Raios X
16.
Medicine (Baltimore) ; 98(29): e16531, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335733

RESUMO

BACKGROUND: To identify the clinical correlations between mechanical power and transforming growth factor-ß1 (TGF-ß1) and connective tissue growth factor (CTGF) in acute respiratory distress syndrome (ARDS) patients, their clinical significance in pulmonary structural remodeling in ARDS patients was investigated. METHODS: Ninety-five patients with moderate or severe ARDS, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from January 2017 to February 2019. Their mechanical power was monitored and recorded, the TGF-ß1 and CTGF levels were detected by enzyme-linked immunosorbent assay (ELISA), their relevance was analyzed, and the relationship between mechanical power and 28-day survival rate was investigated. According to the high-resolution computed tomography (HRCT) examination, the patients were divided into an ARDS group and an ARDS pulmonary fibrosis (ARDS-PF) group. The differences in mechanical power, TGF-ß1, and CTGF between the 2 groups were compared, and the significance of TGF-ß1 and CTGF in the diagnosis of ARDS pulmonary interstitial fibrosis were evaluated. RESULTS: A significant positive correlation between mechanical power and serum TGF-ß1 and CTGF in patients with ARDS was found and the correlation coefficients were 0.424 and 0.581, respectively. The difference between mechanical power and 28-day survival rate was statistically significant (P < .05), while the area under the receiver operating characteristic curves of TGF-ß1 and CTGF for the diagnosis of ARDS pulmonary fibrosis was 0.838 and 0.884, respectively (P < .05). CONCLUSION: A significant correlation between mechanical power and serum fibrosis biomarkers TGF-ß1 and CTGF in ARDS patients was found, and its level was related to the survival prognosis of patients. Mechanical power, TGF-ß1, and CTGF were clinically evaluated for the assessment of lung structural remodeling, such as ARDS pulmonary fibrosis. This study has particular significance to the early prevention of ventilator-induced lung injury and pulmonary fibrosis in patients with ARDS receiving mechanical ventilation.


Assuntos
Fator de Crescimento do Tecido Conjuntivo/sangue , Fibrose Pulmonar/diagnóstico , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/terapia , Fator de Crescimento Transformador beta1/sangue , Ensaio de Imunoadsorção Enzimática , Humanos , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/patologia , Tomografia Computadorizada por Raios X , Lesão Pulmonar Induzida por Ventilação Mecânica/diagnóstico
17.
Indian J Tuberc ; 66(2): 314-317, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31151503

RESUMO

Tuberculosis and sarcoidosis are chronic multisystem granulomatous conditions which have different aetiology and management but may mimic each other clinically, radiologically and pathologically. Both these diseases usually have a sub acute or chronic presentation and it is rather uncommon for them to coexist or present with acute respiratory failure. We report a case of a 57-year-old male who presented with pyrexia of unknown origin with chronic cough. He was initially diagnosed to have sarcoidosis based on clinico-radiological and histologic evidence and was started on corticosteroids. However, he presented within two weeks with acute respiratory distress and on further investigation was diagnosed with co-existing pulmonary tuberculosis.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Sarcoidose/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem
18.
Crit Care Med ; 47(6): 792-799, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30908313

RESUMO

OBJECTIVES: Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). Aim of this study was to evaluate in a large database of acute respiratory distress syndrome patients, the pulmonary versus extrapulmonary form in terms of respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. DESIGN: A secondary analysis of previously published data. PATIENTS: One-hundred eighty-one sedated and paralyzed acute respiratory distress syndrome patients (age 60 yr [46-72 yr], body mass index 25 kg/m [22-28 kg/m], and PaO2/FIO2 184 ± 66). INTERVENTIONS: Lung CT scan performed at 5 and 45 cm H2O. Two levels of positive end-expiratory pressure (5 and 15 cm H2O) were randomly applied. MEASUREMENTS AND MAIN RESULTS: Ninety-seven and 84 patients had a pulmonary and extrapulmonary acute respiratory distress syndrome. The median time from intensive care admission to the CT scan and respiratory mechanics analysis was 4 days (interquartile range, 2-6). At both positive end-expiratory pressure levels, pulmonary acute respiratory distress syndrome presented a significantly lower PaO2/FIO2 and higher physiologic dead space compared with extrapulmonary acute respiratory distress syndrome. The lung and chest wall elastance were similar between groups. The intra-abdominal pressure was significantly higher in extrapulmonary compared with pulmonary acute respiratory distress syndrome (10 mm Hg [7-12 mm Hg] vs 7 mm Hg [5-8 mm Hg]). The lung weight and lung recruitability were significantly higher in pulmonary acute respiratory distress syndrome (1,534 g [1,286-1,835 g] vs 1,342 g [1,090-1,507 g] and 16% [9-25%] vs 9% [5-14%]). CONCLUSIONS: In the early stage, pulmonary acute respiratory distress syndrome is characterized by a greater impairment of gas exchange and higher lung recruitability. The recognition of the origin of acute respiratory distress syndrome is important for a more customized ventilatory management.


Assuntos
Pulmão/fisiopatologia , Troca Gasosa Pulmonar , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Mecânica Respiratória , Idoso , Feminino , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Pressão , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/complicações , Síndrome do Desconforto Respiratório do Adulto/terapia , Tomografia Computadorizada por Raios X
19.
BMJ Open Respir Res ; 6(1): e000308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30713713

RESUMO

Introduction: Bone marrow-derived multipotent adult progenitor cells (MAPCs) are adult allogeneic adherent stem cells currently investigated clinically for use in acute respiratory distress syndrome (ARDS). To date, there is no agreement on which is the best method for stem cells delivery in ARDS. Here, we compared the efficacy of two different methods of administration and biodistribution of MAPC for the treatment of ARDS in a sheep model. Methods: MAPC were labelled with [18F] fluoro-29-deoxy-D-glucose and delivered by endobronchial (EB) or intravenous route 1 hour after lipopolysaccharide infusion in sheep mechanically ventilated. PET/CT images were acquired to determine the biodistribution and retention of the cells at 1 and 5 hours of administration. Results: The distribution and retention of the MAPC was dependent on the method of cell administration. By EB route, PET images showed that MAPC remained at the site of administration and no changes were observed after 5 hours, whereas with intravenous route, the cells had broad biodistribution to different organs, being the lung the main organ of retention at 1 and 5 hours. MAPC demonstrated an equal effect on arterial oxygenation recovery by either route of administration. Conclusion: The EB or intravenous routes of administration of MAPC are both effective for the treatment of ARDS in an acute sheep model, and the effect of MAPC therapy is not dependent of parenchymal integration or systemic biodistribution.


Assuntos
Células-Tronco Adultas/transplante , Células-Tronco Multipotentes/transplante , Síndrome do Desconforto Respiratório do Adulto/terapia , Animais , Brônquios , Células Cultivadas , Modelos Animais de Doenças , Feminino , Humanos , Infusões Intravenosas , Lipopolissacarídeos/imunologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Cultura Primária de Células , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/imunologia , Ovinos , Resultado do Tratamento
20.
Anesthesiology ; 131(3): 716-749, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30664057

RESUMO

Acute respiratory distress syndrome (ARDS) consists of acute hypoxemic respiratory failure characterized by massive and heterogeneously distributed loss of lung aeration caused by diffuse inflammation and edema present in interstitial and alveolar spaces. It is defined by consensus criteria, which include diffuse infiltrates on chest imaging-either plain radiography or computed tomography. This review will summarize how imaging sciences can inform modern respiratory management of ARDS and continue to increase the understanding of the acutely injured lung. This review also describes newer imaging methodologies that are likely to inform future clinical decision-making and potentially improve outcome. For each imaging modality, this review systematically describes the underlying principles, technology involved, measurements obtained, insights gained by the technique, emerging approaches, limitations, and future developments. Finally, integrated approaches are considered whereby multimodal imaging may impact management of ARDS.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia
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