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Critical Care Clinics Oct 2021The optimal fluid management for acute respiratory distress syndrome (ARDS) remains unknown. Liberal fluid management may improve cardiac function and end-organ... (Review)
Review
The optimal fluid management for acute respiratory distress syndrome (ARDS) remains unknown. Liberal fluid management may improve cardiac function and end-organ perfusion, but may lead to increased pulmonary edema and inhibit gas exchange. Trials suggest that conservative fluid management leads to better clinical outcomes, although prospective randomized, controlled trials have not demonstrated mortality benefit. Recent discoveries suggest there is large heterogeneity in ARDS, and varying phenotypes of ARDS respond differently to fluid treatments. Future advances in management will require real-time assignment of ARDS phenotypes, which may facilitate inclusion into clinical trials by ARDS phenotype and guide development of targeted therapies.
Topics: Fluid Therapy; Humans; Prospective Studies; Pulmonary Edema; Respiratory Distress Syndrome
PubMed: 34548138
DOI: 10.1016/j.ccc.2021.05.012 -
The Nurse Practitioner Apr 2020Although acute respiratory distress syndrome is the most common cause of noncardiogenic pulmonary edema, NPs also should be familiar with several other less common...
Although acute respiratory distress syndrome is the most common cause of noncardiogenic pulmonary edema, NPs also should be familiar with several other less common causes, including transfusion-related acute lung injury, neurogenic pulmonary edema, preeclampsia/eclampsia, opioid overdose, high-altitude pulmonary edema, and pulmonary embolism. This article addresses the pathophysiology, clinical presentation, diagnostics, treatment, and nursing considerations associated with each uncommon cause of noncardiogenic pulmonary edema.
Topics: Heart Diseases; Humans; Nurse Practitioners; Nursing Diagnosis; Pulmonary Edema
PubMed: 32205671
DOI: 10.1097/01.NPR.0000657300.99895.45 -
PLoS Neglected Tropical Diseases Apr 2023Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains...
BACKGROUND
Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains the main reason for mortalities associated with scorpion envenomation. The present review aims to elucidate clinical and paraclinical findings associated with scorpion-related myocarditis, and to explore different management strategies and subsequent outcomes.
METHODS
We searched PubMed, Web of Science, Scopus, and Google Scholar for articles related to keywords of myocarditis associated with scorpion envenomation up to May 1, 2022. Each article was carefully reviewed by two independent researchers. In case of disagreement for inclusion, we sought a third researcher opinion.
RESULTS
A total of 703 cases from 30 case reports and 34 case series were included in our review. Myocarditis associated with scorpion envenomation was usually reported in children presenting with cardiopulmonary symptoms including pulmonary edema (60.7%) and shock or hypotension (45.8%). The most common ECG findings are sinus tachycardia (82%) followed by ST-T changes (64.6%). The management typically included inotropes (especially dobutamine), prazosin, diuretics, nitroglycerine and digoxin, when indicated. Mechanical ventilation was required in 36.7% of the patients. Mortality in confirmed scorpion-related myocarditis cases is estimated at 7.3%. Almost all survived cases showed rapid recovery and improvement in the left ventricular function.
CONCLUSION
Even though myocarditis associated with scorpion envenomation is rare, it remains a serious and in some of cases a fatal consequence of scorpion sting. In case of relative presentations, particularly in envenomed children, diagnosis of myocarditis should be considered. Early screening using serial cardiac markers and echocardiography can guide the treatment. Prompt treatment that focuses on cardiogenic shock and pulmonary edema usually results in a favorable outcome.
Topics: Child; Humans; Animals; Scorpion Stings; Myocarditis; Pulmonary Edema; Dobutamine; Respiration, Artificial; Scorpions
PubMed: 37018229
DOI: 10.1371/journal.pntd.0011219 -
Drug and Chemical Toxicology Nov 2023We aimed to observe the possible effects of melatonin (MLT) deprivation (pinealectomy) and exogenous MLT administration on pulmonary edema induced by...
We aimed to observe the possible effects of melatonin (MLT) deprivation (pinealectomy) and exogenous MLT administration on pulmonary edema induced by alpha-naphthylthiourea (ANTU), a toxic chemical agent, in rats. Seventy animals were assigned to seven groups: control, sham pinealectomy (PINX), PINX, ANTU (10 mg/kg intraperitoneal on day 30), ANTU + MLT (10 mg/kg/day i.p. for 30 days), ANTU + PINX, and ANTU + PINX + MLT.In this study, pleural effusion (PE) formation, lung weight/body weight (LW/BW) and PE/BW ratios (fluid accumulation and weight values in the lungs) increase detected. Pre-ANTU MLT administration led to significant decreases in PE, LW/BW, and PE/BW levels. The inhibited glutathione (GSH) and superoxide dismutase (SOD) levels and high malondialdehyde (MDA) levels that ANTU increase lipid peroxidation in the study. MLT administration eliminated oxidative stress by reducing MDA and ameliorating GSH and SOD levels.Pre-ANTU MLT administration led to a significant decrease in interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels in the lung when compared to the ANTU group without MLT administration. Post-pinealectomy ANTU administration significantly increased IL-1β and TNF-α levels when compared to ANTU and MLT administration without pinealectomy. Diffused inflammatory cell infiltration, interstitial pulmonary edema, and histopathological congestion were observed after the administration of ANTU. Severity of the damage was elevated in the ANTU + PINX group. MLT treatment regressed pulmonary effusion and edema and improves lung structure. In brief, the findings suggested that MLT inhibited proinflammatory mediators and could serve as a therapeutic agent to prevent inflammatory disorders.
Topics: Rats; Animals; Pulmonary Edema; Melatonin; Pinealectomy; Tumor Necrosis Factor-alpha; Thiourea
PubMed: 36069203
DOI: 10.1080/01480545.2022.2119994 -
Journal of Cardiothoracic and Vascular... Aug 2017Tissue edema, in particular pulmonary edema, increasingly is recognized as a perioperative complication affecting outcome. Management strategies directed at avoiding... (Review)
Review
Tissue edema, in particular pulmonary edema, increasingly is recognized as a perioperative complication affecting outcome. Management strategies directed at avoiding excessive fluid administration, reducing inflammatory response, and decreasing capillary permeability commonly are advocated in perioperative care protocols. In this review, transpulmonary thermodilution (TPTD) as a bedside tool to quantitatively monitor lung water accumulation and optimize fluid therapy is examined. Furthermore, the roles of TPTD as an early detector of fluid accumulation before the development of overt pulmonary edema and in risk stratification are explored. In addition, the ability of TPTD to provide insight into the etiology of pulmonary edema, specifically differentiating hydrostatic versus increased pulmonary capillary permeability, is emerging as an aid in therapeutic decision-making. The combination of hemodynamic and lung water data afforded by TPTD offers unique benefits for the care of high-risk perioperative patients.
Topics: Extravascular Lung Water; Fluid Therapy; Humans; Postoperative Complications; Pulmonary Edema; Thermodilution
PubMed: 28465120
DOI: 10.1053/j.jvca.2017.02.018 -
Heart Failure Clinics Jul 2020Noninvasive positive pressure ventilation (NIPPV), which can be applied without endotracheal airway or tracheostomy, has been used as the first-line device for patients... (Review)
Review
Noninvasive positive pressure ventilation (NIPPV), which can be applied without endotracheal airway or tracheostomy, has been used as the first-line device for patients with acute decompensated heart failure (ADHF) and cardiogenic pulmonary edema. Positive airway pressure (PAP) devices include continuous PAP, bilevel PAP, and adaptive servoventilation. NIPPV can provide favorable physiologic benefits, including improving oxygenation, respiratory mechanics, and pulmonary and systemic hemodynamics. It can also reduce the intubation rate and improve clinical symptoms, resulting in good quality of life and mortality.
Topics: Acute Disease; Heart Failure; Humans; Noninvasive Ventilation; Positive-Pressure Respiration; Pulmonary Edema; Treatment Outcome
PubMed: 32503751
DOI: 10.1016/j.hfc.2020.02.005 -
Hawai'i Journal of Health & Social... Mar 2022Causes of the extraordinarily high and increasing incidence of snorkeler drownings in Hawai'i have remained unexplained for years. Defining the mechanisms and factors...
Causes of the extraordinarily high and increasing incidence of snorkeler drownings in Hawai'i have remained unexplained for years. Defining the mechanisms and factors predisposing to drowning while snorkeling is needed to provide recommendations to substantially mitigate the incidence of this form of preventable death. The mechanisms of drowning are described and insight into the predisposing factors are explored in this study. Methods included measuring snorkel airway resistance characteristics, case reports from the State of Hawai'i Medical Examiner's office, and collating information by survey, principally from rescued survivors. This study identified 2 modes of drowning while snorkeling that need further investigation: accidental or inadvertent aspiration, and hypoxia resulting from acute negative pressure pulmonary edema. The incidence of drowning from mechanisms of hypoxia due to rapid onset pulmonary edema is an important focus of the study and a number of potentially significant predisposing factors are presented that need further investigation but provide bases that may become part of updated policies and practices for snorkelers to substantially lower the risk of death. This report is meant for both medical and public health information purposes.
Topics: Drowning; Hawaii; Humans; Hypoxia; Incidence; Pulmonary Edema
PubMed: 35261987
DOI: No ID Found -
Pediatrics and Neonatology Jul 2022
Topics: Electric Impedance; Hemorrhage; Humans; Pulmonary Edema; Tomography; Tomography, X-Ray Computed
PubMed: 35093298
DOI: 10.1016/j.pedneo.2021.12.003 -
British Journal of Sports Medicine Nov 2016Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The... (Review)
Review
BACKGROUND
Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The potential causal mechanism for swimming-related death is unclear.
OBJECTIVE
To examine available studies on the hypothesised mechanisms of swimming-related death to determine the most likely aetiologies.
MATERIAL AND METHODS
MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (1950 to present) were searched, yielding 1950 potential results, which after title and citation reviews were reduced to 83 possible reports. Studies included discussed mechanisms of death during swimming in humans, and were Level 4 evidence or higher.
RESULTS
A total of 17 studies (366 total swimmers) were included for further analysis: 5 investigating hyperthermia/hypothermia, 7 examining cardiac mechanisms and responses, and 5 determining the presence of pulmonary edema. The studies provide inconsistent and limited-quality or disease-oriented evidence that make definitive conclusions difficult.
CONCLUSIONS
The available evidence is limited but may suggest that cardiac arrhythmias are the most likely aetiology of swimming-related death. While symptoms of pulmonary edema may occur during swimming, current evidence does not support swimming-induced pulmonary edema as a frequent cause of swimming-related death, nor is there evidence to link hypothermia or hyperthermia as a causal mechanism. Further higher level studies are needed.
Topics: Arrhythmias, Cardiac; Cause of Death; Humans; Pulmonary Edema; Swimming
PubMed: 26941276
DOI: 10.1136/bjsports-2015-094722 -
Soins. Gerontologie 2016
Topics: Aged; Heart Failure; Humans; Pulmonary Edema
PubMed: 27842653
DOI: 10.1016/j.sger.2016.09.012