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Tidsskrift For Den Norske Laegeforening... Jun 2018
Topics: Aged; Bronchoscopy; Foreign-Body Migration; Humans; Male; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 29893103
DOI: 10.4045/tidsskr.17.1025 -
Thoracic Cancer Feb 2022Clinically, some specific pulmonary nodules have safe resection margins that are located in multiple subsegments in the center of lung lobe. It is therefore difficult to...
BACKGROUND
Clinically, some specific pulmonary nodules have safe resection margins that are located in multiple subsegments in the center of lung lobe. It is therefore difficult to ensure the resection margins through conventional combined subsegmentectomy or wedge resection, and thus lobectomy is required. For these types of pulmonary nodules, "split" operation was performed to fully inflate the reserved lung tissues on both sides. This study aimed to preliminarily assess the feasibility and safety of "split" operation.
METHODS
Cases with these types of pulmonary nodules were selected. Some of the cases were subjected to "split" operation and the operation conditions, including operation time, bleeding amount, length of hospital stay, computed tomography (CT) reexaminations, and pulmonary function, were analyzed.
RESULTS
The "split" operation was performed and successfully completed for seven patients. There was no case of conversion to thoracotomy and the median operation time, bleeding amount, and length of hospital stay were 219 min, 30.0 ml, and 4 days, respectively. No death or pulmonary complications such as pulmonary infection, lung torsion, and bronchopleural fistula occurred, and only one patient had incision fat liquefaction. After 3 months, the median percentage of preserved pulmonary function was 85.8% and a CT scan showed that the reserved lung tissues of the seven patients were well inflated and without obvious imaging findings of atelectasis.
CONCLUSION
"Split" combined subsegmentectomy can be used as a new and safe operative method for deep pulmonary nodules with safe resection margins involving multiple subsegments in the center of the lung lobe.
Topics: Humans; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Pulmonary Atelectasis; Retrospective Studies; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Torsion Abnormality
PubMed: 34907669
DOI: 10.1111/1759-7714.14275 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2019
Topics: Artifacts; Child; Conscious Sedation; Humans; Image Enhancement; Lung; Lung Diseases; Magnetic Resonance Imaging; Patient Positioning; Pulmonary Atelectasis; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 31430776
DOI: 10.1055/a-0943-1168 -
BioMed Research International 2015Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this... (Review)
Review
Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this scenario by applying increased airway pressures for a short period of time which meant to open the collapsed alveoli. Although the procedure can improve oxygenation, but due to the heart-lung and right and left ventricle interactions elevated intrathoracic pressures can inflict serious effects on the cardiovascular system. The purpose of this paper is to give an overview on the pathophysiological background of the heart-lung interactions and the best way to monitor these changes during lung recruitment.
Topics: Animals; Heart; Hemodynamics; Humans; Positive-Pressure Respiration; Pulmonary Alveoli; Pulmonary Atelectasis; Respiration
PubMed: 26682219
DOI: 10.1155/2015/478970 -
Therapeutic Advances in Chronic Disease 2022Misdiagnosis and underdiagnosis of pulmonary hypertension caused by fibrosing mediastinitis (PH-FM) are considerably prevalent due to unspecific symptoms and as well as...
BACKGROUND
Misdiagnosis and underdiagnosis of pulmonary hypertension caused by fibrosing mediastinitis (PH-FM) are considerably prevalent due to unspecific symptoms and as well as the lack of awareness of this fatal disease.
OBJECTIVES
The aim of this study was to evaluate the diagnostic accuracy of the chest X-ray (CXR) for screening the patients with PH-FM from those with pulmonary hypertension (PH).
DESIGN
This was a retrospective observational cohort study.
METHODS
The patients with suspected PH were recruited between October 2014 and October 2020. All the clinical data and CXR findings were collected. The sensitivity, specificity, and likelihood ratio of the CXR features were calculated. Logistic regression was used to identify the factors associated with the CXR characteristics and FM and to generate a prediction model. Finally, the diagnostic efficiency of the prediction model was evaluated using nomogram and internal validation.
RESULTS
The patients with PH-FM ( = 36) and PH caused by the diseases other than FM (PH-non-FM, = 62) were enrolled. The CXR features, including atelectasis, pleural effusion, consolidation, nodules, calcification, interlobular septal thickening, and interstitial reticulation, were more prevalent in patients with PH-FM than in those with PH-non-FM (all < 0.05). Atelectasis had a specificity of 97%, a sensitivity of 50%, and a greater accuracy for diagnosing of PH-FM [area under the curve (AUC) = 0.720; 95% CI: 0.634-0.806] than the other factors did. The combination of tuberculosis, natural logarithmic NT-proBNP (lnBNP), atelectasis, pleural effusion, and prominent right heart border constituted a prediction model to distinguish the PH-FM from the PH-non-FM, with a sensitivity of 91.7% and a specificity of 83.9%. The model demonstrated good prediction performance by showing an AUC of 0.922 (95% CI: 0.861-0.983) in the internal validation.
CONCLUSION
In this study, atelectasis was the most specific and accurate CXR characteristic for identifying PH-FM in the PH patients. The combination of atelectasis, pleural effusion, prominent right heart border, tuberculosis, and lnBNP constituted a prediction model that distinguished the PH-FM patients from the PH-non-FM ones with good performance.
PubMed: 36583160
DOI: 10.1177/20406223221143245 -
Acta Veterinaria Scandinavica Sep 2022Computed tomography (CT) scanning of the lung is known to be a valuable tool when investigating lung pathology of the dog. During CT-scan the dog needs to be immobilized...
BACKGROUND
Computed tomography (CT) scanning of the lung is known to be a valuable tool when investigating lung pathology of the dog. During CT-scan the dog needs to be immobilized and general anesthesia has historically been considered as gold standard although being a more expensive and time-consuming alternative to sedation. Today, modern high speed multidetector CT-scanners offer new possibilities for sedation as an alternative. Both anesthesia and sedation can cause lung atelectasis, and this can be problematic when reading the CT-images since it potentially can masque or mimic lung pathology leading to misdiagnosis. The objective of this prospective analytic study was to investigate the prevalence of lung atelectasis and changes in lung attenuation over time in dogs that receive intravenous sedation and positioned in sternal recumbency.
RESULTS
20 dogs without known lung pathology underwent three consecutive CT-scans of the lung; the first scan was initiated as soon as the dog was sufficiently sedated, the second scan approximately 5 min after the first one and the last scan after the dog's orthopaedic scan was completed. The dogs received intravenous sedation in a combination of dexmedetomidine and butorphanol and were kept positioned in a strict sternal recumbency during sedation and exam. Each lung lobe was individually examined in an axial plane and measurements of dorsal, ventral, and mean lung attenuation were made. Atelectasis or areas with poorly aerated lung tissue were not detected as all parts of the lobes were normally aerated at all three scans. A statistically significant increase in lung attenuation between the first and the second scan (P = 0.03) and between the first and the third scan (P = 0.0004) was seen in the ventral part of the lobes.
CONCLUSIONS
This study indicates that CT-examination of the lungs can be performed on sedated dogs that are kept in a sternal recumbency without development of atelectasis. It also suggests that there is an early correlation between time and increase in lung attenuation.
Topics: Anesthesia, General; Animals; Dog Diseases; Dogs; Lung; Prevalence; Prospective Studies; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 36076254
DOI: 10.1186/s13028-022-00643-0 -
Experimental Physiology Jan 2021What is the central question of the study? The aim was to determine the effects of duration of acceleration in the cranial-caudal direction (+Gz) on acceleration...
NEW FINDINGS
What is the central question of the study? The aim was to determine the effects of duration of acceleration in the cranial-caudal direction (+Gz) on acceleration atelectasis and identify measurement techniques that can be used to assess it. What is the main finding and its importance? Non-invasive measurement of acceleration atelectasis using electrical impedance tomography and estimates of pulmonary shunt provide more detailed assessment of acceleration atelectasis than traditional forced vital capacity measures. Using these techniques, it was found that as little as 30 s of exposure to +Gz acceleration can cause acceleration atelectasis. The results of the present study will allow a more accurate and detailed assessment of acceleration atelectasis in the future.
ABSTRACT
Recently, there have been reports of acceleration atelectasis during fast jet flight despite the use of systems designed to minimize this. Before further investigation of this, indices suitable for use in applied settings and identification of acceleration durations that elicit it are required. Fifteen non-aircrew subjects underwented five centrifuge exposures lasting 15, 30, 60 and 2 × 90 s with a plateau of +5 Gz (acceleration in the cranial-caudal direction) while breathing 94% O during all but one control exposure (21% O ). Lung volumes and gas exchange limitation were assessed after each exposure. Regional lung impedance and compliance were measured after Gz exposure using electrical impedance tomography and the forced oscillatory technique, respectively. The presence of acceleration atelectasis was confirmed by reductions of 10-17% in vital and inspiratory capacity after 60 and 90 s Gz exposures (P < 0.05) and resulted in reduced regional lung impedance and a gas exchange limitation of 8.1 and 12.5%, respectively (P < 0.05). There was also a small but significant decrease in regional lung impedance after 30 s exposures. Functional residual capacity and lung compliance were unchanged in atelectatic lungs (P > 0.05). In the majority of individuals, >60 s of Gz exposure while breathing 94% O causes acceleration atelectasis. Electrical impedance tomography and the measurement of gas exchange limitation provide useful indicators of acceleration atelectasis. Acceleration atelectasis exerts its effects primarily through basal lung closure and reflex inspiratory limitation, both of which can be reversed by performing three maximal inspiratory breathing manoeuvres.
Topics: Acceleration; Adult; Female; Humans; Hypergravity; Lung; Male; Oxygen; Pulmonary Atelectasis; Respiration; Vital Capacity; Young Adult
PubMed: 32281162
DOI: 10.1113/EP088495 -
Danish Medical Journal Mar 2018Post-operative pulmonary complications are a common cause of morbidity and mortality in patients undergoing heart surgery. The aim of this systematic review was to... (Review)
Review
INTRODUCTION
Post-operative pulmonary complications are a common cause of morbidity and mortality in patients undergoing heart surgery. The aim of this systematic review was to determine if preoperative inspiratory muscle training could prevent the development of pneumonia and atelectasis in patients undergoing coronary artery bypass grafting (CABG) or heart valve surgery.
METHODS
Systematic searches were performed in MEDLINE, Embase and the Cochrane Library. The included studies compared the development of pneumonia and atelectasis in CABG patients or heart valve surgery patients who were prescribed either preoperative inspiratory muscle training or usual care. The quality of the studies was assessed using the Cochrane Risk of Bias Tool.
RESULTS
The search yielded 2,479 records. The inclusion criteria were fulfilled by five studies. All the studies were randomised controlled trials. We found that the development of both pneumonia and atelectasis was significantly reduced among patients who received inspiratory muscle training preoperatively compared with patients treated with usual care.
CONCLUSIONS
Preoperative inspiratory muscle training may reduce the risk of developing pneumonia and atelectasis. However, more trials are needed to support and strengthen the evidence found in this systematic review before routine implementation of this kind of training preoperatively.
Topics: Breathing Exercises; Coronary Artery Bypass; Humans; Length of Stay; Muscle Strength; Pneumonia; Postoperative Complications; Preoperative Care; Pulmonary Atelectasis; Randomized Controlled Trials as Topic; Respiratory Muscles
PubMed: 29510803
DOI: No ID Found -
BioMed Research International 2021To evaluate the utility of radiomics features in differentiating central lung cancers and atelectasis on contrast-enhanced computed tomography (CT) images. This study is...
OBJECTIVES
To evaluate the utility of radiomics features in differentiating central lung cancers and atelectasis on contrast-enhanced computed tomography (CT) images. This study is retrospective.
MATERIALS AND METHODS
In this study, 36 patients with central pulmonary cancer and atelectasis between July 2013 and June 2018 were identified. A total of 1,653 2D and 2,327 3D radiomics features were extracted from segmented lung cancers and atelectasis on contrast-enhanced CT. The refined features were investigated for usefulness in classifying lung cancer and atelectasis according to the information gain, and 10 models were trained based on these features. The classification model is trained and tested at the region level and pixel level, respectively.
RESULTS
Among all the extracted features, 334 2D features and 1,507 3D features had an information gain (IG) greater than 0.1. The highest accuracy (AC) of the region classifiers was 0.9375. The best Dice score, Hausdorff distance, and voxel AC were 0.2076, 45.28, and 0.8675, respectively.
CONCLUSIONS
Radiomics features derived from contrast-enhanced CT images can differentiate lung cancers and atelectasis at the regional and voxel levels.
Topics: Adult; Aged; Algorithms; Contrast Media; Diagnosis, Differential; Female; Humans; Imaging, Three-Dimensional; Lung Neoplasms; Machine Learning; Male; Middle Aged; Pulmonary Atelectasis; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34820455
DOI: 10.1155/2021/5522452 -
Respiratory Care Apr 2015The sigh is a normal homeostatic reflex that maintains lung compliance and decreases atelectasis. General anesthesia abolishes the sigh reflex with rapid onset of... (Review)
Review
BACKGROUND
The sigh is a normal homeostatic reflex that maintains lung compliance and decreases atelectasis. General anesthesia abolishes the sigh reflex with rapid onset of atelectasis in 100% of patients. Studies show a strong correlation between atelectasis and postoperative pulmonary complications, raising health-care costs. Alveolar recruitment maneuvers recruit collapsed alveoli, increase gas exchange, and improve arterial oxygenation. There is no consensus in the literature about the benefits of alveolar recruitment maneuvers. A systematic review is necessary to delineate their usefulness.
METHODS
The search strategy included utilizing PubMed, CINAHL, the Cochrane Library, the National Guideline Clearinghouse, and all subsequent research reference lists up to January 2014. Inclusion criteria involved studies that compared the use of an alveolar recruitment maneuver with a control group lacking an alveolar recruitment maneuver in adult surgical subjects not suffering from ARDS or undergoing cardiac or thoracic surgeries.
RESULTS
Six randomized controlled trials of the 439 studies initially identified achieved a score of ≥ 3 on the Jadad scale and were included in this review. Alveolar recruitment maneuvers consisted of a stepwise increase in tidal volume to a plateau pressure of 30 cm H2O, a stepwise increase in PEEP to 20 cm H2O, or sustained manual inflations of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cm H2O. Subjects in the alveolar recruitment maneuver groups experienced a higher intraoperative PaO2 with improved lung compliance. Different alveolar recruitment maneuvers were equally effective. There was a significant advantage when alveolar recruitment maneuvers were followed by PEEP application.
CONCLUSIONS
Alveolar recruitment maneuvers followed by PEEP should be instituted after induction of general anesthesia, routinely during maintenance, and in the presence of a falling SpO2 whenever feasible. They allow the anesthesia provider to reduce the FIO2 while maintaining a higher SpO2 , limiting the masking of shunts. Utilization of alveolar recruitment maneuvers may reduce postoperative pulmonary complications and improve patient outcomes.
Topics: Adult; Aged; Anesthesia, General; Blood Gas Analysis; Female; Humans; Lung Compliance; Male; Middle Aged; Oxygen Consumption; Positive-Pressure Respiration; Pulmonary Alveoli; Pulmonary Atelectasis; Pulmonary Gas Exchange; Randomized Controlled Trials as Topic; Recruitment, Neurophysiological; Tidal Volume
PubMed: 25425708
DOI: 10.4187/respcare.03488