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Radiology Nov 2022COVID-19 pneumonia may lead to pulmonary fibrosis in the long term. Chest CT is useful to evaluate changes in the lung parenchyma over time.
BACKGROUND
COVID-19 pneumonia may lead to pulmonary fibrosis in the long term. Chest CT is useful to evaluate changes in the lung parenchyma over time.
PURPOSE
To illustrate the temporal change of lung abnormalities on chest CT scans associated with COVID-19 pneumonia over 1 year.
MATERIALS AND METHODS
In this prospective study, patients previously hospitalized due to COVID-19 pneumonia who visited the radiology department of a tertiary care center for imaging follow-up were consecutively enrolled between March 2020 and July 2021. Exclusion criteria were acute respiratory distress syndrome, requirement of intubation and/or mechanical ventilation, pulmonary embolism, and any interstitial lung disease. High-resolution volumetric noncontrast chest CT scans were acquired at 3, 6, and 12 months from the first diagnosis and were compared with baseline CT scans. The imaging features analyzed were ground-glass opacity (GGO), consolidation, pleuroparenchymal band, linear atelectasis, bronchiectasis and/or bronchiolectasis, reticulation, traction bronchiectasis and/or bronchiolectasis, and honeycombing. The prevalence distribution of lung abnormalities was recorded at all time points.
RESULTS
Eighty-four participants (56 men; mean age, 61 years ± 11 [SD]) were studied. GGOs and consolidations represented the main baseline lung abnormalities, accounting for a median severity score of 9 (IQR, 7-12.7; maximum possible score, 20), which indicates moderate lung involvement. The baseline prevalence of GGOs decreased from 100% to 2% of participants at 1 year, and that of consolidations decreased from 71% to 0% at 6 months. Fibrotic-like abnormalities (pleuroparenchymal bands, linear atelectasis, bronchiectasis and/or bronchiolectasis) were detected at 3 months (50% of participants), 6 months (42% of participants), and 1 year (5% of participants). Among these, pleuroparenchymal bands were the most represented finding. Fibrotic changes (reticulation and traction bronchiectasis and/or bronchiolectasis) were detected at 3-6 months (2%) and remained stable at 1 year, with no evidence of honeycombing. At 1 year, lung abnormalities due to COVID-19 pneumonia were completely resolved in 78 of 84 (93%) participants.
CONCLUSION
Residual lung abnormalities in individuals hospitalized with moderate COVID-19 pneumonia were infrequent, with no evidence of fibrosis at 1-year chest CT. © RSNA, 2022.
Topics: Male; Humans; Middle Aged; COVID-19; Prospective Studies; Tomography, X-Ray Computed; Lung Diseases, Interstitial; Bronchiectasis; Pulmonary Atelectasis
PubMed: 35536134
DOI: 10.1148/radiol.220019 -
Respiratory Care Jan 2020The difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in...
BACKGROUND
The difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in a model of ARDS.
METHODS
10 pigs submitted to randomized PEEP steps of 0, 5, 10, 15, 20, 25 and 30 cm HO were evaluated with the use of lung ultrasound images, alveolar-arterial oxygen difference (P ), transpulmonary mechanics, and volumetric capnography at each PEEP step.
RESULTS
At PEEP ≥ 15 cm HO, atelectasis and P progressively decreased while end-inspiratory transpulmonary pressure (P), end-expiratory P, and driving P increased (all < .001). Bohr dead space (V /V), airway dead space (V /V), and alveolar dead space (V /V ) reached their highest values at PEEP 30 cm HO (0.69 ± 0.10, 0.53 ± 0.13 and 0.35 ± 0.06, respectively). At PEEP <15 cm HO, the increases in atelectasis and P were associated with negative end-expiratory P and highest driving P. V /V and V /V showed the lowest values at PEEP 0 cm HO (0.51 ± 0.08 and 0.32 ± 0.08, respectively), whereas V /V increased to 0.27 ± 0.05. Enghoff dead space and its derived V /V showed high values at low PEEPs (0.86 ± 0.02 and 0.79 ± 0.04, respectively) and at high PEEPs (0.84 ± 0.04 and 0.65 ± 0.12), with the lowest values at 15 cm HO (0.77 ± 0.05 and 0.61 ± 0.11, respectively; all < .001).
CONCLUSIONS
Bohr dead space was associated with lung stress, whereas Enghoff dead space was partially affected by the shunt effect.
Topics: Animals; Capnography; Lung; Models, Theoretical; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiratory Dead Space; Respiratory Distress Syndrome; Swine; Tidal Volume
PubMed: 31615922
DOI: 10.4187/respcare.06843 -
Scientific Reports Apr 2022Atelectasis is a frequent clinical condition, yet knowledge is limited and controversial on its biological contribution towards lung injury. We assessed the regional...
Atelectasis is a frequent clinical condition, yet knowledge is limited and controversial on its biological contribution towards lung injury. We assessed the regional proteomics of atelectatic versus normally-aerated lung tissue to test the hypothesis that immune and alveolar-capillary barrier functions are compromised by purely atelectasis and dysregulated by additional systemic inflammation (lipopolysaccharide, LPS). Without LPS, 130 proteins were differentially abundant in atelectasis versus aerated lung, mostly (n = 126) with less abundance together with negatively enriched processes in immune, endothelial and epithelial function, and Hippo signaling pathway. Instead, LPS-exposed atelectasis produced 174 differentially abundant proteins, mostly (n = 108) increased including acute lung injury marker RAGE and chemokine CCL5. Functional analysis indicated enhanced leukocyte processes and negatively enriched cell-matrix adhesion and cell junction assembly with LPS. Additionally, extracellular matrix organization and TGF-β signaling were negatively enriched in atelectasis with decreased adhesive glycoprotein THBS1 regardless of LPS. Concordance of a subset of transcriptomics and proteomics revealed overlap of leukocyte-related gene-protein pairs and processes. Together, proteomics of exclusively atelectasis indicates decreased immune response, which converts into an increased response with LPS. Alveolar-capillary barrier function-related proteomics response is down-regulated in atelectasis irrespective of LPS. Specific proteomics signatures suggest biological mechanistic and therapeutic targets for atelectasis-associated lung injury.
Topics: Acute Lung Injury; Humans; Inflammation; Lipopolysaccharides; Lung; Proteomics; Pulmonary Atelectasis
PubMed: 35487970
DOI: 10.1038/s41598-022-11045-7 -
BMC Anesthesiology Mar 2023Atelectasis may play a substantial role in the development of pneumonia. However, pneumonia has never been evaluated as an outcome of atelectasis in surgical patients....
BACKGROUND
Atelectasis may play a substantial role in the development of pneumonia. However, pneumonia has never been evaluated as an outcome of atelectasis in surgical patients. We aimed to determine whether atelectasis is related to an increased risk of postoperative pneumonia, intensive care unit (ICU) admission and hospital length of stay (LOS).
METHODS
The electronic medical records of adult patients who underwent elective non-cardiothoracic surgery under general anesthesia between October 2019 and August 2020 were reviewed. They were divided into two groups: one who developed postoperative atelectasis (atelectasis group) and the other who did not (non-atelectasis group). The primary outcome was the incidence of pneumonia within 30 days after the surgery. The secondary outcomes were ICU admission rate and postoperative LOS.
RESULTS
Patients in the atelectasis group were more likely to have risk factors for postoperative pneumonia including age, body mass index, a history of hypertension or diabetes mellitus and duration of surgery, compared with those in the non-atelectasis. Among 1,941 patients, 63 (3.2%) developed postoperative pneumonia; 5.1% in the atelectasis group and 2.8% in the non-atelectasis (P = 0.025). In multivariable analysis, atelectasis was associated with an increased risk of pneumonia (adjusted odds ratio, 2.33; 95% CI: 1.24 - 4.38; P = 0.008). Median postoperative LOS was significantly longer in the atelectasis group (7 [interquartile range: 5-10 days]) than in the non-atelectasis (6 [3-8] days) (P < 0.001). Adjusted median duration was also 2.19 days longer in the atelectasis group (β, 2.19; 95% CI: 0.821 - 2.834; P < 0.001). ICU admission rate was higher in the atelectasis group (12.1% vs. 6.5%; P < 0.001), but it did not differ between the groups after adjustment for confounders (adjusted odds ratio, 1.52; 95% CI: 0.88 - 2.62; P = 0.134).
CONCLUSION
Among patients undergoing elective non-cardiothoracic surgery, patients with postoperative atelectasis were associated with a 2.33-fold higher incidence of pneumonia and a longer LOS than those without atelectasis. This finding alerts the need for careful management of perioperative atelectasis to prevent or reduce the adverse events including pneumonia and the burden of hospitalizations.
TRIAL REGISTRATION
None.
Topics: Humans; Pneumonia; Pulmonary Atelectasis; Electronic Health Records; Retrospective Studies; Elective Surgical Procedures
PubMed: 36906539
DOI: 10.1186/s12871-023-02020-4 -
Microbiology Spectrum Apr 2022Consolidation is one complication of pediatric severe community-acquired pneumonia (SCAP) that can respond poorly to conservative medical treatment. We investigated the...
Consolidation is one complication of pediatric severe community-acquired pneumonia (SCAP) that can respond poorly to conservative medical treatment. We investigated the pathogens that cause pediatric SCAP including cases with persistent consolidation that need bronchoscopy intervention. Alveolar lavage fluid (ALF) samples collected from cases admitted to Children's Hospital of Fudan University with SCAP during January 2019 to March in 2019 were retrospectively tested by the RespiFinder 2SMART multiplex PCR (multi-PCR) assay targeting 22 respiratory pathogens. A total of 90 cases and 91 samples were enrolled; 80.0% (72/90) of the cases had pulmonary consolidation and/or atelectasis. All samples were positive with targeted pathogens tested by multi-PCR, and 92.3% (84/91) of the samples were co-detected with pathogens. Mycoplasma pneumoniae (MP) and (ADV) as the two dominant pathogens, with the positive rates of 96.7% (88/91) and 79.1% (72/91), respectively. Most of the samples were positive with MP and ADV simultaneously. As a control, 78.0% (71/91) of the samples were positive by conventional tests (CT), in which MP had the detection rate of 63.9% (55/86) by a traditional real-time PCR assay, while ADV were positive in 13.1% (12/91) of the samples by a direct immunofluorescence assay (DFA). In cases with persistent pulmonary consolidation, the positive rates of pathogens by multi-PCR and CT were 100% (72/72) and 81.9% (59/72), respectively. There were no significant differences of MP or ADV positive rates between cases with and without pulmonary consolidation. MP and ADV most prevalent in pediatric SCAP cases required fiberscope intervention, and presented with coinfections dominantly. Pathogens that cause pediatric severe community-acquired pneumonia (SCAP) requiring bronchoscopy intervention are understudied. Through this study, we explore the etiology of SCAP form alveolar lavage fluid (ALF) samples by the RespiFinder 2SMART multi-PCR assay. It is observed that high mixed detection rates of Mycoplasma pneumoniae and in ALF samples collected from hospitalized SCAP children experienced bronchoscopy intervention. Eighty percent of the cases had pulmonary consolidation and/or atelectasis. The presence of possible coinfection of these two pathogens might contribute to poor clinical anti-infection response. The results of this study might be helpful for the selection of clinical strategies for the empirical treatment of such pediatric SCAP cases.
Topics: Adenoviridae; Adenoviridae Infections; Child; Coinfection; Community-Acquired Infections; Humans; Infant; Mycoplasma pneumoniae; Pneumonia; Pulmonary Atelectasis; Retrospective Studies
PubMed: 35311565
DOI: 10.1128/spectrum.00026-22 -
Journal of Feline Medicine and Surgery Jun 2017Objectives The objective of this study was to determine if modification of inspired oxygen concentration or positive end-expiratory pressure (PEEP) would alter...
Objectives The objective of this study was to determine if modification of inspired oxygen concentration or positive end-expiratory pressure (PEEP) would alter bronchoalveolar lavage (BAL)-induced changes in pulmonary mechanics or atelectasis, as measured using ventilator-acquired pulmonary mechanics and thoracic CT. Methods Six experimentally asthmatic cats underwent anesthesia and non-bronchoscopic BAL, each under four randomized treatment conditions: 100% oxygen, zero PEEP; 30% oxygen, zero PEEP; 100% oxygen, PEEP 2 cmHO; and 30% oxygen, PEEP 2 cmHO. Pulse oximetry was used to estimate oxygen saturation (SpO). Ventilator-acquired pulmonary mechanics and thoracic CT scans were collected prior to BAL and at 1, 5 and 15 mins post-BAL. Results While receiving 100% oxygen, no cat had SpO <91%. Some cats receiving 30% oxygen had decreased saturation immediately post-BAL (mean ± SD 70.8 ± 31%), but 6/8 of these had SpO >90% by 1 min later. There was a significant increase in airway resistance and a decrease in lung compliance following BAL, but there was no significant difference between treatment groups. Cats receiving no PEEP and 30% oxygen conserved better aeration of the lung parenchyma in BAL-sampled areas than those receiving no PEEP and 100% oxygen. Conclusions and relevance Alterations in pulmonary mechanics or atelectasis may not be reflected by SpO following BAL. The use of 30% inspired oxygen concentration failed to show any significant improvement in pulmonary mechanics but did diminish atelectasis. In some cats, it was also associated with desaturation of hemoglobin. The use of PEEP in this study did not show any effect on our outcome parameters. Further studies using higher PEEP (5-10 cmHO) and intermediate inspired oxygen concentration (40-60%) are warranted to determine if they would confer clinical benefit in cats undergoing diagnostic BAL.
Topics: Animals; Asthma; Bronchoalveolar Lavage; Cat Diseases; Cats; Female; Male; Oximetry; Oxygen; Positive-Pressure Respiration; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 27250742
DOI: 10.1177/1098612X16651471 -
The Journal of International Medical... Feb 2021To assess the clinical characteristics of 168 children with adenovirus pneumonia complicated by pulmonary consolidation and atelectasis.
OBJECTIVE
To assess the clinical characteristics of 168 children with adenovirus pneumonia complicated by pulmonary consolidation and atelectasis.
METHODS
We retrospectively studied patients with adenovirus pneumonia complicated by pulmonary consolidation and atelectasis admitted to Xiamen Children's Hospital from March 2019 to August 2019. In total, 168 patients were recruited and divided into a severe group and non-severe group according to disease severity. Clinical results were assessed.
RESULTS
All children had fever and cough, 29 had wheezing, and 82 had dyspnea. Pleural effusion was found in 53 patients. Mixed infections were present in 95 patients. A total of 105 patients received hormone therapy, 72 received intravenous gamma globulin, and 103 underwent bronchoscopy, among whom 6 were found to have bronchial casts. Of the 168 children, 166 were cured and two died. The patients were divided by disease severity, with 82 in the severe group and 86 in the non-severe group. The two groups showed significant differences in the fever course, pleural effusion, mixed infections, hemoglobin concentration, procalcitonin concentration, and lactate dehydrogenase concentration.
CONCLUSION
A long fever course, mixed infection, pleural effusion, decreased hemoglobin concentration, and increased procalcitonin and lactate dehydrogenase concentrations may be associated with more severe adenovirus pneumonia.
Topics: Adenoviridae; Child; Humans; Pleural Effusion; Pneumonia, Viral; Pulmonary Atelectasis; Retrospective Studies
PubMed: 33530809
DOI: 10.1177/0300060521990244 -
Journal of Applied Physiology... Apr 2022Positive pressure ventilation exerts an increased stress and strain in the presence of pulmonary fibrosis. Thus, ventilation strategies that avoid high pressures while...
Positive pressure ventilation exerts an increased stress and strain in the presence of pulmonary fibrosis. Thus, ventilation strategies that avoid high pressures while maintaining lung aeration are of paramount importance. Although physiologically variable ventilation (PVV) has proven beneficial in various models of pulmonary disease, its potential advantages in pulmonary fibrosis have not been investigated. Therefore, we assessed the benefit of PVV over conventional pressure-controlled ventilation (PCV) in a model of pulmonary fibrosis. Lung fibrosis was induced with intratracheal bleomycin in rabbits. Fifty days later, the animals were randomized to receive 6 h of either PCV ( = 10) or PVV ( = 11). The PVV pattern was prerecorded in spontaneously breathing, healthy rabbits. Respiratory mechanics and gas exchange were assessed hourly; end-expiratory lung volume and intrapulmonary shunt fraction were measured at and . Histological and cellular analyses were performed. Fifty days after bleomycin treatment, the rabbits presented elevated specific airway resistance [69 ± 26% (mean ± 95% confidence interval)], specific tissue damping (38 ± 15%), and specific elastance (47 ± 16%) along with histological evidence of fibrosis. Six hours of PCV led to increased respiratory airway resistance (Raw, 111 ± 30%), tissue damping (G, 36 ± 13%) and elastance (H, 58 ± 14%), and decreased end-expiratory lung volume (EELV, -26 ± 7%) and oxygenation ([Formula: see text]/[Formula: see text], -14 ± 5%). The time-matched changes in the PVV group were significantly lower for G (22 ± 9%), H (41 ± 6%), EELV (-13 ± 6%), and [Formula: see text]/[Formula: see text] ratio (-3 ± 5%, < 0.05 for all). There was no difference in histopathology between the ventilation modes. Thus, prolonged application of PVV prevented the deterioration of gas exchange by reducing atelectasis development in bleomycin-induced lung fibrosis. The superposition of physiological breathing variability onto a conventional pressure signal during prolonged mechanical ventilation prevents atelectasis development in bleomycin-induced lung fibrosis. This advantage is evidenced by reduced deterioration in tissue mechanics, end-expiratory lung volume, ventilation homogeneity, and gas exchange.
Topics: Animals; Bleomycin; Lung; Positive-Pressure Respiration; Pulmonary Atelectasis; Pulmonary Fibrosis; Pulmonary Gas Exchange; Rabbits; Respiration, Artificial; Respiratory Mechanics
PubMed: 35201935
DOI: 10.1152/japplphysiol.00670.2021 -
Journal of Applied Physiology... Jul 2021Tidal volume delivered by mechanical ventilation to a sedated patient is distributed in a nonphysiological pattern, causing atelectasis (underinflation) and...
Diaphragm neurostimulation during mechanical ventilation reduces atelectasis and transpulmonary plateau pressure, preserving lung homogeneity and [Formula: see text]/[Formula: see text].
Tidal volume delivered by mechanical ventilation to a sedated patient is distributed in a nonphysiological pattern, causing atelectasis (underinflation) and overdistension (overinflation). Activation of the diaphragm during controlled mechanical ventilation in these sedated patients may provide a method to reduce atelectasis and alveolar inhomogeneity, protecting the lungs from ventilator-induced lung injury while also protecting the diaphragm by preventing ventilator-induced diaphragm dysfunction. We studied the hypothesis that diaphragm contractions elicited by transvenous phrenic nerve stimulation, delivered in synchrony with volume-control ventilation, would reduce atelectasis and lung inhomogeneity in a healthy, normal lung pig model. Twenty-five large pigs were ventilated for 50 h with lung-protective volume-control ventilation combined with synchronous transvenous phrenic-nerve neurostimulation on every breath, or every second breath. This was compared to lung-protective ventilation alone. Lung mechanics and ventilation pressures were measured using esophageal pressure manometry and electrical impedance tomography. Alveolar homogeneity was measured using alveolar chord length of preserved lung tissue. Lung injury was measured using inflammatory cytokine concentration in bronchoalveolar lavage fluid and serum. We found that diaphragm neurostimulation on every breath preserved [Formula: see text]/[Formula: see text] and significantly reduced the loss of end-expiratory lung volume after 50 h of mechanical ventilation. Neurostimulation on every breath reduced plateau and driving pressures, improved both static and dynamic compliance and resulted in less alveolar inhomogeneity. These findings support that temporary transvenous diaphragm neurostimulation during volume-controlled, lung-protective ventilation may offer a potential method to provide both lung- and diaphragm-protective ventilation. Temporary transvenous diaphragm neurostimulation has been shown to mitigate diaphragm atrophy in a preclinical model. This study contributes to this work by demonstrating that diaphragm neurostimulation can also offer lung protection from ventilator injury, providing a potential solution to the dilemma of lung- versus diaphragm-protective ventilation. Our findings show that neurostimulation on every breath preserved [Formula: see text]/[Formula: see text], end-expiratory lung volume, alveolar homogeneity, and required lower pressures than lung-protective ventilation over 50 h in healthy pigs.
Topics: Animals; Diaphragm; Humans; Lung; Pulmonary Atelectasis; Respiration, Artificial; Swine; Tidal Volume; Ventilator-Induced Lung Injury
PubMed: 34110233
DOI: 10.1152/japplphysiol.00119.2021 -
Romanian Journal of Morphology and... 2022Flexible fiberoptic bronchoscopy (FFB) remains the most important minimally invasive method for the diagnosis of lung cancer (LC). We performed a retrospective study to...
Flexible fiberoptic bronchoscopy (FFB) remains the most important minimally invasive method for the diagnosis of lung cancer (LC). We performed a retrospective study to assess the main endoscopic findings of malignant lung tumors in the large airways in a cohort of Romanian patients. The group consisted of 32 (84.21%) men and six (15.78%) women, with an average age of 64.63±6.07 years. The bronchoscopic examination allowed the detection and biopsy of 36 malignant lung tumors, and in two other cases, due to malignant atelectasis, the patients were sent to a Department of Thoracic Surgery, to perform the biopsy following the surgery. Histopathological (HP) examination revealed the presence of squamous cell carcinoma (SCC) in 19 (50%) patients, adenocarcinoma (ADC) in 11 (28.94%) patients and small cell lung cancer (SCLC) in eight (21.05%) patients. The macroscopic and microscopic analysis of the lung tumors showed that infiltrative forms were found in most cases (58.33%), followed by exophytic (mass) endobronchial lesions (22.22%) and mixed forms (19.44%). If most infiltrative forms were SCC (66.66%), the exophytic and mixed lesions were most frequently ADC (50% and 57.14%). The tumor lesions caused both malignant bronchial stenosis (57.89%) and malignant atelectasis (42.1%). The main mechanisms involved in bronchial malignant obstruction were endoluminal (50%), mixed (31.57%) and extraluminal (18.42%) mechanisms. In conclusion, FFB remains the main method of diagnosing LC in the large airways. The most common macroscopic appearance of lung tumors revealed by bronchoscopy was the infiltrative appearance. In half of our patients, the malignant bronchial obstruction was achieved by endoluminal mechanism. The most common pathological form found in our patients was the SCC, as described in half of the investigated patients.
Topics: Humans; Male; Female; Middle Aged; Aged; Bronchoscopy; Retrospective Studies; Lung Neoplasms; Small Cell Lung Carcinoma; Adenocarcinoma; Carcinoma, Squamous Cell; Pulmonary Atelectasis
PubMed: 36374142
DOI: 10.47162/RJME.63.2.08