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Case Reports in Pulmonology 2024A 60-year-old man treated with valproic acid (VPA) for epilepsy developed atelectasis and respiratory failure after an accidentally aspirated VPA tablet-induced mucus...
A 60-year-old man treated with valproic acid (VPA) for epilepsy developed atelectasis and respiratory failure after an accidentally aspirated VPA tablet-induced mucus hypersecretion. Following bronchoscopic removal of the aspirated tablet, his respiratory status improved and massive sputum production did not recur. We hypothesized that the aspirated VPA tablet increased the expression of mucin-related genes, thereby increasing mucus production. Our experiments using a human respiratory epithelial cell line revealed that VPA directly upregulates the airway mucin-related genes. We believe that this is the first case report of aspirated VPA-induced severe atelectasis and respiratory failure, which were successfully treated with the bronchoscopic removal of the VPA tablet.
PubMed: 38529055
DOI: 10.1155/2024/6650141 -
Medicine Mar 2024Cryptococcosis presenting as endobronchial obstruction and lung collapse is an extremely rare occurrence. While these patients were treated with antifungal agents,... (Review)
Review
RATIONALE
Cryptococcosis presenting as endobronchial obstruction and lung collapse is an extremely rare occurrence. While these patients were treated with antifungal agents, unfortunately, half of them showed a suboptimal response.
PATIENT CONCERNS
A 45-year-old immunocompetent male was admitted to the hospital due to a cough, yellow phlegm, and dyspnea persisting for 5 months. Chest computer tomography revealed a mass in the right main bronchus accompanied by right lower lobe atelectasis.
DIAGNOSES
Endobronchial cryptococcosis presenting as endobronchial obstruction and lung collapse.
INTERVENTIONS
Early rigid bronchoscopic therapy was performed to resect endobronchial obstruction, which combined with antifungal agent.
OUTCOMES
The patient recovered well with completely clinical and radiologic resolution at 1 year follow-up.
LESSONS
This case provides a good example of successful utilization of the early respiratory interventional therapy combined with antifungal agent in obstructive endobronchial cryptococcosis.
Topics: Humans; Male; Middle Aged; Antifungal Agents; Cryptococcosis; Bronchi; Lung; Bronchial Diseases; Pulmonary Atelectasis; Airway Obstruction
PubMed: 38518007
DOI: 10.1097/MD.0000000000037455 -
Cureus Feb 2024Necrotizing pancreatitis represents a severe variant of acute pancreatitis characterized by the death of pancreatic tissue (necrosis). This condition commonly stems from...
Necrotizing pancreatitis represents a severe variant of acute pancreatitis characterized by the death of pancreatic tissue (necrosis). This condition commonly stems from inflammation and damage to the pancreas, leading to the development of areas of dead tissue within the organ. Pleural effusion, on the other hand, involves the accumulation of fluid within the pleural cavity. Typically, these effusions are of mild to moderate severity and tend to occur on the left side. In the following case report, we present a 25-year-old male who was diagnosed with necrotizing pancreatitis and bilateral pleural effusion. It is important to emphasize that cardiopulmonary physiotherapy plays a crucial role in managing pleural effusion. Such interventions, which encompass breathing exercises and thoracic expansion exercises, are pivotal for optimizing lung ventilation, enhancing oxygen levels, and preventing complications such as atelectasis and pneumonia. By boosting oxygenation and improving lung compliance, physiotherapy helps reduce the risk of respiratory problems and expedites the recovery process. This approach enables young individuals to regain their lung function and overall quality of life. In this particular case, the patient received medical management and pulmonary rehabilitation, resulting in a decrease in the Modified Medical Research Council Scale score and an improvement in the six-minute walk test (6 MWT), which subsequently enhanced their quality of life.
PubMed: 38516494
DOI: 10.7759/cureus.54524 -
Cureus Nov 2023Secretion retention, atelectasis, and reduced lung compliance occur when endotracheal or tracheostomised patients cough ineffectively. There is a possibility of... (Review)
Review
Secretion retention, atelectasis, and reduced lung compliance occur when endotracheal or tracheostomised patients cough ineffectively. There is a possibility of infection if the collapsed regions of the lungs are not reinflated. Therefore, to improve clinical outcomes, such as diaphragm mobility and thickness, lung volume, and thickness of the abdominal muscles, and decrease the length of hospitalizations, mechanical and manual techniques, such as balloon blowing exercises and incentive spirometer, are required. PubMed, Google Scholar, Pedro, Clinical Keys, Helinet, ProQuest, and Science Direct databases were used for the literature search considering the inclusion and exclusion criteria. The several manual and mechanical methods that were employed for lung expansion treatment for the potential populations are highlighted in this overview of the literature. Ten studies were considered in this review: five on balloon-blowing exercises, four on tracheostomy with incentive spirometry exercises, and one on incentive spirometry with balloon-blowing exercises. The effects were examined on individual outcomes that included rate of perceived exertion (RPE), diaphragm mobility, pulmonary function, volume of breath, length of hospitalization, and postoperative day complications. The structured protocols proved to be effective in improving lung expansion and pulmonary function for the potential population that involved healthy adults, noncritical COVID-19 adults, smokers, thoracotomy patients, and tracheostomised patients. The road to recovery is yet unexplored and underachieved because of the lack of evidence.
PubMed: 38511105
DOI: 10.7759/cureus.49283 -
Respiratory Medicine Case Reports 2024This study presents a rare case of plastic bronchitis (PB) in a 57-year-old adult post-lung lobectomy, a condition predominantly found in post-Fontan children. The...
This study presents a rare case of plastic bronchitis (PB) in a 57-year-old adult post-lung lobectomy, a condition predominantly found in post-Fontan children. The patient exhibited progressive dyspnea and complete atelectasis on the surgical side, revealing a gray rubbery bronchial cast obstructing the right main bronchus. Treatment involved repeated bronchoscopies, glucocorticoids, acetylcysteine, physiotherapy, and a low-fat diet, leading to gradual improvement. No similar cases have been reported, highlighting PB's diagnostic challenge. This underscores the need to consider rare conditions like PB in post-lobectomy complications. Timely examinations and bronchoscopies are essential for accurate diagnosis, ensuring prompt treatment and improving patient outcomes.
PubMed: 38510662
DOI: 10.1016/j.rmcr.2024.102002 -
Annals of Geriatric Medicine and... Jun 2024Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions...
BACKGROUND
Older patients are particularly vulnerable to age-related respiratory changes. This prospective randomized controlled trial studied the effects of high and low fractions of inspired oxygen (FiO2) with the recruitment maneuver (RM) during extubation on lung atelectasis postoperatively in older patients undergoing major abdominal surgery.
METHODS
We randomized a total of 126 patients aged >60 years who underwent both elective and emergency major abdominal surgeries and met the inclusion criteria into three groups (H, HR, and LR) using computer-generated block randomization. Group H received high FiO2 (1), Group HR received high FiO2 (1) with RM followed by a positive end-expiratory pressure of 5 cm H2O, and Group LR received low FiO2 (0.4) with RM followed by a positive end-expiratory pressure of 5 cm H2O 10 minutes before extubation. Oxygenation and atelectasis were measured using the arterial partial pressure of oxygen (PaO2)/FiO2 ratios and lung ultrasound score. Postoperative pulmonary complications were recorded up to 24 hours postoperatively.
RESULTS
The mean PaO2/FiO2 at 30 minutes post-extubation was significantly higher in Groups LR and HR compared to that in Group H (390.71±29.55, 381.97±24.97, and 355.37±31.70; p<0.001). In the immediate postoperative period, the median lung ultrasound score was higher in Group H than that in Groups LR and HR (6 [5-7], 3 [3-5], and 3.5 [2.25-4.75]; p<0.001). The incidence of oxygen desaturation and oxygen requirements was higher in Group H during the postoperative period.
CONCLUSION
The RM before extubation is beneficial in reducing atelectasis and postoperative pulmonary complications, irrespective of the FiO2 concentration used in older adults undergoing major abdominal surgeries. (Trail registration number: Reference No. CTRI/2022/04/042115; date of CTRI registration 25/02/2022; and date of enrolment of the first research participant 05/05/2022).
PubMed: 38509825
DOI: 10.4235/agmr.23.0180 -
Journal of Thoracic Disease Feb 2024Postoperative pulmonary complications after esophagectomy still represent a matter of concern. High flow nasal cannula (HFNC) early after major abdominal and thoracic...
BACKGROUND
Postoperative pulmonary complications after esophagectomy still represent a matter of concern. High flow nasal cannula (HFNC) early after major abdominal and thoracic surgery has demonstrated some advantages over conventional oxygen therapy. Data about respiratory effect of HFNC after esophagectomy is scarce. The primary aim of this study is to investigate if the early use of HFNC after esophagectomy could enhance patients' postoperative respiratory oxygenation (ROX) index and, ultimately, reduce postoperative pneumonia.
METHODS
In this single center retrospective study all patients undergoing to esophagectomy for cancer from May 2020 to November 2022 were evaluated. Historical cohort (HC) received postoperative oxygen supplementation with Venturi mask or nasal goggles, and a cohort was put under HFNC (HFNC cohort). ROX index, blood gas analysis, radiological atelectasis score (RAS), post-operative complications' data and information on hospital stay have been collected and analyzed.
RESULTS
Seventy-one patients were included for the final statistical analysis, 31 in the HFNC and 40 in the HC cohort. Mean age was 64±10 years and body mass index (BMI) was 26 [24-29] kg/m. ROX index was higher in the HFNC patients than in the HC, 20.8 [16.7-25.9] 14.9 [10.8-18.2] (P<0.0001). In the HFNC cohort patients, pH was higher, 7.42 [7.40-7.44] 7.39 [7.37-7.43] than HC, while PaCO was lower in HFNC cohort compared with HC, 39 [36-41] 42 [39-45] mmHg, respectively (P=0.01). RAS was similar between the two cohorts of patients, 1.5±0.98 1.4±1.04 in the HFNC and the HC cohort, respectively (P=0.611). Lower acute respiratory failure (ARF) rate was recorded among HFNC than HC cohort, 0% 13% respectively, P=0.06. No difference in pneumonia frequency between two cohorts was shown.
CONCLUSIONS
HFNC improved the ROX index after esophagectomy through significant respiratory rate reduction. This tool should be considered for early respiratory support after extubation in this category of patients, not only as a rescue therapy for ARF, but also to optimize early postoperative respiratory function. Whether this will improve patients' outcomes requires further large randomized controlled trials.
PubMed: 38505084
DOI: 10.21037/jtd-23-1176 -
Frontiers in Medicine 2024Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing...
INTRODUCTION
Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing literature to compare outcomes between high tidal volume (HTV) and low tidal volume (LTV) strategies in this unique patient population.
METHODS
We searched for studies published up to August 30, 2023, in five databases, following a PECO/PICO strategy. We found six studies for quantitative analysis and meta-analyzed five studies.
RESULTS
This meta-analysis included 396 patients with CSCI and mechanical ventilation (MV), 119 patients treated with high tidal volume (HTV), and 277 with low tidal volume (LTV). This first meta-analysis incorporates the few studies that show contradictory findings. Our meta-analysis shows that there is no significant statistical difference in developing VAP between both comparison groups (HTV vs. LTV) (OR 0.46; 95% CI 0.13 to 1.66; > 0.05; : 0%), nor are there differences between the presence of other pulmonary complications when treating with HTV such as acute respiratory distress syndrome (ARDS), atelectasis, onset of weaning.
CONCLUSION
In patients with CSCI in MV, the use of HTV does not carry a greater risk of pneumonia compared to LTV; in turn, it is shown as a safe ventilatory strategy as it does not establish an increase in other pulmonary complications such as ARDS, atelectasis, the onset of weaning nor others associated with volutrauma. It is necessary to evaluate the role of HTV ventilation in this group of patients in primary RCT-type studies.
PubMed: 38495112
DOI: 10.3389/fmed.2024.1362318 -
BMJ Open Mar 2024A history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate...
BACKGROUND
A history of SARS-CoV-2 infection has been reported to be associated with an increased risk of postoperative pulmonary complications (PPCs). Even mild PPCs can elevate the rates of early postoperative mortality, intensive care unit (ICU) admission and prolong the length of ICU and/or hospital stays. Consequently, it is crucial to develop perioperative management strategies that can mitigate these increased risks in surgical patients who have recently been infected with SARS-CoV-2. Accumulating evidence suggests that nitric oxide (NO) inhalation might be effective in treating COVID-19. NO functions in COVID-19 by promoting vasodilation, anticoagulation, anti-inflammatory and antiviral effects. Therefore, our study hypothesises that the perioperative use of NO can effectively reduce PPCs in patients with recent SARS-CoV-2 infection.
METHOD AND ANALYSIS
A prospective, double-blind, single-centre, randomised controlled trial is proposed. The trial aims to include participants who are planning to undergo surgery with general anaesthesia and have been recently infected with SARS-CoV-2 (within 7 weeks). Stratified allocation of eligible patients will be performed at a 1:1 ratio based on the predicted risk of PPCs using the Assess Respiratory Risk in Surgical Patients in Catalonia risk index and the time interval between infection and surgery.The primary outcome of the study will be the presence of PPCs within the first 7 days following surgery, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm and aspiration pneumonitis. The primary outcome will be reported as counts (percentage) and will be compared using a two-proportion χ test. The common effect across all primary components will be estimated using a multiple generalised linear model.
ETHICS AND DISSEMINATION
The trial is approved by the Institutional Review Board of Xijing Hospital (KY20232058-F1). The findings, including positive, negative and inconclusive results, will be published in scientific journals with peer-review processes.
TRIAL REGISTRATION NUMBER
NCT05721144.
Topics: Humans; COVID-19; Nitric Oxide; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; SARS-CoV-2; Treatment Outcome
PubMed: 38485487
DOI: 10.1136/bmjopen-2023-077572 -
Scientific Reports Mar 2024Limited information is available regarding the association between preoperative lung function and postoperative pulmonary complications (PPCs) in patients with...
Limited information is available regarding the association between preoperative lung function and postoperative pulmonary complications (PPCs) in patients with esophageal cancer who undergo esophagectomy. This is a retrospective cohort study. Patients were classified into low and high lung function groups by the cutoff of the lowest fifth quintile of forced expiratory volume in 1 s (FEV) %predicted (%pred) and diffusing capacity of the carbon monoxide (DLco) %pred. The PPCs compromised of atelectasis requiring bronchoscopic intervention, pneumonia, and acute lung injury/acute respiratory distress syndrome. Modified multivariable-adjusted Poisson regression model using robust error variances and inverse probability treatment weighting (IPTW) were used to assess the relative risk (RR) for the PPCs. A joint effect model considered FEV%pred and DLco %pred together for the estimation of RR for the PPCs. Of 810 patients with esophageal cancer who underwent esophagectomy, 159 (19.6%) developed PPCs. The adjusted RR for PPCs in the low FEV group relative to high FEV group was 1.48 (95% confidence interval [CI] = 1.09-2.00) and 1.98 (95% CI = 1.46-2.68) in the low DLco group relative to the high DLco group. A joint effect model showed adjusted RR of PPCs was highest in patients with low DLco and low FEV followed by low DLco and high FEV, high DLco and low FEV, and high DLco and high FEV (Reference). Results were consistent with the IPTW. Reduced preoperative lung function (FEV and DLco) is associated with post-esophagectomy PPCs. The risk was further strengthened when both values decreased together.
Topics: Humans; Esophagectomy; Retrospective Studies; Lung; Forced Expiratory Volume; Respiratory Distress Syndrome; Esophageal Neoplasms; Postoperative Complications
PubMed: 38480929
DOI: 10.1038/s41598-024-56593-2