-
The European Respiratory Journal Jun 2011Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery...
Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery (LVRS) or to be used in patient groups in whom LVRS is not appropriate. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in patients with emphysema. The benefit is most pronounced in, though not confined to, patients where lobar atelectasis has occurred. Few data exist on their long-term outcome. 19 patients (16 males; mean±sd forced expiratory volume in 1 s 28.4±11.9% predicted) underwent BLVR between July 2002 and February 2004. Radiological atelectasis was observed in five patients. Survival data was available for all patients up to February 2010. None of the patients in whom atelectasis occurred died during follow-up, whereas eight out of 14 in the nonatelectasis group died (Chi-squared p=0.026). There was no significant difference between the groups at baseline in lung function, quality of life, exacerbation rate, exercise capacity (shuttle walk test or cycle ergometry) or computed tomography appearances, although body mass index was significantly higher in the atelectasis group (21.6±2.9 versus 28.4±2.9 kg·m(-2); p<0.001). The data in the present study suggest that atelectasis following BLVR is associated with a survival benefit that is not explained by baseline differences.
Topics: Body Mass Index; Bronchoscopy; Exercise Test; Female; Humans; Lung; Male; Middle Aged; Physical Endurance; Pneumonectomy; Pulmonary Atelectasis; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Quality of Life; Radiography; Treatment Outcome
PubMed: 20947683
DOI: 10.1183/09031936.00100110 -
Journal of Applied Physiology... Nov 2013Little is known about the small airways dysfunction in acute respiratory distress syndrome (ARDS). By computed tomography (CT) imaging in a porcine experimental model of...
Little is known about the small airways dysfunction in acute respiratory distress syndrome (ARDS). By computed tomography (CT) imaging in a porcine experimental model of early ARDS, we aimed at studying the location and magnitude of peripheral airway closure and alveolar collapse under high and low distending pressures and high and low inspiratory oxygen fraction (FIO2). Six piglets were mechanically ventilated under anesthesia and muscle relaxation. Four animals underwent saline-washout lung injury, and two served as healthy controls. Beyond the site of assumed airway closure, gas was expected to be trapped in the injured lungs, promoting alveolar collapse. This was tested by ventilation with an FIO2 of 0.25 and 1 in sequence during low and high distending pressures. In the most dependent regions, the gas/tissue ratio of end-expiratory CT, after previous ventilation with FIO2 0.25 low-driving pressure, was significantly higher than after ventilation with FIO2 1; with high-driving pressure, this difference disappeared. Also, significant reduction in poorly aerated tissue and a correlated increase in nonaerated tissue in end-expiratory CT with FIO2 1 low-driving pressure were seen. When high-driving pressure was applied or after previous ventilation with FIO2 0.25 and low-driving pressure, this pattern disappeared. The findings suggest that low distending pressures produce widespread dependent airway closure and with high FIO2, subsequent absorption atelectasis. Low FIO2 prevented alveolar collapse during the study period because of slow absorption of gas behind closed airways.
Topics: Animals; Disease Models, Animal; Hemodynamics; Lung; Oxygen Inhalation Therapy; Pressure; Pulmonary Atelectasis; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Distress Syndrome; Swine; Time Factors; Tomography, X-Ray Computed
PubMed: 24009007
DOI: 10.1152/japplphysiol.00763.2013 -
Particle and Fibre Toxicology Dec 2021Refractory Ceramic fibres (RCF) are man-made mineral fibres used in high performance thermal insulation applications. Analogous to asbestos fibres, RCF are respirable,...
BACKGROUND
Refractory Ceramic fibres (RCF) are man-made mineral fibres used in high performance thermal insulation applications. Analogous to asbestos fibres, RCF are respirable, show a pleural drift and can persist in human lung tissue for more than 20 years after exposure. Pleural changes such as localised or diffuse pleural thickening as well as pleural calcification were reported.
RESULT
A 45 years old man worked in high performance thermal insulation applications using refractory ceramic fibres (RCF) for almost 20 years. During a occupational medical prophylaxis to ensure early diagnosis of disorders caused by inhalation of aluminium silicate fibres with X-ray including high-resolution computed tomography (HRCT), bilateral pleural thickening was shown and a pleural calcification next to a rounded atelectasis was detected. Asbestos exposure could be excluded. In pulmonary function test a restrictive lung pattern could be revealed. In work samples scanning electron microscopy (SEM) including energy dispersive X-ray analysis (EDX) classified used fibres as aluminium silicate fibres. X-ray powder diffraction (XRD) and transmission electron microscopy (TEM) showed crystalline as well as amorphous fibres.
CONCLUSIONS
A comprehensive lung function analysis and in case of restrictive lung disorders additional CT scans are needed in RCF exposed workers in accordance to the guidelines for medical occupational examinations comparable to asbestos exposed workers.
Topics: Ceramics; Humans; Microscopy, Electron, Scanning; Middle Aged; Mineral Fibers; Occupational Exposure; Pulmonary Atelectasis; Respiratory Function Tests
PubMed: 34965858
DOI: 10.1186/s12989-021-00441-y -
Canadian Respiratory Journal 2015Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to...
Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.
Topics: Airway Obstruction; Bronchial Diseases; Constriction, Pathologic; Female; Humans; Middle Aged; Pulmonary Atelectasis; Respiratory Function Tests; Scoliosis; Stents; Tomography, X-Ray Computed
PubMed: 26083538
DOI: 10.1155/2015/640573 -
BMC Anesthesiology Aug 2022The majority of patients may experience atelectasis under general anesthesia, and the Trendelenburg position and pneumoperitoneum can aggravate atelectasis during... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of ultrasound-guided alveolar recruitment manoeuvres compared with sustained inflation or no recruitment manoeuvres on atelectasis in laparoscopic gynaecological surgery as assessed by ultrasonography: a randomized clinical trial.
BACKGROUND
The majority of patients may experience atelectasis under general anesthesia, and the Trendelenburg position and pneumoperitoneum can aggravate atelectasis during laparoscopic surgery, which promotes postoperative pulmonary complications. Lung recruitment manoeuvres have been proven to reduce perioperative atelectasis, but it remains controversial which method is optimal. Ultrasonic imaging can be conducive to confirming the effect of lung recruitment manoeuvres. The purpose of our study was to assess the effects of ultrasound-guided alveolar recruitment manoeuvres by ultrasonography on reducing perioperative atelectasis and to check whether the effects of recruitment manoeuvres under ultrasound guidance (visual and semiquantitative) on atelectasis are superior to sustained inflation recruitment manoeuvres (classical and widely used) in laparoscopic gynaecological surgery.
METHODS
In this randomized, controlled, double-blinded study, women undergoing laparoscopic gynecological surgery were enrolled. Patients were randomly assigned to receive either lung ultrasound-guided alveolar recruitment manoeuvres (UD group), sustained inflation alveolar recruitment manoeuvres (SI group), or no RMs (C group) using a computer-generated table of random numbers. Lung ultrasonography was performed at four predefined time points. The primary outcome was the difference in lung ultrasound score (LUS) among groups at the end of surgery.
RESULTS
Lung ultrasound scores in the UD group were significantly lower than those in both the SI group and the C group immediately after the end of surgery (7.67 ± 1.15 versus 9.70 ± 102, difference, -2.03 [95% confidence interval, -2.77 to -1.29], P < 0.001; 7.67 ± 1.15 versus 11.73 ± 1.96, difference, -4.07 [95% confidence interval, -4.81 to -3.33], P < 0.001;, respectively). The intergroup differences were sustained until 30 min after tracheal extubation (9.33 ± 0.96 versus 11.13 ± 0.97, difference, -1.80 [95% confidence interval, -2.42 to -1.18], P < 0.001; 9.33 ± 0.96 versus 10.77 ± 1.57, difference, -1.43 [95% confidence interval, -2.05 to -0.82], P < 0.001;, respectively). The SI group had a significantly lower LUS than the C group at the end of surgery (9.70 ± 1.02 versus 11.73 ± 1.96, difference, -2.03 [95% confidence interval, -2.77 to -1.29] P < 0.001), but the benefit did not persist 30 min after tracheal extubation.
CONCLUSIONS
During general anesthesia, ultrasound-guided recruitment manoeuvres can reduce perioperative aeration loss and improve oxygenation. Furthermore, these effects of ultrasound-guided recruitment manoeuvres on atelectasis are superior to sustained inflation recruitment manoeuvres.
TRIAL REGISTRATION
Chictr.org.cn, ChiCTR2100042731, Registered 27 January 2021, www.chictr.org.cn .
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Lung; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis; Ultrasonography; Ultrasonography, Interventional
PubMed: 35974310
DOI: 10.1186/s12871-022-01798-z -
BMJ Case Reports Apr 2016Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited... (Review)
Review
Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited evidence to inform on its most effective management. We present two cases of large volume thoracocentesis resulting in acute respiratory decompensation that was treated by reintroducing the drained pleural fluid back into the pleural cavity. We also present a review of the literature specifically assessing the reported incidence rate of REPO after pleural fluid drainage. In both of our cases, symptoms and signs of respiratory instability were promptly reversed on reintroduction of the drained pleural fluid into the patient's pleural space-a therapy we have termed 'rapid pleural space re-expansion'. This was not associated with any short-term adverse outcomes. The occurrence of REPO is a rare event with most cohort studies reporting an incidence of between 0% and 1%.
Topics: Aged; Drainage; Dyspnea; Female; Humans; Incidence; Pleural Cavity; Pleural Effusion; Pneumothorax; Pulmonary Atelectasis; Pulmonary Edema; Thoracentesis
PubMed: 27122103
DOI: 10.1136/bcr-2016-215076 -
Anaesthesia Jul 1954
Topics: Aged; Anesthesia; Anesthesia, Inhalation; Anesthesiology; Humans; Pulmonary Atelectasis
PubMed: 13171546
DOI: 10.1111/j.1365-2044.1954.tb01560.x -
Critical Care (London, England) 2010This article is one of ten reviews selected from the (Springer Verlag) and co-published as a series in . Other articles in the series can be found online at... (Review)
Review
This article is one of ten reviews selected from the (Springer Verlag) and co-published as a series in . Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the is available from http://www.springer.com/series/2855.
Topics: Critical Illness; Humans; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiratory Distress Syndrome
PubMed: 20236454
DOI: 10.1186/cc8851 -
BMC Anesthesiology Jul 2022Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS).
METHODS
We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO) and fraction of inspired oxygen (FiO) ratio (PaO/FiO), and other explanatory variables were acquired from each patient before and after recruitment.
RESULTS
Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO/FiO between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO/FiO and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered.
CONCLUSIONS
Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it's long-term effects on pulmonary complications and hospital length of stay.
TRIAL REGISTRATION
ChiCTR1900024379 . Registered 8 July 2019,.
Topics: Adult; Barotrauma; Humans; Lung; Oxygen; Postoperative Complications; Prospective Studies; Pulmonary Atelectasis
PubMed: 35820814
DOI: 10.1186/s12871-022-01748-9 -
British Journal of Anaesthesia Jul 2003
Review
Topics: Anesthesia, General; Anesthetics, General; Humans; Intraoperative Complications; Postoperative Complications; Pulmonary Atelectasis; Risk Factors; Tomography, X-Ray Computed
PubMed: 12821566
DOI: 10.1093/bja/aeg085